{"id":376,"date":"2026-05-01T07:22:09","date_gmt":"2026-05-01T06:22:09","guid":{"rendered":"https:\/\/catmoirwolfe.com\/?p=376"},"modified":"2026-04-27T07:15:28","modified_gmt":"2026-04-27T06:15:28","slug":"teletherapie-revolution-numerique-ou-compromis-therapeutique","status":"publish","type":"post","link":"https:\/\/catmoirwolfe.com\/en\/teletherapie-revolution-numerique-ou-compromis-therapeutique\/","title":{"rendered":"Tele-therapy: digital revolution or therapeutic compromise?"},"content":{"rendered":"<p>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. <\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Yes <a href=\"https:\/\/mitpress.mit.edu\/9780262045926\/the-distance-cure\/\" type=\"link\" id=\"https:\/\/mitpress.mit.edu\/9780262045926\/the-distance-cure\/\">its origins date back to the 1950s<\/a>, teletherapy has only recently seen massive adoption, driven by technological advancements and the need for <a href=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/tmj.2023.0612\" type=\"link\" id=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/tmj.2023.0612\">maintain remote access to care<\/a>. <\/p>\n\n\n\n<p>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?<\/p>\n\n\n\n<p>In this article, we explore in depth the advantages, disadvantages, and scientific challenges of teletherapy.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>What is teletherapy?<\/strong><\/h2>\n\n\n\n<p>The <a href=\"https:\/\/shs.cairn.info\/telepsychologie--9782749274423?lang=fr\" type=\"link\" id=\"https:\/\/shs.cairn.info\/telepsychologie--9782749274423?lang=fr\">teletherapy<\/a> refers to any form of psychotherapy conducted remotely using communication technologies. It can take several forms:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Video conferencing (Zoom, Teams, etc.)<\/strong><\/li>\n\n\n\n<li><strong>Telephone calls<\/strong><\/li>\n\n\n\n<li><strong>Written messaging (chat, email)<\/strong><\/li>\n\n\n\n<li><strong>Specialised mental health applications<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Contrary to popular belief, teletherapy is not a new form of therapy, but rather a\u00a0<strong>Mode of delivery<\/strong>\u00a0of the same therapeutic approaches (psychoanalytic therapy, cognitive and behavioural therapy, humanistic therapy, etc.).<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>The effectiveness of teletherapy: what does science say?<\/strong><\/h2>\n\n\n\n<p>One of the most debated questions concerns the effectiveness of teletherapy compared to face-to-face consultations.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Generally equivalent results<\/strong><\/h3>\n\n\n\n<p>Several studies show that teletherapy is\u00a0<strong>Globally as effective as in-person therapy<\/strong>, notably for disorders such as depression, anxiety, or post-traumatic stress.<\/p>\n\n\n\n<p>For example:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>One <a href=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/tmj.2021.0294?utm_source=chatgpt.com\">2022 meta-analysis<\/a> concluded that videoconference therapy is\u00a0<strong>comparable in effectiveness to face-to-face therapy for reducing depressive symptoms<\/strong>.<\/li>\n\n\n\n<li>One <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532701\/?utm_source=chatgpt.com\" type=\"link\" id=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532701\/?utm_source=chatgpt.com\">Systematic review<\/a> indicate that\u00a0<strong>The majority of studies find no significant difference<\/strong>\u00a0between the two modalities.<\/li>\n\n\n\n<li><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0165032723001726?utm_source=chatgpt.com\">Further work<\/a> confirm that teletherapy can produce\u00a0<strong>similar results in the treatment of depression<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Patient satisfaction and engagement<\/strong><\/h3>\n\n\n\n<p>Studies also show that:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients report <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK532701\/?utm_source=chatgpt.com\">levels of\u00a0<strong>high satisfaction<\/strong><\/a>, comparable to those of traditional consultations.<\/li>\n\n\n\n<li>My <a href=\"https:\/\/journals.sagepub.com\/doi\/full\/10.1089\/tmj.2021.0294?utm_source=chatgpt.com\">dropout rates are\u00a0<strong>Similar<\/strong><\/a><strong> between the two formats<\/strong>.<\/li>\n\n\n\n<li>In some cases, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK586283\/?utm_source=chatgpt.com\">teletherapy can even improve\u00a0<strong>commitment<\/strong><\/a>\u00a0(for example via more accessible phone sessions).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Methodological limitations<\/strong><\/h3>\n\n\n\n<p>However, one must remain cautious:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Some research indicates that the evidence is still\u00a0<strong>heterogeneous and sometimes limited<\/strong>.<\/li>\n\n\n\n<li>Results may vary depending on:\n<ul class=\"wp-block-list\">\n<li>the type of disorder<\/li>\n\n\n\n<li>the population (children, adults, elderly people)<\/li>\n\n\n\n<li>the quality of the therapeutic connection<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Teletherapy: advantages and disadvantages <\/h2>\n\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><tbody><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Advantages<\/strong><\/td><td><strong>Disadvantages<\/strong><\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Increased accessibility<\/strong><br>This is arguably the most obvious advantage.<br>Teletherapy allows for:<br>\u2013 Consult from anywhere (home, work)<br>Reduce geographical constraints<br>\u2013 Access remote specialists<br>It is particularly beneficial for:<br>\u2013 Rural or isolated areas<br>\u2013 People with reduced mobility<br>\u2013 Patients suffering from social anxiety<br>In this regard, it contributes to\u00a0<strong>reduce inequalities in access to care<\/strong>. <\/td><td><strong>A sometimes strained therapeutic relationship<\/strong><br>The quality of the therapeutic alliance is a key factor in the success of therapy.<br><a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0272735824000515?utm_source=chatgpt.com\">Some studies show<\/a> that the therapeutic alliance is altered in teletherapy.<br>Or, from a distance:<br>Non-verbal signals are harder to perceive<br>\u2013 Human contact is reduced<br>\u2013 Communication can be less fluid<br>Even though some studies show a comparable alliance, this question remains debated.<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>Flexibility and time savings<\/strong><br>Teletherapy offers great flexibility:<br>\u2013 No travel time<br>\u2013 More flexible hours<br>\u2013 Possibility of shorter or more frequent sessions<br>This promotes regularity of follow-up, a key factor in therapeutic success.<\/td><td><strong>Technical problems<\/strong><br>Teletherapy relies heavily on technology. Obstacles such as:<br>an unstable internet connection<br>\u2013 audio\/video problems<br>\u2013 difficulties in accessing digital tools<br> can disrupt the session and be detrimental to the quality of care.<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>A familiar environment for the patient<\/strong><br>Being at home can:<br>Reduce initial stress<br>\u2013 Encourage emotional expression<br>\u2013 Strengthen the feeling of security<br>Some patients feel\u00a0<strong>more comfortable discussing sensitive topics<\/strong>.<\/td><td><strong>Privacy concerns<\/strong><br>Data security is a major issue<br>\u2013 Hacking risks<br>\u2013 Lack of privacy at home<br>\u2013 Use of insecure platforms<br>This may put some patients off, particularly on sensitive topics.<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>A continuity of care<\/strong><br>Teletherapy allows for continued support even in cases of:<br>Moving house<br>Journey<br>\u2013 Health situation (e.g. a pandemic)<br>Therefore, it plays a vital role in the\u00a0<strong>Therapeutic stability<\/strong>.<\/td><td><strong>Less suited to certain situations<\/strong><br>Teletherapy is not always appropriate, particularly for:<br>Severe psychiatric disorders<br>\u2013 Crisis situations (suicidality, psychosis)<br>\u2013 Children and\/or adolescents (according to some clinicians)<br>In these cases, face-to-face support may be preferable.<\/td><\/tr><tr><td class=\"has-text-align-left\" data-align=\"left\"><strong>A promising technological innovation<\/strong><br>Recent advances are opening new prospects:<br>\u2013 Emotional tracking tools<br>\u2013 Virtual reality, which can help treat certain disorders such as social phobia<br><strong>Yet, we do not know<\/strong> <strong>the risks again<\/strong> <strong>of these new technologies<\/strong><\/td><td><strong>The digital divide<\/strong><br>Not everyone has access to:<br>\u2013 reliable internet connection<br>\u2013 suitable equipment<br>\u2013 the necessary digital skills<br>This may exclude certain populations, particularly the elderly or those on low incomes.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<div style=\"height:52px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-text-color has-background has-link-color wp-element-button\" style=\"color:#304b43;background-color:#f5d757\"><strong>Find out more about my video coaching<\/strong><\/a><\/div>\n<\/div>\n\n\n\n<div style=\"height:53px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><strong><strong>Teletherapy in the context of psychodynamic therapy<\/strong><\/strong><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>A historically grounded approach to face-to-face interaction<\/strong><\/h3>\n\n\n\n<p>Psychoanalytic and psychodynamic therapies are based on the exploration of unconscious processes, internal conflicts, and past relational experiences. They place central importance on:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>the therapeutic alliance<\/strong><\/li>\n\n\n\n<li><strong>The transference and countertransference<\/strong><\/li>\n\n\n\n<li><strong>silences, affects, and the non-verbal<\/strong><\/li>\n\n\n\n<li><strong>the therapeutic setting<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Traditionally, this approach has been built within a very structured framework and often in person (the famous couch in classical psychoanalysis). <\/p>\n\n\n\n<p>This has long led some clinicians to consider teletherapy as\u00a0<strong>Incompatible<\/strong> with rigorous psychodynamic practice.<\/p>\n\n\n\n<p>However, this position has evolved significantly in recent years.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Psychodynamic teletherapy: a practice now being studied<\/strong><\/h3>\n\n\n\n<p>Contrary to popular belief, psychodynamic therapy&nbsp;<strong>can be carried out remotely<\/strong>, and it is the subject of empirical research today.<\/p>\n\n\n\n<p><a href=\"https:\/\/guilfordjournals.com\/doi\/abs\/10.1521\/pdps.2020.48.4.437\">Recent studies<\/a> Show that:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Online psychodynamic therapies can produce\u00a0<strong>significant clinical outcomes<\/strong>, particularly for depression and anxiety.<\/li>\n\n\n\n<li>The therapeutic alliance \u2013 yet central to this model \u2013 can be\u00a0<strong>maintained at a comparable level<\/strong>\u00a0to that of face-to-face.<\/li>\n\n\n\n<li>Psychodynamic processes (transference, resistances, interpretation) continue to operate, even through a screen.<\/li>\n<\/ul>\n\n\n\n<p>Online psychodynamic approaches are\u00a0<strong>overall effective<\/strong>, Although the data is still under development.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Remote working: a transformation rather than a disappearance<\/strong><\/h3>\n\n\n\n<p>One of the major concerns relates to the issue of&nbsp;<strong>Transfer<\/strong>, in other words, the way in which the patient projects emotions and relationship patterns from their past onto the therapist.<\/p>\n\n\n\n<p>From a distance, this phenomenon:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Don't disappear<\/strong>, but it can transform<\/li>\n\n\n\n<li>Can be expressed differently (e.g. relationship with the screen, with technology, with physical absence)<\/li>\n\n\n\n<li>It can even be enhanced by new elements (e.g. invasion of the patient's personal space via camera)<\/li>\n<\/ul>\n\n\n\n<p>Some clinicians observe that:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The digital framework can\u00a0<strong>to reveal specific dynamics<\/strong>\u00a0(control, avoidance, dependence)<\/li>\n\n\n\n<li>Being at home changes the relationship with the therapist.<\/li>\n\n\n\n<li>The transfer may include elements relating to\u00a0<strong>Presence\/absence<\/strong>\u00a0(connection, latency, disconnections)<\/li>\n<\/ul>\n\n\n\n<p>In other words, teletherapy does not eliminate psychodynamic processes: it&nbsp;<strong>reconfigure<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>The therapeutic framework: an element to redefine<\/strong><\/h3>\n\n\n\n<p>In psychodynamic tradition, the&nbsp;<strong>frame<\/strong>&nbsp;(Times, place, posture, frequency) is fundamental. It structures the relationship and allows for psychic work.<\/p>\n\n\n\n<p>In teletherapy, this framework becomes more flexible\u2026 but also more fragile.<\/p>\n\n\n\n<p>The stakes include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Managing interruptions (noise, surroundings, notifications)<\/li>\n\n\n\n<li>The stability of the connection<\/li>\n\n\n\n<li>Respect for privacy in the patient's personal space<\/li>\n<\/ul>\n\n\n\n<p>The therapist must therefore:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Redefine the framework explicitly<\/li>\n\n\n\n<li>Maintain consistency despite the distance<\/li>\n\n\n\n<li>To pay attention to variations in the arrangement<\/li>\n<\/ul>\n\n\n\n<p>This is the transition from a \u201cphysical\u201d framework to a\u00a0<strong>\u201csymbolic and relational\u201d<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Non-verbal communication and presence: a relative loss<\/strong><\/h3>\n\n\n\n<p>Another critical point relates to the reduction of non-verbal signals. There are <strong>less access to global body language<\/strong>, a limited field of vision (often to the face), and difficulty perceiving certain micro-expressions.<\/p>\n\n\n\n<p>However, videoconferencing still allows a significant portion of affect to be captured. Some therapists report a\u00a0<strong>attention paid to voice, rhythm and silences<\/strong>.<\/p>\n\n\n\n<p>This is not about the disappearance of the non-verbal, but a\u00a0<strong>perceptual channel change<\/strong> through the screen.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Resistance and defence in the digital context<\/strong><\/h3>\n\n\n\n<p>Teletherapy introduces new forms of resistance:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Easily cancel or reschedule (one click is all it takes)<\/li>\n\n\n\n<li>Camera off<\/li>\n\n\n\n<li>Multitasking during the session<\/li>\n\n\n\n<li>Difficulty in emotionally connecting through the screen<\/li>\n<\/ul>\n\n\n\n<p>But these behaviours can in themselves become\u00a0<strong>clinical material<\/strong> enabling the analysis of avoidance, the desire for control, and the difficulty of being present for oneself and for others.<\/p>\n\n\n\n<p>From a psychodynamic perspective, these elements are not obstacles to be eliminated, but rather&nbsp;<strong>indices to explore<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Psychodynamic therapy via video conferencing is most suitable for patients who:<\/strong><\/h3>\n\n\n\n<p>Given the specificities of psychodynamic teletherapy, this approach is most suitable for people:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>already engaged in therapeutic work or having had experience of it<\/li>\n\n\n\n<li>with good mentalisation skills<\/li>\n\n\n\n<li>seeking deep introspection<\/li>\n<\/ul>\n\n\n\n<p>However, psychodynamic teletherapy, like teletherapy in general, is more delicate for people:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suffering from severe disorders (significant mental disorganisation)<\/li>\n\n\n\n<li>having major relationship difficulties<\/li>\n\n\n\n<li>in acute crisis situations<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\"><strong>Conclusion: an adaptation, not a betrayal<\/strong><\/h2>\n\n\n\n<p>From a psychodynamic perspective, teletherapy is not merely a technical change. It modifies:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>the relationship with space<\/strong>\u00a0At home vs. in the office<\/li>\n\n\n\n<li><strong>the relationship with the body<\/strong>\u00a0Physical presence vs. mediated presence<\/li>\n\n\n\n<li><strong>the relationship with others<\/strong>\u00a0(distance, screen, temporality)<\/li>\n<\/ul>\n\n\n\n<p>But these transformations can also enrich our understanding of contemporary psychological functioning, in an increasingly digital world.<\/p>\n\n\n\n<p>Far from betraying the principles of psychodynamic therapy, teletherapy offers one.&nbsp;<strong>contemporary adaptation<\/strong>.<\/p>\n\n\n\n<p>Although it requires adjustments \u2014 technical, clinical, and ethical \u2014 it also shows that:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>unconscious processes do not depend solely on physical presence<\/li>\n\n\n\n<li>The therapeutic relationship can exist and develop remotely<\/li>\n\n\n\n<li>The framework can evolve without losing its structuring function<\/li>\n<\/ul>\n\n\n\n<p>In short, teletherapy invites psychodynamic therapy to do what it has always done:&nbsp;<strong>to adapt to the transformations of the subject and its environment<\/strong>.<\/p>\n\n\n\n<div style=\"height:40px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-text-color has-background has-link-color wp-element-button\" href=\"https:\/\/catmoirwolfe.com\/en\/\" style=\"color:#304b43;background-color:#f5d757\"><strong>Find out more about my video coaching<\/strong><\/a><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Depuis quelques ann\u00e9es, et plus particuli\u00e8rement depuis la pand\u00e9mie de COVID-19, la t\u00e9l\u00e9th\u00e9rapie s\u2019est impos\u00e9e comme une modalit\u00e9 incontournable dans le domaine de la sant\u00e9 mentale. Aussi appel\u00e9e th\u00e9rapie en ligne, th\u00e9rapie \u00e0 distance ou t\u00e9l\u00e9psychoth\u00e9rapie, elle consiste \u00e0 r\u00e9aliser des s\u00e9ances entre un th\u00e9rapeute et un patient via des outils num\u00e9riques tels que la [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":377,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[1],"tags":[],"dipi_cpt_category":[],"class_list":["post-376","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>La t\u00e9l\u00e9th\u00e9rapie : r\u00e9volution num\u00e9rique ou compromis th\u00e9rapeutique ? - Cat Moir Wolfe<\/title>\n<meta name=\"description\" content=\"D\u00e9couvrez la t\u00e9l\u00e9th\u00e9rapie. 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