I have found that establishing and maintaining a sense of relatedness and emotional presence in the therapeutic interaction can be a major task. This can be an even greater challenge in a video session.
Several years ago, I started to promote online therapy with growing frequency because I noticed how convenient it was for clients to access. I also realized how convenient it was for me to provide therapy this way. This mutually beneficial arrangement presented many possibilities and opportunities, mainly to provide therapeutic services to a larger pool of individuals in a wide-ranging virtual ‘landscape’. Yet, this way of providing psychotherapy services was still perceived as an unpopular option, and the growing acceptance was still at a very slow pace. The general feeling was that it took away and compromised the essential human element vital to the therapeutic interaction.
The preferred modality was, as it had always been—the in-person, face-to-face interaction in a professional office at a location that you travelled to for your hour-treatment and then left. The reality between service provider and service consumer included a set of taken-for-granted set of social conventions: for the consumer, it involved such practices as preparing, planning, scheduling, and confirming appointments; coordinating transportation and travel time to and from the hospital, clinic, or office; considering the cost, mode of payment and time restrictions, availability, and proximity of parking, and perhaps assessing the practicality of which mode of transportation to use. For the service provider, some of the social conventions included travelling away from home and family to and from a single or multiple professional work locations, proportionally distributing a significant portion of the day between patients, colleagues, and administrative and support staff, and taking on separate and distinct roles from those in their personal lives. Overall, there was much more socializing, movement, interactions, and closer physical proximity with others.
Part and parcel of the normalized reality for the patient may have also included the routine of being greeted by a receptionist on arrival to a facility, waiting at a designated area, and even being called in to enter another room that signaled the beginning of the “appointment”. We can certainly imagine the number of “cues” we all got accustomed to knowingly and unbeknownst to us that constituted the reality of attending a therapy appointment.
Since Covid-19 appeared, however, we continue to experience the significant intrusions and restrictions on our personal space, our private lives, public activities, and the disruptions to our social existence. We have been forced to modify our previous routines, with much resistance we feel compelled to develop new routines by adopting new and safer behaviours. A year later now, and we continue to struggle with the potential in real threat of infection, contamination, illness. We have witnessed and experienced every aspect of our individual and collective lives morph before our very eyes in real time. We continue to scramble to find new and effective ways to approximate an open-ended ‘new normal’. We seem to have adopted the daily mission of protecting our body from the virus compromising our health. We have also adopted routines to minimize the impact of the pandemic and the inextricably and ubiquitous psychosocial implications.
By now, we have come to realize that we find ourselves reluctantly but increasingly part of a new and very different reality. This is a worldview where the ‘new normal’ contains much mystification—inducing confusion about what is ‘really’ being experienced and feeling confused but not really recognizing it as such. Our experiences of our new normal, and the ways we communicate these experiences continue to obscure our daily consciousness with greater frequency and impact. For example, the construct of ‘change’ has brought to the forefront the reality that “things will never be the same again,” and that “we will feel the impact for years to come”. The reality of ‘risk’ related to the Covid-19 viral infection and the need to flatten the curve poses an ongoing and mounting lethal threatening possibilities requiring combating it on a worldwide scale.
‘Social distancing’ and ‘social isolation’ have taken on the reality of an existential conundrum. Our ambivalence has intensified as we continue to struggle with how to reconcile our basic need for social connection on the one hand and the need to be safe, on the other hand. For the in-person presence of another human being and the need for personal space and time alone has been a major challenge. The oscillation between moving toward and moving away from our significant others perpetuates that challenge. Our need to protect ourselves and those we love and care about, and to feel safe and protected has become our daily objective.
With this backdrop in mind, we can see more clearly that the pandemic has severely aggravated the normal and new stresses of life, and further intensified the suffering of individuals living emotional, psycho-social, and psychiatric conditions. Previously considered a convenient option, remote accessibility and online delivery of psychotherapy have become an integral part of the new normal. Since living with the ongoing looming threat of Covid-19 and doing our best to meet the critical need for safety and protection, online therapy delivers far more than a preference for occasional convenience.
When you consider the fundamentally sensitive nature of human relationships, it is equally obvious that relationships pose challenges at every turn. Psychotherapy is a particularly unique context in which relationship challenges between the therapist and the patient are examined and managed. This allows the therapist to assist the patient to experience the ‘therapeutic’ impact that facilitates the personal growth of the patient.