Nuances in Teletherapy
Nuances in Teletherapy
We’re living in an age of technology explosion, and since Jan 2020’s COVID, teletherapy is here to stay. In addition to video platforms such as WhatsApp, Skype, FaceTime, Webex … we have health HIPAA compliant ones, e.g. Doximity, Sessions, etc.
When I started in the field, there was no Internet! The only way for therapists to practice was in person, and clients drove to the office, at times many miles away from their home or office, to see me in person for 50 minutes. Neither my clients nor I questioned it because we had no frame of reference, no alternative. I couldn’t fathom we’d be living in an age where we’d be able to not only hear but also see each other from half way across the planet. Before the pandemic, I was already doing some sessions remotely, but after offices started opening up, most of my clients wanted to continue with tele-therapy. It was more convenient, e.g. they did sessions from work, home, from their cars, a park … my tech clients typically book a conference room for an hour. In addition to time saved from driving back and forth from my office, clients found they could more consistently keep their appoints, e.g. if traveling for work or vacation, instead of skipping their session, they simply hop on to their device and voila—they keep the therapeutic process going. They also found that if they’re having an emergency, I was available to see them via video.
At their request, I currently see a few clients via phone calls (rather than video), and for these clients I’m exquisitely attuned to their idiosyncratic, unique inflections, their voice timbre, pregnant silences, quality of their voice, the catches in their breath. I find myself listening for the pauses within the silence. Every single person has their unique stamp and signature of voice. Yes, we have unique identifying fingerprints, but for me, each of my clients has a singularly beautiful way of expressing their truth, feelings and their subjective reality through voice. I listen hard, as if I’m literally hanging on to the edge of a boulder. It’s exciting and exhilarating for me to hand on to their syllables because the tiniest inflection which they may not have had the previous sentence, this often has meaning. I love the process of listening on the phone because it requires me to sharpen my hearing sense. When I’m listening to my client on the phone without video, because voice and hearing is my central vehicle for parsing meaning and emotion, intention and purpose … I become tunneled. It’s not “tunnel vision,” but “tunnel sound.” I deliberately cultivate and hone my hearing to be laser focused because my work demands it. I’m excited I get to do this every single day and each client, it’s completely different. My experience listening to one client’s voice is 100% different from my next client. The differences in vocal intonations are magnificent. I love being able to connect and vibe through voice. It’s almost like dancing with a partner with whom you’ve danced with so often, you anticipate their next move with rhythm and timing with precision.
Video sessions are another universe. Every nano bit of data that comes through me in a phone call, also registers on video but in a different way. The difference is that human beings cannot simultaneously process multiple sources of information optimally. With clients on video, the auditory aspect is of course present, and in addition, the visual enters. What do I mean by ‘visual’? During my first video session with my client, I establish a general baseline, e.g. their expressions, facial and vocal mannerisms (macro and micro), body language, paralinguistic and linguistic aspects all play a part in may understanding. So many infinite bits of informations matters such as twitches and eye blinks, a vertical ripple of face, an upward tug of mouth, a moist eye, a rapid blinking, a stare, an exerted effort toward remaining facially stoic.
What’s fascinating is how I sense the actual emotion registering through the video screen and/or phone line. How is the psychological wealth of this human being communicated to me when he/she is not sitting in the same room? How am I able to grok and get them? How? It’s absolutely magical and I’m forever grateful. It’s a gift from my clients to me.
I’ve talked about only the unidirectional flow of information: from my clients to me. It’s not unidirectional; it’s bidirectional. This is where the next level of magic happens: my clients are simultaneously gleaning data from me to them. It’s a reciprocal process: Client —-> Me ——> Client ——> Me … and so forth. This is an infinitely recurring loop, which almost never perfectly replicates. Depending on the session or time within each session, it’s an ascending or descending spiral. Often, clients and I are adjusting to and accommodating for each other. Challenging and allowing the other space. This is the essence of human interaction. When the grace in this interpersonal space bleeds into the intrapersonal psyche of the client—this is the part where healing happens.
The best endorsement about the efficacy of tele-therapy? The client. Every single person who has ever come to try it, they have stayed the course and loved it. I have had a few people who, in the initial email, have said they strongly prefer to see a therapist in person. In these cases, I’ve always encouraged them to seek out someone who does therapy in office. Clients knows themselves and who am I to judge what they know to be optimal for them? They know their needs and deserve to chart a therapeutically successful path for themselves.