The Gift of Remote Therapy
Despite the much touted convenience of remote therapy, the question lingers as to whether the client loses something important through this mode. I certainly had my doubts when I began. Let’s dive in. The most burning question is how the therapeutic relationship is affected. Therapy, regardless of theoretical underpinnings and techniques, is a relationship between two people. I certainly believed that that is always better in real life. The pandemic has only underlined how qualitatively different it is to actually be with another human; richer, more perceptively layered. However, as I develop remote therapeutic relationships, I am realizing there is more that may be advantageous to this mode of therapy than simply convenience.
Therapeutic Relationships: a definition
Therapy is a distinct relationship with strong boundaries and a very specific purpose; to heal by exploring the nature and circumstances of a client, primarily via conversation. A disembodied therapist on a screen may serve in some very significant ways. Yalom in his seminal work on the therapist-client relationship, The Gift of Therapy (2002) famously called therapy “a dress rehearsal for life”. The therapist is separate from your regular life which is where you want the actual changes to happen.
Some Thoughts About the Therapeutic Relationship Remotely
In the literature and folklore of many cultures, counsel and intervention happens through conversations with ghosts, gods, angels, spirits, fairies, witches and disembodied characters. These beings who intervene have distinctly human characteristics, they engage in a dialogue with the confused or hurt or stuck person. Sound familiar? This is absolutely not to imply therapists are gods or spirits, but the format strikes me as significant. Where is despair most likely to be played out? In the battlefield of the home.
In the Bhagavad Gita, which is so rich with metaphors demonstrating the inner struggle, Arjun sits at the edge of the battlefield disheartened and unwilling to go into battle. Krishna shows up and engages him in a long conversation, in which Arjun expresses his frustrations and doubts and feelings of stuckness and despair. Whether you live alone or with others, home is an extraordinarily powerful expression of oneself. Remote therapy invites the therapist there, and that adds an intimacy to the process of therapy. We are at the edge of the battlefield, the client’s life, a poignant and rich place to offer counsel.
Why Does Location Matter?
The backdrop is unique to the client. A more egalitarian power dynamic is created when the therapist is brought into their home. The institutional feeling of the same officelike backdrop with an assembly line of clients is eradicated with this methodology. I feel close to clients and their life when a cat shows up on the screen which happens frequently or when a patient can go get the special bottle of lavender scent they use to calm and focus.
The Gifts of Windows
Yalom highlighted the importance of looking out the patient’s window. The word “window” seems significant in remote therapy. In a real life situation there is more visual stimulus from the surroundings. Computer based therapy quite literally reduces the interaction to a window. I have felt a part of clients’ tears and laughter and facial expressions in a way that seems very focused, more focused than real life . The slightest grimace and facial motion is amplified. When one holds a young baby, they will focus intensely on your face and can hold that gaze for a long time, it is their first interactive learning experience. There is much to learn from the countenance of another human as they speak or don’t speak, especially as one wades through emotional material. Furthermore, you can see yourself and the clients can see themselves in the second window. There is a built in visual representation of what is going on between you, a piece of meta visual information about interaction that no other method of communication provides. This may be especially valuable in therapy. The screen offers a constant reminder of themselves , a literal mirror to observe their process. They can see themselves as well as the therapist and some self knowledge within an interaction comes to light. In traditional psychoanalysis the analysts removed themselves from the visual line to not unduly influence client’s thought processes. In a remote interaction the client has the visual of the therapist and also themselves. This may add another sensory layer to the experience and can be used by the therapist who frequently summarizes and gives feedback on what they see and hear.
The Issue of Autonomy
We therapists are there to facilitate and encourage autonomy, wise thinking and decision making, and skilled reactions and actions in the client’s life. Therefore, the very real danger of breeding a dependence on the therapist that blocks that growth towards autonomy must always be considered. Perhaps the degree of separation afforded by remote work can actually be beneficent.
What about the Body?
The sensations of the body by itself are an important part of awareness and self understanding. With this mode, the client is alone with themselves physically. When we are alone we experience the most acute physical sensations. This makes being alone a good time to practice somatic awareness. A therapist can directly allude to and question bodily sensations which are happening in real time while the client is physically alone. There is research that demonstrates that physically being around someone can provide a measure of comfort to our nervous systems. Could being physically alone be helpful towards clients' growth towards autonomy, the necessary self awareness, and being able to soothe one’s own nervous system?
Remote therapy brings to the fore many interesting questions for research and exploration. It may have been born out of necessity and for the sake of convenience, but on the metaphysical level this mode could in some cases be beneficial to the therapeutic process. I am reminded of how Alexander Fleming came upon penicillin simply because the experiment he was trying to run became moldy. Our jobs as therapists always is not to simply roll with cultural norms but to stay vigilant and aware of all the micro factors involved in healing via a therapeutic relationship. I suspect we may have inadvertently stumbled on a modus operandi with great potential for this work. I suggest and encourage people seeking therapy to consider this mode as not only more convenient, but as a format for therapy that may benefit them because of its inherent qualities.
Yalom, I. (2002). The Gift of Therapy. Harper Collins.