Title: How is therapeutic presence conceptualized, experienced and measured in online counseling: A systematic review

The COVID-19 pandemic led to a rapid digitalization of mental health care, and this shift thereafter led to significant changes in therapeutic practice. This raises new discussions about how psychotherapists sustain relational depth and connection online. Therapeutic presence, defined as bringing one’s whole self into the therapeutic encounter through full awareness and attunement, is considered a foundational element of safety, empathy, and therapeutic alliance. A literature search was conducted across PubMed, Scopus, APA PsycNet, Taylor & Francis Online, and Web of Science between the years 2015 and 2025. Articles were chosen following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal was assessed using the Joanna Briggs Institute (JBI) Checklist for quantitative studies, the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies, and the Mixed Methods Appraisal Tool (MMAT, 2018 edition). This systematic review, using a narrative synthesis, explains how therapeutic presence is conceptualized, experienced, and measured in online counselling. Furthermore, it examines therapist and client perspectives, measurement validation, and theoretical frameworks. The review combines and analyzes data from qualitative, quantitative, mixed-method, and conceptual studies to provide a comprehensive understanding of presence in digitally mediated psychotherapy. Keywords: therapeutic presence, online counselling, teletherapy, telepresence, therapeutic alliance, online therapy