Online Therapy Adventures of a Couples Therapist

If you would have told me a year ago that I would fully transfer my private practice into cyberspace, I would have laughed.  My office was at the heart of my clinical work. It was the space where the magic happened. Although online therapy has been around for quite some time, I regarded it as a second-grade alternative to in-person psychotherapy. The face-to-face interaction during the therapeutic process seemed to be of paramount importance for the success of my clients. I assumed that the lack of my physical presence during our sessions would translate into my inability to hold therapeutic space for them. I was also concerned about my ability to read full body cues during the video sessions. Usually, it is only our face and upper body that is visible during video calls. Lastly, the resistance I felt toward online counseling stemmed from my clinical specialty. I work with couples. Fitting two people and the process unfolding between them into the angle of a single smart-device lens appeared to be impossible.

…And then 2020 happened. Covid19 presented us with a new landscape to which we had to adjust. By the end of March, I decided to no longer see my clients in person, and by the end of May I had to let go of my office altogether. Online therapy seemed to be the only safe and reasonable option at that time. Although some of my old clients decided to discontinue the work, others adopted the new format wholeheartedly. 

After spending the last six months doing online couples therapy I can evaluate the telehealth format from a place of experience, rather than prejudice. The most obvious benefit of online therapy is its convenience. Having my office at home expanded my availability to my clients, increased my scheduling flexibility, and completely eliminated my commute. In the city of traffic jams, this is not the least of considerations. 

Additionally, I surveyed my clients, who had both, worked with me in person, as well as in the online therapy format. They unanimously reported having a similar or better experience with online counseling listing the convenience of it and the emotional comfort of being in a familiar space while processing emotionally laden material. 

From a couples therapist's vantage point, it seems like there is an added value in being able to observe my clients in their “natural habitat.” They often present more relaxed and their interaction tends to be more honest. Limited visibility of the full body during the online sessions seemed to be fully compensated by the expanded view of clients’ faces. During video sessions, our faces tend to present closer on the screen, than they would have been during in-person sessions. It allows for a detailed observation of facial expressions and provides plenty of non-verbal information to support the therapeutic process. 

Online therapy also presented a few unique demands and prerequisites, such as high-speed internet connection and up-to-date equipment. I found myself initially coaching my clients on how to sit and where to position their smart devices for an optimal online therapy experience. However, once those conditions were met, the depth of the online therapeutic process seemed to be very similar to that of in-person couples therapy. 

Recently I shared with my husband that the last few months of seeing clients in my virtual office and mastering the art of online therapy changed my professional vision for the future. I told him “I am not going back.”  Online therapy gifted me with new degrees of freedom while preserving the quality and depth of my clinical work. The physical space of my office was substituted by the cyberspace of the World Wide Web. However, one thing remained unchanged - the inter-subjective space between my clients and me. This is the space where transformation and growth occur. I will meet you there.