The psychotherapy consultation room is seen as a sacred space. Just look at Freud’s. Those who have been seduced by psychoanalysis over the years come to it with a sense of reverence – like going to a secular mass. Consultation rooms haven’t changed since Freud’s time (except, perhaps, the replacement of the couch by a chair); in fact, the therapist’s consultation room is probably one of the most tech-free spaces you’ll find these days. That is, however, outside the thousands of therapists who have taken their practices online.
Welcome to the fourth instalment of Stillpoint Spaces’ blog on its ongoing research with counsellors and psychotherapists working online. If you’d like to catch up, you can find the first three instalments below:
- A Psychotherapy for Today: research, development, and practice in the digital age.
- The Psychology of Online Space: where is it?
- Online Therapy, Where Hugs are Not Possible: research into online psychotherapy (part 3)
Our research project has now completed its sixth focus group session with therapists working online. The feedback has been positive. Not only are we producing dozens of themes and experiences from which we can get a better understanding of the challenges of online work, but research participants are finding that the project itself is actually improving the way they are doing their own online work.
Working online is not a simple translation of face-to-facework to doing the same thing on Skype
While the work continues to be therapeutic, the mode of delivery has changed, and this is something that therapists need to be mindful about when working online. One of the big themes that arise in relation to this difference is the notion of containment and holding: online, containment can seem more porous.
One research participant-therapist noted that the online container is more easily breached because the therapist, though in control of his or her own space, is not longer in control of the client’s. In such a case, the client may not be working in a secure space and thus the container might be breached:
[for example] the client is at work, co-worker suddenly pops in, opens the door and interrupts . . . there seems to be much less security, stability, materiality. It seems like maybe we’re more willing to tolerate that as well, because this sort of thing would never happen with that in-person meeting. – Research Participant-Therapist
The lack of “corporeality” or real-life interaction can be frustrating for both therapist and client:
That container has changed when my client has moved away . . . [the therapeutic relationship] is in me, it’s an accelerated frustration that I sense . . . in not having what we used to have, in not having that container that was there, and . . . I sort of need . . . for the client to be back in the room to be able to meet on that level. – Research Participant-Therapist
The Porous Container of Unreliable Technology
Through the research we have come to understand that the container that we seek to achieve in face-to-face meetings (which is also vulnerable to porousness sometimes) is particularly vulnerable to disruption and distraction. Therapists, who have usually spent more time doing face-to-face work than online work will be hyper-vigilant to such disruptions and they often feel quite anxious about them. Because of this anxiety, they will often compensate to “make up” for it.
Simply by working online can feel like a taboo to many psychotherapists:
It feels sometimes as if I was breaking some fundamental aspect of psychotherapy . . . I start with guilt, like sort of feeling like a crook, right, like a criminal. And just by being super nice and super empathetic . . . so I can sort of forget myself towards the end of the session. – Research Participant-Therapist
In contrast to this, therapists who have been working across the platform longer have noticed the anxiety change into a kind of excitement:
Much of what was being identified as a source of anxiety [in the research group] has been a major source of anxiety for me earlier . . . where I did feel like a crook, uncertain at points in time, where I did feel like I was breaking a taboo, where I did suffer the consequences of . . . all kinds of criticism. That … helped me realise that the difference was mostly a difference of time and place rather than an actual psychological difference in terms of how I perceive online … I would say that I have come to realise the importance of the framework that everybody has been underlining and how important it is to be extra careful in the online environment . . .
And you know this is where, my anxiety, my fear, my guilt turns into excitement and to a genuine sense of appreciation for the opportunity to be doing this [research]” – Research Participant-Therapist (italics added)
When the tech goes wrong, and the picture freezes, or the sound goes wonky, therapists usually feel responsible for it:
I can very much relate to the guilt … owning the responsibility [of the] disruption.
Despite these interruptions:
What the online environment offers for me is the sort of freeing the psyche from certain information materialisation… when you sit and work with someone in another country it really frees, it really puts the finger on what a psychic thing reality is. And that’s what I sense very much, and some of the profoundest meetings I had is . . . I was very surprised by how deep and how far you can go almost accelerating that in your connection, actually, because it breaks down that physical space.” – Research Participant-Therapist
The research group was pretty much unanimous that working online and face-to-face is very different indeed. But as discussed in our post about space, there is something universal and intangible about the space between two individuals engaged in psychotherapy that seems to transcend the apparatus over which it is deployed.
Sacred, Profane, and Even Worse, Banal
Many of our participants recalled their own face-to-face therapy and the feelings they experienced when they would arrive for it. A number of visceral and tangible images came to mind:
- The nature of the journey to and from the therapist’s office.
- Crossing of “the threshold” into therapeutic space.
- Seeing their therapist, maybe shaking their hand, making eye contact.
- The smell of the room, its decoration, its feel.
- The sense of sitting in the chair or lying on the couch.
- The sound of the therapist’s voice, the non-verbal sense of connection.
All of these elements, and more, gave clients (all of our therapists have also been clients) a sense of something sacred. When moving to online work, there was a sense amongst our participants of breaking a taboo, of taking this sacred space and making it profane. This sentiment was referred to in some of the quotes above in reference to the breaking of the frame, making the therapy vulnerable. However, on further discussion, we discovered that it was the banal, not the profane that was the true worry:
Perhaps the danger, the ultimate threat is not profanity, but banalisation. Yeah, that the banality of the medium is probably the gravest danger” – Research Participant-Therapist
Our computers are where we do our most banal stuff: our emails, our Facebook, our taxes and our shopping. When going to the physical location of our therapist’s consulting room, we purposefully move out of that banal space, into what one might call the sacred – and there, we may talk about the profane (to be fair, we also talk about the banal). But what happens to us when our the sacred work that is to be done by therapy is done over an essentially banal platform?
What happens when we move from answering an email straight into a therapy session, or straight from our therapy session into our online grocery shopping for the week? It has the capacity to banalise the work.
Taking a more reflexive and active approach to the work online
If this is the case, then therapists working online need to manage, in some way, the encroachment of banality. But how? First, by taking responsibility for what is happening at the therapist’s end of the line.
- Are all disrupting windows shut down?
- Are we sure the session won’t be interrupted by notifications of emails, text messages, etc.
- Have we got a backup plan if the technology fails?
- Have we taken as much care in the preparation of our space as we would in our face to face consultation room.
- Have we addressed the medium of communication with our clients and discussed what this might mean, what the limitations are, etc.
- Have we enquired deeply enough into the choice we’ve made to work online (in general, and with particular clients).
- Have we carried out any kind of assessment as to whether or not is is appropriate to work online with this particular individual?
On a deeper level, should we be encouraging our clients to take space, maybe ten minutes, before and after a session to create a virtual “threshold”? While this makes some sense, it also implies that we are trying to translate our offline consultations into online ones. We have found that we need a new way to approach online work, as it is not a matter of a simple translation from one deployment of psychotherapy to another medium. Having agreed to this, we need to deploy our therapy thinking skills to adapting to this particular medium.
What is clear is this. For those of us working online (at least in this research group) there is a real will to create a particular kind of psychological space, that may be described as being sacred on a medium that is clearly banal. In a sense, a consultation room is also banal. It’s a room with two chairs in it – but the intention of that space makes it special.
Online space is different, but it is equally amenable to intention. With the right intention we can get closer to offering something that transcends the medium itself. This is a matter of will and thought from the therapists working online, and the way in which they develop online containment. However, we are also discovering that this project involves an active engagement with the technology itself to enable the possibilities within the medium to be creative, therapeutic, and ultimately, transcendent of banality.
 I use “Skype” in the generic. All counsellors are working across the Stillpoint encrypted platform which was designed for confidential psychotherapy work.
More on the psychodynamics of online life in my book, The Psychodynamics of Social Networking: connected-up instantaneous culture and the self.
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