The Analytic Fourth: Telepsychotherapy between Opportunities and Limitations

The COVID-19 pandemic changed psychotherapeutic practice overnight increasing online psychotherapy. Thus, the virtual tool-with a reference to Ogden’s analytic third-became a mediator, both concrete and symbolic, in the therapist-patient couple and can be considered an analytic fourth. This chapter addresses and deepens some issues highlighting both the great advantages and also the limits of the changes in psychotherapeutic practice. First, the implications of the online dimension are analyzed. Indeed, sitting in front of a video camera and observing the other through a screen activates various transference and countertransference fantasies that need to be taken into account. Second, how the online emotional sphere evolved in many ways is discussed. The encounter shifted from a physical dimension to an image that does not show the patient’s entire body but often only a part and some non-verbal elements may be lost more easily. Third, how the pandemic broke the privacy barrier is underlined. Clinical implications are reported.