Tele‐analysis: the use of media technology in psychotherapy and its impact on the therapeutic relationship

Abstract

A growing number of approaches in psychotherapy make use of internet- and other media-based interactions. This paper discusses the impact on the therapist-client relationship of using media technology and gives an overview of the current state of the debate. It is suggested that the technical conditions of internet-based interactions produce new forms of social relationships that differ significantly from face-to-face-interactions and that unconscious, nonverbal cues get lost. Research on the therapeutic interaction making use of 'discourse linguistic' methods is presented. The loss of nonverbal cues has implications for psychotherapy in general and especially for the treatment of patients who have difficulties relying on a secure therapeutic relationship. Emotional security in interactional relationships is transmitted to a much greater extent by nonverbal cues than by verbal content; psychoanalytic methods are specialized to refer to this level of interaction. Two alternative scenarios are discussed based on the psychoanalytic theories of Winnicott and Lacan: the risk of an illusionary, idealized image of the other and the possibility that cyberspace can be used for psychological development as a transitional space.

Up-to-date review of psychotherapy via videoconference: implications and recommendations for the RANZCP Psychotherapy Written Case during the COVID-19 pandemic

“…For example, Roesler discusses how idealisation of the therapist – through projections, fantasy and other processes – can undergo intensification by the nature of the virtual relationship. 1 Therefore, the transformative process of therapy can be obstructed due to the absence of reality input that is otherwise inherent in face-to-face encounters. Roesler further argues that psychological maturity cannot occur in the imaginary (virtual) space, and operating primarily in this space reinforces the difficulties in developing authentic real-world interpersonal relationships.…”

“…6 A psychoanalytic perspective, including that of Jung, has argued that no interaction with another is purely objective, and that images constructed of others are always subject to the influence of one’s inner-world experience. 1…”

“…There is growing uptake of videoconferencing (VC) technology in psychiatric practice. 1,2 This has been driven by technological advances and movements to make health care more accessible. 1,3 In light of the COVID-19 pandemic, there has been a surge of usage in VC due to regulations mandating physical distancing.…”

“…The use of VC has been widely accepted for use in various types of psychotherapy. 1–3 VC not only provides accessible psychiatric care and cost-effectiveness, but an equivalence in outcomes to in-person care, across a broad range of psychiatric illnesses and patient demographics. 1,2,4,5 Surveys of therapist satisfaction with VC and confidence in conducting VCP have also yielded positive results.…”

Therapeutic Relationship of Telepsychiatry and Telebehavioral Health: Ideas from Research on Telepresence, Virtual Reality and Augmented Reality

“…42 In addition, nonverbal cues get lost, which has implications for psychotherapy, in general, and especially for the treatment of patients who have difficulties relying on a secure therapeutic relationship. 43 Overall, TBH sometimes is better than in-person care. 44 Trust is a key part of the therapeutic relationship and CMC may exacerbate challenges in communicating with truth and trust.…”