I have been thinking about how remote sessions differ from in-person sessions. The following thoughts are especially applicable to patients with whom I have been working in person, but, if you’re considering starting therapy – or simply thinking about how “virtual therapy” might differ from in-person work, I suggest you consider the following.
1) If we meet in person, you travel to see me. You leave what you were doing previously. You travel, you arrive. You sit down in my office. You may wait a few minutes or longer for me in my waiting room.
2) When we meet in person, you are in my space – a space that exists for you as a space in which you do therapy or psychoanalysis – and in which you only do therapy or psychoanalysis. And you do it with me.
3) Before you sit down in my office, you may encounter someone else in the waiting room – someone you see often, or someone you never see. You may encounter someone leaving my office regularly, or occasionally. Or, you may encounter someone leaving my office whom you’ve never seen before. You may think about this person, these people, about their relationship to me, about their relationship to you. You may barely register them.
4) If you arrive at or before our session’s scheduled start time: before we even encounter one another, you sit in my waiting room, on my couch, or in one of my chairs. You might use my bathroom, or make yourself a cup of tea or coffee, or water. You might take a moment, or a minute, or longer, to accustom yourself to being in my space. Maybe you think about what you hope we’ll discuss in session. Maybe you try not to script the session. Maybe you read some e-mails, some news, or page through your various social media accounts. Maybe you looked at one or more of the magazines in my waiting room. In any event – you engage in something of a ritual. You prepare yourself – in whatever way is right for you – for our incipient session. And, at our appointed time, you most likely hear my door open, hear my footsteps coming down the hall to retrieve you from the waiting room, and you have some feelings. We greet one another in a somewhat ritualized, familiar, way, and, together, we proceed back to my office. Maybe you tell me you’ll be right there, as you finish a task or e-mail or text in the waiting room. Maybe you stand right at my door, waiting for it to open.
5) If you arrive after our session’s scheduled start: maybe you’ve hurried. Or you’ve tarried. You’ve dreaded arriving, or flagellated yourself for being late. Or, you’ve simply been engaged in other thoughts – about work, about relationships, about nothing. But you enter my building, approach and enter my suite, and find your way to my office, the door open, to find me sitting in my chair, waiting for you.
6) According to certain rituals, you might lay yourself down on my couch, or seat yourself in one of my two chairs, and I sit in mine. And, perhaps, you poured yourself a glass of water from the water bottle I provide you, or blow your nose using my tissues.
7) And, whether you arrived before, at, or after our scheduled start time, you take in all sorts of sensory information. To the extent you have use of your senses, you take in the sights, sounds, smells of my building, of my waiting room, of me. I enter your consciousness not just in a cognitive way, but in a sensory way – and in a sensory way that itself has an existence in time. The building’s sights, sounds, smells precede those of the waiting room, which precede those of my office itself.
In other words, our session has begun – and a lot has happened – by the time the session “starts.” And of course, at the end of the session, all of the steps of arrival take place in reverse. You leave me, my office, my suite, my building. You take a train, or a bus, or a car, or you walk for some number of minutes before your life outside of our work together fully resumes. You transition – from us, to you.
Video sessions – obviously – differ dramatically from in-person sessions.
To begin with, the ritual – to the extent there is one – of “starting” a session is radically attenuated. It starts, of course, with your computer, or your phone – a device that, in the current moment, you may well be spending a LOT of time using. You may well have a relationship with, and to, the device itself.
You use the device for a lot of purposes: to interact with colleagues. To interact with friends, romantic and sexual partners, family. You work on it. You read the news on it. You watch TV, movies, other forms of entertainment on it. You may use it to masturbate, or to arrange dates, or sexual trysts. We join one another, in other words, in a space crowded with associations, memories, thoughts, and feelings – the vast majority of which have nothing to do with me, or with the work you and I do together. But now, we are about to join one another – not in my office, but on your device.
You’ve clicked on the link to my “waiting room.” Maybe the link is handy, easily available. Maybe you’ve had to hunt for it. Maybe your connection is strong; maybe it’s weak. If all goes well, you find yourself in my “virtual waiting room.”
At this point, it’s worth reflecting on how much, already, is different from our normal patterns. Are you in the same space you’ve been in all day? Do you do our sessions somewhere else? Do you do them in the same place each time? In the same position? Do you move around? Do you “arrive” at our sessions, taking time and space between what comes before our session and our session? Or do you simply switch screens, from whatever you were doing previously to me? Do the sights and smells and sounds entering your awareness change? Are they associated with me? With our work together? Or are they the same as all the other sights, smells, sounds you take in all day, every day? And, do you have thoughts or feelings about the fact that the sights, smells, sounds I’m taking in are, necessarily, radically different from yours? That we’re not sharing a sensory experience?
And the transition from the virtual waiting room to the online session is a jarring one. You don’t hear my door open, hear my footsteps, hear my voice, see my face. Your screen changes, and THERE I AM. Liminality, transition, are not features of this waiting room. It’s as if I teleport you from the waiting room to my chair. Except you haven’t moved, you aren’t in my chair. You’re in your chair, miles away from me. You only see part of me. You only see part of the room in which I’m seeing you. What’s to the left, you may wonder? To the right? What lies behind the computer on which I’m looking at you? Am I even looking at you, you may wonder? Or at something else that lies beyond, above, below, or to the side of my screen?
Throughout our session, all of these questions, all of the differences between an in-person session and a virtual session, loom large. The technological questions – the quality of the audio, of the video. The way in which you take in the audio – is my voice, am I, for instance, entering your head via earbuds? Emanating already from within your ear canal? Or from a tinny speaker? Does the voice you’re hearing sound like mine? How is it different? What about the inevitable glitches, the latency, the frozen frames, the lost connections? The fact that in person, we can speak at the same time from time to time, but, when that happens now, you may say, “No, go ahead.” Or I may.
None of this is to say anything negative about virtual sessions. You may well find virtual sessions more comfortable, more convenient, safer. You may be better able to confide in me, to disclose, in this virtual context. Or you may not.
What I’m saying is that virtual sessions are different from in-person sessions, and it’s a mistake to imagine that they’re not, that they don’t give us lots to think, and talk, about.