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Psychoanalysis in a Globalized Community: "Skype" Video Treatment of Patients in China by CPPNJ Analysts


By Cristine Grapa, LCSW, LMFT

On May 6, 2012, we were transported from the Rutgers Campus across worlds of geography, politics, history, and culture to present-day China! The journey held wonders as a story of human interest, of humanitarian and professional outreach and discovery, and of unprecedented technological opportunities and resources to be explored in the context of analytic treatment and training. Our ‘traveling machine,’ the China American Psychoanalytic Alliance (CAPA), is a non-profit organization incorporated in 2006 to develop and promote mental health services in China by training local mental health professionals as psychodynamic psychotherapists and by providing psychoanalytic and psychotherapeutic treatment to its community-in-training.

CAPA's mission emerged in response to grassroots needs noted by Elise Snyder, MD, during a 2001 trip to Beijing where she was invited to present a paper on psychoanalysis. Dr. Snyder found that there was a severe paucity of mental health services within an environment marked by alarming suicide rates and serious mental health problems, increasingly evident in the rapid, changing milieu of contemporary China. At the same time, China’s mental health community has an avid interest and desire for organized intensive training, treatment, and psychoanalysis, a need that had not been met. Continued assessment, collaboration, and innovative use of modern technology between 2001 and 2006 resulted in CAPA's inception.

CAPA carries out its mission through a modified psychoanalytic training program fashioned after the tripartite structure of most psychoanalytic institutes combining class work, clinical supervision, and personal therapy. CAPA offers basic and advanced two-year adult psychodynamic psychotherapy programs and a low-fee treatment clinic for its candidates. Currently, there are 160 candidates attending classes in more than ten cities, plus supervision in both of these programs; 53 candidates are involved in three to five sessions a week of psychoanalysis, 54 in once a week psychotherapy, and more are still on the waiting list.

The program is largely web-based, imported from outside China, delivered in English, and conducted live through Skype and ooVoo video-conferencing. Its 350 dues-paying members are predominantly from the U.S. analytic community (APsaA, Freudian Society, IPA, William Alanson White, CPPNJ, and others), but also from Australia, Canada, South America, Europe, and Israel. There are more than 170 Chinese dues-paying members of varied medical and mental health backgrounds. CAPA's training is locally supported and co-sponsored by various Chinese hospitals, universities, medical, psychological and mental health departments, and clinics. Additionally, CAPA organizes annual study tours to China that include lectures, consultations, face-to-face meetings, other professional events, supportive promotions, and networking in China and abroad.

Dr. Richard Reichbart, CPPNJ faculty and member of the Board of Directors at CAPA, chaired the meeting on May 6 and introduced the four CPPNJ faculty members who have been involved with CAPA training and treatment activities in China. Sally Rudoy, LCSW, set the stage with background information about CAPA's history, its mission, and programs. She also attended the 2011 Annual Study Tour of China and shared her rich personal experience with pictures, stories, and findings from her travels. Charlotte Kahn, Ed.D spoke of her two-years of clinical supervision experiences in China via Skype and of her own visits and local exchanges during this more extensive period of time. She spoke with enthusiasm and insight about the motivation of Chiinese mental health professionals and their thirst for knowledge, as well as the professional and personal growth she observed among candidates challenged by many complex cultural, political and socioeconomic factors.

Irwin Badin, Ph.D shared his experience teaching a Case Presentation Seminar this year via ooVoo video-conferences. He described the subject matter to be uniquely suited to the candidates' needs for more structured and formalized assessments, a case presentation format, and less concrete processing of clinical material. He concurred with the observation of a high degree of motivation, interest and need among CAPA candidates. Richard Reichbart, Ph.D and Lysa Lyons, Ph.D spoke of their psychoanalytic treatment via Skype with a female candidate in twice-weekly therapy and a male candidate attending treatment three times a week. Their presentations highlighted fascinating clinical issues in need of exploration, cultural understanding and sensitivity, as well as a wealth of insights and innovative adaptations in the course of their work.

China's turbulent modern history (1949-1976) of prolonged and intense totalitarian control, persecution, "cultural purification," and mass execution, together with abject poverty and famine, lack of education, denial of basic human rights, and insufficient social supports has resulted in intergenerational transmission of trauma, chaos, terror, family disruption, dysfunction, and individual emotional scaring. Many examples were observed and discussed by the panel. Most evident, however, was the panel's experience of the candidates' touching spirit of genuine gratitude, fresh hope, eagerness to trust, engage, learn, grow, and search for meaning. The panel noted an idealizing transference related in part to China's culture of self-denial, collectivism, and deference to authority. Yet China's emergence into the world community since the economic reforms and openness of 1978 speaks of human resilience and of traits that have not only insured survival and adaptation, but also the ability to grow and thrive.

Attuned to current indigenous needs, CAPA's psychoanalytically based program is a work-in-progress that seems to nurture back to life injured and neglected infants, adults, and families alike. Undoubtedly, it will continue to change as it grows and becomes integrated through the filter of an increasingly savvy mental health community in a vastly different culture, socioeconomic and political environment, a community in flux, with the need to evolve and respond effectively through its own distinctive culture, in its own way, at its own pace. The seasoned analysts on the panel conveyed their interest in the present and future analytic learning opportunities provided by the various aspects and stages of this unique professional bond and its unfolding separation-individuation process.

The audience in attendance expressed a matching interest to hear progress reports and continuing discussion of the clinical issues encountered. To get involved and respond to CAPA's ongoing need for faculty volunteers, contact the panel members or CAPA's website recruiters at www.capachina.org.