A Therapist-Approved Guide to Virtual and In-Person Therapy
It’s March of 2020 and I emerge from a session to hear swirls of chatter racing, billowing from the back office at my then-clinical training center. “They’re saying it might grow to pandemic levels”. “Do you think it’s gotten to San Francisco yet?”. “There’s no way we’ll all have to work from home, right? Can you imagine doing therapy online?”
If we only knew what we were about to get ourselves into. The global pandemic threw therapists for a major loop and working from home was just one of many, many adjustments we, along with the rest of the world, were forced to embrace. There were a lot of things running through my mind back then, of which, to be completely frank, how to make telehealth therapy work was not at the forefront. I, like many people, was in a one-foot-in-front-of-the-other kind of mindset as the world settled into the year that was 2020.
My entire in-person practice transitioned to a virtual one that year which both evoked what felt like a more distant therapeutic relationship than face-to-face therapy and an intensely more intimate one (I’ve met more partners, pets, children, and Amazon delivery people than you can imagine!). In online therapy as in life, there are pluses and minuses here. Let’s break it down together.
Zoom or bust
By now, you probably know the deal. Transitioning to virtual life, whether professional, personal, or in this case, therapeutic, certainly has its perks. Before virtual therapy, a session was 50 minutes long in theory but not in practice. You had to factor in time to commute, time for parking, or wiggle room for the lyft / muni / citi bike to arrive on time. Now, a virtual therapy session is genuinely 50 minutes long, freeing your time up a bit and relieving the parts that just plain old don’t want to leave the house (This was a pre-covid thing for everyone, right? Right?!)
Virtual therapy offers so much flexibility in all kinds of contexts. You’re a parent, time is a waning, precious resource, and the idea of starting therapy from the comfort of your house / car / closet / laundry room and getting right back to your regular life might sound deeply appealing. No frills. Just you, your therapist, and your weekly crying session (and I say this with absolutely no shade here because life is hard and weekly crying sessions are crucial).
Or what if you have a demanding job? Or juggle a few different ones? Or live in a town with a limited pool of therapists? Popping onto a screen from wherever feels private and comfortable has made it possible for a lot more people to take care of their mental health.
Another benefit of virtual therapy (of likely many) is the relief that may come in sharing your most intimate thoughts and feelings with someone via a screen. There can be a way in which virtual therapy feels distant enough to loosen the parts of us that feel awkward or uncomfortable sharing ourselves. Consider someone struggling with social anxiety. Sharing feelings openly in person might feel very challenging in this case, making virtual therapy that much more appealing. Skipping the relational tension that may arise in opening ourselves up to someone face-to-face could create the opportunity for a person to feel comfortable sharing their inner world more quickly. It makes me think of the benefits of the stereotypical therapeutic couch. You know, the one where a patient would lie down on the couch and the analyst would sit behind them, just listening? The purpose here was originally intended for the patient to feel safe enough to talk. To free associate without concerning themselves with their analyst’s reactions. This may be more applicable to a phone session than a video conferencing one, but these scenarios are similar in spirit. Free yourself of relational anxiety and gain the safety and courage to share yourself.
Shall we tête-à-tête?
Ok, before you clutch your chest in a social anxiety attack, hear me out. Yes, in-person therapy comes with some disadvantages. Several depending on your particular context. You must factor commute time, time for parking, wiggle room for the lyft / muni / citi bike. You must grapple with the intimacy and potential anxiety that comes with being in-person with your therapist. You might need to coordinate child care or talk to your boss about carving out personal time for mental health purposes during the work day. You might even need to brave…gasp…Bay Bridge traffic (this is true horror).
Allow me to offer some rebuttals.
Consider that the commute time accompanying in-person therapy can be a weekly, forced mechanism for self-care. Treat it as taking yourself out on a weekly solo date. Maybe you get some boba tea or an ice cream after session. Maybe you take advantage of the surroundings and cross that daily walk off your list. Or maybe the simple car / bus / bike ride home is enough quiet time to serve as a refuge from daily life. How often do we allow ourselves this type of a pause?
Similarly, the intimacy and potential anxiety of being face-to-face with your therapist can have enormous interpersonal benefits. Just like a workout is uncomfortable at times, so are many parts of therapy, including noticing what it’s like to communicate your feelings face-to-face with another human being.
Unfortunately, some inexplicable, mysterious frequency can get severed with virtual therapy. Or muddied by the surroundings, including having to answer the door for delivery folks, to see people walk around (if you’re in your car), to know your partner or roommate is in the next room. It may be an unnoticeable thing, or not present for you whatsoever, but I have found there to be a quiet, almost imperceptible self-censoring that can happen in these contexts. There’s real value in going to a therapy office, knowing these are the grounds where you can take your mask off and just be your true, human self.
A private office clears this noise up and at least offers the chance for you to bare your true self and to work through the relational barriers that arise to protect yourself from real life, in-person vulnerability.
All this is to say that mental health is something to be nurtured and my hope is this article helps get you one step closer to clarifying what works best for you.
