Robert M. Gordon

Introduction: The China American Psychoanalytic Alliance (CAPA) has been offering psychoanalytic psychotherapy training and treatment to Chinese mental health professionals entirely over the Internet since 2006. When the COVID‐19 pandemic began, most practitioners worldwide had to turn to teletherapy. US psychoanalytic practitioners were more negative towards teletherapy than those from other theoretical orientations. We predicted that CAPA practitioners as compared to US psychoanalytic practitioners would be more prepared for teletherapy services during the pandemic, since they their training and treatment had been on‐line.Method: We compared survey results from 164 CAPA practitioners with 165 US psychoanalytic practitioners (matched for age) who had recently psychoanalytically treated a patient on‐line. CAPA participants were recruited from CAPA email lists and the US sample were recruited from the Society for Psychoanalysis and Psychoanalytic Psychology of the American Psychological Association, the American Psychoanalytic Association and International Psychotherapy Institute.Results: CAPA practitioners as compared to US psychoanalytic practitioners had more positive opinions about teletherapy before the pandemic; had more positive opinions about teletherapy during the pandemic; and had more positive opinions about the effectiveness of teletherapy in working with transference, relational issues and resistance. The CAPA practitioners were more prepared to do psychoanalytic psychotherapy during the pandemic than the US psychoanalytic practitioners.Discussion: Xiubing Wang discusses these findings in terms of her own experience as a CAPA graduate and treater before, during and after the COVID‐19 pandemic in China.

I summarize several studies on the effectiveness of distance training and treatment ^{1 1} I will use the term “distance treatment,” but this is interchangeable with other terms as such as “Internet mediated therapy” “remote treatment,” telepsychotherapy,” “Video-conferencing mediated treatment.” View all notes with Chinese mental health professionals. We found that experts on the average felt that teaching, supervising and treating over video-conferencing (VCON) were only “slightly less effective” than local work. The highest significantly rated indications for treatment over VCON are: “To offer high-quality treatment to underserved or remote patients” and “When patient is house-bound or travel would be impractical.” The highest significantly rated contraindication for treatment over VCON is “Patient needs close observation due to crisis or decompensation.” The next logical step was to assess the opinions of CAPA graduates about the effectiveness of their distance psychoanalytic training and treatment. We found that the more the graduates used a psychoanalytic formulation was highly correlated with the number of years in distance education and the more days a week in their own therapy. Graduates highly rated the effectiveness of their own psychoanalytic therapy over VCON. The CAPA graduates thought that the therapist variables (warmth, wisdom, empathy, and skillfulness) were far more important in the effectiveness of their treatment than whether the treatment was local or with VCON, or the cultural differences with their therapist. The graduates’ ratings of how they are currently practicing psychoanalytic psychotherapy were highly correlated with how their own therapists practiced psychoanalytic treatment, as measured by the Comparative Psychotherapy Process Scale (CPPS) items. Dr. Maranda Sze’s preliminary findings from a survey of 163 CAPA students found that they increased from practicing psychodynamic psychotherapy from 55% pre-CAPA to 78% currently, with increased private practice hours, and increase in fees charged. There was also significant increased time in their own psychoanalytic treatment. Overall, these studies show the success of creating a new generation of psychoanalytic therapists in China.

Institutes for the training of psychoanalytic therapists are mostly limited to major metropolitan centres. This presents a problem for the training of psychodynamic psychotherapists and psychoanalysts. Psychoanalytic training programmes have three components: a personal analysis, a didactic curriculum, and intensive supervised psychoanalytic clinical work. The didactic education and supervision may be easier to provide online, as compared to conducting psychoanalysis over Internet. However, psychoanalytic treatment over the Internet by video conferencing presents somewhat different problems than most other psychological treatments. Fishkin et al. reported on the China American Psychoanalytic Alliance, which provides treatment, education, and supervision to Chinese mental health professionals over the Internet. Many psychoanalysts are concerned that psychoanalytic treatment cannot translate well over the Internet and that cultural differences might significantly diminish the effectiveness of the treatment. Nonetheless, the findings demonstrate that distance psychoanalytic/psychodynamic training is perceived by graduates as highly effective and can produce therapists who use psychoanalytic formulations and techniques in their work with patients.

How effective is psychoanalytic/psychodynamic distance training over the Internet? To assess this, we surveyed graduates of the 2-year and 4-year programs of the China America Psychoanalytic Alliance (CAPA). The main results of the 90 graduates' surveys showed that 77% of their work involves a psychoanalytic formulation of their cases as compared to other theoretical orientations. Graduates highly rated the effectiveness of their own psychoanalytic therapy over videoconferencing (VCON). Graduates' ratings of treatment with their patients over VCON positively correlated with years of psychoanalytic education, number of days a week in own treatment, years doing psychoanalytic treatment, and degree working with a psychoanalytic orientation. Graduates thought that therapist variables (skillfulness, warmth, empathy, and wisdom) were much more important in the effectiveness of their treatment than whether the treatment was in-person or with VCON, or the presence of cultural differences with their therapist. The...