The unexpected gifts of online therapy

Yesterday, I was left alone in a room by my client.

Lisa (not her real name), a single mother, was speaking to me from her home; I was at my desk in a different part of Europe. We had connected via computer webcams and Skype video-conferencing software.

We were in the middle of an online therapy session when my client’s 4-year old daughter grew impatient with waiting and started to cry outside the door. Lisa had an anxious look on her face. Then she apologized, stood up and went to calm her child down. After she left the room, I found myself alone, staring at Lisa’s empty living room with a dark television screen in a corner and some modern artwork on the wall, painted in grey.

Usually we hold our sessions at a time when Lisa’s daughter is at the nursery. If the little one is ill or during holidays, she still has her session while keeping her child out of the room happily set in front of a video.

Lisa is a very intelligent young woman and a gifted musician. Fighting to make a living in a hard Russian city, with no support from family or her son’s father, she longs to follow her passion for music and instead survives by playing violin at rich peoples’ parties, and writing music for TV commercials. She often feels extremely isolated, stuck in her life and in her oppressive reality.

From the other side of the closed door, I could hear her child’s high-pitched voice, as she grew more and more upset and frustrated. I remained ‘alone in this room’ for not more then three minutes, but my feeling of anxiety and despair kept growing and soon it became almost unbearable. I felt a strong temptation to “leave” the room, to go away, to fade. I could easily have done that with a single click, but I didn’t.

The little girl’s crying reached my ears with such despair that I felt powerless and paralysed. The fact that I was physically far away, sitting in my own office, in another country, made the whole experience somehow even more powerful. Though of course the physical distance between us made it impossible for me to pick up the child and comfort him, at the same time, I knew that’s exactly what he needed.

In traditional face-to-face therapy, I usually rely exclusively on my clients’ words, - the narrated version of their ‘out there’ life that they choose to share with me. When practicing online, I often witness their personal reality first-hand: I am sometimes admitted, albeit virtually, into their offices, their kitchens, and sometimes even into their bedrooms. I may also glimpse their pets or their flatmates peeping into the room during the session.

Classical psychotherapy would view such intrusions as harmful nuisance, as “breaking the frame,” but in online psychotherapy, they help me gain better insight into my clients’ actual experience of their world.

Sometimes my clients, even the most articulate of them, struggle to translate their inner experience into words. As do some of my other clients, Lisa uses elaborate talking as a way to hide, deflecting attention from unbearable feelings of shame and abandonment.

Even if I knew from our previous work how painful her early childhood had been, and how often she was left alone by her parents, only that day was I able to fully empathise with her emotional pain.

When she “abandoned” me in the room, she unconsciously made me feel exactly as she had felt for most of her babyhood: alone in her pram, left outside on their kitchen balcony. In Russia at that time, this was a common practice. It was widely believed that babies slept better in the cold, breathing fresh air.

This old pre-verbal experience of lying alone in the confined space of her pram, tightly swaddled and unable to move, soon came to define her general feeling in life. Crying was pointless, - nobody would come. To escape was impossible.

This winter, Lisa was feeling stuck and left alone in the cold again. Her country was falling into a deep despair with no hope for escape.

When Lisa finally managed to soothe her son, and the notes of despair faded from his voice, the door I had been staring at for the last long few minutes finally opened, and she stepped back into the room. She looked exhausted and vulnerable.

When she sat down, we looked into each other’s eyes, - or rather into the webcam installed on top of our screens - and I understood her much better. Though for only a few minutes, I had entered into and experienced the feelings of despair, loneliness and frustration with which she had been living.

Lisa started to speak but suddenly stopped. In my pained expression, she recognized her own suffering. This accentuated ‘face-to-face’ quality of the screen sometimes transforms the dialogue into such a deep mirroring opportunity. At this point the silence we shared had a different quality: we felt closer then we have even been.

The session was almost over but I knew that our therapy was now entering a new stage. Armed with this new understanding, I would be able to support her better in her search for fulfilment and a better contact with others.

This could never have unfolded with such immediacy if Lisa had been coming to my office in person. I would never have heard her daughter’s crying, which so clearly resonated with my own inner child.

I practice a relational approach to therapy, and now working mostly by Skype, I am thrilled to discover how technology adds a new dimension to the old face-to-face talking therapy practice.

The video connection I use to meet with my clients allows us to experience contact differently. We are far away from each other, often separated by thousands of miles, and these unpredictable gifts in the shape of a cat, a neighbour ringing at the front door, or a parcel delivered to the doorstep -- all these unexpected intrusions provide welcome insight into the client’s world.

Traditional therapy, where therapist and client are present in the same room, would view these interruptions as « breaking the frame » and therefore harmful to the treatment.

Sometimes these interruptions come as a shock, as when a jealous girlfriend suddenly stormed into the room because she suspected her boyfriend was having a cyber-affair, but I always value them and try to make the most of them in the ‘here-and-now’ of our therapeutic encounter. These idiosyncrasies of online psychotherapy only add to the creative element of my work that I truly cherish.

#onlinetherapy