For a few years now, and more particularly since the COVID-19 pandemic, teletherapy has established itself as an essential modality in the field of mental health.
Also known as online therapy, remote therapy, or telepsychotherapy, it involves conducting sessions between a therapist and a patient via digital tools such as video conferencing, telephone, or even messaging.
Yes its origins date back to the 1950s, teletherapy has only recently seen massive adoption, driven by technological advancements and the need for maintain remote access to care.
But this evolution raises many questions: is it as effective as in-person therapy? What are its benefits and limitations? And above all, who is it really for?
In this article, we explore in depth the advantages, disadvantages, and scientific challenges of teletherapy.
What is teletherapy?
The teletherapy refers to any form of psychotherapy conducted remotely using communication technologies. It can take several forms:
- Video conferencing (Zoom, Teams, etc.)
- Telephone calls
- Written messaging (chat, email)
- Specialised mental health applications
Contrary to popular belief, teletherapy is not a new form of therapy, but rather a Mode of delivery of the same therapeutic approaches (psychoanalytic therapy, cognitive and behavioural therapy, humanistic therapy, etc.).
The effectiveness of teletherapy: what does science say?
One of the most debated questions concerns the effectiveness of teletherapy compared to face-to-face consultations.
Generally equivalent results
Several studies show that teletherapy is Globally as effective as in-person therapy, notably for disorders such as depression, anxiety, or post-traumatic stress.
For example:
- One 2022 meta-analysis concluded that videoconference therapy is comparable in effectiveness to face-to-face therapy for reducing depressive symptoms.
- One Systematic review indicate that The majority of studies find no significant difference between the two modalities.
- Further work confirm that teletherapy can produce similar results in the treatment of depression.
Patient satisfaction and engagement
Studies also show that:
- Patients report levels of high satisfaction, comparable to those of traditional consultations.
- My dropout rates are Similar between the two formats.
- In some cases, teletherapy can even improve commitment (for example via more accessible phone sessions).
Methodological limitations
However, one must remain cautious:
- Some research indicates that the evidence is still heterogeneous and sometimes limited.
- Results may vary depending on:
- the type of disorder
- the population (children, adults, elderly people)
- the quality of the therapeutic connection
Teletherapy: advantages and disadvantages
| Advantages | Disadvantages |
| Increased accessibility This is arguably the most obvious advantage. Teletherapy allows for: – Consult from anywhere (home, work) Reduce geographical constraints – Access remote specialists It is particularly beneficial for: – Rural or isolated areas – People with reduced mobility – Patients suffering from social anxiety In this regard, it contributes to reduce inequalities in access to care. | A sometimes strained therapeutic relationship The quality of the therapeutic alliance is a key factor in the success of therapy. Some studies show that the therapeutic alliance is altered in teletherapy. Or, from a distance: Non-verbal signals are harder to perceive – Human contact is reduced – Communication can be less fluid Even though some studies show a comparable alliance, this question remains debated. |
| Flexibility and time savings Teletherapy offers great flexibility: – No travel time – More flexible hours – Possibility of shorter or more frequent sessions This promotes regularity of follow-up, a key factor in therapeutic success. | Technical problems Teletherapy relies heavily on technology. Obstacles such as: an unstable internet connection – audio/video problems – difficulties in accessing digital tools can disrupt the session and be detrimental to the quality of care. |
| A familiar environment for the patient Being at home can: Reduce initial stress – Encourage emotional expression – Strengthen the feeling of security Some patients feel more comfortable discussing sensitive topics. | Privacy concerns Data security is a major issue – Hacking risks – Lack of privacy at home – Use of insecure platforms This may put some patients off, particularly on sensitive topics. |
| A continuity of care Teletherapy allows for continued support even in cases of: Moving house Journey – Health situation (e.g. a pandemic) Therefore, it plays a vital role in the Therapeutic stability. | Less suited to certain situations Teletherapy is not always appropriate, particularly for: Severe psychiatric disorders – Crisis situations (suicidality, psychosis) – Children and/or adolescents (according to some clinicians) In these cases, face-to-face support may be preferable. |
| A promising technological innovation Recent advances are opening new prospects: – Emotional tracking tools – Virtual reality, which can help treat certain disorders such as social phobia Yet, we do not know the risks again of these new technologies | The digital divide Not everyone has access to: – reliable internet connection – suitable equipment – the necessary digital skills This may exclude certain populations, particularly the elderly or those on low incomes. |
Teletherapy in the context of psychodynamic therapy
A historically grounded approach to face-to-face interaction
Psychoanalytic and psychodynamic therapies are based on the exploration of unconscious processes, internal conflicts, and past relational experiences. They place central importance on:
- the therapeutic alliance
- The transference and countertransference
- silences, affects, and the non-verbal
- the therapeutic setting
Traditionally, this approach has been built within a very structured framework and often in person (the famous couch in classical psychoanalysis).
This has long led some clinicians to consider teletherapy as Incompatible with rigorous psychodynamic practice.
However, this position has evolved significantly in recent years.
Psychodynamic teletherapy: a practice now being studied
Contrary to popular belief, psychodynamic therapy can be carried out remotely, and it is the subject of empirical research today.
Recent studies Show that:
- Online psychodynamic therapies can produce significant clinical outcomes, particularly for depression and anxiety.
- The therapeutic alliance – yet central to this model – can be maintained at a comparable level to that of face-to-face.
- Psychodynamic processes (transference, resistances, interpretation) continue to operate, even through a screen.
Online psychodynamic approaches are overall effective, Although the data is still under development.
Remote working: a transformation rather than a disappearance
One of the major concerns relates to the issue of Transfer, in other words, the way in which the patient projects emotions and relationship patterns from their past onto the therapist.
From a distance, this phenomenon:
- Don't disappear, but it can transform
- Can be expressed differently (e.g. relationship with the screen, with technology, with physical absence)
- It can even be enhanced by new elements (e.g. invasion of the patient's personal space via camera)
Some clinicians observe that:
- The digital framework can to reveal specific dynamics (control, avoidance, dependence)
- Being at home changes the relationship with the therapist.
- The transfer may include elements relating to Presence/absence (connection, latency, disconnections)
In other words, teletherapy does not eliminate psychodynamic processes: it reconfigure.
The therapeutic framework: an element to redefine
In psychodynamic tradition, the frame (Times, place, posture, frequency) is fundamental. It structures the relationship and allows for psychic work.
In teletherapy, this framework becomes more flexible… but also more fragile.
The stakes include:
- Managing interruptions (noise, surroundings, notifications)
- The stability of the connection
- Respect for privacy in the patient's personal space
The therapist must therefore:
- Redefine the framework explicitly
- Maintain consistency despite the distance
- To pay attention to variations in the arrangement
This is the transition from a “physical” framework to a “symbolic and relational”.
Non-verbal communication and presence: a relative loss
Another critical point relates to the reduction of non-verbal signals. There are less access to global body language, a limited field of vision (often to the face), and difficulty perceiving certain micro-expressions.
However, videoconferencing still allows a significant portion of affect to be captured. Some therapists report a attention paid to voice, rhythm and silences.
This is not about the disappearance of the non-verbal, but a perceptual channel change through the screen.
Resistance and defence in the digital context
Teletherapy introduces new forms of resistance:
- Easily cancel or reschedule (one click is all it takes)
- Camera off
- Multitasking during the session
- Difficulty in emotionally connecting through the screen
But these behaviours can in themselves become clinical material enabling the analysis of avoidance, the desire for control, and the difficulty of being present for oneself and for others.
From a psychodynamic perspective, these elements are not obstacles to be eliminated, but rather indices to explore.
Psychodynamic therapy via video conferencing is most suitable for patients who:
Given the specificities of psychodynamic teletherapy, this approach is most suitable for people:
- already engaged in therapeutic work or having had experience of it
- with good mentalisation skills
- seeking deep introspection
However, psychodynamic teletherapy, like teletherapy in general, is more delicate for people:
- Suffering from severe disorders (significant mental disorganisation)
- having major relationship difficulties
- in acute crisis situations
Conclusion: an adaptation, not a betrayal
From a psychodynamic perspective, teletherapy is not merely a technical change. It modifies:
- the relationship with space At home vs. in the office
- the relationship with the body Physical presence vs. mediated presence
- the relationship with others (distance, screen, temporality)
But these transformations can also enrich our understanding of contemporary psychological functioning, in an increasingly digital world.
Far from betraying the principles of psychodynamic therapy, teletherapy offers one. contemporary adaptation.
Although it requires adjustments — technical, clinical, and ethical — it also shows that:
- unconscious processes do not depend solely on physical presence
- The therapeutic relationship can exist and develop remotely
- The framework can evolve without losing its structuring function
In short, teletherapy invites psychodynamic therapy to do what it has always done: to adapt to the transformations of the subject and its environment.
