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  • Harriet Brown

Online Therapy - Not Better Or Worse Just Different

Updated: May 15

When I was training to be a therapist, I saw clients in a practice next to a recycling bank. I’d be listening attentively as a client talked about a past hurt, when suddenly they'd be interrupted by the noise of hundreds of bottles clanking and smashing and two men wheeling them around, one shouting to the other ‘Hey, John, fancy a Nandos?' I often think of this when people are anxious about trying therapy online, worried it’s less effective than its issue free room based cousin. A lot has been said about the challenges of online therapy, so as I’ve worked in this way for a while and really enjoy it, I thought it might be helpful to write my thoughts and impressions of what it may uniquely have to offer you, the client.

It’s undeniable that working online means you lose physical proximity to your therapist, but in other ways you are also nearer and more intimate. Sitting facing each other through screens, my client and I are, figuratively, up close and face to face. In person this kind of proximity might feel intrusive and understandably inspire the thought, 'get out my face,' but in my experience the presence of a screen allows this to feel both comfortable and pleasantly intimate. So much emotion is visible in tiny facial shifts, a slight movement of the lips, a brow or maybe, most importantly, something almost imperceptible that emerges behind the eyes. Arguably being both near and far away may, at times, allow me, the therapist, greater access to your interior world and you, the client, an enhanced experience of my empathetic attunement to it. What online therapy takes away in terms of reading body language, it may give back in terms of facial expression. Being up close up may have advantages.

Being both near and far away may be helpful to you in other ways too. I’m aware as I ready myself for an online session, fetching a glass of water from my kitchen, sitting in my own chair at my own desk, that I’m particularly relaxed. The psychoanalyst Donald Winnicott spoke about the therapeutic relationship being a ‘holding’ environment, where a client feels safe enough to express and emote, knowing they will be met with attention and empathy. For those clients who feel safe in their own home, a therapist being both near and far away may facilitate this sense of being ‘held.’ I think this can be particularly true if you find it difficult or shaming to express your emotions. Being in a familiar environment, surrounded by your own possessions, at one remove from your therapist through a screen, may allow you to lose some of your feelings of self-consciousness and feel safer to talk.

There are also the practical aspects to online work that can be incredibly beneficial. The therapist you see is no longer dictated by the area you live in. It makes me think of the film ‘Lost in Translation’ where two people who would never have met otherwise, form a bond during a chance encounter in Japan. The right therapist for you might be in another city or country and now there’s nothing to stop you seeking them out. It can also be incredibly helpful if you have moved abroad, live in a remote area, are busy and want to cut back on travel time, or, as it happens, need to stay indoors during a pandemic. And for many people who face challenges leaving home due to disability or illness it means you never have to go without the therapeutic help you might want.

I often think the greatest concern people have about online work is whether they will be able to build the same kind of relationship with a therapist. And yet so many of the relationships we have in life are mediated through screens. We often form a deep sense of connection with characters in films, television dramas and soaps. The amount of people we are inspired and influenced by that we only get to know onscreen is endless: politicians, chefs, vloggers, the list goes on. The famous humanistic psychologist Carl Rogers said that one of the core conditions for therapy to take place is simply that two people, one a therapist and one a client, are in psychological contact. The amount of people I have seen screen to screen, who experience personal growth, tells me this psychological contact is definitely possible in cyberspace. Of course online therapy won’t be for everyone, and in certain instances it may not be suitable, but if you are thinking of taking the leap, I would urge you to put your preconceptions aside and give it a try. You may come to the conclusion it’s not better or worse, just different.

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