When you can’t reach out and touch someone: more research into psychotherapy by Skype
Pretty much every American from my generation can still sing the AT&T jingle, “Reach out and touch someone” – a jingle that encouraged us all to pick up our phones and call someone that we loved. It’s a clever jingle because, clearly, you can’t reach out and touch someone physically from the other end of a telephone. The idea of that ad was that you could reach out and touch someone’s heart, you could touch them emotionally even if you could not feel the warmth of their skin.
This typical ad from 1987 demonstrates this by showing us how a mother’s intuition overcomes the obstacles of a disembodied voice. Like the seasoned psychoanalyst, she sees through the words and gets right to the meaning of it, right to what’s going on. Technology and dismissive words aren’t going to put this mom off the trail.
But this is, of course, an advertisement – its aim is to “get you” emotionally in order to sell you a product – to convince you that it’s worthwhile to reach out and touch someone over the phone, because it works. It may not be as good as a hug, but it’s pretty close. Can we say the same about psychotherapy by Skype* – not as good as a hug, but pretty close?
Gillian Isaacs Russell covers this question in her important new book Screen Relations: the limits of computer-mediated psychoanalysis and psychotherapy. In it she notes that psychotherapy that occurs only on Skype lacks an important potential for real life physicality. As one of her subjects stated:
Skype actually obscures the therapist’s potential for professional fallibility, while it may heighten the potential for his fantasy unchecked by reality. You might think, ah, well, that’s a good thing surely. But not so fast. The good therapist chooses to be professional in drawing physical boundaries. But Skype forces the therapist to draw physical boundaries. Therefore, the patient can never observe the therapist’s choice to create a safe environment and not to act on impulse (38-39).
During Skype based therapy, there is no potential of being kissed or kicked.
Clearly, it would be an ethical violation for a therapist to kiss or kick their patient. However, as Russell points out, the potential for a boundary to be broken in this way creates a live space in the live encounter that doesn’t exist
over Skype (though there are myriad ways in which boundaries can still be broken). For therapies that involve a profound re-working of fixed attachment strategies, being in this zone of potential threat with a trusted therapist who chooses not to break such boundaries can be a profoundly healing experience – particularly for individuals whose boundaries have been broken before. By missing this zone of possibility by doing an entire psychotherapy over Skype, are we missing something? If you’d like to hear more from this perspective, please check out this freely available
Research Continues:
Stillpoint Spaces research continues to interrogate this point of difference between co-present and online work. This blog post constitutes the fifth instalment that aims to share our research with you while it is still in progress. If you’d like to catch up on our previous work, you can start here at the beginning. Our aim is not to show that therapy by video conferencing is “just as good” as co-present work. We simply recognise that more and more people are engaged in such work as a matter of necessity or convenience. Recognising this we acknowledge that we to think critically about it so we can better understand it, and make improvements where necessary.
Since we run our own online counselling platform we feel it is our responsibility to also understand as best we can the psychodynamics of relating over it for the purposes of psychotherapy. As a platform developed by therapists for therapists, we aim to be responsive to research in the field while using our own local resources to research our own work.
Psychotherapy online is reaching out and touching people – yet we want more.
Every single one of our research subjects (who are psychotherapists delivering depth psychotherapy by way of video conferencing) has said hands-down that they have had profound relational moments online. Yet, for so many of us, this still doesn’t feel like enough. One of our research participant therapists strongly stated:
I have come to the conclusion recently though some experiences with my patients where the relationship has felt very much real. This is a creative relationship never met in the offline space, and it’s felt attached, it’s felt therapeutic, and it’s felt very real.
While many others in the focus group identified with this experience, many express a sense of still wanting more. Another research participant therapist stated:
I find myself wanting to [physically] reach out…not that I would touch a client in my practice… but then [I] compensate.. you know leaning into [the computer screen] just leaning in.” This therapist went on to say “several clients have articulated, ‘maybe someday we can meet…for real’. While there is a sense of loss that comes with this knowledge that the client may never meet their therapist in the flesh, there is also a sense of safety, she continues, “the knowledge that I [client] will never meet you [therapist] walking in to the grocery store provides me with a sense of safety”. In reference to Russell’s perspectives above, we have to ask whether or not this sense of safety is one that enables therapy to progress, or if it gets in the way by destroying some sort of active potential.
“Click, click, click, and you’re gone.”
The use of a technical platform in which one remains very much in control of the relationship is another contributor to a different kind of power dynamic that doesn’t exist in co-present work. One of our subjects was concerned that this enables greater objectification of the other**:
The other becomes an abstraction. He or she becomes an image, it can be managed, it can be turned off, turned on, saved, it can do all things to our image and to the images of the other in a screen like that…
In co-present psychotherapy there is no way to have such omniscient control over the other. In a previous post we encountered the problem of the platform, the home computer, being a
technology of banality. This theme was followed up by a participant who remarked about:
the banality of being able to click, click, click, enter, exit.” She goes on to say how much more is involved in coming and going to an actual therapy session in a real place in the world, “there is so much that a client coming offline has to do, that effort that is required to come into the office, all those things as being preparatory to enter . . . what they do as they exit and go back into the other world, those kind of thresholds maybe are collapsed when you just click …
You can’t just move offline therapy online and say, “it’s the same!”
While our research grouping continues to acknowledge that profound work can happen via video conferencing, we also unanimously agree that such work is not a simple translation of offline to online. A lot more thinking has to go into what happens when the thresholds that one would normally expect from a depth psychotherapy experience (preparing for a session, travelling to the therapist’s consultation room, arriving with all the sensory experiences that comes with, the ending of the session and the leaving) are collapsed into click, click, exit. While some members of the group suggested creating, digitally, some kind of threshold, others argued that we should simply try and understand the collapsed thresholds better. In any case, such thresholds are collapsing all over the place, not just in therapy sessions:
Maybe the work is not so much to lower the thresholds but to unpack…many of the thresholds that have been collapsed by virtue of framing this work online…one would really have to incorporate the very architecture of these spaces, the very essence of what does it mean to actually be involved in the rite of travelling to get to an alternative space as we do in the physical world where and when we meet with the therapist.
Therapy by technology isn’t just a matter of when it goes wrong, it’s also about when it goes right.
While our earlier focus groups were very much concerned with dealing with technological failure (when the wifi goes down, when images get pixilated or there’s a great deal of interference) we seem to have progressed to thinking through the problematics of when it goes right too. The tech difficulties we encountered in our group (which was on online focus group with small windows in which most of us could see each others’ faces) were often very disturbing. One participant had to leave and come back, having missed an important part of the discussion:
I felt a bit disconnected…not from the group, but lagging behind a little, So I might have formulated an idea and thin I missed the next but….there’s been a kind of catch-up moment for me every now and then, which happens in sessions too.
Another participant, who was unable to join us by video link, but listened in and shared by voice only:
I do feel a certain sense of fragmentation, and I think it has mostly to do with the technology that I don’t see you, you don’t see me. I can relate but I felt that the conversation was really moving and I sort of did relate to most of the topics, but I also felt a bit scattered, a bit sort of difficult to ground myself.
As co-researchers we recognise that the events occurring in an online focus group are not the same thing as conducting a one-to-one therapy session online. However, the experiences we share do resonate and d, importantly indicate that the register in which we are working, when working online, is profoundly different from co-present therapy.
The findings we are coming across here have broad application way beyond the consultation room.
In my own work, The Psychodynamics of Social Networking, I apply what I discovered first-hand in the consulting room to what I believe to be occurring in today’s culture, between people, everywhere. I explore the psychological effects of our continued emotional investment in social media by taking the dynamics that I learned in the consulting room and applying them to the external world. This current research can do the same.
We are all subjected to collapsing thresholds. We are all, most of the time, reaching out to touch people that we cannot touch – and then we may both miss their touch while also feeling relieved that we don’t have to negotiate it.
What are the consequences of this kind digital relating? We are not going to find the answers through quantitative studies. We need to find the answers by making more in depth enquiries into people’s experiences. People’s selves are extended into the digital sphere like never before. Psychotherapy research has a privileged vantage point from which to observe and better understand this phenomenon. The results of such research will extend well beyond the consultation room, as we better understand the consequences of the “click, click, click, exit” nature in which we relate to others across contemporary technologies.
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* Like in previous posts, the word “Skype” is used as a shorthand here to mean video conferencing. Most therapists participating in this research are using Stillpoint’s own online platform, designed by therapists for therapists.
** You can see my work on digital objectification elsewhere in relation to stranger shaming, trolling, and harassment):
More on the psychodynamics of online life in my book,
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