Neurotic Treatment Resistance in Screen- or Phone-Based Analysis

Abstract

The author considers how treatment resistance in technology-mediated work with obsessional neurotic patients can differ from that of in-person sessions, and she then gives corresponding recommendations for clinicians. Three types of resistance are discussed—partially conscious resistance, linguistic resistance, and transferential resistance—with a focus on transferential resistance and its unconscious determinant. The transferential dynamics of obsessional neurosis are explained using the theory of Jacques Lacan, and then these dynamics are tied to manifestations of treatment resistance. The author provides case examples of technology-mediated analytic work with obsessional neurotics and highlights how resistances can be detected and worked through. Working through resistances effectively depends upon making an accurate structural diagnosis and directing the treatment accordingly, but it also rests upon being attuned to the alterations in the medium of a technology-mediated session.

Keywords:

• Lacan
• obsessional neurosis
• psychoanalysis
• remote
• resistance
• technology-mediated

Notes

¹ “Lacan (1996/2006) defined fantasy as “an image set to work in the signifying structure” (p. 637), implying that fantasy consists of imaginary and symbolic order elements. Because fantasy supports and perpetuates the subject’s desire, it binds jouissance into the symbolic.

² Howard Rourk, from Ayn Rand’s (1943/1996), is an excellent portrayal of an obsessive (albeit fantasmatically without neurotic suffering). He claims to be an entirely self-made man, having no family and being impervious to the influence of modern society. As an architect, he has a distaste and disdain for the greats of classical architecture and especially those present-day architects who emulate their style. Rourk chose to be an architect so that he could create buildings that conform to no one’s artistic vision but his own, and he has no interest in or respect for the desire of those who commission the buildings. Thus Rourk attempts to block out the Other and the Other’s desire entirely.

Additional information

Notes on contributors

Stephanie Swales

Stephanie Swales, PhD, is an Assistant Professor of Psychology at the University of Dallas and a licensed clinical psychologist in private practice in Dallas, TX. In 2012, Routledge published her first book, Perversion: A Lacanian Psychoanalytic Approach to the Subject. Her next book, tentatively entitled Psychoanalyzing Ambivalence: On and Off the Couch, is coauthored with Carol Owens and will be published by Routledge in 2018. Stephanie is the founder of the Dallas–Fort Worth Area Lacan Study group and a candidate analyst with the Lacanian School of Psychoanalysis in San Francisco. She also serves as the secretary for the Dallas Society for Psychoanalytic Psychology.