Online Therapy: From Both Sides Now By Barbara Winter, PhD on 6/16/20 - 2:23 PM

In psychotherapy, clients take us into their homes, literally and figuratively. When they fully engage in the therapeutic relationship, they invite us into their emotional homes, some more than others. They show us the way around and ask for our help because the integrity and stability of their home has been fractured.

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Today, with the transition to online therapy, they take us into their homes even more. How often do I sit in a session, like I did with John, who was talking about the lackluster sex in his marriage and, as he did, pulled out a photo of his wife and children? Or Jan, who had just lost her mother and, in deep grief and bereavement, searched for a picture of her parents at their wedding 50 years ago.

Pictures shared in the office via iPhone, iPad, or whatever device that accompanies them, are way more commonplace than ever before. Just the other day, Emily showed me an online picture of what her new home, made of steel drums, will look like.

It is a technologically mediated world, no doubt.

But with COVID-19, we have been given access into our clients’ actual homes. With shelter-in-place, therapy has largely, at least up until now, transitioned to telehealth through video platforms like Zoom, Doxy.me, or Facetime, or for some who can only show us a small bit, by phone.

Much has been written of therapy sessions being interrupted by the family dog or cat, kids in the background or a Grub Hub delivery. For many, these have been moments of new exploration, humor or something in between. How many of us have laughed at the glitches, random incoming texts, or alerts from CNN about the latest stock market plunge or surge. Fortunately, my interruptions have been limited.

Having recently read the New York Times piece by psychotherapist Lori Gottlieb on how the toilet has become the new therapy room and more, I wondered if I had perhaps been too rigid and controlling. I have emailed my clients to assure that they glean the most of our sessions by creating a safe and sacred space for themselves to have our sessions, and even make sure that they have tissues close by just in case we hit on a sensitive spot. I have also asked them to consider taking time before and after sessions to contemplate our work (akin to the drive to and from the therapy office) and that they not just run back to check on the rib roast. That said, not everyone has had privacy; with kids in online learning and the recent work from home status and other family members joining to shelter in place for the period of time, it can become quite challenging for clients to carve out the special space and time that therapy demands.

I have been brought into bedrooms, living rooms, home offices, lanais, cars and even a closet - but not yet a toilet. I have had house tours but have yet to meet other members of the family, with the exceptions of meeting an ex-spouse and a few grown kids.

In these moments, I can’t help but feel as if I am an unintentional intruder into my clients’ personal spaces, although with time and repetition (a therapy phrase), that has softened and I have felt less of a voyeur. Yet with the advent, or should I say the domination, of telehealth, this experience remains new for me. It can be comical watching a client run from room to room in an attempt to find privacy in a closet. This particular client obviously did not receive my preparatory email.

While my reflections over issues of privacy and intrusion are sincere, I am also concerned about the other side of the looking glass, so to speak. What is this experience like for my clients? What do they really see? It’s not just about what we see and experience. We all show up a bit differently as well. I know there are therapists doing sessions from their living rooms, and in some cases a designated bedroom or room with a false background, or even their cars. I have had the opportunity to view the workspaces of colleagues. I am fortunate to have available to me a designated home office, detached somewhat (with separate entrance) from the main house, pretty much (but not failsafe) indestructible to outside forces... no kids, dogs, or random visitors (although the landscapers have made an appearance from time to time). I wonder what our clients see, feel and experience when allowed entry from the virtual waiting room into our personal spaces. This is all curious to me and definitely grist for the mill when we return to (a new) normal.

Entering my clients’ space, having been ‘forcefully’ invited in, has given me a new sense of closeness to them. I wonder what is in the mind of clients who are now given the opportunity to be voyeurs into our lives? What is it like trying to access their emotions and inner states from a car? Given that our playing fields have become levelled (we are both in our homes), how does that affect their relationship with us?

I’m curious. How does the client/therapist relationship change when both have access to the one-way mirror?
 


File under: Musings and Reflections, COVID-19 Blogs