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<p>Psychodynamic therapies emphasize the healing potential of emotional awareness and relational presence. In online therapy, the therapist’s presence becomes transformed - mediated by written words and digital distance. This exploratory qualitative study examined how participants with Somatic Symptom Disorder (SSD) experienced therapist presence versus absence in Internet-based Emotional Awareness and Expression Therapy (I-EAET), an online psychodynamic treatment designed to help patients engage with avoided emotions linked to physical symptoms. Semi-structured interviews were conducted with ten participants who had completed either a guided or unguided version of I-EAET as part of a randomized controlled trial. Data were analysed using reflexive thematic analysis. The participants described that therapist contact was experienced as both supportive and limited: written guidance provided containment, motivation, and validation, but there was an absence of immediacy and emotional resonance. Working without a therapist was described as fostering autonomy and self-reflection, yet often evoked feelings of isolation. Across conditions, participants described a movement between dependence and independence, containment and solitude. Clinical implications include tailoring the level of therapist involvement to patients’ relational needs and emotion-regulation capacities.</p>

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Between Presence and Distance: Patients’ Experiences of Therapist Connection in Internet Administrated Psychodynamic Therapy for Somatic Symptom Disorder

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月24日

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  • Camilla von Below,
  • Klara Hagfeldt,
  • Veronica Hallonlöf,
  • Peter Lilliengren,
  • Daniel Maroti

摘要

Psychodynamic therapies emphasize the healing potential of emotional awareness and relational presence. In online therapy, the therapist’s presence becomes transformed - mediated by written words and digital distance. This exploratory qualitative study examined how participants with Somatic Symptom Disorder (SSD) experienced therapist presence versus absence in Internet-based Emotional Awareness and Expression Therapy (I-EAET), an online psychodynamic treatment designed to help patients engage with avoided emotions linked to physical symptoms. Semi-structured interviews were conducted with ten participants who had completed either a guided or unguided version of I-EAET as part of a randomized controlled trial. Data were analysed using reflexive thematic analysis. The participants described that therapist contact was experienced as both supportive and limited: written guidance provided containment, motivation, and validation, but there was an absence of immediacy and emotional resonance. Working without a therapist was described as fostering autonomy and self-reflection, yet often evoked feelings of isolation. Across conditions, participants described a movement between dependence and independence, containment and solitude. Clinical implications include tailoring the level of therapist involvement to patients’ relational needs and emotion-regulation capacities.