A psychologist shares what he’s learned switching to online therapy.

Does teletherapy work?  Yes.  How does teletherapy work? The therapist-client relationship is the most important reason it can be effective.  I’d like to share my experience switching from in-person to online therapy to drive this point home.

On March 13th, I made the fateful decision to temporarily switch my practice entirely to online therapy.  It was two days after a fateful Wednesday evening in the history of the US pandemic response.  That night, in what had previously seemed unthinkable, the NBA decided to postpone it’s season. Tom Hanks & Rita Wilson became the first celebrities to disclose that they had tested positive for coronavirus.  President Trump bungled a supposedly reassuring address downplaying the pandemic.  The next day, the stock market would begin to nosedive.  Across the country, people were beginning to come to terms with the impact the pandemic was having to ‘life as normal.’  A new normal had dawned, whether we liked it or not.

In the beginning of this switch, it felt like the only constant to the teletherapy sessions (from the old days) was the white noise machine.

Other than that, everything about the therapy office seemed to have changed.

Sure, I still wore a dress shirt to my video teletherapy sessions.  What clients didn’t see now were the shorts.

Yes, the waiting room still existed.  It just now existed on Zoom – until I chose to ‘admit’ my clients into our sessions.

It is true that there are always background noises and distractions, wherever therapy is held.

Outside my Philadelphia office, it was the sounds of pedestrian traffic, cars honking and ambulance sirens blaring, and the occasional drunk reveler yelling or singing in the alleyway.

Outside my home teletherapy office, the noise comes from my two young daughters fighting with each other over who gets to play with their baby brother; or my baby son screaming at the top of his lungs when he decides his nap is over.

Like so many others in the working world, being a psychologist in the times of coronavirus and shelter-in-place has meant adjusting to a changing workplace.

Perhaps not surprisingly, one of the biggest changes has been the shift in boundaries that come with doing teletherapy sessions from home.  In her piece for the New York Times on teletherapy, psychotherapist Lori Gottlieb writes that “the toilet has become the new couch.”  While that hasn’t been my experience, I have had to tell my 5-year old that it’s not OK to sneak into the home office during sessions to grab printer paper for her drawings.

Although teletherapy boundaries can be more fluid, the therapeutic relationship remains solid.  In the middle of one session, a client’s wife walked into the room to tell him she was going grocery shopping, and without notice he turned the screen to her to “introduce” us.  Immediately after doing this, he asked “was it OK that I did that?”  Although I didn’t answer his question – is there a right answer anymore? – this led to a valuable discussion about our relationship and my role in this new phase of his life.  It is moments like this that support the research which shows that the therapeutic relationship matters more to treatment outcomes than any particular approach or technique.

Now as I look back on the increasingly distant pre-coronavirus days, I realize that so much of the therapeutic encounter felt a bit scripted.  The couch.  The box of tissues.  The clock on the wall.  The waiting room with magazines that people would rather read on their phones.  Yes, even the white noise machine.

What still feels as fresh and important as ever is the relationship process that happens between two people in the room during therapy.  Although the ‘room’ has changed, the relationship endures.  With this in mind, the most important quality therapists can bring to teletherapy is our presence in the relationship.  This means having empathy for and curiosity about a wide range of client experiences; and listening carefully with an open mind, especially in the midst of difficult, painful emotions.  For clients, this means recognizing emotional vulnerability as an opportunity: to be heard and to be seen in a way that is deeply affirming, and to learn and grow from the process of working with your therapist.

It turns out that in the end, teletherapy does work – because the therapeutic relationship transcends the need for being physically present together in an office.  While the shared space certainly helps with the immediacy of the therapeutic encounter, all we truly need is a ‘connection’ – in the many meanings that this word holds.

—

Eric Spiegel, Ph.D. is a licensed psychologist, owner of Attune Philadelphia Therapy Group, and Immediate Past-President of the American Society of Clinical Hypnosis.  Dr. Spiegel is the co-author of Attachment in Group Psychotherapy, published by the American Psychological Association.  Connect (@drericspiegel) on Twitter and Facebook.