Losing the Couch: Finding the "Sacred Place" in Online Therapy By Anastasia Piatakhina Giré on 4/28/15 - 7:29 PM

I clearly remember my very first visit to my British psychotherapist. She used to receive her patients in her conservatory. Her dogs sometimes got impatient and produced considerable clatter, which I could clearly hear from inside the house. The front door would be unlocked. Clients just had to push the gate to get through an unkempt garden into the peculiar therapy room. She would be already comfortably sitting there in the same old chair, and a flowery cup of tea would be ready; weak for her, and strong for me. When I was late, my tea was cold. Maybe it was her subtle way of punishing me…

I actually loved this place. Years later I can still recall its particular smell of wet dogs and a damp garden. That therapy room had become an anchor for me, which safely attached me to the Island that was then my temporary home; I was in the midst of yet another international move.

Now that I use the online setting for my psychotherapy practice, I sometimes wonder what my clients will remember of our encounters. No particular smell of madeleines will ever be attached to a virtual space.

Any therapist, myself included, hopes that his therapy room can become some sort of “sacred place” to his clients, a place for individual growth. We all work towards this goal, creating small rituals and paying careful attention to the boundaries of the therapeutic relationship.

With the current expansion of online counseling, therapists and their clients are seeing this sacred element of therapy being taken away. Our cherished therapy rooms are disappearing, replaced by a simple desk and a computer.

I have kept a traditional face-to-face practice in Madrid, on top of my online work, so when I connect with a client on Skype, he can always spot behind me the background of a traditional therapy room decorum: two large armchairs, a box of Kleenex, a smiling Buddha statue… a pale reminder of the physical space where our encounter would have had to take place just a few years ago.

A couch, a bookshelf, and a coffee table… we have been familiar with these traditional attributes of a therapy room for ages. Anybody coming to a therapist for the first time knew what to expect, and rarely got surprised. In a space, tightly bound by walls, boundaries tended to be clear: the therapist had his own chair, the client might have a choice between two chairs and a couch. In this place both the therapist and the client felt safe. This space seemed eternal… until the online option emerged, bringing confusion.

Now online therapy is practiced within a no-place space. The couch is gone. And each of us therapists responds to this loss in different ways, which vary as in any grief—from denial and anger to acceptance.

During an online session, two people stare at their respective computer screens, without sharing a common place. This becomes an opportunity to build their own space together. It is very much like coming to a new empty area, and building from a green field a house here or there, then eventually a village.

In my experience, this lack of a physical place actually fosters creativity.

Many people I meet in my practice live very mobile lives, geographically unsettled; so the perceived neutrality of the no-place becomes a real asset in addressing the displacement-related issues.

Amélie’s story is one such case. She was back to Paris after 10 years in Korea for her husband’s career. There, Amélie had felt isolated and disoriented in her vast house, while her husband was travelling extensively. She had had to leave behind her music teacher job, and after several years of this expatriate life, she was feeling lost. Now back to her native Paris, she was feeling depressed. Her first panic attack happened in a shopping mall. She did not know where she was and was not able to get out of this unfamiliar place crowded with strangers. She was struck by an acute sense of derealisation. She reached out to me, in addition to her local psychiatrist.

“How is it for you to tell me your story here, online?” I asked.

Actually, Amélie felt safe, her anxiety was stepping back. She was relieved, as she could meet with me from the only place that still felt familiar—her parents’ Parisian flat. Driving to a therapist’s office would have been too much for her at that point. The online space we shared became in this case a way of dealing with her confusion without re-introduction of another different place.

Every time I connect with a client, especially for the first time, I am ready to get surprised. Those who seek therapy online generally use and abuse the flexibility allowed by the technology, so I “meet” them (virtually) in their holiday house, hotel room, office, kitchen, or lounge.

Without moving from my desk, I am then able to spot small samples of their physical realm. I always feel touched by the trust involved in this “letting me in.”

The whole situation has now been reversed: it is not the therapist who lets his client in, but the client who is choosing which of his sceneries to share with his therapist.
These “unexpected gifts” somehow make up for the lost couch.

In any successful therapy there is a time when the client ends up internalising the reparative relationship with his therapist, creating the “safe place” within, that anchoring gift I received from my first therapist. When this happens, the concrete place does not matter as much as the “virtual” place discovered. And the person is able to go anywhere, feeling safe enough to further explore the world.

As in the case of Amélie, the placeless reality of the online setting accelerates this natural shift from place towards relationship.

I enjoy both my online and my face-to-face practices. When connecting with a client, I always attempt to recreate the ever-important “sacred place” of a therapy room, together with my client, in this ethereal space offered to us by technology.

File under: The Art of Psychotherapy, Therapy & Technology, Online Therapy