TRANSCRIPT
More and more, we live in the age of therapy video, psychotherapy, telephone psychotherapy. And while I’m not saying it’s inherently a bad thing, I don’t think it’s a good thing.
I haven’t been a therapist now for about 14 years, but in the 10 and a half years that I was a therapist, I worked with people face to face, in person, and I loved that. I think it was really important. I considered it vitally important that I sit across from a person and have a relationship with a real human being, with only air and a little bit of physical space in between us.
Now here’s the thing: I do want to acknowledge that there are some advantages in therapy from the perspective of clients. They can pick a therapist who’s not in their geographical location. They have a much broader and wider range of potential therapists to pick from. And it also saves time. You don’t have to travel half an hour or an hour or two hours to have a session with this therapist. That’s the advantage for clients.
The advantage for therapists is, well, they can work from anywhere. They can work at any time. They don’t need to rent a private office and pay a lot of extra money. So hypothetically, they can charge less money. As it happens, what I see is they don’t charge less money, even though they’re saving a lot of money because they don’t have to have an office rent. They charge the same amount, so they can earn more in the end. They can see a much broader range of clients, but that’s pretty much about it because there’s so much that gets missing when you don’t see people face to face.
Now I’m going to use an analogy that I’ve thought of. Not a perfect analogy; it’s open to flaws. But an analogy is long-distance romance. Something gets lost when people have a partner, a romantic partner, who lives 4,000 miles away, and your entire relationship is on a computer screen and on a telephone. It can be a real relationship emotionally, but it’s missing something. And I’m not talking even missing the sex—sex aside and the physical intimacy aside—it’s missing some sort of connection that’s actually kind of similar to what gets missing when there’s psychotherapy only virtually through telephone and video. It’s something about being human that gets missing, some sort of human interaction that gets lost, an energy.
I think about this just in terms of knowing people. I’ve had friends and friends who I knew only on video and telephone for a long, long time, and then we met in person. And then it was like, wow, this person who I thought I knew so well, I realized I only knew certain parts of them. And when I am physically in the same space with them, I can realize whole other sides of their personality that just were missing, that never got transmitted through the phone or the computer. Whole bits and pieces, sometimes very large parts of their energy that I didn’t feel—good parts and bad parts. And I think it’s the exact same thing in psychotherapy.
And whole other things in psychotherapy. I think of like working with clients and in the first session realizing—it’s a sort of a sad example—but realizing someone who I never would have picked up if it had only been in the phone or the video because they never talked about it. But realizing, let’s say that they don’t have good dental hygiene; they have bad breath. And this client might come in, and maybe in the first session I don’t want to give that feedback to the client. It’s a little too intimate; maybe we need to build a relationship first. But then they’re saying why their relationships don’t work and why they have conflicts on their job, and realizing, “I think I get why.” And yet this would never be known. Maybe the client himself doesn’t even know that he has bad breath. And yet through therapy on the phone and in the video, this might never come out.
Or I know some therapists who’ve never even seen what the client looks like because they’ve only done therapy through the phone. And there are certain things about the client that are not transmittable through the phone. And they might even ask, “Well, can you tell me what you look like?” And the client might not share things because they might even not know it about themselves, or there might be things that they’re too embarrassed to share. Whereas it can become very obvious when the person’s sitting in front of you.
Also, another one that gets missing even through video therapy is this amazing magical thing that happens between people when they sit across from each other, and that’s eye contact. There’s something, some message that happens with eye contact that just doesn’t happen with videos. It’s impossible to make eye contact through a video screen.
I think of this weird thing that I learned as a hitchhiker—someone who’s hitchhiked a lot—that when a car passes you, going, comes towards you and passes you going 60 miles an hour, what is that, about 100 kilometers an hour? And they fly past you, and it’s literally the smallest fraction of a second when that car passes. You actually can make eye contact with a driver when they’re going by you that fast, in a hundredth of a second. And in that moment of eye contact, some relationship gets built. Some emotional message gets sent, or many emotional messages get sent. And I’ve had people later, 10 minutes later, come back and say, “In that moment of eye contact that we shared in that hundredth of a second, something got transmitted,” and they felt they needed to come back and pick me up. And yet on the telephone and in the video, that isn’t transmitted. And how sad.
I think actually there are a lot of psychotherapists out there that they don’t actually want to have that eye contact with clients. They don’t want the intimacy. They don’t want the intensity of sitting with a human being. And I get that. I don’t like it; I don’t think it’s right. But I think there are a lot of therapists out there who it’s too much. It’s too much to talk to people and be with them for eight hours a day, to have eight or nine or ten psychotherapy sessions with actual human beings. It’s easier to have the distance of teletherapy, the distance of the video, the distance of the audio on the telephone.
I can’t tell you how much, how many times it’s happened. I’ve sat with a client directly face to face, with a chair in front of me, and there are no words exchanged, but I can feel it—how much pain they’re in. And they can just cry and cry because they can feel that I’m on their wavelength. And that might be transmitted a little by video, but not so much.
And I think of something also that I first heard. I knew it was true when I read it, but I read it somewhere in the words of the kind of weird psychotherapist, but he was a genius in his own way. I don’t agree with a lot that he said, but the therapist Milton Erickson, and he only worked in person with people, said, “The farther a client travels to see me, the more likely they are to change and heal in their lives.” And I’ve seen that too. The harder a client works to come to therapy, the more effort that they put in to travel to see me, the more time they put in, the more of an inconvenience it is in a way in their lives, the more they open themselves up to this healing process. It’s in a way like they have to make more of a sacrifice to make this come true, to make themselves want to change.
And I’m not saying it’s true 100% of the time. I’m not saying this should negate teletherapy in all cases. But I have heard this from a lot of people I worked with, and I also experienced it myself, having to travel over an hour to get to see a therapist. That time to travel, the inconvenience to travel, the process of physically doing some work to get to see the therapist was a meditative time that was metaphorical for the process of realizing the value in this experience of thinking about what was going to happen in that session, of walking toward that session. That physical journey of walking to the session or traveling to that session.
Or people telling me, “Oh yeah, I had to drive for two hours to come and see you,” and I’m like, “Did you listen to music while you were driving there?” No, no, no, no. The whole time, it was like a physical transformation to come. This is my silent time. This is my meditative time to think about what I am going to talk about. This physical process of maybe even driving across state lines to come to the office, I need this time.
And for me also, as a therapist, thinking, walking to an office, preparing my office, cleaning it up, making it physically ready, that gets me in the mindset of being in this physical place where I can give my heart and my soul and my ears to a person who’s sitting across from me.
I think if it’s too easy in therapy, it’s maybe cheating the process a little. And I think the client, well, I think they should get the more bang for their buck. Make it a little harder for me too.
And then I think of another thing because I’ve talked to, well, quite a number of therapists who do teletherapy. One thing that they say is, “Well, you know, it makes it a little easier for me. I don’t have to dress up,” or if they know that they’re only going to be viewed from the chest up, they can just wear pajamas in the bottom half of their body. Or they can drink alcohol before a session because they know that the client isn’t going to smell it on their breath. And it makes the therapist more relaxed to deal with a more stressful client. It makes them a little bit less emotionally connected.
Or therapists telling me they’re smoking a little bit of marijuana before the session so they can be a little bit more open, but really a little bit more dissociated. And nobody’s going to know it because the client can’t pick that up in them because of the distance.
Or the therapist saying, “Yeah, I can see 12 therapy clients a day when I do teletherapy, but back when I used to see them in person, I could only see six because it was so much more intense.” And I think, well, is that fair for the client? I think it should be very intense for the therapist.
And so all in all, in this world of evidence-based therapy, where there’s so much evidence-based for the value now in teletherapy, I think if I had to give my vote, I think I would go back to the vote of people seeing a real human being in front of them, having a real human connection, a full emotional connection with a human being, face to face, eye contact to eye contact.