To zoom or not to zoom: that is the question.
No one question has occupied the professional minds of psychotherapists in the 2020s quite like this. Are online and in the room equivalent? And if not, how ought we work?
In Shakespeares’ famous soliloquy, Hamlet debates the merits of continuing to face life in all its rub, work and suffering, versus the temptation of an everlasting (though existentially limiting) sleep. To be or not to be, isn’t just asking whether we choose life or death, but I feel, whether we engage thoughtfully and actively in life, despite the inherent difficulties of doing so.
With 20:20 hindsight, it’s easy to see that prior to the pandemic the question of online working was under-explored amongst psychotherapists. Back then, I heard two opposing views: that online working is “no good”, conversely, that it’s “exactly as good”. Then, I didn’t think much about it, though now I recognise I was probably biassed toward the embodied relating of physical presence. Importantly, and as is often the case, when bias goes unchecked it becomes an unconscious worldview. It becomes, in effect, a little death. A death to thinking.
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That all changed when the pandemic lockdowns necessitated an overnight shift to online working. The adjustment was massive and I know many colleagues struggled with the technology and the isolation. There was little evaluation of nuanced implications as we simply had no choice, and little clinical experience to draw upon.
The “return to normalcy” was less sudden and less total. There were calls for a full return, but across the board this didn’t eventuate. In my practice and the practices I supervise, a more organic emergence took place, based on the needs of individual cases and the practical considerations of the therapist. What seems to have stabilised now, is a more hybrid way of working. And in that stability and with more critical reflection, some interesting patterns and considerations seem to be becoming clear.
As we began to emerge from lockdown, I attended a seminar on online working, attended by many psychoanalytically oriented therapists. I have to admit being shocked at the primacy of mind in the presentation. The central argument seemed to be that in meeting on screen, therapist and client still relate through seeing, hearing and speaking, so then the same relational experience is had. The argument glossed over the embodied aspects of relating, and didn’t account for what is excluded through the camera’s frame. To be fair, the mostly analytic audience picked up on this in the discussion, but the initial paradigm bias was striking.
Similarly, I’ve heard therapists who work from a psychospiritual perspective, suggest that when working online, intuitive knowing is equally as available as it is when working in the room. To my mind, this is a gross generalisation, and fails to recognise the subtle embodiments that contribute to transpersonal ways of knowing, some of which I will explore later.
I have also seen many proponents of working online, and can imagine those practicing manualised therapies, may only consider practical and behavioural dimensions. In this way, online and offline formats can seemingly be equated: the same worksheet is competed, the same words spoken and thoughts and feelings expressed. But again, such an examination is only looking at what’s going on in the therapeutic relationship at a superficial level. Indeed, in some ways of working, and at some levels of relating, these determinations may well be quite valid. The point I am making is that whatever paradigm we are working with, is likely to bring bias and assumption. Reflecting from an integrative perspective, and sitting with as many dimensions of to be and not to be as possible, is where we can remain truly alive to the question.
Institutional and personal blindspots
I’ve eluded above that there was a call to return to “normalcy” when lockdown restrictions ended. Such calls I feel, failed to understand the enormous shift in lifestyles and preference that occurred throughout the pandemic. Evidence of this is how widespread “TWATS” (those working in-person on Tuesday, Wednesday and Thursday) have become in many organisations our clients work. Clients have moved countries or cities, shifted timetables around to fit in with changed employment expectations. In many cases, returning to the old “normal”, simply wasn’t possible nor desirable. At an ethical level, we should note that the calls to return in some cases, were cried out by economic “masters”, who sought out some benefit of their own. Power isn’t always bad, but acknowledging the bias of those who might benefit, is important to avoid unconscious manipulation.
Personal blindspots may also have contributed to an avoidance of return to the post lockdown world. Newsflash: therapists have our own “stuff”. We might be colluding with a clients fear of return, because working from home is convenient. We might underestimate the unconscious fear we carry, since the collective trauma of pandemic and lockdown. We owe it to our clients and the work we do, to become as aware and as free from such unconscious material as we can. In this way, we can remain alive in relationship with them.
Examining relationships in zoom and in the room
The hybrid way of working has provided the opportunity to contrast the experiences of online and offline working, noting how the same dyad (i.e. client, therapist relationship) may show up differently. My examination here is by no means complete, but reflects some key aspects of my thinking, and the thinking of the many colleagues who I have discussed it with.
The container and the online frame
The most fundamental consideration for safe and effective therapy is the container. Maintaining safety of the container in the online format is an extra demand that the therapist must think about. Can the relationship consciously process the implication of a client joining the session from an intimate space such as a bedroom? Does the therapist know when the client forgets to shut the door? And how does the risk of being overheard by a colleague, partner or parent, affect the quality of the work? This is an additional dimension to an already big job of containment. It’s important to think this through, as in some cases, working online might not be safe or effective enough for the work.
We also might consider how the video format alters the frame. Even the best webcam and screen cannot capture all of the clients body language, or every detail of the room. To mediate this, we might setup the camera to capture some of the torso, without reducing the clarity of facial expression. We might also work with what is (consciously or otherwise) bought in, or left out of the frame. Such work can be fruitful, but can’t completely emulate the 360° visual attention of being in the room.
The screen as attachment mediator
The title of Susie Orbach’s 1999 book The Impossibility of Sex connects us to an important limitation of online working. The screen not only mediates physical proximity, but also the possibility of physical contact. While such contact might already be precluded by ethical boundaries, the impossibility introduced by the screen brings a deeper, less rational distance. We might ask, is the fear of violence or sexual violation truly available, when separated via a screen? In my experience it might be there in mind, but the rawness, hence the evoked emotion of projective fear or desire, is greatly lessened.
This is particularly striking when working with younger or dissociated psychological parts who might not recognise the therapist on the screen, as the therapist they know. The sense of trust can be subtly diluted, as the two dimensional image doesn’t convey the entirety of the embodied relationship. Especially to parts who may desire, or fear, skin on skin closeness. This it seems, is surmountable in an online format with focussed and attentive work. We might imagine the physical closeness, or have the client find words to describe the desire or the fear. We might process trauma that these parts carry. But, in my experience, when a dyad returns to offline working, aspects of these experiences which have not been processed can emerge - sometimes with great fervour.
The counter-side of this is the enhanced intimacy of being with a client, (usually) in their home. This can bring a level of comfort and relaxation that actually enhances relational intimacy. At the same time, some of the ritual and separateness of attending the therapists office in person is lost. Again, no clear winner here, just further considerations and differences of which to attend.
Relational presence: a transpersonal phenomenon
If we return briefly to the mind-centric thinking of the psychoanalytic meeting I mentioned above, we come across an incorrect, though pervasive assumption. To paraphrase, it is to assume that all embodied affect is stimulated by what is seen, heard and thought. This is the “mind as computer” paradigm, a caricatured “central processing unit” with various “input and output” devices. Any embodied practitioner knows that the bodymind is much less centralised, and much more of its own autonomic intelligence. Any practitioner who works “from the field”, or with a highly attuned presence will also know the stimulation of affect, and more broadly “transpersonal knowing” arises from our introverted sensations. That is to say, deep within, we have a knowing which is without.
In Jungian terms, we might consider this the access point to archetypal realms or the collective unconscious. But transpersonal knowing can arrive into awareness from any of a number of dimensions of consciousness. To use the work of Ken Wilbur, we can see that the archetypal and the collective are aspects of the causal level of consciousness. If we considered the energetics of the physical body, then we are operating at the subtle level of consciousness, where we come across the concept of the centaur or bodymind. It is here that we meet an important distinction of what constitutes relationship in the offline world. For contact at the subtle level, despite being a non-seen realm of consciousness, is in part, related to physical proximity. Wilbur’s thesis is that the subtle body extends about a metre (give or take) from the physical body, and my experience tells me the same.
These concepts are perhaps confusing, so an example might help. I was walking down the street recently. and although I didn’t at first see it, I became aware that a frightened black cat had pounded down the steps of a terrace house. If I slowly replay the moment, I recall very clearly a sensation in my leg. It was not physical contact (extraverted sensing), rather an energetic disturbance which I noticed in my leg (introverted sensing). If I extrapolate, I believe the cat’s subtle energy field had met mine, and in that moment, my body communicated the frightening presence of another being. In a sense, my leg was frightened by the cat, milliseconds before I saw, heard, or even discerned the presence of the cat.
We tune into this subtle awareness all of the time, though we might not be aware of it. Walking into a crowded tube car on London underground’s northern line on a weekday morning is particular evidence of the subtle. The unspoken sense of dread in the collective energy of the car is often palpable. Conversely, the vibe of a lively car on a Friday evening is often times infectious. We are collective, interconnecting animals, and it is in part through this subtle level of energetic communication that this interconnectedness occurs.
Then, we have to consider, what bioenergetic communication is missing when we aren’t in the room? This is not to say that there’s no embodiment, because clearly working on screen captures empathic resonances which originate through seeing and hearing, or are communicated at the causal level. But some aspects of energetic rawness, experienced at the subtle, require actual proximity.
So to zoom, or to room? What’s it to be?
You’re probably not expecting me to offer a binary response to this question, and I’m not going to. Though I would say, that I expect any practitioner who works entirely and exclusively in one format or the other may well be deadening some possibility within their practice. The most important thing is to consider the issue broadly, and if possible, from multiple dimensions and dimensions outside of your dominant worldview.
In all things, understanding the tension of the opposites and what is gained or lost along that tension is what’s important. In the case of online working, I’ve noticed in my internal processes, that I am beginning to develop a felt sense for when there’s something excluded by the screen. When this happens, I suggest, encourage or insist that we spend some time working in my physical office. In every case so far, this has resulted in an uncovering of an emotional dynamic which was hiding. And, importantly, the now conscious dynamic can be worked with once we’re back in the online format.
So returning to Shakespeare. To be or not to be, is indeed the question. The answer however is never to answer it. To instead stay alive, with the grit and the rub, to the those beautiful questions, that don’t require a terminal answer.
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