Arnon Rolnick


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How the Thechnique camp and the Relational camp use the internet

The different approaches to internet-based treatment that have been adopted by the two camps should not come as a surprise, as each camp has approached these developments in very different ways. In fact, there are significant publications about the use of internet in psychotherapy, but each camp has developed its own approach to issues related to telemedicine that do not necessarily coincide with that of the other camp.

The techniques camp might have been expected to be the first to implement and document its application of remote interventions, as this camp is more likely to use technology than the relationship camp that sometimes attempts to detach the therapeutic process from the world of computers and telecommunication. Surprisingly though, the relationship camp was the first to begin writing about tele-therapy. As an anecdote, we might consider the fact that Freud would sometimes correspond with his patients though letters, which can be seen as the beginning of remote therapy.

The dynamic world has always been concerned with setting. Hundreds of articles have been written about the question of whether lying on the couch can be considered the same type of treatment as facing the therapist (cf Grotstein, 1995). In other words, the question of the importance of face-to-face interaction has been pondered for many years.

Perhaps the first time that this camp dealt directly with remote therapy was when the telephone was introduced into the world of therapy. Therapists began to address the question of how to continue treatment when the patient traveled on business trips and was unable to visit the therapist's office (see Saul, 1951). This was a crucial issue, as therapists at that time believed that therapy sessions should take place 4–5 times per week. Psychoanalysis by phone, without seeing the patient, would most likely have been acceptable as it does not significantly differ from laying the couch without eye contact between the patient and therapist.

However, there was significant opposition to the idea of using the phone for psychoanalysis. For example, Argentieri and Mehler (2003) represented the conservative-traditional stance that this could not be considered psychoanalysis but rather "only a supportive treatment".

However, the need to teach psychoanalytic approaches and to train therapists in remote countries such as China caused some members of this camp to "break the rules" and to dare to provide remote supervision and later even remote psychoanalysis for therapy students. Other developments were the introduction of Skype software which significantly improved the visual image, and the increasing speed of the Internet which enabled higher video density and thus better quality communication. It is clear that the transition to remote treatment challenges certain fundamental dogmas and principles that characterize for the relationship camp, which explains the availability of vast literature and discussions on this option, and on the legitimacy of remote care via the internet. Quite a few books have already been written on this subject. "Distance Psychoanalysis" (Carlino, 2011), "Screen Relations" (Russell, 2015), "The Digital Age on the Couch" (Lemma, 2017) and the special issue of Psychoanalytic Perspectives (2017). The most impressive enterprise on this subject is undoubtedly a series of four books published between 2013 and 2018, entitled Psychotherapy Online (Scharff, 2013a, 2013b, 2016, 2018). Each volume offers a fascinating discussion on the significance of remote treatment and how it affects the therapeutic relationship.

Despite the abundance of books and articles, very little quantitative research on this subject has been conducted so far in this camp. Qualitative analyses and even research on the attitudes of psychoanalysts about remote therapy are still lacking.

The techniques camp did not ignore the possibilities offered by the Internet but focused mainly on the possibility of adapting techniques that were developed for face-to-face

therapy for online therapy, without addressing the question of how this may interfere with the development of the therapist-patient relationship. In Albert Ellis' introduction to Debrig-Palumbo and Zeine book (2005) on online therapy, for example, he writes that "a big myth in psychotherapy is that, in order to relate well to your clients, you have to show them fine empathy, support, and acceptance, and you have to see them face to face -Nonsense!"

Therefore, it is not surprising to see that much of what has been done in the field has not focused on face-to-face video meetings but rather on transferring CBT techniques over the internet. In fact, it might be possible to say that the main focus of the techniques camp is to find ways to make their proven methods more widespread by using the internet.

Azi Barak, one of the first psychologists to use the Internet for therapy, identifies the main areas of online psychological therapy [reference?]. Videoconference is only one example, and perhaps a less common one, of Barak's list. In any case, it is very important to see that thanks to the techniques camp, hundreds of studies emerged within several years on the various aspects of Internet-based treatment. Gerhard Andersson, editor of the leading journal in this field writes that in just a few years there have been over 200 randomized control studies in this field (Andersson, 2018).

Although the techniques camp has developed an entire series of interventions that are not based on direct dialogue with a human therapist, a study was also developed to examine how the therapist can assist in the use of the various applications. Lindner Elinor et al (2014) identified the following factors: encouragement and reinforcement (31 percent), validation (25 percent), guidance and direction (22.2 percent), and incentives (9.8 percent).

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