A dialogue: in response to moving on from face to face to online therapy

Cal Nield, 2020. A dialogue: in response to moving on from face to face to online therapy. Reformulation, Summer, p.15.

Writing this as a companion piece to Rosemary’s new experience of working online, brings to mind a musical or lyrical response, Colwyn Trevarthen’s idea of the musicality of interaction, mediated vocally but resonating on a deeper level and fundamentally experienced bodily.  This in accord with the anxiety, trepidation and excitement which Rosemary described in relation to the opportunities and challenges of technology assisted therapy. Working online challenges traditional understandings and established theoretical frameworks, creating anxiety for therapists about this unknown intersubjective (cyber)space.  It is here, we strive to find resonance once more.

Pre-CoVid-19, some years ago as a diploma of online psychotherapy student, curious to investigate the netscape of this brave wild west I began by sharing my experiences though often felt like entering the gates of the saloon, an often risky endeavour of popping my head above the parapet. More benignly a marmite subject, it often aroused strong emotional responses (insert my defences quote) and the common retort was “it’s not the same!”… “Well of course not...” is now my unapologetic response. Trevarthen’s musicality resonates for me as in the absence of the physical presence, relational depth remains possible, communication can still be experienced bodily, and even in the absence of one or more of the physical senses, (where therapy can be via video, voice only, text or email) the therapeutic encounter can be more intensely felt and potent.

In the context of CoVid-19, therapists have had to take to technology to engage clients in therapy. It has brought opportunity for collaboration around re-contracting a new way of working but that I suspect has got lost amidst the rush. I wonder what the reciprocal role might be, [resentfully connected] to [distant and disconnected], perhaps reflecting a must/or will not dilemma and how that might be enacted within the therapy. Set up to fail comes to mind where online therapy has been bought in to NHS Services as a stop gap or as a wait list initiative.

Why not see it as having unique potential in its own right? How many therapists and clients post CoVid-19 might discover something unexpected in this way of working, discovering indeed that it is not the same, that sometimes less is more. Take away the physical presence and the non-verbals, the therapists has to pay more attention rely on other senses or perhaps more deliberately check things out, maybe even invite the client to check things out. Take away the video screen and pay attention to the voice only, the senses have to kick in further, there is more scope for fantasy, projection and enactment and rupture, more potential for the kind resolution that bodes well.  Maybe less is more – with more scope for intuition, for picking up transference and picking up bodily. “It’s disembodied!” I hear you cry! “We still have bodies!” I reply!  Can we still tune in to ours and encourage the client to attune to theirs?

Behind the screen there might be more a sense of safety for the client to cut to the quick more quickly – the skilful online therapist with awareness of the potential for this can help pace this phenomena whilst taking advantage of it in the work and utilise the online features of physical distance, or of invisibility in audio work, so that the media disinhibition effect acts like yeast an active agent of fermentation in the work. It also brings the work on boundaries to life in an online environment which can seem without boundaries, where there are multiple opportunities for clients to push or challenge them not least because it may be a great leveller when the therapist is not in the comfort of their zoom. 

Oops…sorry….room…!

Cal Nield

References

Suler, John (2004) The http://www-usr.rider.edu/~suler/psycyber/disinhibit.html

Trevarthen, C. Communicative Musicality: Exploring the basis of human companionship Paperback – 11 Mar. 2010  Stephen Malloch (Editor), Colwyn Trevarthen (Editor)