Psychoanalytically Oriented Psychotherapy Online in the Oncological Context

How online counseling helps cancer patients and their loved ones cope

Eugene Riaboshtan (Master of Psychology, Université Côte d'Azur)

 Cancer is not only a medical diagnosis but also a crisis that affects all levels of human existence: physical, emotional, social, and symbolic. Patients and their loved ones face not only pain and fear but also existential uncertainty, a disruption of body image, and a loss of control over their lives. In this context, the need for professional psychotherapeutic support grows, becoming an integral part of comprehensive care.

 The development of online counseling has opened new opportunities for such forms of support—especially where physical movement is limited or finding a specialist with the right profile is difficult. Psychoanalytic therapy, in particular, plays a significant role here, as it focuses on working with the unconscious, transference, and deep inner conflicts that intensify in the face of illness.

The Psychoanalytic Approach: What It Offers in an Oncological Crisis

 Psychoanalysis provides a space to explore feelings, fears, and fantasies without the immediate need to “resolve” them. A cancer diagnosis activates powerful unconscious processes: fear of death, loss of boundaries, the perception of the body as damaged, and regressive tendencies. In such states, a person may lose contact with themselves, their loved ones, and reality.

 One of the most painful consequences of cancer is the disruption of body image and the symbolic meaning of the body. The loss of a breast, hair, patches of skin, or the presence of scars can deeply affect a person’s sense of identity, desirability, and belonging to the feminine or masculine. The body, once perceived as an expression of life, beauty, or sexuality, becomes a reminder of illness, pain, and vulnerability. These changes often lead to a sense of alienation from one’s own body, feelings of shame, and a loss of language with which to speak about one’s sexuality or attractiveness. In this way, corporeality becomes a bearer not only of physical but also of symbolic losses—making it a crucial theme for therapeutic work.

 Illness affects not only the physical body but also the symbolic order: the familiar system of meanings, roles, and identities. A person may suddenly shift from being “a mother,” “a professional,” or “a beloved partner” to “a cancer patient” or “stage N”—a label that pushes aside all other social and personal definitions. Death, now a real possibility, threatens not only the body but also symbolic existence: the fear of being forgotten while still alive, of leaving no trace, of disappearing from others’ memory, of falling out of the system of meaning. People often encounter newly formed “voids,” insomnia, and somatization, where words fail.

 The psychoanalyst’s task is not to comfort or distract but to be present with the patient in their anxiety, aggression, and feelings of helplessness. Through bearing witness to these states and helping to symbolize them, an internal restructuring becomes possible. The person finds new footholds, learns to live with the illness without being completely destroyed by it.

 Therapy helps bring the illness back into language, transforming it into signifiers that, in turn, help the person continue living and fighting the disease.

Classic psychoanalytic writings on the significance of transference, regression, and primary objects in crisis situations gain particular relevance in the context of oncology.

 Loved ones also experience a loss of orientation. Often unsure how to behave, and unable to cope with their anxiety, they may adopt defensive behaviors: denial of the illness, avoidance of conversations, excessive rationalization, or overprotectiveness. This can deepen the inner conflict of patients, who feel the seriousness of their situation acutely but do not encounter spoken, emotionally validating support. Wider social circles—colleagues, neighbors, acquaintances—often distance themselves from both the illness and the patient, unsure how to engage. This amplifies isolation and reinforces the sense of losing social significance.

 Psychoanalytic therapy thus becomes relevant not only for patients but also for their relatives—those who are present daily, caring, striving to “hold it together,” but who remain in the shadow of the diagnosis. Relatives often experience chronic stress, suppressed anger, guilt, anxiety, and a complete redefinition of their role in the family. Caring for the patient can become a heavy burden, leaving little room for their own emotions, which they are forced to set aside, freeze, or hide under a mask of “strength” and “rationality.”

 This is especially acute for adult children caring for sick parents. Often, they must simultaneously manage their own lives, careers, and families while taking on physical and emotional responsibility for vulnerable parents. Their internal dynamics are fraught with conflicts: love and anger, compassion and irritation, fear and exhaustion coexist, evoking strong ambivalence and guilt.

 Spouses and partners face similar challenges, as they must not only provide support but also reimagine intimacy, boundaries, and their shared future. Sometimes illness disrupts not just daily rhythms but also the deepest symbolic anchors of their relationship—sexuality, care, and the ideal of a “real family.”

 The psychotherapeutic space allows these individuals not just to “vent” but—more importantly—to acknowledge the complexity of their feelings, understand their place in the new system, and rethink the impossibility of total control. Such work helps them avoid disintegration from caregiving, preserve emotional vitality, responsiveness, and sometimes even save their relationships. The result is a more resilient and mature support system, where everyone has the right to their own experience.

Online Counseling: A New Access to Support

 The COVID-19 pandemic radically changed society’s attitude toward online interactions. What was previously deemed impossible or unethical became the new norm: education, work, medicine—and psychotherapy—moved massively into the digital sphere. This shift not only broadened conceptions of possibility but also created new accessibility for those previously excluded from therapeutic spaces for objective reasons.

 For cancer patients and their families, the online format has been a breakthrough. Frequent trips to clinics, weakened immunity, and side effects of chemo- or radiotherapy make offline visits physically impossible or extremely exhausting. Online consultations reduce physical strain, maintain regular contact, and flexibly adapt to the patient’s condition.

 Moreover, the remote format removes numerous barriers that previously prevented participation in psychotherapy. Patients undergoing aggressive treatments often feel self-conscious about their appearance: hair loss, skin changes, swelling. Even the simple need to “show up” can provoke anxiety and shame. The online setting creates a sense of safety—a chance to stay in one’s room, in comfortable clothes, without leaving home—and thus facilitates engagement in the therapeutic process.

 Online therapy also benefits caregivers—children, spouses, relatives. These individuals often juggle caregiving, work, and household duties, leaving little time or energy for regular visits to a therapist. The ability to join a session from home or during a work break, without hours spent commuting and waiting, makes psychoanalytic support realistic and achievable. As a result, they can preserve their resilience, emotional resources, and capacity to care without internal collapse.

Thus, online counseling is not just convenient—it challenges the stereotype of psychotherapy’s inaccessibility for cancer patients and their support networks. It makes possible what once seemed impossible: regular, high-quality, meaningful therapeutic work amid extreme physical and emotional vulnerability. If oncology treatment protocols recognize the importance of psychoemotional support, such a synchronized model could become a new standard of comprehensive care.

An Online Space for Psychoanalytic (Psychotherapeutic) Support: Expanding the Horizons of Care

 All of the above—from the exacerbation of inner conflict in a cancer diagnosis to the overload of family members, from body shame to the inability to attend offline sessions—points to the need for a systemic, accessible, and sensitive approach to psychotherapeutic care. In today’s world, this can take the form of a specialized online space that thematically and substantively encompasses the full spectrum of psychoanalytic support in the oncological context.

—flexible, open, and evolving. Its essence lies in creating conditions where psychoanalytic therapy and related support are accessible and meaningful for people experiencing severe illness and those around them.

·       Regular online consultations with specialists (psychoanalysts, art therapists, clinical psychologists)

·       An archive of video lectures and seminars on topics such as living with illness, loss, guilt, ambivalence, bodily changes, and parent-child dynamics in illness

·       Educational materials for professionals working with cancer patients, including doctors, caregivers, nurses, and social workers

·       Supportive formats for caregivers: groups, lecture series, individual sessions

·       Research and clinical texts presented in a popular-scientific format to give participants intellectual support and understanding of their emotional states

This space is not only about “treatment” but also about helping people endure, listen, and remain themselves. It can become a “third place” between medical institutions and personal circles, where individual voices are heard and where there is no need to hide fear or “put on a brave face.”

 The online format makes this space particularly flexible and inclusive: participants can connect from a hospital bed, their home, or even their workplace. This helps avoid isolation and restores a sense of belonging to a human, thinking, feeling community—to culture itself.

 Creating such a space is not only a technological or therapeutic project. It is an ethical choice for life—where the suffering person has a voice, presence, and support.

Oncology requires a comprehensive approach. Medical treatment is crucial but not enough. Psychoanalytic therapy is not an alternative—it is a necessary complement that helps people preserve their inner integrity, dignity, and ability to live—even in the face of mortal threat.

 Online spaces make such therapy accessible, flexible, and personalized. Integrating psychoanalysts and art therapists into cancer care is not only a humanistic task but also a strategic investment in quality of life and medical efficacy itself.

 This approach deserves support: institutional, financial, and research-based. Foundations, for example, could sponsor targeted therapy within such spaces—transforming them into sustainable models of care.

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