Laura Cushing-Harries reviews The Distance Cure: A History of Teletherapy (The MIT Press, 2021) by Hannah Zeavin.
Since Breuer and Freud first coined the phrase the ‘talking cure’ at the end of the nineteenth century, therapy has been understood to necessarily take place between two embodied subjects ‘engaged in person-to-person’ conversation in a private room (2021:2). Not so, according to Hannah Zeavin’s The Distance Cure: A History of Teletherapy. Instead, the therapeutic encounter has always occupied diverse and distanced spaces, temporalities and media. The therapeutic dyad, consisting solely of therapist and patient, should be reimagined as a triad, reliant on a patient, therapist, and the communication technologies they use to connect.
Arranged over five chapters and a coda, The Distance Cure chronologically traces the developments in, and adoptions, of new media to deliver therapy. In her introduction, Zeavin’s insightful analysis of the therapeutic frame provides a vital grounding to understand received ideas about the analytic scenario, demonstrating the fluidity of the frame, which has always been open to adaptation and revision. Yet, its persistence in one guise or another might go some way to explaining why new forms of therapy have continued to emerge (7). Throughout the book, Zeavin examines how intimacy has been fostered from a distance. From letters, advice columns and radio broadcasts, to crisis hotlines, radio call-ins, personal computers, mobile phones, and chatbots, intimacies have been made possible by and through mediation. Zeavin’s study extends beyond the talking cure to argue that therapy is an ever-mediated ‘communication cure’ and that, in turn, the type of media used informs the kinds of relationality made possible by it (58).
Published a little over 18 months after the onset of the Coronavirus pandemic, this monograph arrives at a point when the world has faced seismic shifts in the way we communicate with each other. As more and more elements of our lives have moved online, greater attention is being paid to distance’s emotional and affective impacts. Zeavin’s timely history illustrates that distanced therapeutic communication is ‘as old as psychoanalysis itself’ (4).
Drawing on a constellation of sources, such as clinical texts, primary materials, counselling scripts and personal documents, as well as software, newspaper articles and radio broadcasts, Zeavin’s narrative is largely led, she admits, by the dominant actors (‘inventor, theorist and clinician’) in these stories (22). While her attempts to incorporate what she terms the ‘quieter stories’ into her study are to be commended, the lack of archival materials means that she has had to adopt oral history and autoethnography approaches to flesh out the experiential elements of her history. Zeavin is quick to qualify that she will not offer an analysis of the curative capabilities of various teletherapies. Rather, she examines the contexts in which new therapies emerge and how developments in technology raise ‘concerns about what media add to human relationships and what they subtract’ (5).
In chapter one, ‘The Written Hour’, Zeavin narrates the troubled beginnings of psychoanalysis, which both longed for unmediated communication and predicated its practice on talking. ‘Mediation’, Zeavin writes, ‘consistently appears as a metaphor rather than intrinsic feature’ in psychoanalytic discourse, which derides mediated therapy as an inferior and impure form of analysis (29). Here Zeavin focuses on two examples of distanced therapy mediated through letters. The first is Freud’s longstanding correspondence with friend and colleague Wilhelm Fleiss. Where others have seen these letters as evidence of reported self-analysis, Zeavin argues that analysis also happens in them. The formal characteristics of epistolary correspondence are analogous to traditional forms of therapy. These letters unfold sequentially over an extended period (37). They are addressed directly to another individual. Moreover, the frequency with which they were written suggests ‘a practiced habit whose duration allows for mutual transference’ (40).
In the second example, Zeavin examines the famous case of ‘Little Hans’, Freud’s only known analysis of a child (mediated through his physician-father, Max Graf). This proto-teletherapy solves the problem of access to help. While Freud and Hans both lived in Vienna, the letter was a necessary mode of treatment for a child whose agoraphobia prevented him from leaving the house. The letter, Zeavin concludes, not only shapes and supports the analytic scenario – it also calls attention to the ‘medium’ (57).
In chapter two, ‘Mass Intimacy’, Zeavin charts the history of therapeutic encounters on the radio. Zeavin eloquently examines radio’s dual ability to communicate to the masses while cultivating a private or, at times, voyeuristic encounter. Beginning with Donald Winnicott’s parenting broadcasts (1939-1962), aimed at a lone matriarch on the home front, she then considers more recent radio call-in shows that enable listeners to identify with and listen in on the problems callers face. While Zeavin notes that many radio call-in hosts were anti-feminist women, focussing on issues related to marital relationships, and that Winnicott aimed his broadcasts at an ‘archetypal mother’ (84), the question of why this space might be so gendered remains tantalisingly obscure. That said, the subject of Zeavin’s forthcoming book, Mother’s Little Helpers: Technology in the American Family, promises to develop the initial observations on gendered technologized care made here.1 Zeavin’s final example, therapist Esther Perel’s podcast Where Shall We Begin? curiously collapses Winnicott’s public therapy model and recent call-in radiotherapeutic entertainment into a single program. This is both a “real” therapy session, albeit one in which the clients are aware that they are being recorded, and a meta-analysis of analysis itself.
Moving from radio to phone in the third chapter, ‘The Far Voice’ examines the Protestant origins of the crisis hotline that adopted a psychoanalytically inflected pastoral care approach. During the post-war moment in the UK and North America, the hotline overcame the economic and temporal constraints of in-person, qualified therapy by providing a wealth of trained voluntary resources that “patients” could access at will (99). Chad Varah, a British Anglican vicar and the founder of the Samaritans, believed the hotline could function as an emergency service delivered by the religious counsellor, who was a ‘particularly good candidate to listen to the problems of the suicidal’ (94). Moreover, the anonymity afforded by the phone meant that callers could more easily discuss sensitive and taboo issues related to suicide, homosexuality and premarital desires. Other Protestant groups subsequently formed other hotlines. The most interesting of these was established by a self-named “queer Anglican priest” (115), Bernard Mayes, whose San Francisco-based service hoped to reach the suicidal and the lesbian and gay community, which often existed outside of the church. The one-to-one nature of the telephone call remains in keeping with the conventional therapeutic scene, but hotlines differ, Zeavin argues, in that help is user-led. Able to determine the length of their call, how often they revisit, and which hotlines they use, callers possess more agency than they would in traditional scenarios, made possible by the media object.
From the comforting ear at the end of the line to the screen, Zeavin’s fourth chapter, ‘Auto-Intimacy’, traverses traditional forms of self-help, including the diary, the development of computerised therapies, automated and algorithmic healthcare, and the rise of CBT with its ‘self-guided therapeutic regime’ (131). ‘Auto-intimacy’ refers to self-communication enabled through a media object, making the user both the patient and therapist at once by augmenting their understanding of their condition (133). Here the therapist is removed and replaced with a nonhuman other. Zeavin weaves the history of well-known computerised therapists – programs such as ELIZA and SHRINK – with contemporary examples of wellness software deployed by large corporates to support their employees. In a neoliberal context in which wellness=productivity, Zeavin questions the motives behind the burgeoning market of self-help and automated mood tracker therapies.
Chapter five, ‘Written Speech’, explores the shift from the consulting room to the Internet through online etherapy forums, cyber clinics and email delivered by professionals and peers. The talking cure is now the writing cure. Zeavin’s examination of chat, emails and text messages, which combine the conventions of epistolary correspondence and speech (202), opens up a fascinating discussion about how distanced communication evolves within a given digital environment. Where the therapist reads a patient’s non-verbal cues or ruptures in speech, here a patient’s medium-specific ‘nontextuals’ illustrate mental distress through ‘the breakdown of the formal features of paragraph and sentences’, transforming text into written speech and lending an immediacy to distanced intimacy (201).
On reading The Distance Cure, one is keenly aware of the implications this research has on how we read and understand our contemporary moment following the coronavirus pandemic. Zeavin’s ‘Coda: When Distance is Everywhere’ not only reflects on the dramatic social and economic changes that have impacted the individual during 2020 but also on what the pandemic has revealed about being an individual in society. The therapist who blames their exhaustion on yet another session on screen, Zeavin argues, belies the fact that the medium has been there all along and overlooks the effects that the ‘broader social sphere’ might be having. That the ‘mind sciences […] frequently privilege the individual and their psyche over and against the social’ (218) remains a constant concern. Zeavin posits that just as the pandemic has revealed pre-existing divisions and inequalities in society, we should also take the opportunity to revaluate whom, where and by what means the helping profession attempts to help. The Distance Cure is an eloquently written and rigorously researched history of teletherapy, offering an important contribution to the history of mental healthcare delivery that furthers much-needed discussions on affordability, access and provision. ‘Teletherapy cannot fix that which is systemic’ (232), but at a time when distance is everywhere, it seems imperative to consider how new and more inclusive communicative relationships might be forged.
Dr Laura Cushing-Harries is an Associate Research Fellow at Birkbeck, University of London. Her medical humanities research examines modernism and its intersection with clinical structures and practice, with a particular focus on Samuel Beckett, mental health, chronic illness and patient advocacy. She can be found on Twitter @LCushingHarries.