Mediated Presence

This chapter explores how digital mediation reshapes psychoanalytic practice, focusing on the challenges and ethics of online therapy. The analytic encounter has always depended on embodied presence: two bodies sharing space to enable psychic transformation. The digital age, intensified by the COVID-19 pandemic, has reconfigured this presence through screens, compelling therapists to rethink what is gained and lost when therapy unfolds online. Two conceptual axes guide the discussion: the embodied presence axis , concerning how the loss of physical co-presence limits somatic countertransference and implicit communication; and the relevance axis , which examines how epistemic trust and truth-value are maintained when analytic communication is technologically mediated. Through clinical examples, the chapter illustrates how therapists can use remembered somatic markers to sustain continuity and meaning when working online while also addressing the intensified risks of enactment, boundary erosion, and the “digital transference”. The chapter extends to ethical considerations, arguing that online therapy constitutes a distinct setting with unique affordances and deprivations. It calls for transparency about its differences from in-person therapy/analysis, emphasising the need to balance accessibility and consideration of the ethical principles of beneficence and non-maleficence. Ultimately, the chapter positions online therapy as a viable but ethically complex modality requiring renewed attention to embodiment and the truthfulness of analytic engagement.