Online Therapy: are you tuned in?
A neuro-physiology scientist, Stephen Porges recently published a paper on the impacts of Covid-19 to our nervous system here. In the article, he also mentions about the physiological adjustment to the video-conferencing, relevant to the recent situation of many. Most of us had to adapt to digital meetings and learning. As a therapist, I have learnt interesting insights which could inform therapists and businesses alike about the challenges to accompany such transition.
“Our neural sensitivity to video images is rather numb”
The historic use of video technologies in the past decades had been for entertainment or business marketing. This means that to a certain extent, we do not associate video images to our personal experience.
Porges (2020) calls a spontaneous attunement of the nervous system to the facial expression, bodily gestures and vocal intonation – neuroception. This automatic response to social cues happens in milliseconds during a face-to-face interaction. In virtual exchange, this would require a little more of a conscious effort, making the therapeutic work less effortless and intuitive.
This explains a commonly felt sense of disembodiment in virtual social interactions. We struggle to connect without a responsive reciprocity in those important exteroceptive cues.
Ever more intolerable Silence
Another interesting hurdle of the tele-communication comes from my own Zoom therapy experience: time-spatial perception of pause and moments of silence. Such spaces for insight are essential to the therapeutic process, but somewhat unsettling via the internet-platform. Questions arise in the uncertain mind of whether there was a cut or lagging in the connection.
While dealing with silence can be challenging for both the client and therapist during an in-person session as well, the online experience is again exacerbated by the conditioned attitudes we have gained around the use of our screens:
We are used to multitasking while watching television and streaming movies
This brings us to another challenge of video-meetings mentioned by Porges:
Syntax overload.
In therapeutic context, this happens when the client is confusing their counselling time with FaceTime. There is a reason why a physical therapy office has an almost universal setting signaling to the brain a distinct formality of the therapeutic work. Porges reassures that the virtual world of communication can be just as beneficial, if we accomplish sharing not only syntax, but also the “feeling” moments. I find that virtual attunement of the felt sense is particularly challenging via the screen, as some clients may find it difficult to achieve a necessary relaxed state with the mentioned lack of the orienting inter-personal cues available to them. However, I have also seen writings suggesting that some alertness propagated by the immediacy of the “call” has been seen to direct the conversations short and to the point.
As one can see, there are plenty paradoxes highlighting the individuality of each client:
While some will find an in-person session intimidating, others might report significant frustration with the digital experiences. Interestingly, I have also seen young people who grew up in an Instagram or Facebook-Live culture, yet particularly distracted about their appearance on screen during the call.
This said, many people have been able to embrace Online therapy, and even find lucrative positives to a reduced fee and flexible schedule. Most of the recent preliminary research has also supported the efficacy of the virtual therapy delivery as compared to the face-to-face treatment. With the lift of the social-isolation mandate, not everyone will share the mood of this article, and will continue with online therapy. My practice has seen individuals most benefitting from online therapy, who fall into one of those groups:
People in remote areas or with physical immobility
Individuals new to therapy and not ready for an in-person session
Therapists themselves! Searching for an open ear outside the pool of colleagues
Younger people accustomed to digital self-expression
Last but not least, those seeking a specialty-issues treatment not available in their country of residence
References: The COVID-19 Pandemic is a Paradoxical Challenge to Our Nervous System: A Polyvagal Perspective by Stephen W. Porges, 2020
Photo by Brooke Cagle on Unsplash