Surprisingly, despite the lack of non-verbal cues, transitioning to remote working with clients due to Covid-19 enhanced some of my work.
I am a child and adolescent psychotherapist. In 2017 I completed a diploma level training in online therapy, and I have been practicing online therapy ever since. Like many therapists, since the start of the COVID-19 pandemic, I have needed to transition my ‘in person’ sessions with children and their carers to working remotely.
Like everyone I have found the experience tiring, but I have also had a few surprises, where the therapeutic process has been enhanced by the transition to remote working. The transition process brings into sharp focus different ways of working. When a clients chose to work remotely from the outset, they make a conscious choice to work in this way and the parameters are set out from the start via the contract.
Transitioning from ‘in-person’ to remote ways of working requires flexibility and learning a new grammar for our interactions.
Before reflecting in more detail about the benefits of this transition, I shall share some thoughts on factors that I think contribute to feeling more tired than usual when working remotely with my clients.
Working remotely includes video, telephone, text, and email exchange. All of these ways of communicating require a greater focus than ‘in person’ communication. When in the physical presence of each other, not only do we rely on non-verbal cues, but our very presence co-creates and regulates an ambiance. During video calls we are deprived of full-body language, the time delay and sound distortion alter the normal prosody of the conversation. We have to concentrate harder to make use of what cues there are. We also have to learn new grammar. During an ‘in-person’ session, children and carers find many different ways of pacing the session. It is easy (and acceptable) to get up and move within the room and to change from one activity to another. On a video call, the camera focuses on the head and shoulders, even turning away can take on a ‘larger’ meaning. Silences which are an important part of the therapeutic relationship can take on a different meaning during telephone or video calls. With the increase in internet use during the Covid-19 lockdown, my first reaction to silence is anxiety about the reliability of the technology, rather than attending to the rhythm of the conversation.
All of this contributes to a disconnect; a feeling of being together but apart. In a parallel process of body-mind disconnect, (minds together, bodies apart) I find myself trying to cognitively pay more attention, and I forget to listen to my body responses and struggles to remain emotionally regulated. I think this is what is exhausting.
However, there have been several cases that have been helped rather than hindered by the move to remote working.
During ‘in person’ sessions one of my clients often struggled to stay in the room, often wanting to see his carer who was down the corridor in the waiting room. I tended to understand this exclusively in terms of separation anxiety. When we transferred to video therapy, despite being in the same space as his career, he found a way of being in and out of the session too. He would be on the chair, under the chair, on the desk, under the desk. He placed various parts of his face on the camera, his nose, his eye, his open mouth. At times he hummed rhythmically. This prompted me to understand his fear of falling to pieces and his difficulty in holding himself together. I would not have reached this understanding as quickly without this move to video therapy.
Another young person elected to communicate via email. For the first months of our ‘in person’ sessions, she had often not talked, electing to draw or paint, adding to the communication with the occasional nod or written word. As our work progressed, she would often respond to my questions by writing and this evolved into a written conversation.
In the transition to email therapy, we agreed that she could email me as many times as she wanted during the week, up to two days before our normal appointment day. We also agree she would not write more than 500 words in total. I would respond only once, and she would receive my response on the day of our normal appointment time.
During our ‘in person’ sessions, our exchanges felt discordant as we both reacted to each other’s responses. Sometimes a theme would be picked up again in a subsequent session, but often not. She would often balk at any nuance from me that referred to material from an earlier session. Being given the opportunity to write as and when she wants has enabled her to write more freely. She has time to process my responses in her own time too. Our exchanges are less fragmented and more coherent. I think the fact that there is a permanent record of our exchanges helps us to stay focused.
Exchanges by email have a different time frame to ‘in person’ communication. When physically present with another, other than wearing earplugs, you have no choice but to hear other utterances. Likewise, other than closing your eyes you cannot shut yourself off from pictures drawn and words written, nor can we be oblivious to non-verbal body language and cues. However, when you receive an email, you have a choice as to when (or if) to open it, how much to read at one time and when or if, to respond. This shift, giving my client more control, has helped her develop a greater sense of agency in our relationship and to be less inhibited.
To conclude, whilst I realise that for some clients working remotely may feel less containing and is harder work for both the therapist and the client, I do feel there are some benefits.