The I-Thou Relationship in the Age of Telehealth By Matthew Martin, LPC & Eric Cowan, PsyD on 12/7/20 - 12:36 PM

Martin Buber centered his philosophy of human relations on a fundamental dichotomy that exists between and within human beings. He believed that finding an appropriate understanding and balance within this “I-Thou” dichotomy is essential to human functioning, vitality, and transformation.

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In my first post on this topic, I discussed the interpersonal aspects of Buber’s conceptual framework of I-Thou and I-It. In this second installation, I explore the intrapersonal aspect of this dichotomy through Buber’s explication of “being” and “seeming.” These two attitudes toward self-experience characterize the quality of authenticity in one’s relationships, both with others and with oneself.

Buber rightly understood that human development occurs in a relational context. Human beings are highly social creatures who need love and care from others in order to thrive through infancy and beyond. An absence of these relational needs almost always leads to a psychological injury. The innate potentialities that exist within every human being can only begin to be actualized when they are accurately mirrored in the eyes of another. Buber called this deep participation with and acceptance of another’s essential being “confirmation.” He believed that one’s capacity to confirm and be confirmed in one’s own uniqueness by others is the source of our shared potential for positive growth. For Buber, each person “secretly and bashfully watches for a Yes which allows them to be and which can come to him only from one human person to another.”

Each of us hopes to be confirmed in our uniqueness, but when we reach out to others and experience a lack of confirmation, we tend to sacrifice our authentic thoughts and feelings for expressions that we imagine will win us mere approval. We do this in hopes of preserving our needed attachment to others, since it is much safer to be confirmed as something other than oneself than to chance the possibility of not being accepted at all. In other words, we cultivate the ability to seem a certain way to others to elicit approval, but such approval does nothing to nourish our true being, because it is based in a false persona. Unfortunately, this “seeming” mask tends to get stuck, and as one hides one’s being in fear, the possibility of authentic connection and growth is lost.

The technological aspect of teletherapy sessions inevitably complicates this intrapersonal dichotomy between being and seeming. When client and therapist meet virtually, they see each other, often from the neck up, projected onto a screen. This digital representation of the other situates them into a seeming mode. Each is aware of how their digital image appears. The screen itself can act symbolically as a mask, potentially covering up the being of both client and therapist. The capacity and willingness to refocus one’s perspective within a being mode is thus necessary if client and therapist are to meet each other and find transformative movement in the teletherapy session.

However, this refocusing process contains unique challenges to empathic participation for both therapist and client. The physical separation between client and therapist provides a wider window for both participants to escape into spheres of relation that limit therapeutic movement. This separation tends to make the sessions more about the words being spoken and the concepts being conveyed by those words. Without two bodies in the room, the sessions can drift towards having an experience distance quality, in which psychoeducational rather than process-oriented interventions predominate. Likewise, stereotypical conversations, disjointed narratives from client stories mediated by technology, and fabricated improvements are just a few ways in which the mode of seeming can hijack a telehealth session. These forms of escape are also present in in-person sessions, but the loss of embodied connection involved in teletherapy dramatically increases their likelihood.

The narrowed window of what is physically seen or noticeable in a teletherapy session also opens the door for other forms of disconnection. For example, my inability to see and experience my client’s leg shaking, which can be hidden by the confidence of their talking head or the limited visual field provided to me, can impair the depth of my understanding of their experience. This impairment in understanding can then trigger my own thoughts, such as, “Your client isn’t talking about anything important, so what is the harm in checking to see who just contacted your phone?” which further increases the phenomenological gap between my client and me. A spiraling effect of mismeetings in a teletherapy session can block the being mode and open the door to seeming. A therapist must be willing to let go of the specific, visible aspects of experience, like their body, the screen in front of them, the physical environment around them, and the details that capture attention, if they want to locate the deeper participation needed for client transformation. It is the therapist’s responsibility, perhaps now more than ever before, to model ways of being, so the client will know how to embody the actions needed to move them towards the attainment of their therapeutic goals.

That said, we must not forget that teletherapy also provides opportunities for therapeutic movement that may not exist without this technology-induced separation. For example, the physical distance between client and therapist can create a safer space for clients to share information and experiences that they may not feel comfortable sharing in person or away from the comfort of being in one’s own home. These screen-to-screen sharing opportunities may lack the embodied power of in-person sharing, but as long as the therapist can strive to centralize empathy as the primary means of understanding the client, the breadth of information provided has the capacity to enact lasting change. Teletherapy holds the potential for new horizons for therapeutic gain. However, client and therapist must both be willing to cultivate the process of being together in authentic relation for these gains to find fruition.

To successfully protect the chance for therapeutic change and transformation, we must never forget Buber’s primary caution: “To yield to seeming is man’s essential cowardice, to resist it is his essential courage.”

File under: Online Therapy, COVID-19 Blogs