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Mind the Gap: Online Therapy

Technology offers unprecedented opportunities for support with mental health. The accessibility offered has been invaluable throughout the pandemic. Despite considerable benefits, it’s worth reflecting on how technology is affecting our relationships, including therapeutic ones. The world is reflected by us and to us on a screen which can at times feel enriching. Our online life with its frustrations and gratifications can influence what we become used to in external reality. Its immediacy could endanger the potential opportunity for reflection, the integration of feeling and thinking which is the cornerstone of therapy. With awareness we can perhaps find ways of facilitating slowing down which will help us make the most of the therapy experience.

The psychoanalyst Alessandra Lemma wrote about this in her book "The Digital Age on the Couch" which elaborates some of the ways the technology is changing the therapeutic process. The internet makes everything immediate; we are less used to waiting. If I want a pair of shoes, I can look online and buy them there and then. This is exciting and has accelerated the pace of life so we can fit more in. However, the process of going to a shop, trying them on and walking out of the shop was often tedious but it was alive in my imagination and memory. The delay or gap between wanting and getting something helped me imagine the shoes and keep the desire alive. The process arguably made wearing and enjoying the shoes more satisfying.

There are many gaps in therapy. Waiting between sessions or for your therapist’s holiday to end can feel difficult when you need support. Lemma emphasises is that therapy arouses strong emotions in a context which is frustrating. The client has to wait until their therapist is ready to receive them. It’s comparable to communicating by text or e mail online. When you communicate something or send an instant message, waiting for a reply, (especially when you know it has been read) can be excruciating. You may imagine the person reading your message rejecting it and disappearing out of your life. Online dating can be a fertile ground for these painful fantasies of how you are perceived by others. In that gap it’s easy to imagine the worst. Sometimes it’s only the memory of the real presence of a person and being with them in external reality that can make the waiting bearable. Lemma calls this kind of embodied memory a “somatic marker”. The real person in all their dimensions, stays in mind more easily.

The rituals and the constants of the therapy room can help build the inner strength that helps you to tolerate the frustration of waiting. The journey to and from a session and the experience of being together in a room helps to remember and internalise the therapeutic process gradually. A silent walk on the stairs and the familiar beginnings of sessions are rituals that create and embody the experience for both parties and enable therapy to feel safe as well as memorable. The context of the room, the therapist's physical presence and non verbal cues which provide necessary containment. Implicit communication (non verbal) is more difficult to read online. The focus on emotion and how it is experienced in the body facilitates memory of the session and imagining the next one for both parties.The frustration and feeling of loss (you have to leave the room after an intimate encounter) can leave someone feeling unsupported and vulnerable. However imagining the next session and remembering the last in a way that is rooted in space and time and experienced physically helps with the waiting. This can help someone feel more real, able to tolerate the frustration and start to feel a bit more secure.

The internet has potential to widen access to therapy through the use of Zoom or Skype sessions which is exciting and people may feel safer to reveal difficult things. It can be positive experience so long as we are aware of how technology affects the process. This can become part of the conversation so that we're using it in the most beneficial way. During the pandemic, many therapists and clients have found innovative ways of creating space before and after a session to reflect and slow down. Thinking about this with your therapist will ensure you get the most out of the experience.

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