Online Therapy

Even before the current Corona pandemic, numerous professionals, including mental health practitioners such as psychiatrists and psychologists, offered their services online for those who found it difficult to come in for a face-to-face meeting—whether because of geograpical distance, limited mobility, age and health considerations. 

With the advent of the Corona virus and the increasing need to maintain social distancing, telepsychology has become the medium of choice, with some people preferring the good old-fashioned phone to smart phones, computers and video conferencing.

People already in the process of therapy and used to face-to-face meetings with their therapist need to adjust in the transition to online therapy. It does feel different to communicate via technology, even when it works seamlessly. 

Video-conferencing brings the therapist into one’s actual home and this may feel a bit weird, perhaps even fuel fantasies regarding closeness and distance—all of which can be food for the therapeutic mill and provide important insights into how you experience interpersonal relationships and intimacy. Some may find it strange to see themselves in a little window while talking to the therapist. While this feature can easily be  cancelled, it may provide a mirror reflecting how we come across at certain moments, perhaps teach us something valuable about ourselves. Or not.

To the extent that the therapy and the therapist have become the patient’s “emotional home”, this felt sense of being home will extend into the new medium, continue to manifest itself despite the new arrangement. At the same time, it is important this setting remain a professional one, with fixed hours, clear boundaries, timely beginnings and ends. Once it is clear the therapy session is over, one of the partners leaves the video session first. I allow patients to be the one to call the shots and press the button, just like they are the ones to physically leave the office.

For new patients, starting from scratch with a new therapist they’ve never met may be both easier and more difficult. It is always a challenge, to start therapy with someone you don’t know, even if they come highly recommended. Among other things, you may wonder to what extent they will be able to be attuned and resonate with you, be there for you, understand your predicament. Can you trust them with those heartfelt issues you may never have shared or even vocalized before? Will they be able to contain you? Help you? Now, on top of all this, you need to reach out online. Is it easier for you or more difficult? Are you used to long distance work, perhaps given your job? Or does it seem daunting? From a technical point of view, it is fairly straightforward.

As you know, communication has both verbal and nonverbal aspects. Much of it is nonverbal and involves the whole body, not only the face.

Yet online, especially since we are usually sitting down, we have mostly the eyes and ears and the entire face to go by, as well as what is said and not said, and the silences in between.

The human face is considered the most important organ or body part to convey emotions. We rely on visual and auditory information. It is the center of sensory intake through our eyes and ears. We communicate via our voice and both transmit and receive messages via the muscles and receptors of the face. 

Eye contact, facial expressions, the distance of both therapist and patient from the screen, whether they use their hands—all these have bearing on what is communicated. Facial expressions and accompanying gestures convey affect (feelings). These may be enhanced by sensory-based language, for all emotions have bodily referents (e.g., “my heart is heavy”, “I could dance for joy”, “my mind feels foggy.”)

There are a myriad of ways in which we convey our meaning, many of them auditory. These include tone of voice, intonation, loudness, stress and rhythm—the music of speech. Our language, choice of words and imagery are also key in our communication with each other.

We are social beings, and many of us feel best when we are socially engaged and connected, in relationship. In addition to self-regulation, which we learn and refine as we develop, throughout our life span we rely on each other for co-regulation. This is especially so during these trying times. As the saying goes, friends can be good medicine.

All of these channels of communication and social engagement are available to us both face-to-face and via online therapy. Let’s use them!