How Psychotherapists Practice in the Digital Era

City University of New York (CUNY) CUNY Academic Works Dissertations, Theses, and Capstone Projects CUNY Graduate Center 2-2021 How Psychotherapists Practice In the Digital Era Josh Weinstein The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/4186 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] HOW PSYCHOTHERAPISTS PRACTICE IN THE DIGITAL ERA by JOSH WEINSTEIN A dissertation submitted to the Graduate Faculty in Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2021 © 2021 JOSH WEINSTEIN All Rights Reserved ii How Psychotherapists Practice In the Digital Era by Josh Weinstein This manuscript has been read and accepted for the Graduate Faculty in Psychology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy. __________ __________________________________ Date Elliot Jurist Chair of Examining Committee __________ __________________________________ Date Richard Bodnar Executive Officer Supervisory Committee: Diana Diamond Lissa Weinstein Stephen Hartman Alex Kriss THE CITY UNIVERSITY OF NEW YORK iii ABSTRACT How Psychotherapists Practice In the Digital Era by Josh Weinstein Advisor: Elliot Jurist The digital era, marked by digital devices connected via high speed data networks, has altered human experience in profound ways over the past 40 years. The potential for novel forms of human relating and fulfillment of desire has led to myriad changes in behavior, thought and unconscious activity. While many adapt or thrive in expanded reality, for some, the digital can be context, source and/or location for psychological affliction. When those who suffer seek psychological relieF, how psychotherapists listen for, conceptualiZe and work with the effects of the digital matter a great deal. While theoretical and quantitative research literature exists at a population level, there is little study of how analytically oriented psychotherapists practice in light of the technological world. This dissertation used an interpretive qualitative method with a small sample (n=6) to explore in depth how analytically oriented clinicians based in New York City in Spring 2019 and Fall 2020 are responding to this phenomena. Results suggest that therapists tend to use existing theory and clinical methods to guide treatment, but to varying degrees are attuned to new or extreme presentations of symptomology that finds expression in digital modes. Younger therapists and those that include Lacan as part of their theoretical orientation were more agile in hearing traces of the digital both in manifest and latent aspects of patient communication and linking them conceptually to sometimes novel methods of working with such effects. The inclusion of factors unique to the technological era in clinical training, a treatment method for digital illness, and two novel theoretical constructs informed by the literature reviewed and interviews, the Virtual Cathexis and Techno-shame, are proposed. iv ACKNOWLEDGMENTS This dissertation has been in progress since the spring of 2017, when I first proposed it to Elliot Jurist, more than 3.5 years ago. I have been fortunate that my interest in this area of study and this project in particular has kept me easily engaged through the lengthy period it has taken to go from conception to completion. At the same time, I want to acknowledged several important people for their contribution, support, and love, without which this project would not have reached its Zenith. I am deeply grateful to Elliot Jurist for his excitement and interest in my proposal from the outset, which gave the dissertation a solid foundation and home at City. Elliot and I meet in a coffee shop on the Upper West Side several times over the summer and fall of 2017 to discuss texts that grounded my inquiry. These texts included Sherry Turkle’s “Reclaiming Conversation,” and Isaac Tylim’s “The Techno-Body and the Future of Psychoanalysis.” Through conversation, Elliot helped me articulate my questions and guided them into a form fitting for a doctoral dissertation. I want to thank Elliot for his investment in helping craFt the design and development of the study and his timely feedback throughout the review process. Elliot truly helped me move from start to finish. Lissa Weinstein and Diana Diamond’s positive and constructive feedback preceding and following the proposal defense built confidence and oriented me towards ideas and literature that allowed me to take a broader and more equanimous vantage point. I am very grateful to my readers Alex Kriss and Stephen Hartman for their participation in and comments during the oral defense. Both were influential on my thinking about the digital from early on in my research and their informed response to the manuscript at the end of the project highlighted positions I had overlooked as well as offered meaningful endorsement of the value of the work. v While I hope this dissertation will have significance for the field of clinical psychology, from a personal perspective, it marks the bounds of many major personal life events. I got married, lost my father and welcomed the birth of my daughter, not to mention completing my internship year during a global pandemic over the past 2.5 years. Each alone was a lengthy emotional journey and I am profoundly grateful to my wife, Tina Kukielski, who showed me what love could do as we both weathered the highs and lows of these intense times. Tina made significant personal sacrifices, including relinquished a professionally important position, while maintaining her full time job to lovingly care for our daughter, Delta Em Weinstein, so I had time to analyze the interviews and synthesize the dissertation into coherence. Thanks to her parents, Phil and Elisa Kukielski, who made several multiweek visits to care for Delta and kept us all well fed, so I could work. My father, Melvin Jay Weinstein, was so proud to read my dissertation while in process, and although he did not live to see this work completed, his spirit was a assuring force that contributed to the perseverance needed to complete the project. My mother, Joan Weintein’s steady, sensitive love taught me from an early age to recogniZe the psychological impact of seemingly small things events and to value human connection, fundamental beliefs that have guided my life and this work. My daughter, Delta, now 1.5 years old, is a light, a new orientation, a spirit, whose life is already unfolding in the digital ecosystem – and I watch and participate with fascination and love, that I hope, allows her, in time, to build coherence and enjoy ambiguity through fluid engagement with the dynamics of an always changing world, knowing she has been and will be loved in all her forms. vi Table of Contents Page CHAPTER 1 ................................................................................................................................... 1 CHAPTER 2 ................................................................................................................................... 6 CHAPTER 3 ................................................................................................................................. 87 CHAPTER 4 ................................................................................................................................. 96 CHAPTER 5 ............................................................................................................................... 175 REFERENCES ........................................................................................................................... 205 vii CHAPTER ONE Introduction Adam Gopnik, writing in The New Yorker in 2011, created a simple, yet illustrative tripartite classification system to review a set of new books, written by academics for general audiences, about the effects of the Internet: “the Never-Betters, the Better-Nevers, and the Ever- Wasers” (Gopnik, 2011). According to Gopnik’s schema, the “Never-Betters” and the “Better- Nevers” were polemical and absolutist, the positive and negative ends of the spectrum, whereas the “Ever-Wasers” were essentialists, naming the power of new technology to invariably provoke extreme reactions that attenuate in time. Each group identified differing foci that guided them towards distinct conclusions about the nature and impact of the new digital reality. My intention is to highlight that divergent opinions reflect the challenge of forming an integrated understanding of the effects of the technological world on human experience in the present moment. Opposing conclusions are derived from distinct models of making meaning that consider opportunity, risk and respond to change in different measure. Each position brings different truths into focus, naming distinct features of the digital era acontextually and making predictions about implications. The present moment may, by nature, be unknowable as a gestalt, irreducible to broad consensus, more prone to projections of hope, fear, fantasy and wish than the past, seen through the cool lens of history. The digital era is one of the defining forces in the world today, unleashing change on a scale greater than the industrial or mechanical revolutions. The global proliferation of digital devices

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