Privacy

My first finding was that privacy concerns can impact a client’s ability to be fully open and honest with their therapist, as well as their willingness to pursue therapy in the first place. Several of the clients I talked to are college students who previously pursued in-person therapy when they were not living at home. Some found that although teletherapy options were offered, pursuing teletherapy from their homes was not an option due to privacy concerns. One client I interviewed, when I asked her whether or not she would be actively pursuing teletherapy were she living at home that semester (she opted for off-campus housing) said, 

“I honestly don’t think I would, just because of the privacy issues, and I don’t feel as comfortable like back home to do therapy. Yeah I definitely feel more comfortable, like where I’m living currently, because I have more space.” -Y, client

She went on to discuss how her home had “thin walls” and she wouldn’t want her family hearing the nature of what she was discussing. However, she also mentioned that she sometimes felt nervous expressing her current grievances with her living situation to her therapist should those very same roommates overhear her conversation. Other clients I spoke with expressed similar concerns.

“No I uh, totally would, but for yaknow [gestures to the door] but I don’t know that it’s so much for the fear of my parents overhearing or my sister for that matter, certainly not my sister. But for fear of having conversations, having those conversations, in this house, where I can’t be that person.” -S, client

Typically, entering a therapists office means entering a new, and neutral space. You can define who you will be in that space. If you want to, you can bring your full self, or if you choose not to, you can shape who you are in that space. But what happens when these spaces of work, and home, and childhood trauma fold into one space. How would one have a conversation in a place where she is no longer that person? How do our personal associations with an environment impact our ability to feel comfortable and our ability to be honest?

I was curious how the same privacy concerns might impact therapists similarly. One of the therapists I spoke with continued to conduct the sessions she led from tele-call in her office. However, she also mentioned that some of the clients she was perviously working with expressed concern or discontinued therapy due to the new privacy concerns in conducting sessions from their home. The second therapist I spoke with mentioned that he was living with other therapists, who were all able to keep to their rooms and not disturb one another when sessions were taking place. 

From this, I seemed to infer that the group more concerned with privacy was, in general, clients since they are the ones in a session who are typically more vulnerable. 

Emotional Distance

Through conducting interviews, I also found that therapy created an enhanced sense of emotional distance between the client and therapist. This seemed to be felt by both clients and therapists alike. However, the impact of this sense of distance differed between clients and therapists. Surprisingly, many clients that I spoke with seemed to like this increased feeling of distance. One client I spoke to said:

“And also like, I feel like something about Zoom. Like kind of distances you a little bit from the person you're speaking to, which is sometimes good in therapy, I think, because like, you're not thinking too much in your head, like thinking like, oh, should I say this or that you kind of just say it. And in some situations, that's like, really bad because, you know, you still want to connect with the person a little bit.” -Y, client

This quote demonstrates this two-sidedness to the feelings surrounding teletherapy. For Y, this distance helped her feel like she could be honest upfront with her therapist, but also felt foreign to her, given the way that we regularly connect with other human beings. 

For one client, S, she found that this distance relieved some of the pressure of interpersonal connection that she felt in her in-person experiences. 

“Honestly, I think I’m more comfortable online. I, I have issues with empathy, and connecting to other people, and when you’re online, the pressure to get over that isn’t as smothering.” -S, client

Therapists, on the other hand, seemed to have a different view concerning this sense of distance. In a podcast where therapists discussed the transition to practicing online in response to Covid-19, they discussed how “when you’re in the room with someone, there’s a flow that goes back and forth that is energizing. The Zoom platform disrupts that, and the transfer of energy is not happening.” The men went on to discuss how without this “energy” of being in the same room as another person, the experience was very fatiguing. Many students or professionals using the Zoom platform for several hours a day had a similar experience noting this feeling of “Zoom Fatigue.” 

One client in a focus group I contacted expressed similar feelings of this lack of energy transfer. 

“So I don't know, I’m, like, really into the aura thing. But I do think that people have mental energy, I think it is harder to pick up on someone's energy when you're not physically in the same space as them […] I don't know, I think like, there's just something innately special about being in the same room as someone else.”

It seems that regardless of whether or not you’re interacting with others digitally for work, school, or therapy, there is a difficult to articulate energy missing from the experience. The impact on what this missing energy does, however, I think varies from individual to individual and from experience to experience. 

Another factor that influences the sense of emotional distance is the absence of being able to perceive body language. As humans, we are used to interacting in spaces where we can read so much more than someone else’s words. One of the clients that I interviewed currently conducts her therapy sessions over the phone. According to Professor Mehrabian, 93% of conversations are non-verbal, and 55% percent of conversations are communicated through body language. It’s no wonder something feels “missing” from these digital conversations. 

Many of the clients I interviewed had had in-person therapy, however were now seeing new therapists online. When I asked them questions about their therapists, many drew blanks. What kind of space were they in? Had they had online therapy practices prior to the pandemic? Although the conversation between a therapist and a client is generally focused on the client, it did surprise me that the clients I spoke to seemed to know so little about their therapist. 

“My therapist has a very in conspicuous white background so she's by a window because she has like the like me. But that's that's all I know about her.” 

However, it is difficult to determine whether this is something that reflects the digital platform, or something that is generally true of client-therapist relationships. 

Convenience & Affordability

“I’ve had a much better experience online than in-person. And this way I don’t have to pay an Uber driver every week.” -S, client

One aspect of the project I had not previously considered embarking into my research was the impact of transportation on the whole therapy experience. For many, traveling to and from a therapy session in the past might take as long as the therapy session itself. For those without access to a vehicle, shared rides or public transportation might introduce additional costs to the price of therapy itself. While the cost of therapy itself for many hasn’t changed, the associated costs of transportation have been significantly reduced if not eliminated depending on where the sessions are conducted. In that way, therapy might be made more affordable and convenient. 

One of the therapists had a similar take, mentioning that you couldn’t beat the convenience, though he also noted that he missed the energy surrounding the in-person experience. He mentioned that the remote experience allowed him to feel like he had more time in his day than he previously thought.

For many of the clients I spoke with, they said that given the choice (pandemic aside) they would prefer the experience of teletherapy for the convenience alone whether the remote availability meant taking less time out of the work day, being able to have more regular sessions, avoiding paying an Uber driver, or eliminating a thirty minute walk.

In terms of affordability, teletherapy appears to have a mixed impact on finances for therapists. For some therapists, many clients are no longer able to afford therapy if their financial situation has changed. In April of 2020, due to Covid-19 the unemployment rate in the United States reached a record high of 14.7%. However, for one therapist I talked to, she mentioned that her finances actually improved as a result of the pandemic. With sessions being held remotely, she said, many of her clients became more consistent, as they weren’t having to reschedule due to travel, etc.

Additionally, one concern that came up in multiple interviews was insurance concerns. I believe that this issue might be one particularly facing college students who may currently be residing in a different state than they would regularly be. This causes difficulty when therapists may only be able to practice when the client is currently living in the same state. Even though virtual therapy is not different whether you’re in the same state as your therapist or not, due to licensing and insurance, many therapists are not able to practice with clients they might have otherwise.

Emotional Processing

For in-person therapy sessions, there are certain ritualistic procedures that are introduced by the nature of the space. Prior to a visit, a client may have to wait in a waiting room, and when they walk into the office itself, they know they are entering an environment where a certain type of conversation will be conducted. In leaving the appointment, they may have the drive or other form of transportation between therapy and home, creating a forced transition between the two environments. This transition, for many, is completely absent. One client in a focus group discussion mentioned how she takes an hour out of her workday to do therapy on the very same computer where she did her work, watched Netflix, and talked with her friends. 

For many, Covid-19 has meant very little separation of work and home, so this was a question I was particularly interested in. 

“But yeah, I've definitely like, after therapy sessions, though, I've definitely felt like I had to, like, take a step back for like, 10 minutes, and just like, process everything. But I don't know if that's just like, because it's virtual. Or it's just like therapy, and you just need to process emotions and stuff.” -Y, client

Additionally, for those living in shared spaces, they may feel that they aren’t able to process the emotions that they need to. 

“I don’t if I’m still crying I’ll just stay in my room until it stops. Um, and then I kind of have to hide it, yaknow, which doesn’t help the whole trauma thing. But, but I don’t feel safe if I’m not sure I won’t be bothered. My parents are, yaknow, polite enough to not deliberately invade when I’m, yaknow, but, doesn’t mean I feel safe.” -S, client

For some, these environments can feel like unsafe spaces to process emotions. Relating back to my findings around privacy, when these environments feel to unsafe, this can lead to the client not wanting to pursue therapy at all. 

One client I talked to mentioned that he typically would prepare dinner after his therapy sessions to create a sense of space between the emotions of the session and returning to doing homework, etc. Others mentioned that they would typically take a nap, just lie in bed,  other means of artificially creating the space that was naturally created by travel time.