ABSTRACT
This chapter explores some of the ethical and technical challenges posed by shifting to the use of distance-shrinking communication technologies, for psychoanalysis and psychodynamic therapy. It focuses primarily on the challenge of talking honestly with patients about the values/disvalues and risks of using these technologies as well as the perennial problem of obtaining truly informed, voluntary consent. The difficulties presented by the unique situations of two very different patients about altering the frame to work at a distance illustrate some of the dilemmas many of us face, as the availability of online resources expands. Brandon and Carl are typical of many teletherapy patients today, in that they would not have been able to benefit from continuing their analyses without the use of distance-shrinking technologies. There were costs to working online for both that suggest the importance of being reluctant to agree to such work if satisfactory arrangements can be made for in-person work.
