When remote analysis is used as an attack on the frame

Henri Rey's theory of claustro-agoraphobia is helpful for the understanding of the difficulties that can arise when the frame of treatment is modified in remote analysis or psychoanalytic psychotherapy. The felt intense closeness and the actual distance of remote analysis lend themselves to a defensive position in remote analysis when the patient feels at once trapped in the analysis and yet unable to be without the analysis. I suggest here that such claustro-agoraphobic fears arise particularly at times in the analytic process in which change is imminent. The patient is then confronted with giving up old systems of defence. Moving away and changing to remote analysis can provide a relief in the face of the simultaneous fear of closeness and of distance. With such patients, the two steps of moving away and changing to remote analysis can be seen as an unconscious attack on the frame by a part of the patient that is defending itself against such fears in the face of change. Once the setting has changed in remote psychotherapy, the analyst too can be drawn into the claustro-agoraphobic position in the face of the patient's attacks on the analyst's symbolic thinking and his internal frame.