Presented by: Arthur Niesser, Dr. Med., Derek Hook, PhD & Leora Trub
Discussion by: Todd Essig, PhD
This conference will consider some clinical and theoretical considerations in telehealth versus in-person psychoanalytic treatments. Dr. Niesser will explore if there might be groups of patients for whom online analysis might be advantageous compared to the traditional in-person setting. The potential for a ‘safe space’ is examined, especially in view of erotic transference and countertransference. Furthermore, the preferred choice of setting might depend in part on the therapist’s personality.
Rather than immediately designating teletherapy (or for that matter, in-person therapy) as the inferior form, Dr. Hook suggests we might pause and ask: how have ‘distanced’ forms of treatment (analysis via phone, teletherapy, etc.) drawn our attention to certain facets of the ‘original’ form of psychoanalysis that often go unremarked upon? For example, in Lacanian psychoanalysis with neurotic analysands, a degree of anxiety is often considered necessary, just as a degree of personal distance (following the imperative to work rather in the symbolic than in the imaginary). I will note the role of a type of ‘minimal uncanny’ effect in teletherapy, highlight a few points in respect of differing forms of transference, and consider what interpretative potentials arise from a combining the two forms of psychoanalytic work.
According to Dr. Trub, digital culture increasingly conflicts with longstanding assumptions about psychoanalytic practice. This tension was sharply amplified by the abrupt, unprepared shift to telehealth during the COVID-19 pandemic. Contemporary clinical practices suggest that certain traditional analytic ideals may have exceeded their explanatory and regulatory usefulness. As a result, these ideals may no longer function reliably as markers of deviations from the analytic frame or as guides for reestablishing idealized technique under digitally-mediated conditions. This presentation argues for a new paradigm for conceptualizing the analytic ideal, as one which is rooted in the paradoxes that exist at the heart of digital experience.
The Illusion of Equivalence. Telehealth requires us to act as if in-person and remote modalities are equivalent in order to function, while knowing clinically that they are not. The paradox lies in sustaining continuity of care without collapsing meaningful differences in embodiment, proximity, and shared space.
Holding at a Distance: Maintaining Presence in Absence. Telehealth asks the therapist to provide holding and presence in the absence of shared physical space, requiring presence to be actively produced rather than passively given. What is usually sustained by co-location must now be symbolically, relationally, and technologically assembled.
Healing without Resolution. In a fractured and technologically mediated world, psychotherapy cannot promise wholeness without acknowledging brokenness—including its own. Telehealth becomes therapeutic not by resolving contradiction, but by modeling how psychic life can be held together in the presence of inconsistency, loss, and limits.
