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A new way of doing tele-analysis by Samuele Filomena

What I am presenting is something completely new in the tele-therapy world of analysis and in describing that, I think, the best is convey you how I got there.

The main difference is that the patient is connecting to my office in London from my office in South Italy, where he physically can go there and find all the equipments (internet connection, a sofa, a computer).

This idea came from  my necessity to do my own analysis when I am in Italy and for this reason I set up first a studio for myself and after I thought why not offer this service to local people that can benefit of that.

I have been seeing a patient now for an year and half, and I did some consultations online and in person, and when I am there I see my patient in person.

Equipments

I choose for the connection a Chrome OS computer that starts in 10 seconds and instead a programm like Vsee or Skype (thatdo not run on Chrome OS) I create a room on Tawk.com, a canadian start-up that runs this server using EasyRTC.

This technology is a browser to browser connection and the set up is very easy.

At the beginning when you enter in the website of my room, in this case www.tawk.com/psicote the programm will ask to set up the microphone and web cam and when this is done I receive the call on my webpage open. The patient cannot see if I am online like Skype or Vsee.

Of course to be in contact with the patient I use Whatapp, for instant message in case of difficulties.

The web page program runs on any machine  (Window, Mac, Linux) with Firefox, Chrome or Opera browsers.

For the moment I am doing this in one way from Italy to London, and I did some trials from Lodnon to Italy, where my English patient can go in my office in London when I am in Puglia and it works.

I am establishing now some entry door systems that can allow me to open the door of my office from remotely. I am using DoorBird at the moment in my office in Italy and it works, also I am exploring the possibility to instal some domotika accessories, for example swichting on the light and the clima, etc.

What are the advantages of this system?

There is a physical place where people can go and it can be implemented in remote areas.

Possible application and development.

There are different possible application of this way of working in tele-therapy.

The first that comes to my mind is the implementation of a virtual clinic. A building with rooms and entry codes equipped with the computer and internet connection where people can go and access therapist all over the world.

The possibility for a colleague to set up a room in his/her office if there are some requirements (language, approach, interest, a specific pathology).

Improve the access to people where there are no therapist.

Creating consulting room in cyties and places where it is difficult to find a therapist, that are most the time available in big cities and the possibilities to acces that in rural places.

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The house and the car

I spent last two years with a child in therapy for him be able to build his own house and to play with it. Also he built a car inside himself that allows him to leave the house and go around and move around. What these two elements represent in his mind?

The house is the place where to be and feeling safe and where he can go to shelter himself, Winnicott calls it the pure female element.

The car is the movement from the house to explore the outside world, it is linked with the walking and talking, it is the pure male element.

The use of these two pure elements simultaneously creates the wave of the mind, we can represent the function of the mind with a wave, like the hart wave.

But the mind’s wave is made of two components and when we are in the session with a patient or in a interaction with another human being we are able to detect it.

But as analyst our task is to recognize and identifie these two pure elements and own they are in relation to each other.

A much more emphasis was given to the male element in the development of the psychoanalytic theory and very few attention has been given to the female pure element, the psycho-sensorial in Gaddini terms.

This bias is due to the fact that psychoanalysis as science of the development went in the opposite direction to discover the secret of the mind and the paycho-oral, or male element is the last one coming.

The focus was mainly on introjections and projections and very few attention was given to the imitation process.

The mind is coming from the body, imitating the body’s functions and to register the wave we need a mind able to tune on in this very primitive process where no words are available.

At the beginning of life after birth the configuration of the two waves is as stated by Freud in a letter to Marie Bonaparte. All the aggression is outward and all the libido is inward, and the decathexis of the aggression allow the cathexis of libido, not the contrary.

It is the mother at the beginning that supplies to shelter to the baby and in this way is able to incorporate a safe place where to be inside. From the mother slowly a father comes out, at the beginning as a duplicate of the mother and after as an extraneous and external object and his role is to take the child out from the mother to explore the external world. The interaction and interweaving of these two pure elements allows a mature interaction with others, identification.

As institute we need a premises where we can feel safe and also we need a car to go around and explore new opportunity. The training allows me for example to set up a new way of working where I set up two offices and I can see people in person in each of them of my patients can go in one of them when I am in the other one. This modality could be useful to set up a virtual clinic for our institute. I consider this innovative and I understand people having concern, but this is what came out from my training, the interaction between my personality and this journey. It took me three years to convince you to move from telephone to video conference and probably it will take me another three year to set up the clinic and the next thirty to explain to the scientific community this revolutionary metha-psychology.

The last remark, psychoanalysis like all the other sciences was born in the Hellenistic period in the third century before Christ and on the same period appear the nuclear family and other modernity.