Family Therapy in the Age of Zoom: What a Long Strange Trip Itʼs Been

Family Therapy in the Age of Zoom: What a Long Strange Trip Itʼs Been

by Jay Lappin
An old-school family therapist attempts to reconcile the distancing forced upon us by the pandemic.

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If there is no plan, nothing can go wrong
Kim Ki -Taek — Parasite

Itʼs not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.
Charles Darwin

Itʼs recycling day, canʼt we just put the kids outside on the curb?
Parent — Pandemic, week five

Dude!...Youʼre Glitching!
Fourteen year old girl on Zoom session


Long Strange Trip

The pandemic has changed the larger world forever and will forever change the world of therapy. Our therapeutic ecology — how we practice our craft, where and with whom — will never be the same. Itʼs as if weʼve clicked into a science fiction show and canʼt change the channel because weʼre in it — clients and therapists have become talking heads, connecting as best we can and collectively feeling the fatigue attrition that accompanies the absence of being in person. The Grateful Dead were right: itʼs been a long strange trip, especially for the empaths.

Our therapeutic ecology — how we practice our craft, where and with whom — will never be the same
Michael is a single man in his thirties. Heʼs suffered a lifetime of painful shyness and being overweight. His job requires computer skills, so he spends most of his time in his cubicle, with little socialization on the phone or with co-workers. Heʼs described breaks and lunch as “torture.” Prior to lunch, he would get revved up with good intentions and then, he said, “Iʼm like Wile E. Coyote chasing the Roadrunner — I hit the wall.” One time, he got the gumption to attend a meet-up group for shy people, and no one showed. Yet, despite these challenges, heʼs determined to be more social. Then, something happened. At our last Zoom therapy meeting, he was more confident and relaxed, like heʼd just put on old slippers — smiling and even cracking jokes. For me, it was a kind of optimistic disorientation. At first, I thought that it was the combination of medication, his Wile E. Coyote resolve and hopefully some of the therapy that, like the British Baking Show, had produced a slice of Magic Pie. It wasnʼt — it was the pandemic.

Because of “social distancing,” Michael paradoxically experienced being together with people while he was apart. Everyone now shared his life
Because of “social distancing,” Michael paradoxically experienced being together with people while he was apart. Everyone now shared his life — now he could enter conversations with the knowledge that others also shared the taut, jangled wiring of his interior. It was as if he became an Italian apartment-dweller sheltering in place with his neighbors and singing together with them off their shared community of balconies, everyone listening with hearts joined in the absence of judgement and the voices of hope. Better still, because of the imposed distancing, Michael could now be safely social.

The Zoom Era

And what about therapists — what is this doing to us? Many are working from home. Those of us with children, pets or partners and who donʼt have a home office have to find a “quiet space.” Ha! Good luck with that basement, people! Or, if weʼre lucky and the landlord isnʼt banning entry, we can go into our off-site office space — but that, too, has its own set of Zoomy consequences, not the least of which is “Zoom Fatigue.” By dayʼs end, sessions can feel like youʼre in the front row at a lecture on sofa cushions where the speaker can see you. Just as you start to blissfully nod off, your head suddenly jerks back, and you snort loudly and say something weakly therapeutic like, “really..?” and then wipe the drool onto your sleeve — très embarrassing.

Zooming our clientʼs home space is not without merit. Back in the day when I was a probation officer in Cabin Creek, West Virginia, and then a social worker doing school evals, and then a research therapist on a project with heroin addicts and their families, I was blessed with being both witness and participant in the amazing diversity of the human condition. You learned to go with the flow and, you swam in the deep end of the family pool — dogs, cats, kids, babies, ferrets, frogs, multiple TVʼs, radios blaring, grandparents, people who just showed up whom you didnʼt know, dinner on the stove, or a silence that also spoke to you — all this before the age of the Internet. It was so powerful that when I first started my private practice, I would ask families to invite me to dinner and a family session at their home.
Now, we have Zoom — welcome to the shallow end. But we can all still learn to swim.
Now, we have Zoom — welcome to the shallow end. But we can all still learn to swim.


You can observe a lot by watching.
Yogi Berra
 

Peter Lopez, a family therapist on the board of The Minuchin Center for the Family, is a home-based family therapist. On one of his Zoom visits, he wanted to speak to both parents and have an enactment with them that would increase the parentʼs executive capacity and demonstrate to themselves and their kids that Mom and Dad were on the same page. In a moment of inspiration spurred by there not being enough headphones for everyone, he asked the parents to “move closer together so you can share…”

when we meet on Facetime, you are in my office — so when you put your shirt on we can start, and you can tell me how youʼre doing.
Another family therapist, a young woman who works with a diverse population of low-income families and mandated, substance-abusing high-risk teenagers, finds that being “in & not in” someoneʼs house can diminish her connection and, in some cases, embolden teens to challenge her — like the fifteen year old teenager who greeted her on FaceTime lying in his bed with his shirt off. “Would you do that in my office?!,” she asked, incredulous. “Uh, no, but Iʼm not in your office….” “Well, when we meet on Facetime, you are in my office!” And then, softer — “So when you put your shirt on we can start, and you can tell me how youʼre doing.”

She still delineates the boundaries — for the kids she sees, her office is their safe space. To compensate for the in-person absence, sheʼs upped the amount of between-session “homework” that she and her clients then share at the next session. Trauma and disconnect are prevalent. A young girl being raised by her grandmother whose mother is absent provided a path in between sessions. Together they came up with an assignment to come to sessions with a weekly playlist of songs that emotionally spoke to the client. The girl picked “How Could You Leave Us?” by NF, which should come with a warning label and tissues — itʼs remarkable.
 

We have to be inter-connected with everyone and everything.
Thich Nhat Hanh

You cannot solve a problem from the same level of consciousness that created it.
Albert Einstein


An informal survey asking therapists to describe their experience of practicing Zoom therapy in the pandemic seems to break into two distinct groups: one, maintaining a kind of Buddhist perspective of acceptance –— that life is suffering and impermanence in which every day is an opportunity to practice mindfully — to another, a bit less accepting — “I fucking hate it!”

A Third Way?

Which begs the question — is there a third way? The short answer is “Yes.” And itʼs not without precedent. Einsteinʼs quote is like learning a brilliant escape trick from a gifted magician. The magic is not what is seen or said but in what he doesnʼt say. What he omits is the specificity of consciousness — it does not have to be higher or lower, just different. And we therapists are all about being different. To be effective, we access different aspects of ourselves that then activate different and more adaptive aspects of our clients. Itʼs what Minuchin described as the “differential use of self.” If we want others to be different, then we have to be different. For systems thinking and for family therapy, in particular, those differences in thinking were already in the works well before the pandemic.

Lynn Hoffman pointed out in Foundations of Family Therapy (1981) that “the advent of the one-way screen, which clinicians and researchers have used since the 1950s to observe live family interviews, was analogous to the discovery of the telescope. Seeing differently made it possible to think differently.” And by circular extension, thinking differently also comes from acting differently.

Up until now, weʼve relied on our in-session felt experience, one-way mirrors and videotaping to guide ourselves as instruments of change. One recursive emotional and visual distinction between the now and the then of the one-way mirrorʼs transformative introduction, is that families could not see the people behind the glass, nor could the people behind the glass see themselves being seen. Videotaping sessions, however, offered a “third” answer, giving therapists the capacity of “seeing” themselves and the familyʼs patterns in context. It shined a light on how to experiment with adapting interventions systemically and collaboratively. While inventing Structural Family Therapy, for example, Minuchin, Jay Haley and Braulio Montalvo invited family members behind the mirror. They recognized cultural and class differences between themselves and the “natural healers” from the minority community that they were training to be therapists. Minuchin realized that “in order to join, we needed to change.”

With Zoom however, there is a binding irony that holds therapists and clients in itsʼ grasp. It is as if we share front row seats watching a mystery play
With Zoom however, there is a binding irony that holds therapists and clients in itsʼ grasp. It is as if we share front row seats watching a mystery play. The opening sceneʼs roiling dense fog and dim lights mask the fullness of detail, so we squint, holding our breath hoping to see whatʼs really there. Weʼre doing our parasympathetic best to figure out the plot. Itʼs the work of it that fatigues us and leaves us wondering if this is as good as it gets.

Therapy is therapy as therapy does, but how we use ourselves in this new environment re-boots an age-old clinical question; what exactly is both necessary and sufficient to produce change? Montalvo called the position from which we work “The possibilistic premise.” Meaning that regardless of the location of the familyʼs pain, we are still faced with respectfully challenging the systemʼs homeostatic “stuckness.” We know that we can effect those changes in person. When Zooming, however, it can sometimes feel as if weʼre “Major Tom,” floating in space, attempting to weld the hull as we circle the earth.

So, as Bowlby, Susan Johnson, the Gottmans and our own families have shown us, the quality and kind of our earthly and relational attachments are important. While we may feel even more like Russian Dolls, breathlessly stacked within each otherʼs context and the context of the world writ large, itʼs not a question of “if” we adapt and attach in different ways, itʼs more a matter of “How?” Perhaps as Theodore Reik suggested, we should listen with greater clarity, not just with a “Third Ear,” but now with ear buds. We are finding ways to compensate for whatʼs lost with diminished sight and the absence of physical presence. Our adaptive make-up is yielding results. However because we are inherently empaths, we feel the absence of presence. But we shouldnʼt feel bad entirely. Rumiʼs poem, “Love Dogs,” reminds that “the howling necessity” implores us to “cry out in your weakness,” such that “the grief you cry out from, draws you toward union.”
 

Itʼs the end of the world as we know it, and I feel fine.
R.E.M.

 

Postscript from the Bunker

After not seeing our granddaughters at our house for eleven weeks, my wife and I share a grandparental Folie à Deux — an ache like an old injury that weʼd come to accept, now reawakened with every primitively crayoned coloring book that hung on our walls like an in-home Childrenʼs Louvre. As grandparents of a certain age, now when my wife and I see all their stuffed animals in a pile, we silently share the Buddhist themes of impermanence and suffering. It feels like a Christmas Story staging of Toy Story — our precious time together is ghosted in front of us as a reminder to our mortal selves that “this is it.” This perfect time of their lives, full of wonder and imagination, is just another pandemic curtain closing on the “Duck Duck Goose” show. Now our own mortality is awaiting, as quiet mourners do when “joining” family and friends on a Zoom funeral.
 

Alone together.
Dave Mason

 

our own mortality is awaiting, as quiet mourners do when “joining” family and friends on a Zoom funeral
Then thereʼs this — amidst all the noise, people find themselves and others. I see a recovering alcoholic/substance abuser in his thirties. Heʼs been in recovery for seven years. He has a great sponsor and a solid home group. As the pandemic continued, he began to miss the in-person connection with his group and his sponsor. So last week, with the intent of doing “Step work,” he and his sponsor sat safely apart on his sponsorʼs back porch. As night began to fall, he said that without any cues, they both simultaneously became silent and quietly surveyed the backyard as darkness fell. He said it was one of the best conversations that heʼd ever had.


Like the scene from Little Miss Sunshine, when on their way to the “Little Miss Sunshine” contest, Dwayne flips out after finding out that his color blindness has just destroyed his dream of joining the Air Force, getting away from the “fucking losers” that constitute his family and having a life of his own. Heʼs profanely inconsolable. His mother says, “I donʼt know what to do!” Then his stepfather says to Olive, “Olive, do you want to try talking to him?” Without a word or hesitation, Olive gingerly makes her way down the embankment, ignoring the dust scuffing up her red cowboy boots, and squats down next to her big brother. She puts her arm around Dwayne, leaning her head onto his shoulder. She doesnʼt say a word. They both sit together as one in the silence. Quietly, as if whispering a confession, Dwayne says, “O.K., Iʼll go.” He then helps Olive up the hill and says to his family, “I apologize for the things that I said, I didnʼt mean them.” They load in the van and continue on.

Off in the distance is a billboard, the message faded but visible, “United We Stand.” We can hope
Off in the distance is a billboard, the message faded but visible, “United We Stand.” We can hope. 



© 2020, Psychotherapy.net LLC
Bios
Jay Lappin Jay Lappin, MSW, LCSW is a New Jersey licensed marriage and family counselor and social worker, as well as NASW Clinical Diplomat. He is board member emeritus of the Minuchin Center for the Family, adjunct faculty for the University of Pennsylvania, Graduate School of Education and clinical supervisor for Drexel University’s Master of Family Therapy Program. For fourteen years, Jay studied, then taught and supervised at the Philadelphia Child Guidance Clinic. For fifteen years, he was the principle trainer and consultant for Delaware’s Department of Services to Youth, Children & Their Families “Family Focus” program—a “whole systems” initiative involving all three operating divisions and their personnel including a pioneer program in family reunification. He has also served on the boards and held offices for the New Jersey American Association of Marriage & Family Therapy and the American Family Therapy Academy. He has written on Structural Family Therapy from a cross cultural perspective, implementing larger systems change and conducting family sessions. He has been a contributing editor for the Psychotherapy Networker and interviewed Salvador Minuchin for psychotherapy.net. Jay has conducted workshops, lectures and supervised throughout the United States, Germany and Taiwan. Closer to home, in New Jersey, he’s been in private practice for forty years. Jaylappin.com