Online Therapy. Will it work?

Jennifer, a 32-year-old former ivy-league graduate currently commencing on a revived ‘career’ as a professional golfer, reported her love for her husband in every way other than his lack of initiation in the bedroom. “he’s a great father, a great husband, engaging and a wonderful friend. “. This was her first session. At the 45-minute mark, however, she leaned back, cropped back her medium length hair into a ponytail, and began to speak of him as dull, boring, and uneventful, not simply in the bedroom yet somewhat everywhere. Rather than give the indication that she had wanted to work it out, instead she spoke of a new life. A life that involved the sexual partner(s) of her choice; a life where she could explore her sexuality and one that did not include him in the bedroom… but did in the other areas of her life.

She depicted her life to be highly routine, driven, adrenaline based, and purposeful, a life she left as a younger woman. A life in which her mastery of a particular high-level skill set is critical. There were clearly many stores I haven’t yet heard. Yet I did hear one—at the 45-minute mark there was a switch.

In the office that kind of observation would have been a no brainer. In fact, it would have knocked me over. Over video I’m sure I, as well as many others, are missing a lot; all I can say is thank goodness for the often second chance. We may need those with online therapy.

Screen Work

Working via screen, with firewall, elicits extensive energy on the part of the therapist. Energy to be present and to be aware of the nuances that are usually taken in organically within 4 walls.
And for me, I’m working in a light-filled home office, dedicated almost exclusively to work-related matter. I’m not setting up a make-shift space with a floor screen or blue light barrier mask the space, I can only imagine that to be more challenging. So, in some ways, although I don’t see patients in this space, it is familiar in connection with the work I do.

I believe my greatest asset as a clinician is my presence. It’s my ability to be present in the room with a patient, to be able to listen to and hold their struggles while helping them navigate their pain without judgment and with hope. I have always worked within my frame whilst increasingly relying on my intuition and felt sense while in the same space. Added to my work, it has made me a much stronger therapist.

That is not the case, at least not as of yet, with teletherapy, video therapy. Because I am not in the same room with them it requires substantially more work to stay with them on their side of the screen.

I am exhausted at the end of the day. I need to be with them to help them. I’m struggling.
It has only been one week for me; I’m just starting this journey.

If it taught me one thing so far (and I believe we all have lessons to learn, bigger than this) it has taught me to take a few minutes for myself between sessions. Somehow in office it works; on video it’s different.

I had heard about Jennifer’s ‘castration’ from her husband, with whom I had met previously for several sessions, someone who is a bit reticent and reluctant not just in the bedroom but in their relationship overall. Undefined in his current work direction and in a relationship, he is quite sensitive to her statements about his romantic abilities or lack of engagement in life at this time. Until that 45-minute mark she was not that powerful and all sophisticated woman he described her to be, at least not to me. Perhaps it was the screen. Perhaps it was what would have happened had she been in my office. Until we are together in the office I may not know.

This piece was edited and repurposed at Psychotherapy Networker.

For more information on how to received Online Telehealth Services with Dr. Winter read here.