Literally, we know the answer to the question of where our online world exists: within the cloud. While this cloud is itself distributed over a myriad of data centers across the globe, its activities generally operate so seamlessly that we feel it is happening right in front of us on our desktop computers or tablets, or in the palms of our hands with out smart phones (we certainly notice when it’s not working so seemlessly). With the social web available at our beck and call, the gap between ourselves and others collapses to such a degree that it’s as if they reside in our pockets: buzzing, pinging, and ringing their way into our consciousness night and day.
In this second part of the Stillpoint Spaces research project on depth psychotherapy online, we investigate this theme.
While the population at large will be using technology to communicate and connect as a matter of course, psychotherapists and counsellors working online have to think it through very deeply to make online relationships psychologically as useful and ethical as possible. While our research at Stillpoint Spaces aims to find out how therapy online can be better delivered, a happy byproduct of this research is insight into the psychological nature of online spaces in general. One of the consequences of our research will be enabling other aspects of online social media to be better equipped to deal with complex human psychology and emotion.
Important differences and similarities between online and offline spaces:
Our research is already beginning to show that there are important differences and similarities between therapeutic work online and in person. While this may seem obvious, the ways in which these similarities operate can be surprising. For example, long before video conferencing, psychoanalysts were very clear that much of what makes up the relationship between patient and therapist is not just the “real relationship” between them, but also the relationship in the mind. We call this the “transferential relationship” – that part of the relationship that isn’t just “in the room” between two people, but also that piece that exists in the mind.
The nature of a “virtual world” connected to but separate from the “real world” isn’t so different from the idea of “psychic [or psychological] reality” being connected to but separate from objective reality.
We tend to fill gaps in our understanding of other people’s minds with the experiences that we’ve gained from previous relationships. So, for example, when you are trying to understand what your boss is thinking (and she’s not giving much away) you may expect her to respond to you like your mother or father did. The same thing happens in therapy. In short, the entire relationship was never all in the room, even when therapist and patient were working in the room together: there was always the shadow of previous relationships.
When moving this relationship online, it really throws this “fill in the blank” transferential relationship into relief. It isn’t lost on either patient or therapist how limited the literal frame of a computer screen is, which in turn limits what we can see and experience with each other, which can increase fantasy and projection. Our research subjects (who are all “participant therapists” who work online) expressed concerns about not being able to see enough body language, or noticing how one might gesture with their hands when speaking. The nature of technology too, enables distractions that would not normally be tolerated in a consultation room – such as emails or alerts that might be contaminating either the therapist’s or the patient’s computer screen.
I think people are very conscious of just how selective this frame is, and in this kind of artificiality that we never quite know, just how artificial is this box?
– Research Participant-Therapist
I noticed that by working online, technology sort of surrounds the session. And the session stands completely on this kind of technology . . . I identified that my fantasy of what psychotherapy is, or what a psychotherapist is supposed to be, it’s usually sort of very fleshy and incarnated and related; and this sort of setup, sort of, turns me off-balance, and I have to find balance again.
– Research Participant-Therapist
Psychotherapy online isn’t just a matter of translating live practice to online practice, but requires careful thinking about the meaning of working through technology:
Meaning is crucial in depth work, and the fact that working over tech has meaning of its own is evidenced in one therapist reporting the dreams of his patient that included the technological mediation between patient and therapist. Other meanings, particularly in relation to the sometimes unreliability of the technology, can provoke feelings of abandonment in the patient – something our therapist research subjects were painfully aware of, with one therapist-participant noting that it’s as if they have to “own the experience of disruption” – but also related this to the disruptions (like traffic noise or building work outside a consulting room) that often interrupts therapy in the real world.
Many of our research participant-therapists note how they experience anxiety about how well the technology will work and may compensate for this by being extra attentive. One participant-therapist sees the same patient live and online depending on whether or not they are in town, and report an important difference. This therapist noted the effort this patient made to “look good” during live sessions by way of carefully applied makeup and wearing designer clothing. During online sessions, however, the look was much more casual and the therapist reported that there was a “marked difference” and “I felt a lot closer to her in the online space.” Others therapists also note that patients seem less inhibited online.
“When you sit and work with someone in another country it really frees, it really puts the finger on what a psychic thing realty 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.”
Many of our research subjects reported that there was indeed a sense that working online was more casual, and that they met patients in a variety of settings that the therapists had little control over. Therapists themselves reported feeling different if they were working from their normal consulting room, or in a different place, such as their home or a hotel room. In an article in Forbes psychoanalyst Todd Essig expressed concern about this potential casualness in online work, describing one case in which a patient took his therapy while driving via hands-free telephony. Therapists working ethically online would share Essig’s concern and would set appropriate boundaries. The nature of this very research is to identify the potential “slippages” in working over technology, so they can be dealt with thoughtfully and respectfully.
Most of our participant-therapists agreed that there was a difference in working online and offline, and we are getting towards qualifying exactly what those differences are. In some ways, as discussed above, online work can feel less inhibited and because of that more relationally “real,” while in other ways, there is no escaping that there’s an artificiality to it. There is simply no one way of looking at it.
What is becoming clear is that the online space is indeed a kind of real space, a limited space, and a psychological space between two people. One participant-therapist asked simply “What is the space where we meet?” and went on to draw his mind’s picture of that space:
The room of the person speaking was something like the continuation of my space, of my room. So the middle of the space is . . . my room [and the other wall behind the patient] is actually the wall of the person in front of me which is thousands of kilometers away from me . . . and I know it’s not easy to explain or understand it, and even I don’t really understand it” it’s like being in an imaginative space.
– Research Participant-Therapist
In this quote, we can again see the imaginal nature of this online “in between” space, and think about useful ways of understanding that in order to achieve what we so value in the depth psychotherapies – meaning making.
By creating an opportunity for therapists who are working online to discuss freely what it is like, and what emerges for them, Stillpoint has created a resource for each other to make meaning of the work that we are doing. By continuing the grounded theory approach to this space, we are also collecting themes that will enable us to create more thoughtful, contained and psychologically effective online spaces for therapists and patients alike. Our stated goal of creating a body of research from which we can further extrapolate to other online spaces is well underway – and very much a work in progress.
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