Uncanny Teletherapy: Working with Extimacy

J Am Psychoanal Assoc. 2023 Apr;71(2):237-258. doi: 10.1177/00030651231170561.

Abstract

Responses to the question of teletherapy have multiplied over the past decades, yet many therapists are grappling with the challenges and opportunities of teletherapy for the first time in the wake of the Covid-19 pandemic. For many clinicians, teletherapy was, at least initially, unfamiliar and unsettling. Much of the literature construes teletherapy as a degradation of an original-incapable of providing the intimacy achieved and maintained in two-bodies-in-a-room therapy-or as a good enough simulation. Both positions risk enshrining the consulting room as offering an unmediated scene of therapy. An alternative approach to the strangeness, distance, and mediations so prominent in the transition to teletherapy takes up a qualified sense of Freud's concept of the uncanny: the "minimal uncanny" and its reformulation in Lacanian theory as extimacy, a lens through which to explore intimacy and bodily proximity in the transition to teletherapy. Through the logic of extimacy, a theoretical view emerges that approaches teletherapy not as a poor substitute for real therapy, or a good enough substitute, but as an exemplary case of the therapeutic encounter.

Keywords: Covid-19; Lacan; extimacy; intimacy; psychoanalysis; psychotherapy; teletherapy; uncanny.

MeSH terms

  • COVID-19*
  • Humans
  • Pandemics*