Psychotherapy by Zoom – what is different?

Preparing for psychotherapy by video: Before, during and after …

Introduction

There is a natural and understandable reticence about undertaking psychotherapy by video link. We intuit that it will feel different. It is different in important ways. It cannot be the same as a face-to-face session in the usual clinical setting.

So let’s think a little about why this move from a personal meeting to a ‘remote’ meeting is different and use this knowledge to help ourselves optimize the therapy-via-video experience. There are times when we may need to use video as the better alternative to not meeting at all. Not just during this time of coronavirus but also when psychotherapist and patient are geographically too distant from one another to meet in person.

A Safe Space

In psychotherapy, we tell our therapist things that we wouldn’t say to family and friends. We sometimes hear ourselves saying things that we didn’t know that we felt or thought. We do this not just because of the rule of confidentiality and absence of judgment from our therapist but because of the presence of the therapist and the physical and emotional ambience that she or he has created in the room. An ambiance and culture that we co-create over time as we fill the room with our story and our felt experience of sessions.

Our Different Selves – public, private, vulnerable, unknown

If our relationship with our therapist is secure, one in which we feel understood and sensitively attuned to, we feel safe enough to drop our ‘public face’, the one that we show to most others and even loosen the boundaries of our ‘private self’ that we only show to our intimate partner or friends. Being able to relax our guard permits our ‘vulnerable self’ and sometimes parts of our ‘unknown self’ to show up. We feel more ready to reveal and explore areas of uncertainty, vulnerability, guilt and shame. In many forms of therapy we may link these feelings back to familial and childhood events and experiences. Getting into a friendlier and more compassionate relationship with our feelings – less fearful and shame-filled – is a step towards self-acceptance and having less need to hide private thoughts and feelings.

Setting as a ‘second skin’ around therapy relationship and transitions to and from setting

The therapy setting – both the room and the regular allotted time – serves as a second skin around the relationship with our therapist, a protective outer shell perhaps, that provides a safe space and gives us confidence to take risks in what we reveal to our therapist and to face our self.

The physical journey to our therapy appointment is part of the ritual that helps with the transition from outside world to the therapy space where free, associative discourse is encouraged. Our mind turns inward as we reflect on our feelings over the past week or since our last appointment and we prepare to account honestly to ourselves and our therapist for the part we have played in events or relationships. Our ‘failures’ and ‘successes’ in applying what we are slowly, and sometimes painfully, learning in therapy.

Leaving the therapy setting is another transition. We know that we may often feel a little too raw or vulnerable for ‘ordinary’ social encounters At the beginning of therapy or after a session touching on deep pain or shame we may be left shaken for several hours or even days and need an emotional retreat. When feeling released from oppressive feelings, we may unthinkingly transfer our ‘free speech’ into relationships where a therapist’s thoughtfulness and non-judgmental stance is absent. In such circumstances, we might meet with lack of understanding, jarring upset or hostility from those whom we had thought available to hear our ‘revelations’.

How do we apply this knowledge to therapy via an internet video platform?

  1. Firstly, regard this appointment with the same respect as you would if you were attending it in the consulting room. It is an appointment that is different from any other appointment. One where we hold our self to account and think about our thinking, our feelings and our actions. One in which we want our vulnerabilities and feelings to be available to reflect upon.
  2. Secondly, establish that you have uninterrupted quiet private space for the appointment with a buffer of at least 10 minutes and preferably 30 mins either side of it. Consider the room you have available and what seating and lighting arrangements might enable you to feel relaxed and to have your face and shoulders in view, and well lit, to assist me in seeing your facial expression and bodily posture – important elements to the meaning of your communication.
  3. Thirdly, think about the transition into the therapy space and what might assist with this. It may be helpful to walk a little outside or to meditate quietly to mark a break from the work or chores or interactions we have been involved with beforehand . Check in advance that the computer is set up for connecting and that sound and picture are working (Zoom has a test facility for this). Ensure that other electronic devices are switched off to avoid distracting noises or messages during the session.
  4. Fourthly, during the session, let me know if the connection quality is varying and the picture freezes or sound drops off. Synchronous interaction between you and me is a key element to feeling attuned to and overcoming the artificiality of the electronic medium. I shall let you know if my picture or sound becomes poor. If a technical failure happens, I shall take responsibility for reconnecting and may telephone you to let you know what I am trying or to help you if the problem is at your end.
  5. Keep a clock in view to avoid any surprise when I tell you we have reached the end of the session.
  6. Finally, the transition out of therapy. I suggest you close the computer or move away from it at the session’s end. Checking emails or using other applications immediately will deny yourself the opportunity to digest the session and to further reflect on what has been revealed or learnt. Another stroll outside or sitting quietly alone or jotting notes might assist you.

I hope that these reflections may assist you in your work together with your therapist and ensure that the sessions by video link are as effective as they really can be.

Marcus Page

22.03.20