BookREVIEW: Screen Relations

Screen RelationsThe limits of computer-mediated psychoanalysis and psychotherapy


Gillian Isaacs Russell

Reviewer: Aaron Balick

Screen Relations is a very important book that should be read by any therapist working online via video conferencing or considering doing so. While there are many excellent books in the field that address the important issues about this still new and evolving phenomenon, Russell’s is the first to take a truly critical appraisal of this type of online work. It is based not only on speaking to clinicians and patients experiencing therapy by video conferencing, but also upon on the latest research in a variety of fields including neuroscience, attachment, communication studies, and of course, the clinic. Further, Russell is no stranger to working remotely, having been involved deeply with China American Psychoanalytic Alliance (CAPA), which was heavily involved in cross national Skype based psychoanalysis. It was through this and other experiences that she decided to write the book:

“This book was written because of a dawning understanding that what was happening between me and my patients in mediated treatments was not the same as the co-present process in the consulting room” (8).

The whys and the whats behind this statement are crucial to any therapist who uses Skype or its equivalents even for the occasional session and are outlined in fine detail throughout the text. Whatever your own experience, you will likely finish the book with the impression that whatever advantages or disadvantages there are to doing psychotherapy by way of video-conferencing, doing so is not a simple translation of co-present work to online psychotherapy.

Those of you familiar with my own book The Psychodynamics of Social Networking will know that I have an abiding interest in the relationship between technology and psychotherapy. While my book does not cover online work as such, since it was published in 2014 I am inevitably included in conversations around it. Because of this, there were a series of fortuitous (some may say synchronistic) events that ultimately came to land Russell’s book upon my desk.

I wrote much of my book in Boulder Colorado, where, though English, Gillian Isaacs Russell now lives. We heard of each other over the Stillpoint Spaces Network in which we were both asked to give webinars on our books. After hooking up with Stillpoint, I began to facilitate research among their counsellors and therapists who were working via video-conferencing. It was in the middle of this project that I returned to Boulder, where I met with Russell for an entire afternoon of discussion about her book, her findings, and what I was beginning to find in my own research with Stillpoint. While my findings were just in development, they resonated very much with hers, and we found a lot to talk about.

In essence, my own developing ideas were identical to Russell’s findings that emerged from years of hard graft, that online treatments were not the same as co-present ones; both of us had the same question. Why? While practitioners and patients alike shared their moments of connection and depth that they experienced with their online patients, still, something was different. Only what was it? Further, the therapists I spoke to who were very committed to their online practices (some of whom work almost exclusively online) had difficulty putting their fingers on what it was that caused them discomfort. While my research is ongoing, Russell’s is now fortunately complete and beautifully rendered in her book.

While many therapists have turned to working online for a variety of reasons, I am concerned that most are not thinking through the dynamics that are inherent in practicing via video conferencing. While in the beginning many traditional therapists railed against online work for reasons of dogma, misunderstanding, rigidity, or just fear, as it becomes less taboo, the concern is that now therapists are engaging in it without adequately thinking it through. As if working online is a natural extension of offline work that needs no further consideration.

While the basic issue of undependable technology that breaks down, pixilates, and unceremoniously drops its participants mid-session is clear, Russell highlights a great deal of other issues that require deep consideration. For example: the consequences of lack of direct eye contact, body language, and the general atmosphere that is available in co-present therapy; the ease from which a patient (or therapist) can easily exit a session when the going gets tough; the availability for distraction that the medium itself offers to both parties; mutual embodiment; the potentiality (even if never realised) for physical touch; the nature of attachment and intersubjectivity that is mediated through technology; and worryingly, indications that sessions carried out on video conferencing may be less easy to remember for therapist and patient.

Each of us is liable to have a feeling or a sense about what it means to work online, and many of us may have come to conclusions about its efficacy. Some of us will have found that we can achieve and keep relationship there, and have moments of profound meeting. Others, however, will find that it lacks a certain je ne sais quois that can only be achieved in co-present sessions.

I’m afraid that having a sense that “it works” or “it doesn’t work” simply isn’t enough. As technology progresses, our duty of care as psychotherapists extends to the work we do, on or offline. Working online is not a simple translation of offline work to the digital sphere; it is a different operation altogether that in some ways disables relationship, while at other points may enable a different kind of relating.

Any therapists working online owe it to themselves and their patients to engage in this excellent book to better ground and understand their work in this increasingly digital age. Russell has offered us a comprehensive text with which we can engage to challenge ourselves to understand the nature of depth work in the digital world; a text that should be required reading at psychotherapy and counselling trainings – and as a source of continued professional development to any counsellor or therapist even considering working with one client online. It is my hope (which is also my hope for my own book) that this book will be read outside the world of psychotherapy where it can be applied to better understand the relational world that we are developing as a culture in the context of our ever expanding digital environment.

Dr Aaron Balick is an Integrative psychotherapist and supervisor, honorary senior lecturer at the Centre for Psychoanalytic Studies at the University of Essex and chair of The Relational School, UK.  In addition to his academic and clinical work, Aaron is a  cultural theorist and regular communicator of mental health and psychological issues within the media. He is the author of 'The Psychodynamics of Social Networking: connected up instantaneous culture and the self'.
Aaron Balick


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