Bodies on the line: how telepsychology brought about new relationalities between therapists and their clients during the COVID-19 pandemic

Author: Leanne Downing1
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  • 1 University of New South Wales, , Australia
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This article explores a series of psychosocial and embodied relationalities that emerged between registered solo-practice psychologists and their clients during the COVID-19 social lockdowns that took place in Australia between June and August 2020. Drawing on findings from a larger qualitative research project into Australian psychologists’ experiences of maintaining therapeutic relationships via teleconferencing technologies during the pandemic, I explore the ways in which the relational and embodied experiences of taking therapy online resulted in new ways of working with clients over digital media interfaces such as Zoom, Skype and Facetime. Central to this discussion is an exploration of the ways in which embodied attunement, fears of risk and contagion, and concerns around trust and privacy were negotiated to create new, ‘more-than-human’ relationships between therapists, clients and the spaces and technologies that brought them together.

Abstract

This article explores a series of psychosocial and embodied relationalities that emerged between registered solo-practice psychologists and their clients during the COVID-19 social lockdowns that took place in Australia between June and August 2020. Drawing on findings from a larger qualitative research project into Australian psychologists’ experiences of maintaining therapeutic relationships via teleconferencing technologies during the pandemic, I explore the ways in which the relational and embodied experiences of taking therapy online resulted in new ways of working with clients over digital media interfaces such as Zoom, Skype and Facetime. Central to this discussion is an exploration of the ways in which embodied attunement, fears of risk and contagion, and concerns around trust and privacy were negotiated to create new, ‘more-than-human’ relationships between therapists, clients and the spaces and technologies that brought them together.

Introduction

Since its initial detection in late 2019, the SARS-CoV-2 (COVID-19) virus has brought with it a series of embodied and psychosocial implications that cannot be sufficiently articulated within a biomedical paradigm. From business closures and government-imposed curfews, through to widespread job losses, home-schooling requirements and stay-at-home mandates, the COVID-19 crisis has emerged not just as a virus, but also as a profoundly social and psychological phenomenon in which an ever-expanding entanglement of humans, places, spaces, objects and technologies is enmeshed.

In numerous countries, infection control directives have required people to not only change many of their social behaviours, but also actively adjust and pay attention to their own embodiment. To prevent infection, people have been asked to adhere to strict handwashing regimens, wear facemasks, refrain from hugging and handshaking, and forego group leisure activities such as sporting and music events. Moreover, as Dahiya (2020) has recently argued, the lived realities of life in the COVID-19 pandemic have a distinctly phenomenological component, as people are repeatedly required to confront the nature of not only their own embodiment, but also their inter-embodiment with other people, places and objects.

Concepts of ‘corporeal entanglement’, ‘risk’, ‘trust’ and ‘uncertainty’ are at the heart of many of these changes. Indeed, who we touch, when we touch them and who we share indoor spaces with have all become pressing personal, social and, at times, political issues. Not surprisingly, then, nascent scholarship into the psychosocial impacts of the pandemic now calls for new ways of understanding the interconnection of our corporealities, socialities, psychologies and intimacies during this time (Ward, 2020).

In this article I use a more-than-human theoretical lens to discuss findings from a larger qualitative research project into the ways in which Australian solo-practice psychologists used telehealth technologies to build and maintain therapeutic relationships online. Captured and theorised here are the moments in which surveyed therapists reflected on the physical absence of the therapeutic consulting room, and how telepsychology consultations required them to negotiate new kinds of embodied relationalities and power dynamics with their clients. Changes to therapist body language, eye contact and verbal/non-verbal encouragers are addressed and considered against a backdrop of client-end interruptions, fluctuating internet connectivity and technical lags affecting audiovisual quality. Observations developed in this article are centred on survey responses conducted for the above-mentioned study. The psychosocial context, theoretical underpinning and methodology of this larger research are discussed throughout.

Contextualising COVID-19 as a psychosocial event

As governments around the world attempt to deal with the COVID-19 crisis by imposing various restrictions on public movement and social life, the need for theoretically grounded research that critically and empirically engages with the corporeal, sociological and mental health implications of the pandemic has been identified (Ward, 2020). As a result, sociologists, psychologists and theorists from a broad range of disciplines are now working to critically engage with the social and mental health implications of the pandemic (Lupton and Willis, 2021).

As social psychologists, health sociologists and medical historians have repeatedly pointed out, pandemics and their associated risks of contagion are inevitably psychosocial phenomena, which need to be understood and addressed within the shifting meanings and practices of place, time and culture (Rosenberg, 1988; Snowden, 2019). Indeed, far from being the exclusive terrain of virologists, microbiologists and medical practitioners, the psychosocial implications of pandemics must be adequately understood and heeded in order to better prepare for future outbreaks (Dingwall et al, 2013).

In countries such as Australia, the COVID-19 crisis has also revealed a range of systemic inequalities and injustices. According to the Australian Centre for Social Impact (2020), issues of homelessness, social isolation, youth unemployment, disability, indigenous affairs, ageing and workplace wellbeing have all surfaced with new urgency during the pandemic. Simultaneously, the plight of precariously employed workers within the sectors of child care, aged care, disability care, security, academia, retail, food manufacturing and hospitality has also become more apparent (Carey, 2020; Jones et al, 2020; Le, 2021).

These widespread sociological impacts have inevitably brought with them a swift succession of mental health consequences. A national survey conducted during the first month of COVID-19 restrictions in Australia indicated that the prevalence of clinically significant symptoms of depression and generalised anxiety, thoughts of being better off dead and irritability were markedly higher than reported by previous surveys (Fisher et al, 2020). Concomitantly, other studies have shown that pandemics frequently result in enduring mental health consequences for both individuals and the societies they live in (Minihan et al, 2020; Monaghan, 2020). Depression, panic, anxiety and anger are common side-effects of trauma, and people who survive pandemics often encounter ongoing psychological trauma well after the situation has resolved (Schneiderman et al, 2005). Additionally, the robust government mandates required for pandemic control (such as social distancing and isolation) can also lead to poor mental health outcomes, with multiple studies demonstrating that experiences of loneliness, despair, fear, boredom and suicidal ideation are common among individuals who are exposed to these situations (Taylor et al, 2008; Liu et al, 2012; Brooks et al, 2020).

In this context, it is important to remember that healthcare workers and psychologists are equally susceptible to these feelings of fear, distress and anxiety. As Maunder et al’s (2008) study of the severe acute respiratory syndrome (SARS) pandemic revealed, approximately one third of healthcare workers who were active during the pandemic exhibited signs of clinical distress up to two years after the outbreak. Similarly, research is now being published which details the negative mental health impacts of pandemics on both primary and allied health workers (Asaoka et al, 2020; Braquehais et al, 2020; Dobson et al, 2020; Usher et al, 2020).

As essential frontline workers, psychologists have played an important role in managing the coronavirus pandemic in Australia. While national studies into the longitudinal effects of the pandemic on this workforce are yet to be published, international studies suggest that the rapid increase in demand for online services is likely to result in burnout, post-traumatic stress and emotional exhaustion (Joshi and Sharma, 2020). Similarly, in dealing with an increasing number of presentations in which clients discuss their experiences of lockdown-induced suicidal ideation, relationship conflicts, domestic violence and child abuse, therapists are at risk of experiencing secondary traumatic stress and compassion fatigue (Figley, 1995; Bride, 2004; Joshi and Sharma, 2020).

The shared psychosocial experiences that take place between psychologists and their clients during times of social crisis are significant (Tosone, 2011; Benitez-Bloch, 2012). In ‘The world outside: its impact on the treatment setting’, Ellen Ruderman (2013) points out that psychologists and counsellors are often affected by the same psychosocial influences as their clients, especially when it comes to issues such as the economy, healthcare, curtailments to individual rights and war. In reminding therapists of the need to carefully consider how their own inner feelings and processes are influenced by external social issues, Ruderman urges mental health professionals to carefully examine not only the internal mental states of their patients, but also how the world outside the treatment room affects them as practitioners (Ruderman, 2013: 1). It is precisely this intertwining of inner and outer psychosocial worlds and their convergence with other people, places, objects and technologies that motivates this article and the larger study that it draws on.

More-than-human theory and contemporary telepsychology

More-than-human theory, which is sometimes referred to as ‘new materialism’ (Lupton, 2020), has emerged as an important touchstone for empirical research in the health social sciences. As a counterpoint to the Cartesian dualisms of self/other, mind/body and object/subject, more-than-human theory poses a direct challenge to traditional humanist paradigms, which see conscious reasoning as the main attribute of what it is to be human. Encompassing a wide range of theoretical perspectives, including post-humanism, eco-feminism and non-representational theory, proponents of more-than-human theory commonly draw on scholars such as Deleuze, Foucault, Guattari, Latour and Spinoza in order to debunk the primacy of human autonomy.

Where humanism tethers its ontological claims to notions of human agency and consciousness, more-than-human theory (drawing on post-humanism) posits humans as being always engaged in the complex technological, physiological and psychosocial entanglements that take place between humans, technologies, places and spaces. For feminist new materialism scholars such as Barad (2007) and Braidotti (2019), this assertion goes beyond simply recognising that humans work with and through non-human technologies and objects, and into a larger critique of the boundaries that exist between humans and non-humans in the first place.

While functioning as an umbrella term for a broad range of scholarly approaches, a central tenet of more-than-human theory relates to the ontology of ‘matter’. Drawing on a body of work conducted since the 1990s, including that of feminist post-structuralist writers such as Judith Butler (1993) and Elizabeth Grosz (1994), scholars such as Barad (2007) and Braidotti (2019) have clearly argued that ‘matter’ (human and non-human things, objects, bodies, spaces and places) is not of secondary importance to human consciousness, but rather is critical to our understanding of the intra-active assemblages that take place between humans and the world around them. This reconsideration of matter has inspired recent scholarship into more-than-human approaches to healthcare, which in turn have seen a move away from ‘objective’ positivisms around determinants of ill health and towards explorations of how individuals create, experience and understand their health worlds (Andrews and Duff, 2019). Even further, a more-than-human theoretical approach is proving particularly useful for scholars who are interested in exploring the affective relationalities that take place within digitally mediated mental healthcare settings (Duff, 2015; Tucker and Goodings, 2017; Andrews, 2018).

As findings from this and other research have revealed, the relationalities that occur between therapists and their clients online require a substantial rethink of issues such as privacy, therapeutic efficacy, expressions of empathy and resonance, and psychologists’ capacities to appropriately track client responses (Isaacs Russell, 2015; Lemma, 2017; Geller, 2020; Downing et al, 2021). In regard to telepsychology, this article argues that more-than-human theory offers a useful lens through which psychologists and health sociologists can better understand the relationships that emerge between therapists and their clients over digital health technologies.

A critical factor here is how therapists themselves think about the psychosocial dynamics of the online therapeutic encounter. In recent years, psychologists such as Isaacs Russell (2015), Lemma (2017) and Gellar (2020) have raised pertinent observations around the shifting relationalities that occur between therapists and their clients via teleconferencing technologies. Of particular significance here is the work of clinical psychologist Shari Lemma, who, via Deleuze’s concept of ‘becoming’, proposes a model for thinking about telepsychology that sees bodies, technologies and therapeutic practices not as separate entities between which relationalities operate, but rather as being constituted through their always emerging relationship with each other (Lemma, 2017).

Contemporary psychology is, of course, a broad and divergent field, which spans an array of therapeutic approaches including psychoanalysis, cognitive behavioural therapy, mindfulness, gestalt therapy and a myriad of other methodologies. While some psychotherapies (such as gestalt, person-centred and existential therapies) are already engaged in explorations around the materialities of therapeutic relationships (Day, 2016; Geller, 2020), proponents of humanist-based disciplines such as psychoanalysis often find themselves at a conceptual impasse when it comes to reconciling notions of materiality and relationality within the online therapeutic encounter. For example, the primacy of language favoured in Lacanian psychoanalysis can seem incommensurate with the work of new materialism scholars such as Barad, for whom language is ‘given too much power’ (Barad, 2007).

Over the past decade, significant scholarly attention has been directed towards understanding the ways in which psychoanalytic theory and practice foreground, problematise and contribute to the concept of ‘post-humanism’. Noteworthy contributors to this endeavour include Dow and Wright (2021), Brinkmann (2017) and also Matviyenko and Roof (2018), whose recent book on Lacan and post-humanism directly considers what psychoanalysis can add to contemporary conversations about subject/object relations, systems, perspectives and values. Similarly, in thinking through the intersection of psychoanalysis and telecommunications, Scharff’s recent three-volume series, Psychoanalysis Online, offers a number of considered insights into how psychoanalysts have experienced and responded to the changing dynamics of therapeutic analysis in the digital era. A comprehensive examination of this research is beyond the scope of this article; however, it is important to note that a common theme in many of these publications has been the need for psychoanalytic therapists to better engage with the changing nature of mental healthcare in online settings. Of particular importance here is the ways in which future psychoanalysts may choose to work with the concepts of ‘discourse’ and ‘lack’, both of which require perpetual renegotiation in an online setting.

As Lemma (2017) points out, digital media technologies provide therapists with new opportunities for understanding the accessibility and utility of mental healthcare; however, a sophisticated awareness of how to create, use and safeguard the online analytic setting is required. Congruent with Lemma, I would also argue that although this process need not necessarily require wide-scale changes within the psychoanalytic discipline, it is only through a willingness to engage with technological changes and with the observations of other disciplines that a deeper understanding of practising psychoanalysis online can be achieved.

The entwined concepts of ‘matter’ and ‘power’ are of utmost importance here. When the COVID-19 pandemic pushed thousands of Australian therapists towards online psychological consultations, the thing that psychologists missed most sorely was the physical space of the therapeutic consulting room and the bodies within it. As the responses recorded throughout this article demonstrate, not being able to fully see and/or accurately read the physical presentations and gestures of the client was a primary concern for almost all of our survey respondents. Similarly, not being able to control the physical parameters of the consultation space caused confusion and, at times, worry for many psychologists, who often did not know what or who was beyond the frame of the screen at the client end.

As I have argued elsewhere, it was precisely this absence of a defined ‘safe’ space through which therapists and their clients could engage, that led to an abundance of initial concerns around the viability of online psychology during Australian lockdowns (Downing et al, 2021). This concern goes to the heart of more-than-human theory in as much as it effectively compelled therapists and their clients to enter into a series of new relationalities in which issues of power, matter, space and place were, by necessity, renegotiated. Indeed, throughout the COVID-19 pandemic, digital media devices and telecommunication platforms have consistently worked as powerful apparatuses through which new and emerging relationalities are taking place. Leaning in on the work of Barad, telehealth technologies may in this way be understood as an apparatus of bodily production through which specific relationalities and power dynamics come into being (Barad, 2007).

In merging the works of quantum physicist Niels Bohr (1972) with feminist epistemologies and post-structuralist theories, Barad’s post-humanist account of performativity and materialisation brings to the fore the concept of ‘becoming’ and creates a foundation through which we can better understand the telepsychology dynamic. In this way, Barad’s reworking of Haraway’s (1988) concept of the ‘apparatus’ as a generative practice is likely to be of fundamental value for a contemporary understanding of bodily production over telehealth technologies (Barad, 1998).

Moreover, while telepsychology platforms may be considered as apparatuses of bodily production through which human and non-human, biological, technological, social, political and economic forces intra-act, they also function as rich sources of therapeutic information, through which the materialities of the therapist, client and their individual technologies and home–work environments most definitely come to matter. Thus, rather than seeing telepsychology as simply an instrument through which issues of power and embodiment are inscribed into, it makes more sense to understand telehealth as a techno-apparatus of bodily production, through which a range of technical, scientific, biological, economic and psychosocial relations come into being.

When a therapist’s viewpoint and understanding is limited to what can be seen and heard through teleconferencing technologies, and when the client’s (locked-down) home environment becomes the consulting space, changes to therapeutic dynamics are inevitable. As the psychologists in our study frequently reported, new ways of working and relating to clients needed to be swiftly reconsidered. Routinely used body gestures and non-verbal encouragers that worked well in in-person consultations were often found to be no longer effective. Audiovisual glitches and internet connectivity interruptions meant that the ways in which therapists traditionally used their bodies/rooms (matter) to create an atmosphere of safety and understanding no longer worked, and entirely new relationalities needed to be developed in real time with the client. In this way, it is possible to think of telepsychology as an apparatus that both produces and delineates the bodies of therapists and their clients.

The study

In March 2020, as Australia grappled with its first COVID-19 lockdown, the Australian federal government made the decision to add telepsychology appointments to the national Medicare scheme (Australian Government Department of Health, 2020). Before this time, government-subsidised telehealth services were only available to a small percentage of the Australian population; specifically, those who lived in isolated regions and were recognised as living more than 15 kilometres from a registered mental health professional (Australian Psychological Society, 2017). As a result of these changes, Australia’s mental healthcare system experienced a sudden and significant increase in telehealth usage, with 52% of the nation’s mental health consultations happening online between March and May 2020 (Snoswell et al, 2020). For the 5,521 solo-practice psychologists working in Australia at the time, this swift implementation of telepsychology resulted in a series of immediate changes to how they ran their practices and engaged with clients (Australian Institute of Health and Welfare, 2020).

With minimal telehealth training behind them, a lot of psychologists were left unsupported in how to best use teleconferencing platforms. As a result, many began sharing their questions and concerns with each other on peer-to-peer social media platforms. In particular, member-only Facebook feeds began to fill with threads from practitioners who were worried about a range of financial, technological and psychosocial issues. Against a backdrop of their own fears and hesitations about living and working through a pandemic, a series of repeated concerns began to emerge around how the body-focused components of psychotherapy could be adequately conducted when the view of a client’s/therapist’s body was limited.

In wanting to better understand the relational and psychosocial experiences of psychologists, I worked with a Melbourne-based registered psychologist to conduct a qualitative study into solo-practice psychologists’ experiences of online therapeutic relationships during the pandemic. Conducted over a five-week period between July and August 2020, the ‘Navigating the Therapeutic Alliance with Teleconferencing Technologies during the COVID-19 Pandemic’ project involved an online survey in which 50 solo-practice, Australian-based psychologists answered a series of questions about their experiences of using telehealth technologies during the pandemic. The survey was circulated by the Australian Association of Psychologists Inc (AAPi), which is one of two professional bodies for registered psychologists in Australia. While membership with the AAPi is open to all registered Australian psychologists, its mission is to represent the industry needs of non-clinical psychologists who utilise a range of psychodynamic, behavioural, cognitive behavioural, mindfulness and humanistic therapeutic approaches. In order to limit the scope of the research, child psychologists, provisional psychologists and psychologists working outside of private practice were excluded from the study.

The primary aim of the study was to determine whether psychologists in private practice had noticed any differences in how they forged therapeutic alliances over telehealth during the pandemic. Ethics approval to conduct the project was granted by the University of New South Wales. The survey results were then evaluated through an interpretive thematic analysis that drew on literature from new materialsim (more-than-human) scholarship, affect studies and social psychology. This approach is pioneering because it uses critical theory and psychosocial perspectives as a lens through which to interpret practitioner experiences of digital health technologies during a time of social crisis.

Bodies on the line

Of the several findings that came out of the above-mentioned research, the ways in which therapists reported experiencing their bodies as relational instruments are by far the most intriguing. As scholars such as Gellar (2020) have demonstrated, embodied relationality is a critical part of effective therapeutic treatment as it enables the therapist to stay ‘grounded’ within difficult emotions, and provides their client with the opportunity to ‘feel felt, met, and understood’ (Geller, 2020: 2). Following the sudden shift to online consultations, many of our surveyed therapists reported feeling worried about how they were relating to clients online as they could not see each other’s full bodies. As one respondent said: ‘The lack of visual information on client’s body impacts on my ability to accurately pick up on emotional states. At the same time, glitches with technology can result in me missing subtle physical cues or important verbal information.’ Similarly, another respondent worried that it was harder to pick up on subtle emotions over a two-dimensional screen: ‘Reading subtle emotional cues is difficult. I have to rely much more on the verbal components of therapy (e.g., saying: “You look a bit sad?”. It’s also more difficult to spot subtle changes, especially for dissociative clients.’

As Geller and Greenberg (2002) found in their examination of solicited accounts from psychotherapists, therapeutic encounters often involve the therapist using their own body as a sensing receptor for both their own feelings and emotions as well as those of the client. As one therapist in their study stated: ‘[I]t’s just not listening to the words, listening to the tone, listening to what the person’s bodily experience is … but somehow listening with my body to their bodily experience’ (Geller and Greenberg, 2002: 78). Similarly, as Sheryl Brahnam (2014) has observed, it is precisely the therapist’s ability to use their own body and sensing capacities as a finely tuned instrument, that paves the way for authentic therapeutic presence. Brahnam (2014) notes that it is ‘through receptivity and inward attendance, [that] the body of the therapist becomes a sensitive sensor attuned to the self, to the client, and to the relationship’.

In thus using their own bodies as ‘sensing instruments’ through which to navigate the emotional and physical affects of their clients, many therapists rely on in-person consultations that take place within dedicated consultation rooms to provide them with critical information about their clients. This in-place and in-person relational process typically involves the therapist paying close attention to the bodily gestures, tones of voice, facial expressions and eye contact of the client. In turn, this leads to what Levenson and Ruef (1992) have identified as ‘empathetic accuracy’, or the ability of the therapist to accurately perceive how the client is feeling. In our study, concerns around empathetic accuracy were variously articulated as worries about missing important non-verbal signals. As one respondent stated: ‘There’s a lack of connection and we miss body language. Clients talk more as they miss interpersonal cues.’

For therapists and their clients who habitually relied on the therapeutic consulting room as a ‘safe haven’ away from the distractions and risks of the outside world, the implications of not being able to see each other’s full bodies were immense. As dedicated ‘safe spaces’, therapeutic consultation rooms have traditionally played an important role in providing a sense of physical safety and protection to clients (Winnicott, 1953; Isaacs Russell, 2015). When these spaces and the bodies within them suddenly came to represent fears around contagion and disease, a significant layer of complexity was added to the therapeutic encounter. Moreover, the sudden shift to using online teleconferencing platforms such as Zoom, Skype and Facetime resulted in the need for an entirely different relational skillset – one in which the therapist’s reading of the client was often limited to their head and shoulders. As one psychologist noted: ‘It’s difficult to get a sense of the client’s initial presentation via Zoom. I have to be super alert to the client’s body movement/facial expressions when undertaking telehealth … two of my clients have noted that they feel more “distant”. It contributes to fatigue.’

For many therapists and their clients, the move to online psychology consultations also brought with it a series of new issues that had not been negotiated previously. In particular, concerns around privacy risks arose, with several of our respondents expressing concern that their clients did not have a safe or private space within which to attend the session. Therapeutic consultations in cars, bedrooms and broom cupboards quickly became commonplace as clients sought out private spaces away from cohabitants during social lockdowns. This issue was especially pressing for clients who lived in a shared house, or with elderly family members and/or children who were prone to interrupting. As one respondent commented: ‘Many of my clients tend to be less focussed and are distracted by events in their home environment such as children, pets, deliveries, sounds. Some get up and walk around or put the kettle on which causes noise interference.’ Similarly, some therapists said that they needed to explain the need for privacy to new clients who had little or no prior experience of therapy and seemed to think that it would be appropriate to have their session in front of family members and/or housemates.

Concerns for at-risk clients also escalated during this time, with a number of respondents indicating that they found it harder to work with clients who self-harmed and/or were victims of domestic abuse. Issues around the emotional depth of therapy surfaced regularly in these comments, with some therapists saying that they deliberately kept therapy ‘lighter’ as they were unable to create a safe physical space for the session. Concomitantly, some therapists reported the difficulties and anxieties inherent in not being able to visually assess the wrists and body parts of clients who self-harm. According to one therapist, the limitations of the screen made it difficult to see the bodies of self-harming clients and subsequently caused difficulties when trying to ‘assess the injuries of clients who cut and burn themselves’. Similarly, another respondent reported that the absence of a physical consulting space made it ‘harder to provide comfort’ when a client became distressed or expressed suicidal ideation.

New relationalities

The lack of personal contact and the increased ‘performance’ aspect of being online makes therapy much more tiring. (Survey respondent, July 2020)

As Dahiya (2020) has recently argued, the COVID-19 crisis puts us in tension with our own corporeality and demands that we perpetually reassess and confront issues of uncertainty, risk and trust in our day-to-day social interactions. In this regard, a fascinating finding of our research was that the vast majority of our surveyed psychologists reported that the COVID-19 lockdowns created the need for new embodied relationalities online. More often than not, these new relationalities depended on the therapist adjusting their physical gestures to match the realities of a two-dimensional screen and the needs of their individual clients.

For some respondents, this came down to consciously enacting exaggerated physical gestures, while for others, it resulted in a finer attunement of their own physiology in order to pay closer attention to what was happening for the client. In both cases, our responding therapists noted that they were compelled to reflect on how their physical gestures/embodied performances were being received by their clients. As one therapist noted: ‘I’m using larger facial and body gestures and speaking more loudly. I’m also filling the space with words rather than sitting in a companiable silence of understanding. There’s an awkwardness with video lag which results in us speaking over each other and it’s harder to pick up on very subtly facial gestures.’ Another therapist echoed this sentiment saying: ‘I tend to be more animated in my face for telehealth.’

Along the same lines, several respondents recalled their tendencies to use broad gestures such as giving ‘high fives’ to the camera or waving to signal the conclusion of the consult. Others reported being especially mindful of lifting their hands towards the camera if they were making hand gestures to emphasise a particular point or emotional affect. Correspondingly, some therapists reported relying on exaggerated facial expressions rather than body gestures in order to account for the limitations of the screen: ‘I use less subtle cues to guide clients … for example the tone in encouraging ‘mmhm’s’. I am also aware not to cross my arms on the desk as it can appear as a block to the other. I am relying less on subtle facial cues, though they still exist naturally for me.’

Whether psychologists’ physical expressions were bigger or smaller, corporeal or auditory, the significance of these findings is that they demonstrate a series of changes in the ways that therapists experienced their bodies over teleconferencing technologies. In this way, these findings contribute to larger post-humanist discussions around the ‘more-than-human’ relationships that develop between therapists, clients, technologies and spaces. These observations go to the heart of contemporary psychosocial discussions around the importance of recognising relationality as a central way in which human beings understand and respond to each other (Way et al, 2018).

Fears of contagion and the rapid uptake of teleconferencing platforms have, in this way, created a new range of therapeutic relationalities in which therapists have renegotiated how they experience their bodies as sensing tools. In the absence of a material consultation space in which issues of mutual trust and understanding can be explored and validated via embodied presence, the therapists that we surveyed were working hard to re-evaluate therapeutic relationships and embodied relationalities over teleconferencing technologies.

In this way, many of our surveyed therapists were providing a real-time demonstration of a key concept in new materialism: the elimination of the conceptual boundary through which human and non-human entities have been previously bound. To reflect on the work of Barad, we are reminded that: ‘The very nature of materiality is an entanglement. Matter itself is always already open to, or rather entangled with, the “Other”’ (Barad, 2007).

Conclusion

Psychosocial negotiations of risk, anxiety and the fear of contagion played an important role in Australia’s rapid transition to telepsychology services. At a macro level, the federal government’s snap decision to subsidise telepsychology sessions sent a clear message to therapists and their clients about the risks involved in participating in face-to-face consultations. At the same time, public health campaigns around physical distancing and regular news media updates about infection and death rates provided an ever-escalating backdrop of anxiety and fear through which staying home was clearly articulated as the safest option.

Our study demonstrated that the shift from in-person psychotherapy to telepsychology raised a new set of relational challenges around how therapists could best work with clients. Far from simply logging on to a teleconferencing platform, online therapy requires the therapist to engage in a complex series of embodied and sensory renegotiations of the therapeutic relationship in order for the client to feel therapeutically ‘held’ and safe. In this way, considerable difficulties can arise when we assume that the embodied nuances of in-person treatment can be effortlessly transported into a two-dimensional screen space. In the absence of both the client’s fleshy body and that of the therapist, traditional embodied forms of relationality get lost within technologically mediated psychology consultations.

Yet, far from dismissing telepsychology as ‘unworkable’, the vast majority of our surveyed psychologists revealed that they were actively engaged in new forms of therapeutic relationalities with their clients. Indeed, for several respondents, the desire to find different ways of relating online was central to their experiences of offering telepsychology consultations during the pandemic. It is exactly this desire to overcome the challenges of an unexpected situation that has led many therapists to explore new and engaging ways of connecting with their clients online. In turn, these changes have resulted in the creation of new forms of relationality that require therapists to renegotiate issues of power, matter, space and place in the online environment.

Conflict of interest

The author declares that there is no conflict of interest.

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  • Brahnam, S. (2014) Therapeutic presence in mediated psychotherapy: the uncanny stranger in the room, in Riva, G., Waterworth, J., and Murray, D. (eds), Interacting with Presence: HCI and the Sense of Presence in Computer-Mediated Environments, Warsaw: De Gruyter Open Poland, pp 12338, doi: 10.2478/9783110409697.8.

    • Search Google Scholar
    • Export Citation
  • Braidotti, R. (2019) Posthuman Knowledge, Cambridge: Polity Press.

  • Braquehais, M.D., Vargas-Cáceres, S., Gómez-Durán, E., Nieva, G., Valero, S., Casas, M. and Bruguera, E. (2020) The impact of the COVID-19 pandemic on the mental health of healthcare professionals, QJM: Monthly Journal of the Association of Physicians, hcaa207, 113 (9): 613617, doi: 10.1093/qjmed/hcaa207.

    • Search Google Scholar
    • Export Citation
  • Bride, B.E. (2004) The impact of providing psychosocial services to traumatized populations, Stress, Trauma, and Crisis, 7(1): 2946. doi: 10.1080/15434610490281101

    • Search Google Scholar
    • Export Citation
  • Brinkmann, S. (2017) Humanism after posthumanism: or qualitative psychology after the ‘posts’, Qualitative Research in Psychology, 14(2): 10930, doi: 10.1080/14780887.2017.1282568.

    • Search Google Scholar
    • Export Citation
  • Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence, The Lancet, 395(10227): 91220, doi: 10.1016/S0140-6736(20)30460–8.

    • Search Google Scholar
    • Export Citation
  • Butler, J. (1993) Bodies That Matter: On the Discursive Limits of ‘Sex’, New York: Routledge.

  • Carey, G. (2020) The national disability insurance scheme and COVID-19: a collision course, Medical Journal of Australia, 213(3): 141141.e141, doi: 10.5694/mja2.50690.

    • Search Google Scholar
    • Export Citation
  • Centre for Social Impact (2020) Addressing social issue areas in the context of COVID-19, https://www.csi.edu.au/news/covid-19-fact-sheets.

    • Search Google Scholar
    • Export Citation
  • Dahiya, A. (2020) The phenomenology of contagion, Journal of Bioethical Inquiry, 17(4): 51923, doi: 10.1007/s11673-020-09997-4.

  • Day, E. (2016) Field attunement for a strong therapeutic alliance: a perspective from relational gestalt psychotherapy, The Journal of Humanistic Psychology, 56(1): 7794, doi: 10.1177/0022167815569534.

    • Search Google Scholar
    • Export Citation
  • Dingwall, R., Hoffman, L.M. and Staniland, K. (2013) Introduction: why a sociology of pandemics?, Sociology of Health & Illness, 35(2): 16773, doi: 10.1111/1467–9566.12019.

    • Search Google Scholar
    • Export Citation
  • Dobson, H., Malpas, C.B., Burrell, A.J.C., Gurvich, C., Chen, L., Kulkarni, J. and Winton-Brown, T. (2020) Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic, Australasian Psychiatry, 29(1): 2630, doi: 10.1177/1039856220965045.

    • Search Google Scholar
    • Export Citation
  • Dow, S. and Wright, C. (2021) Introduction: towards a psychoanalytic reading of the posthuman, Paragraph, 33(3): 299317, doi: 10.3366/para.2010.0201

    • Search Google Scholar
    • Export Citation
  • Downing, L., Marriott, H. and Lupton, D. (2021) ‘Ninja levels of focus’: therapeutic holding environments and the affective atmospheres of telepsychology during the COVID-19 pandemic, Emotion, Space and Society, 40: 100824, doi: 10.1016/j.emospa.2021.100824

    • Search Google Scholar
    • Export Citation
  • Duff, C. (2015) Atmospheres of recovery: assemblages of health, Environment and Planning A: Economy and Space, 48(1): 5874, doi: 10.1177/0308518X15603222.

    • Search Google Scholar
    • Export Citation
  • Figley, C.R. (1995) Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those who Treat the Traumatized, Hove: Psychology Press.

    • Search Google Scholar
    • Export Citation
  • Fisher, J.R.W., Tran, T.D., Hammarberg, K., Sastry, J., Nguyen, H., Rowe, H., Popplestone, S., Stocker, R., Stubber, C. and Kirkman, M. (2020) Mental health of people in Australia in the first month of COVID‐19 restrictions: a national survey, Medical Journal of Australia, 213(10): 45864, doi: 10.5694/mja2.50831.

    • Search Google Scholar
    • Export Citation
  • Geller, S. (2020) Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions, Counselling Psychology Quarterly: 117, doi: 10.1080/09515070.2020.1787348.

    • Search Google Scholar
    • Export Citation
  • Geller, S. and Greenberg, L. (2002) Therapeutic presence: therapists’ experience of presence in the psychotherapy encounter / therapeutische präsenz: erfahrungen von therapeuten mit präsenz in der psychotherapeutischen begegnung / la presencia terapéutica: la experiencia de la presencia que viven los terapeutas en el encuentro psicoterapéutico, Person-Centered & Experiential Psychotherapies, 1(1): 7186, doi: 10.1080/14779757.2002.9688279.

    • Search Google Scholar
    • Export Citation
  • Grosz, E. (1994) Volatile Bodies: Toward a Corporeal Feminism, Bloomington: Indiana University Press.

  • Haraway, D. (1988) Situated knowledges: the science question in feminism and the privilege of partial perspective, Feminist Studies, 14(3): 57599, doi: 10.2307/3178066.

    • Search Google Scholar
    • Export Citation
  • Isaacs Russell, G. (2015) Screen Relations, London: Routledge.

  • Jones, B., Woolfenden, S., Pengilly, S., Breen, C., Cohn, R., Biviano, L., Johns, A., Worth, A., Lamb, R., Lingham, R. et al. (2020) COVID‐19 pandemic: the impact on vulnerable children and young people in Australia, Journal of Paediatrics and Child Health, 56(12): 185155, doi: 10.1111/jpc.15169.

    • Search Google Scholar
    • Export Citation
  • Joshi, G. and Sharma, G. (2020) Burnout: a risk factor amongst mental health professionals during COVID-19, Asian Journal of Psychiatry, 54(December): 102300, doi: 10.1016/j.ajp.2020.102300.

    • Search Google Scholar
    • Export Citation
  • Le, A.T. (2021) Support for doctoral candidates in Australia during the pandemic: the case of the University of Melbourne, Studies in Higher Education, 46(1): 13345, doi: 10.1080/03075079.2020.1859677.

    • Search Google Scholar
    • Export Citation
  • Lemma, A. (2017) The Digital Age on the Couch: Psychoanalytic Practice and New Media, Abingdon: Routledge.

  • Levenson, R.W. and Ruef, A.M. (1992) Empathy: a physiological substrate, Journal of Personality and Social Psychology, 63(2): 23446, doi: 10.1037/0022-3514.63.2.234.

    • Search Google Scholar
    • Export Citation
  • Liu, X., Kakade, M., Fuller, C.J., Fan, B., Fang, Y., Kong, J., Guan, Z. and Wu, P. (2012) Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic, Comprehensive Psychiatry, 53(1): 1523, doi: 10.1016/j.comppsych.2011.02.003.

    • Search Google Scholar
    • Export Citation
  • Lupton, D. (2020) A more‐than‐human approach to bioethics: the example of digital health, Bioethics, 34(9): 96976, doi: 10.1111/bioe.12798.

    • Search Google Scholar
    • Export Citation
  • Lupton, D. and Willis, K. (2021) The COVID-19 Crisis: Social Perspectives, Abingdon: Routledge.

  • Matviyenko, S. and Roof, J. (2018) Lacan and the Posthuman, 1st edn, Cham: Springer International Publishing.

  • Maunder, R.G., Leszcz, M., Savage, D., Adam, M.A., Peladeau, N., Romano, D., Rose, M. and Schulman, B. (2008) Applying the lessons of SARS to pandemic influenza: an evidence-based approach to mitigating the stress experienced by healthcare workers, Canadian Journal of Public Health, 99(6): 48688, doi: 10.1007/bf03403782.

    • Search Google Scholar
    • Export Citation
  • Minihan, E., Gavin, B., Kelly, B.D. and McNicholas, F. (2020) Covid-19, mental health and psychological first aid, Irish Journal of Psychological Medicine, 37(4): 112, doi: 10.1017/ipm.2020.41.

    • Search Google Scholar
    • Export Citation
  • Monaghan, L.F. (2020) Coronavirus (COVID-19), pandemic psychology and the fractured society: a sociological case for critique, foresight and action, Sociology of Health & Illness, 42(8): 198295, doi: 10.1111/1467–9566.13202.

    • Search Google Scholar
    • Export Citation
  • Rosenberg, C.E. (1988) I. the definition and control of disease—an introduction, Social Research, 55(3): 32730, www.jstor.org/stable/40970505.

    • Search Google Scholar
    • Export Citation
  • Ruderman, E. (2013) The world outside: its impact on the treatment setting, in E. Ruderman and C. Tosone (eds) Contemporary Clinical Practice: The Holding Environment Under Assault, New York: Springer, pp 111.

    • Search Google Scholar
    • Export Citation
  • Schneiderman, N., Ironson, G. and Siegel, S.D. (2005) Stress and health: psychological, behavioral, and biological determinants, Annual Review of Clinical Psychology, 1(1): 60728, doi: 10.1146/annurev.clinpsy.1.102803.144141.

    • Search Google Scholar
    • Export Citation
  • Snoswell, C.L., Caffery, L.J., Hobson, G., Taylor, M.L., Haydon, H.M., Thomas, E. and Smith, A.C. (2020) Telehealth and coronavirus: Medicare Benefits Schedule (MBS) activity in Australia, https://coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-australia.

    • Search Google Scholar
    • Export Citation
  • Snowden, F.M. (2019) Epidemics and Society from the Black Death to the Present, New Haven: Yale University Press.

  • Taylor, M.R., Agho, K.E., Stevens, G.J. and Raphael, B. (2008) Factors influencing psychological distress during a disease epidemic: data from Australia’s first outbreak of equine influenza, BMC Public Health, 8(1): 347, doi: 10.1186/1471-2458-8-347.

    • Search Google Scholar
    • Export Citation
  • Tosone, C. (2011) The legacy of September 11: shared trauma, therapeutic intimacy, and professional posttraumatic growth, Traumatology, 17(3): 2529, doi: 10.1177/1534765611421963.

    • Search Google Scholar
    • Export Citation
  • Tucker, I.M. and Goodings, L. (2017) Digital atmospheres: affective practices of care in Elefriends, Sociology of Health and Illness, 39(4): 62942, doi: 10.1111/1467–9566.12545.

    • Search Google Scholar
    • Export Citation
  • Usher, K., Wynaden, D., Bhullar, N., Durkin, J. and Jackson, D. (2020) The mental health impact of COVID‐19 on pre‐registration nursing students in Australia, International Journal of Mental Health Nursing, 29(6): 101517, doi: 10.1111/inm.12791.

    • Search Google Scholar
    • Export Citation
  • Ward, P.R. (2020) A sociology of the COVID-19 pandemic: a commentary and research agenda for sociologists, Journal of Sociology, 56(4): 72635, doi: 10.1177/1440783320939682.

    • Search Google Scholar
    • Export Citation
  • Way, N., Gilligan, C., Noguera, P. and Ali, A. (2018) Introduction: the crisis of connection, in N. Way, A. Ali, C. Gilligan and P. Noguera (eds) The Crisis of Connection, New York: NYU Press, pp 162.

    • Search Google Scholar
    • Export Citation
  • Winnicott, D.W. (1953) Transitional objects and transitional phenomena; a study of the first not-me possession, International Journal of Psychoanalysis, 34(2): 8997.

    • Search Google Scholar
    • Export Citation
  • Andrews, G.J. (2018) Health geographies II: the posthuman turn, Progress in Human Geography, 43(6): 110919, doi: 10.1177/0309132518805812.

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    • Export Citation
  • Andrews, G.J. and Duff, C. (2019) Matter beginning to matter: on posthumanist understandings of the vital emergence of health, Social Science & Medicine, 226(April): 12334, doi: 10.1016/j.socscimed.2019.02.045.

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    • Export Citation
  • Asaoka, H., Koido, Y., Kawashima, Y., Ikeda, M., Miyamoto, Y. and Nishi, D. (2020) Post‐traumatic stress symptoms among medical rescue workers exposed to COVID‐19 in Japan, Psychiatry and Clinical Neurosciences, 74(9): 5035, doi: 10.1111/pcn.13092.

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    • Export Citation
  • Australian Government Department of Health (2020) COVID-19: whole of population telehealth for patients, general practice, primary care and other medical services, https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/covid-19-whole-of-population-telehealth-for-patients-general-practice-primary-care-and-other-medical-services.

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  • Australian Institute of Health and Welfare (2020) Mental health services in Australia, https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia.

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    • Export Citation
  • Australian Psychological Society (2017) Psychological services via telehealth (videoconference) for people living in rural and remote Australia, https://www.psychology.org.au/getmedia/fd748495-90e7-40d8-bedb-c3d7999cbb2d/18APS-Telehealth-Consumers.pdf.

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  • Barad, K. (1998) Getting real: technoscientific practices and the materialization of reality, Differences: A Journal of Feminist Cultural Studies, 10(2): 87128.

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  • Barad, K.M. (2007) Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning, Durham: Duke University Press.

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  • Benitez-Bloch, R. (2012) Integrating the internal and external worlds of clinical social work: a philosophical and political search, in T.C. Ruderman (ed) Contemporary Clinical Practice: Essential Clinical Social Work Series, New York: Springer.

    • Search Google Scholar
    • Export Citation
  • Bohr, N.H.D. (1972) Niels Bohr: Collected Works, Amsterdam: North-Holland.

  • Brahnam, S. (2014) Therapeutic presence in mediated psychotherapy: the uncanny stranger in the room, in Riva, G., Waterworth, J., and Murray, D. (eds), Interacting with Presence: HCI and the Sense of Presence in Computer-Mediated Environments, Warsaw: De Gruyter Open Poland, pp 12338, doi: 10.2478/9783110409697.8.

    • Search Google Scholar
    • Export Citation
  • Braidotti, R. (2019) Posthuman Knowledge, Cambridge: Polity Press.

  • Braquehais, M.D., Vargas-Cáceres, S., Gómez-Durán, E., Nieva, G., Valero, S., Casas, M. and Bruguera, E. (2020) The impact of the COVID-19 pandemic on the mental health of healthcare professionals, QJM: Monthly Journal of the Association of Physicians, hcaa207, 113 (9): 613617, doi: 10.1093/qjmed/hcaa207.

    • Search Google Scholar
    • Export Citation
  • Bride, B.E. (2004) The impact of providing psychosocial services to traumatized populations, Stress, Trauma, and Crisis, 7(1): 2946. doi: 10.1080/15434610490281101

    • Search Google Scholar
    • Export Citation
  • Brinkmann, S. (2017) Humanism after posthumanism: or qualitative psychology after the ‘posts’, Qualitative Research in Psychology, 14(2): 10930, doi: 10.1080/14780887.2017.1282568.

    • Search Google Scholar
    • Export Citation
  • Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J. (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence, The Lancet, 395(10227): 91220, doi: 10.1016/S0140-6736(20)30460–8.

    • Search Google Scholar
    • Export Citation
  • Butler, J. (1993) Bodies That Matter: On the Discursive Limits of ‘Sex’, New York: Routledge.

  • Carey, G. (2020) The national disability insurance scheme and COVID-19: a collision course, Medical Journal of Australia, 213(3): 141141.e141, doi: 10.5694/mja2.50690.

    • Search Google Scholar
    • Export Citation
  • Centre for Social Impact (2020) Addressing social issue areas in the context of COVID-19, https://www.csi.edu.au/news/covid-19-fact-sheets.

    • Search Google Scholar
    • Export Citation
  • Dahiya, A. (2020) The phenomenology of contagion, Journal of Bioethical Inquiry, 17(4): 51923, doi: 10.1007/s11673-020-09997-4.

  • Day, E. (2016) Field attunement for a strong therapeutic alliance: a perspective from relational gestalt psychotherapy, The Journal of Humanistic Psychology, 56(1): 7794, doi: 10.1177/0022167815569534.

    • Search Google Scholar
    • Export Citation
  • Dingwall, R., Hoffman, L.M. and Staniland, K. (2013) Introduction: why a sociology of pandemics?, Sociology of Health & Illness, 35(2): 16773, doi: 10.1111/1467–9566.12019.

    • Search Google Scholar
    • Export Citation
  • Dobson, H., Malpas, C.B., Burrell, A.J.C., Gurvich, C., Chen, L., Kulkarni, J. and Winton-Brown, T. (2020) Burnout and psychological distress amongst Australian healthcare workers during the COVID-19 pandemic, Australasian Psychiatry, 29(1): 2630, doi: 10.1177/1039856220965045.

    • Search Google Scholar
    • Export Citation
  • Dow, S. and Wright, C. (2021) Introduction: towards a psychoanalytic reading of the posthuman, Paragraph, 33(3): 299317, doi: 10.3366/para.2010.0201

    • Search Google Scholar
    • Export Citation
  • Downing, L., Marriott, H. and Lupton, D. (2021) ‘Ninja levels of focus’: therapeutic holding environments and the affective atmospheres of telepsychology during the COVID-19 pandemic, Emotion, Space and Society, 40: 100824, doi: 10.1016/j.emospa.2021.100824

    • Search Google Scholar
    • Export Citation
  • Duff, C. (2015) Atmospheres of recovery: assemblages of health, Environment and Planning A: Economy and Space, 48(1): 5874, doi: 10.1177/0308518X15603222.

    • Search Google Scholar
    • Export Citation
  • Figley, C.R. (1995) Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those who Treat the Traumatized, Hove: Psychology Press.

    • Search Google Scholar
    • Export Citation
  • Fisher, J.R.W., Tran, T.D., Hammarberg, K., Sastry, J., Nguyen, H., Rowe, H., Popplestone, S., Stocker, R., Stubber, C. and Kirkman, M. (2020) Mental health of people in Australia in the first month of COVID‐19 restrictions: a national survey, Medical Journal of Australia, 213(10): 45864, doi: 10.5694/mja2.50831.

    • Search Google Scholar
    • Export Citation
  • Geller, S. (2020) Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions, Counselling Psychology Quarterly: 117, doi: 10.1080/09515070.2020.1787348.

    • Search Google Scholar
    • Export Citation
  • Geller, S. and Greenberg, L. (2002) Therapeutic presence: therapists’ experience of presence in the psychotherapy encounter / therapeutische präsenz: erfahrungen von therapeuten mit präsenz in der psychotherapeutischen begegnung / la presencia terapéutica: la experiencia de la presencia que viven los terapeutas en el encuentro psicoterapéutico, Person-Centered & Experiential Psychotherapies, 1(1): 7186, doi: 10.1080/14779757.2002.9688279.

    • Search Google Scholar
    • Export Citation
  • Grosz, E. (1994) Volatile Bodies: Toward a Corporeal Feminism, Bloomington: Indiana University Press.

  • Haraway, D. (1988) Situated knowledges: the science question in feminism and the privilege of partial perspective, Feminist Studies, 14(3): 57599, doi: 10.2307/3178066.

    • Search Google Scholar
    • Export Citation
  • Isaacs Russell, G. (2015) Screen Relations, London: Routledge.

  • Jones, B., Woolfenden, S., Pengilly, S., Breen, C., Cohn, R., Biviano, L., Johns, A., Worth, A., Lamb, R., Lingham, R. et al. (2020) COVID‐19 pandemic: the impact on vulnerable children and young people in Australia, Journal of Paediatrics and Child Health, 56(12): 185155, doi: 10.1111/jpc.15169.

    • Search Google Scholar
    • Export Citation
  • Joshi, G. and Sharma, G. (2020) Burnout: a risk factor amongst mental health professionals during COVID-19, Asian Journal of Psychiatry, 54(December): 102300, doi: 10.1016/j.ajp.2020.102300.

    • Search Google Scholar
    • Export Citation
  • Le, A.T. (2021) Support for doctoral candidates in Australia during the pandemic: the case of the University of Melbourne, Studies in Higher Education, 46(1): 13345, doi: 10.1080/03075079.2020.1859677.

    • Search Google Scholar
    • Export Citation
  • Lemma, A. (2017) The Digital Age on the Couch: Psychoanalytic Practice and New Media, Abingdon: Routledge.

  • Levenson, R.W. and Ruef, A.M. (1992) Empathy: a physiological substrate, Journal of Personality and Social Psychology, 63(2): 23446, doi: 10.1037/0022-3514.63.2.234.

    • Search Google Scholar
    • Export Citation
  • Liu, X., Kakade, M., Fuller, C.J., Fan, B., Fang, Y., Kong, J., Guan, Z. and Wu, P. (2012) Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic, Comprehensive Psychiatry, 53(1): 1523, doi: 10.1016/j.comppsych.2011.02.003.

    • Search Google Scholar
    • Export Citation
  • Lupton, D. (2020) A more‐than‐human approach to bioethics: the example of digital health, Bioethics, 34(9): 96976, doi: 10.1111/bioe.12798.

    • Search Google Scholar
    • Export Citation
  • Lupton, D. and Willis, K. (2021) The COVID-19 Crisis: Social Perspectives, Abingdon: Routledge.

  • Matviyenko, S. and Roof, J. (2018) Lacan and the Posthuman, 1st edn, Cham: Springer International Publishing.

  • Maunder, R.G., Leszcz, M., Savage, D., Adam, M.A., Peladeau, N., Romano, D., Rose, M. and Schulman, B. (2008) Applying the lessons of SARS to pandemic influenza: an evidence-based approach to mitigating the stress experienced by healthcare workers, Canadian Journal of Public Health, 99(6): 48688, doi: 10.1007/bf03403782.

    • Search Google Scholar
    • Export Citation
  • Minihan, E., Gavin, B., Kelly, B.D. and McNicholas, F. (2020) Covid-19, mental health and psychological first aid, Irish Journal of Psychological Medicine, 37(4): 112, doi: 10.1017/ipm.2020.41.

    • Search Google Scholar
    • Export Citation
  • Monaghan, L.F. (2020) Coronavirus (COVID-19), pandemic psychology and the fractured society: a sociological case for critique, foresight and action, Sociology of Health & Illness, 42(8): 198295, doi: 10.1111/1467–9566.13202.

    • Search Google Scholar
    • Export Citation
  • Rosenberg, C.E. (1988) I. the definition and control of disease—an introduction, Social Research, 55(3): 32730, www.jstor.org/stable/40970505.

    • Search Google Scholar
    • Export Citation
  • Ruderman, E. (2013) The world outside: its impact on the treatment setting, in E. Ruderman and C. Tosone (eds) Contemporary Clinical Practice: The Holding Environment Under Assault, New York: Springer, pp 111.

    • Search Google Scholar
    • Export Citation
  • Schneiderman, N., Ironson, G. and Siegel, S.D. (2005) Stress and health: psychological, behavioral, and biological determinants, Annual Review of Clinical Psychology, 1(1): 60728, doi: 10.1146/annurev.clinpsy.1.102803.144141.

    • Search Google Scholar
    • Export Citation
  • Snoswell, C.L., Caffery, L.J., Hobson, G., Taylor, M.L., Haydon, H.M., Thomas, E. and Smith, A.C. (2020) Telehealth and coronavirus: Medicare Benefits Schedule (MBS) activity in Australia, https://coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-australia.

    • Search Google Scholar
    • Export Citation
  • Snowden, F.M. (2019) Epidemics and Society from the Black Death to the Present, New Haven: Yale University Press.

  • Taylor, M.R., Agho, K.E., Stevens, G.J. and Raphael, B. (2008) Factors influencing psychological distress during a disease epidemic: data from Australia’s first outbreak of equine influenza, BMC Public Health, 8(1): 347, doi: 10.1186/1471-2458-8-347.

    • Search Google Scholar
    • Export Citation
  • Tosone, C. (2011) The legacy of September 11: shared trauma, therapeutic intimacy, and professional posttraumatic growth, Traumatology, 17(3): 2529, doi: 10.1177/1534765611421963.

    • Search Google Scholar
    • Export Citation
  • Tucker, I.M. and Goodings, L. (2017) Digital atmospheres: affective practices of care in Elefriends, Sociology of Health and Illness, 39(4): 62942, doi: 10.1111/1467–9566.12545.

    • Search Google Scholar
    • Export Citation
  • Usher, K., Wynaden, D., Bhullar, N., Durkin, J. and Jackson, D. (2020) The mental health impact of COVID‐19 on pre‐registration nursing students in Australia, International Journal of Mental Health Nursing, 29(6): 101517, doi: 10.1111/inm.12791.

    • Search Google Scholar
    • Export Citation
  • Ward, P.R. (2020) A sociology of the COVID-19 pandemic: a commentary and research agenda for sociologists, Journal of Sociology, 56(4): 72635, doi: 10.1177/1440783320939682.

    • Search Google Scholar
    • Export Citation
  • Way, N., Gilligan, C., Noguera, P. and Ali, A. (2018) Introduction: the crisis of connection, in N. Way, A. Ali, C. Gilligan and P. Noguera (eds) The Crisis of Connection, New York: NYU Press, pp 162.

    • Search Google Scholar
    • Export Citation
  • Winnicott, D.W. (1953) Transitional objects and transitional phenomena; a study of the first not-me possession, International Journal of Psychoanalysis, 34(2): 8997.

    • Search Google Scholar
    • Export Citation
  • 1 University of New South Wales, , Australia

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