Online Therapy, Where Hugs are Not Possible: Research Into Online Psychotherapy (Part 3)
This blog post has been guest written by Evangelos Tsempelis and is the third part of Zurich Lab’s research into online dynamic psychotherapy. You can read Part 1 and Part 2 by clicking the hyperlinks.
Developing a Concept:
It is part of the mandate of the Zurich Lab to bring psychoanalysis to unlikely contexts. Driven by that passion, we have been engaging over the past couple of years in a series of experiments in Berlin, Zurich, Barcelona and New York City under the banner of Psychoanalysis-on-the-Streets. These engagements, which continue to take place in diverse settings – galleries, cafes, and in the Stillpoint hub in Berlin – have been impactful experiences to all of those who have been involved.
By exposing psychoanalytic ideas to the public in new ways (outside of the usual framework of the lecture room, the counseling office or the training institute) we enable psychoanalysis to have a new and exciting impact in the community. This act of exposure has come with the requirement of shedding entrenched professional attitudes in order to re-experience psychoanalysis in a new way that is often incomplete; within a language that is under construction as we try to relate and engage meaningfully with what is constellated in the moment often beyond our comfort zone.
At the Zurich Lab, we began to wake up to the growing realization that the Internet is in some way the quintessential “street” of our globalizing culture.
It was in this context that we decided to create, with Prairie Care (a US based provider of psychiatric care), a safe online platform where practitioners could engage in delivering psychological services to clients around the globe.
Our step into the digital world was taken cognizant of the fact that working online would not and could not amount to merely sitting in-front of a camera and continuing to do, unimpeded, what one normally does in one’s daily consulting room. As we cautiously took that step, we asked ourselves what new acts of translation would be needed in order to cross this threshold into a new space without compromising the essence of our work as practitioners in the field(s) of healing and well-being.
Engaging in Responsible Research with a community of Research/Practitioners
It soon became evident that this work of reflection would have to be systematized and undertaken with rigorous intent if we wanted to research the deep dynamics at play when we work online. We undertook to carry forward this research initiative with UK based relational psychotherapist and pioneer researcher on the cross-section of psychotherapy and the digital age, Aaron Balick. Together with a remarkable group of psychologists, therapists and analysts working online over Stillpoint Spaces we embarked on a deep exploration of the dynamics, experiences, fantasies and fears encountered as the frontier of therapeutic work is pushed forward into the virtual space. These ongoing exchanges, comprising the prima materia of a developing research project, are already becoming profoundly meaningful experiences for all of us who are engaged with it.
It’s a process of discovery – of technology, and ourselves:
We are discovering how impactful in our online work it already is to have created a space where we can actually share and admit our fears and concerns with like-minded colleagues.
Many of us have discovered that working online brings with it a subtle, often not immediately conscious, sense of guilt.
That guilt is often driven by the awareness that the online environment is a grey zone where the conventions and norms that regulate psychotherapy become dubious or unclear.
As we bring our practice online we each have to ask ourselves both how we define our work and how do we engage with clients in a new unfamiliar framework. Psychotherapists are trained to be cautious and to put their clients’ wellbeing at the highest priority. The safety of the client is directly linked to the idea of creating a safe holding environment, a container as we often say in our lingo. In a time of growing news about cyber fraud, crime and surveillance, that container can seem to be compromised from the get-go. So entering the online space may come with anxiety-laden fantasies of committing a crime or of breaking a sacred oath.
Working Therapeutically Online and Off:
This is why, as we are discovering, being part of a community of online practitioners and working through a platform, developed specifically with online counseling in mind, are important steps in the direction of sealing the container and assuaging apprehensions about the safety of our clients and the sacredness of our work. Still, even after such negative guilt-ridden fantasies have been addressed and rendered fully conscious, there is sometimes a concern that somehow the online work is not on-par with our work in the “real” physical world.
When we work online we are stripped of our sensory field. We are engaging in a technologically-mediated exchange. We can only see and be seen from neck up. The artificiality of a video image seems to hit against deep sensibilities regarding the therapeutic importance of restoring dignity to an often objectified human existence. Video image is immediately associated with artifice, with manipulation and control all of which go directly against the very notions of authenticity, care, and meaningful contingency as cornerstones of therapeutic work. As one colleague poignantly said, when we were exploring the psychological significance of a moment of return/arrival of a client back to the consulting room following a prolonged period of working online with his therapist,
There are no literal hugs in online therapy
Yet, the more we allowed ourselves to speak openly of our biases against online therapy something also begun to shift. A memorable moment, perhaps a shifting moment was when we all paused to acknowledge a sound which had impinged on the virtual cloud of our online group meeting. Here we were a group of ten or so counsellors from different cities in Europe and the U.S. suddenly listening to the cathedral bells tolling in Strasbourg, France (home to one of the colleagues in our meeting).
When you begin to really ask the right questions, one finds that the answers that emerge are much larger than the simple differences between “offline” and “online” work:
We began to ask if the fact that we were deprived of our full sensory experiences in the online environment in fact rendered us more acutely aware of other aspects of our reality which often would remain imperceptible or subliminal. What did it mean to hear these bells? What fantasies did this otherwise familiar sound unleash in this particular digital context in which we stood? Along the same line of thinking, what other fantasies or anxieties, otherwise unconscious in our every day natural attitudes, did our awkward occupancy of the online cloud invite for thematization?
We soon begun to realise that our physical practices too are mediated by technology and infrastructure of which we are often forgetful. The particular lighting, the art work on the walls, the chairs, the carpets that we use to decorate our practices are all potentially rife with implications and suggestions (socio-economic class, taste, professional status to just name a few) which they too, as powerful triggers of fantasy, are capable of impinging the sealed analytical/therapeutic container. Seen from that point of view:
the dichotomy between the online and offline work may seem as an artifice in itself calling for proper deconstruction. Every encounter is an a priori mediated encounter. Every exchange happens within a world of established meanings and conventions.
Adorno by Leandro Gonzalez de Leon
“We are always in the world” as phenomenologists say. Critical theorist and member of the Frankfurt School, Theodor Adorno once said that the hidden desire of every writer is that someday he or she will be read and understood exactly as one intended (…). The fantasy of a direct encounter of unmediated meaning is one to be taken seriously in its analytical implications. Asking what it means to work online, may become an invitation to also ask what aspects of our world or the world of our client have we chosen, unconsciously, to disregard by complicity to our privilege or comfortable natural attitude.
Lacan by Pablo Secca
Equally, insightful have been our observations regarding the anxieties of technological failures. Once so often, the video supported image will freeze, an Internet connection will fall and counsellor and client will be confronted with what in Lacanian language can be referred to as an eruption of the real. Namely, the discovery that the symbolic world of our language, which sustains our meaningful engagement with the world in fact contains gaps, lacks and voids which allow something horrific, a symptom, to announce its presence in a unexpected traumatic interruption.
Making the transition from thinking of the failure of the technology in objective terms to interpreting it psychologically may be a remarkable shift in attitude on the part of the online practitioner. Seen from the former point of view, the technological failure is an embarrassing moment to master and cover up, an impingement in the therapeutic work. Seen from the latter vantage point, the failure of technology is potentially a moment of rapture to cohabit and survive with one’s client: a moment where the unconscious anxieties about death can potentially surface and be addressed. It is a moment where authenticity and integrity, in the face of what always lies beyond our control, can be re-negotiated and re-stored. As it is, just as “hugs are not possible online”, there is similarly no “end session button” in real life: whether online or offline…
