Psychoanalysis.. Over the phone

krankykitty

Hi,

Just wanted to open up a debate here to see what the professional's view is on this!

I saw a notice in a coffee shop today offering psychoanalysis over the phone. It mentioned it was supported by a face to face every two weeks. It had me intrigued and I was wondering if this was something that's common in the psychoanalytic field? Also very curious as to what Odysseus might think of it. My immediate thought was "no" but then I was thinking, if you never actually met up with the analyst, perhaps it's the ultimate "couch" - imagine the stuff you might feel free to say if you weren't actually present with the analyst!

I know from the counselling/psychotherapy side of things online counselling isn't something you can be insured to do at present in Ireland (a friend did her thesis on same), I wonder how phone sessions would be covered on insurance?

Really interested to hear your views on this.

Odysseus

OK up till very recently I was very strong against it. Until I read a paper by a Lacanian analyst by Bruce Fink goggle him. He will do it only in certain cases, some of his clients either travel a lot, or may have to relocate on a regular, so rather than doing a year or analysis with him then him having to try find a Lacanian analyst in another state or country, he will engage in it.

He presented a strong case for it in those cases, and after all we work only with words, so is there much of a difference between listening over a speaker phone and sitting behind the couch. As for therapy or counselling NO, is my quick answer. I'm correcting some essays here so I add a bit more later.

I know of no analyst in Ireland offering this service, especially if they are living here. I’m back in analysis again, I live 80km away and I commute by motor bike, they clearly [the whole 4 of them] haven’t been used since this weather. I still made my three sessions a week.

I really doubt the person you overheard is actually seeing a psychoanalyst. Maybe a counsellor or some other type of therapist.

krankykitty

Will google Fink, thanks for that.. Interesting though that he was only doing it in certain cases.

In this case, it wasn't a conversation I overheard, it was an actual poster on the noticeboard of the shop, advertising Psychoanalysis over the phone service (for strangers basically, not already established clients). So anyone can take this guy's contact details, call him up to avail of this service over the phone. That's probably why I was so intrigued, as i have never seen anything like it before..

Odysseus

Either have I, did he suppply bany details qualifications ofb bodies etc. A.P.P.I., etc?

krankykitty

It was a first for me, so I was curious to see if it was something that was established practice that had just passed me by! No, he didn't list any quals or professional organisations at all, just his name and telephone number. Not saying this particular guy isn't qualified, but it's scary to think that unqualified people can put up such posters and get business!

Odysseus

krankykitty wrote: »

It was a first for me, so I was curious to see if it was something that was established practice that had just passed me by! No, he didn't list any quals or professional organisations at all, just his name and telephone number. Not saying this particular guy isn't qualified, but it's scary to think that unqualified people can put up such posters and get business!

From clinical opinion it is unethical imo, firstly we don't start straight into pure analysis, there is what we call the preliminary sessions, these occur face to face, we would not put a psychotic on the couch; our understanding of that diagnosis is different to the ICD-10/DSM. I would be very weary about making that call over the phone and that is just for starters. Back to correcting essays:(

krankykitty

Have to say, wouldn't be happy with doing it either from a counselling/psychotherapy standpoint, even with established clients. Just something about it that seems like it's breaking a boundary..

Odysseus

Having done some research [thanks to that person they know who they are]this guy does belong to a psychoanalytic professional body, not one I'm in, but it appears he is a psychoanalyst. I can't see the need in Ireland, the only reason for it being the one I stated above.

After an 8 year gap, I'm back in personal analysis and travel from Louth to Dublin 3 times a weeks for my sessions. There is some about the ethics around it that does not sit with me.

Kindnessnow

I dont see how you could possably have the core conditions hence a strong theraputic alliance if therapy is been done over the phone!!!!
Personaly I don't get it!

Odysseus

Kindnessnow wrote: »

I dont see how you could possably have the core conditions hence a strong theraputic alliance if therapy is been done over the phone!!!!
Personaly I don't get it!

Keeping it to psychoanalysis rather than psychotherapy/counselling those core conditions have no or little place in psychoanalytic therapy, but as I said above apart from the reason I read in Fink's book on Lacanian Analysis, I can see no other reason for it.

krankykitty

Glad to hear the person in question is legit and a proper analyst.

It always pays to do your research before engaging with any type of therapist anyway, I know there are a few people out there claiming to be something that they are not. At least in this case it turned out to be ok but it's not always!

Odysseus

Yeah but to be fair I only said it appears, he is a member of a different psychoanalytic organisation than me. However, that is beside the point, I can't see a reason for any form of talking therapy to occur over the phone in Ireland. Did you get access to the paper I mentioned by Fink on the topic, it opens my mind to the concept but only on the grounds I have stated above. If not I can't try get a copy to you if your interested.

_Whimsical_

Odysseus wrote: »

Yeah but to be fair I only said it appears, he is a member of a different psychoanalytic organisation than me. However, that is beside the point, I can't see a reason for any form of talking therapy to occur over the phone in Ireland. Did you get access to the paper I mentioned by Fink on the topic, it opens my mind to the concept but only on the grounds I have stated above. If not I can't try get a copy to you if your interested.

I think you are overlooking whole sections of society that this service might greatly benefit. There are many people who are housebound in ireland because of illness or because they work single handedly as a carer for an invalid with a demanding condition who they can't get cover to mind for an extra hour a week. That sadly is a reality for many many people and they could often do with psychological help & support. There are also those in rural areas who might have no personal transport or children to mind etc.To be able to find the time for an hour a week of analysis is a luxury for many people,then having to put extra time and money aside for travel is one lots just alot can't afford.

Personally I feel most strongly about how valuable a service like this could potentially be for people who are housebound due to illness or being a carer. This year I knew someone who had to access palliative care services .As no treatment was offered for her condition it was recommended she get some support from a psychologist who worked with the sick payed for by the HSE. When she tried to make an appointment there she found the offices this person worked in were at the end of a long driveway and up two flights of stairs & they didn't feel it was ethical to make house calls. My friend could not walk more than a few steps. Trying to attend even a ground floor office once a week would've been impossible for her.Her family rang several private psychologists and counsellors and none would agree to come to her home despite it being in the city centre.

I think it really is time services such as these started to think outside the box in terms of helping provide support to people who really need it. As long as any therapist is fully credited,qualified and researched by the client I think this could be a positive progression in the field.

Odysseus

_Whimsical_ wrote: »

I think you are overlooking whole sections of society that this service might greatly benefit. There are many people who are housebound in ireland because of illness or because they work single handedly as a carer for an invalid with a demanding condition who they can't get cover to mind for an extra hour a week. That sadly is a reality for many many people and they could often do with psychological help & support. There are also those in rural areas who might have no personal transport or children to mind etc.To be able to find the time for an hour a week of analysis is a luxury for many people,then having to put extra time and money aside for travel is one lots just alot can't afford.

Personally I feel most strongly about how valuable a service like this could potentially be for people who are housebound due to illness or being a carer. This year I knew someone who had to access palliative care services .As no treatment was offered for her condition it was recommended she get some support from a psychologist who worked with the sick payed for by the HSE. When she tried to make an appointment there she found the offices this person worked in were at the end of a long driveway and up two flights of stairs & they didn't feel it was ethical to make house calls. My friend could not walk more than a few steps. Trying to attend even a ground floor office once a week would've been impossible for her.Her family rang several private psychologists and counsellors and none would agree to come to her home despite it being in the city centre.

I think it really is time services such as these started to think outside the box in terms of helping provide support to people who really need it. As long as any therapist is fully credited,qualified and researched by the client I think this could be a positive progression in the field.

An interesting point, firstly though remember this guy is advertising a private session not as a member of the HSE. Within the HSE then issues of insurance arise as well as leaving oneself in a position where accused of something that could not arise with a HSE building.

I don't generally offer that service, but in a case like above if the person fell within my remit I would consider it, as I am more interested in getting people into therapy than the admin side of my position. In cases where I did do it I found it did not work for varying reasons, ranging from I have control over my office, a family member cannot just walk in, to the client not engaging to the degree I suspect they would if they came to my office.

However, I have had elderly people attend my Service come brought by careers, other by themselves of friends, family etc, [old people can have drug issues too, though I'm just making that point for the posters here who know where I work.]

As I said phone therapy is different, if you had rang me and it fell within my HSE remit I would look at the situation seriously, if it was outside of the HSE i.e. private work, the chances are I would look at it even harder. The last point is not about the private fee, but as a private clinician I have more freedom than when I'm working for the HSE.

Those with saying that, and this is where it becomes very subjective, a person who wishes to enter any form of psychotherapy needs to make certain sacrifices, whether that is time, travel, money other wise IMO the is no psychological value placed upon it. Does that make sense?

_Whimsical_

Odysseus wrote: »

An interesting point, firstly though remember this guy is advertising a private session not as a member of the HSE. Within the HSE then issues of insurance arise as well as leaving oneself in a position where accused of something that could not arise with a HSE building.

I don't generally offer that service, but in a case like above if the person fell within my remit I would consider it, as I am more interested in getting people into therapy than the admin side of my position. In cases where I did do it I found it did not work for varying reasons, ranging from I have control over my office, a family member cannot just walk in, to the client not engaging to the degree I suspect they would if they came to my office.

However, I have had elderly people attend my Service come brought by careers, other by themselves of friends, family etc, [old people can have drug issues too, though I'm just making that point for the posters here who know where I work.]

As I said phone therapy is different, if you had rang me and it fell within my HSE remit I would look at the situation seriously, if it was outside of the HSE i.e. private work, the chances are I would look at it even harder. The last point is not about the private fee, but as a private clinician I have more freedom than when I'm working for the HSE.

Those with saying that, and this is where it becomes very subjective, a person who wishes to enter any form of psychotherapy needs to make certain sacrifices, whether that is time, travel, money other wise IMO the is no psychological value placed upon it. Does that make sense?

I do appreciate what you're saying and I think that the act of going to a therapist and also establishing a physical space where someone is taken right out of their own life like a therapy room could be valuable , particularly in cases of addiction and behavioural problems. Also I understand what you're saying about making a sacrifice of time or money as a token of commitment to the process.

However, those are not things that everyone can do and in the case of someone who is physically incapable of attending through illness or caring for someone I really don't think it would be an essential component to them being helped. In fact I actually don't think someone in that situation, like the one I outlined in my post above for example, should have to make a sacrifice at all to receive help other than asking for it. Often in the case of someone who is ill the use of their strength and energy just to talk on the phone to a therapist for an hour will be a greater sacrifice than a healthy person might make traveling 50 miles to do the same.

I suppose I just feel that there are a whole host of people out there who through genuinely difficult circumstances cannot leave their home and their needs, even their existence is largely ignored. You do not realise this until it comes to your door or that of your family. I can think of several people under 35 in that situation. I think any effort to remove boundaries from them finding help like offering more services over the phone could be a very positive move. As a therapist,and I'm not one, I could not think of a more rewarding journey to accompany someone on than helping them find meaning and value in life when they're suffering and isolated . If there are therapists who genuinely believe in the process they offer I hope they will start to be more creative in terms of delivering that to a wider public. It's an area that the HSE really need to start looking at although no doubt there are no funds to do so now. Private therapists should be aware that this sector of people are out there and it would be good if they could be open to addressing some of these needs.

Well done Odysseus for at least considering taking patients in unconventional settings. It is more than a lot do.

Odysseus

_Whimsical_ wrote: »

I do appreciate what you're saying and I think that the act of going to a therapist and also establishing a physical space where someone is taken right out of their own life like a therapy room could be valuable , particularly in cases of addiction and behavioural problems. Also I understand what you're saying about making a sacrifice of time or money as a token of commitment to the process.

However, those are not things that everyone can do and in the case of someone who is physically incapable of attending through illness or caring for someone I really don't think it would be an essential component to them being helped. In fact I actually don't think someone in that situation, like the one I outlined in my post above for example, should have to make a sacrifice at all to receive help other than asking for it. Often in the case of someone who is ill the use of their strength and energy just to talk on the phone to a therapist for an hour will be a greater sacrifice than a healthy person might make traveling 50 miles to do the same.

I suppose I just feel that there are a whole host of people out there who through genuinely difficult circumstances cannot leave their home and their needs, even their existence is largely ignored. You do not realise this until it comes to your door or that of your family. I can think of several people under 35 in that situation. I think any effort to remove boundaries from them finding help like offering more services over the phone could be a very positive move. As a therapist,and I'm not one, I could not think of a more rewarding journey to accompany someone on than helping them find meaning and value in life when they're suffering and isolated . If there are therapists who genuinely believe in the process they offer I hope they will start to be more creative in terms of delivering that to a wider public. It's an area that the HSE really need to start looking at although no doubt there are no funds to do so now. Private therapists should be aware that this sector of people are out there and it would be good if they could be open to addressing some of these needs.

Well done Odysseus for at least considering taking patients in unconventional settings. It is more than a lot do.

Cheers, however, this is a significant ethical area, a minefield in one way. One question did the person need therapy or more of a supportive listening service, if it's the latter they question can be asked is the therapy actually offering therapy or something else if you get my point.

Yes it is a strange one that I can do professional visits in our jails and hospitals and other institutions but the person’s home is for the most part out of bounds within the HSE. I see your points, but they are significant ethical issues for some of us. I would make a call on a case by case basis.

Sardonicat

_Whimsical_ wrote: »

This year I knew someone who had to access palliative care services .As no treatment was offered for her condition it was recommended she get some support from a psychologist who worked with the sick payed for by the HSE. When she tried to make an appointment there she found the offices this person worked in were at the end of a long driveway and up two flights of stairs & they didn't feel it was ethical to make house calls. My friend could not walk more than a few steps. Trying to attend even a ground floor office once a week would've been impossible for her.Her family rang several private psychologists and counsellors and none would agree to come to her home despite it being in the city centre.
QUOTE]

Public Services not accessable to those with a physical disability are in breach of the Equality Legistaltion. I am flabbergasted that a HSE Psychologist hired to support sick people did not have an accessable premises!

You should really highlight this to the Equality Authority.

_Whimsical_

Odysseus wrote: »

Cheers, however, this is a significant ethical area, a minefield in one way. One question did the person need therapy or more of a supportive listening service, if it's the latter they question can be asked is the therapy actually offering therapy or something else if you get my point.

Yes it is a strange one that I can do professional visits in our jails and hospitals and other institutions but the person’s home is for the most part out of bounds within the HSE. I see your points, but they are significant ethical issues for some of us. I would make a call on a case by case basis.

What exactly is the ethical issue if you don't mind me asking ?

I think in an instance like this it's perhaps overly simplistic to attempt to differeniate between a listening service & therapy.

Do you see a radical jump between treating someone who is stressed or overwhelmed by issues in their work environment or marriage and someone who is depressed , stressed, overwhelmed with the limitations an illness or work as a carer might put on their life & relationships?

I think illness is probably the most transformative experiences that one can have. It's an enormous challenge to recentre yourself within an unfamillar world, and that is exactly what it is. It doesn't just happen to people on an exterior level. There are huge adjustments to be made on an interior level. I think therapy would definitely be appropriate to help someone cope with the physical limitations they might have but more so with the adjustments that happen on an interior level to how you now see yourself, to getting to know and learn to appreciate a new you, to find meaning in a new life and to how to learn to forge a new road ahead for yourself in the future. I think if done right therapy could be hugely benifical and relevant in such a situation.

JuliusCaesar

Odysseus wrote: »

Within the HSE then issues of insurance arise as well as leaving oneself in a position where accused of something that could not arise with a HSE building.

I'm a bit surprised to hear that. I regularly do homevisits as part of my job - sometimes for assessment purposes, sometimes as part of the treatment. I also go out with clients, for example, people with agoraphobia.

The HSE has a zillion staff who work with people in the home: think of District Nurses, CPNs, home helps, OTs, and almost anyone else who works in the community.

The availability of staff varies from area to area, from region to region.

If you, or somebody you know, is dissatisfied with a service, or is not entitled to a service which is provided in a different area, for heaven's sake write to the HSE complaints section, to your local politician, and to the Minister for Health, and to the patient advocacy bodies. Make your complaint known to officialdom - no use doing the Irish thing and moaning to your friends.

As for people making false accusations against staff, they can do that anywhere.....:(

Odysseus

JuliusCaesar wrote: »

I'm a bit surprised to hear that. I regularly do homevisits as part of my job - sometimes for assessment purposes, sometimes as part of the treatment. I also go out with clients, for example, people with agoraphobia.

The HSE has a zillion staff who work with people in the home: think of District Nurses, CPNs, home helps, OTs, and almost anyone else who works in the community.

The availability of staff varies from area to area, from region to region.

If you, or somebody you know, is dissatisfied with a service, or is not entitled to a service which is provided in a different area, for heaven's sake write to the HSE complaints section, to your local politician, and to the Minister for Health, and to the patient advocacy bodies. Make your complaint known to officialdom - no use doing the Irish thing and moaning to your friends.

As for people making false accusations against staff, they can do that anywhere.....:(

Members of my team do home visits, the outreach team it is within their remit, and they are always two up doing them, that cannot occur with a therapeutic visit. As for the false accusations side, well yes you are right, but we have better protection between CCTV, and with programmes like young persons programme all the rooms have a large glass panel so anyone walking by can see what is going on. There are also lots of people in nearby offices, it do leave me less open to certain accusations.

Of course you are bang on make a complaint if you are not getting the service you need.

Odysseus

_Whimsical_ wrote: »

What exactly is the ethical issue if you don't mind me asking ?

I think in an instance like this it's perhaps overly simplistic to attempt to differeniate between a listening service & therapy.

Do you see a radical jump between treating someone who is stressed or overwhelmed by issues in their work environment or marriage and someone who is depressed , stressed, overwhelmed with the limitations an illness or work as a carer might put on their life & relationships?

I think illness is probably the most transformative experiences that one can have. It's an enormous challenge to recentre yourself within an unfamillar world, and that is exactly what it is. It doesn't just happen to people on an exterior level. There are huge adjustments to be made on an interior level. I think therapy would definitely be appropriate to help someone cope with the physical limitations they might have but more so with the adjustments that happen on an interior level to how you now see yourself, to getting to know and learn to appreciate a new you, to find meaning in a new life and to how to learn to forge a new road ahead for yourself in the future. I think if done right therapy could be hugely benifical and relevant in such a situation.

I'm not avoiding your question mate, I have a family emergency going on and I'm trying to sort out a way to get from Louth to Dublin, as my motorbikes are of no use to me with this weather. I will try to answer your question as soon as I can. Of course if anyone else wants to jump in:)

_Whimsical_

Odysseus wrote: »

I'm not avoiding your question mate, I have a family emergency going on and I'm trying to sort out a way to get from Louth to Dublin, as my motorbikes are of no use to me with this weather. I will try to answer your question as soon as I can. Of course if anyone else wants to jump in:)

No problem and no hurry. Didn't mean to put you on the spot. I hope that everything is ok. Safe journey.:)

JuliusCaesar

Odysseus wrote: »

Members of my team do home visits, the outreach team it is within their remit, and they are always two up doing them, that cannot occur with a therapeutic visit.

Sorry! I keep assuming that what happens in Mental Health happens everywhere! We can't possibly do visits in two's - that's only ever done if there's a risk assessment which advises that.

Odysseus

JuliusCaesar wrote: »

Sorry! I keep assuming that what happens in Mental Health happens everywhere! We can't possibly do visits in two's - that's only ever done if there's a risk assessment which advises that.

No problem, but yeah the Addiction Services is a totally different beast to the Mental Health Services.