Now I See You, Now I Don’t: Screen Services, Short Stature, and the Fear of Being Seen

Abstract

As psychoanalysts venture into the online world, they are confronted with both anxiety and opportunity. In this paper, I attempt to add to our collective thinking about the perils and potentials of introducing technologically mediated communication (e.g., Skype, FaceTime) into the treatment situation. I present the case of an 11-year-old boy of short stature, or Dwarfism, for whom screen relations–based sessions were used as an adjunct to face-to-face psychoanalytic psychotherapy. I argue that the introduction of screen relations provided the patient with a temporary respite from the narcissistic pain of being seen. Indeed, although I agree that relying on screen relations risks the possibility of relational disconnection between analyst and patient, it may also provide a means for the patient to begin to exert a degree of control over impinging reflected appraisals of himself via the analyst’s visual, auditory, and physical copresence without banishing them entirely. In the case I present, the introduction of screen relations presented the analytic dyad with an opportunity to work through important relational meanings attached to the patient’s experience of being small. Over time, the patient was able to risk new, increasingly intimate forms of engagement both inside and outside of the consulting room.

Keywords:

• narcissism
• screen services
• short stature
• skype
• technology

Notes

¹ Short stature is a technical term used to refer to children whose growth is at or below the fifth percentile for their age and sex (Frankel, 1996).

² Aside from Frankel (1996), there are no articles on the psychoanalytic literature on the effect of short stature during childhood and adolescence. Although the environmental response to the child’s discovery of short stature significantly contributes to risk of psychopathology (e.g., Lussier, 1980), Frankel has presented five cases and argued that in those cases, short stature provides an adequate explanation for the difficulties of the children in question.

³ Becker (1973) pointed out that in typical development, a child is able to experience herself as omnipotent and indestructible; from this base of secure support, she increasingly develops a sense of her own power. In contrast, the child of short stature can be painfully aware of her own limitations in comparison with her peers, in addition to the plethora of medical interventions that are likely intertwined with her growing up. Ultimately, the child of short stature may be forced to confront the possibility of her own death prematurely.

Additional information

Notes on contributors

Tom Wooldridge

Tom Wooldridge, PsyD, is Chair in the Department of Psychology at Golden Gate University, where he teaches courses in counseling skills, family therapy, and psychodynamic therapy. He has published numerous journal articles and book chapters on topics such as eating disorders, masculinity, technology, and psychoanalytic treatment. His book Understanding Anorexia Nervosa in Males was published by Routledge in 2016. He is currently editing Psychoanalytic Treatment of Eating Disorders: When Words Fail and Bodies Speak , to be published with Routledge in 2018. In addition, Dr. Wooldridge is an Executive Director at the National Association for Males with Eating Disorders and has a private practice in Berkeley, CA, where he provides psychoanalytic psychotherapy and family therapy. He is a candidate at the Psychoanalytic Institute of Northern California.