Before the pandemic, I had a pretty low opinion of conducting therapy by phone or video. I thought that it would take away from the rapport-building value of physical presence in session, that it would be a frustrating and inefficient way of working on intimate life issues in a forced and artificial environment. In fact, I probably would never have tried teletherapy had the Covid pandemic not forced my hand. And overall, I’m happily surprised with the experience. It’s opened doors for me to be able to treat clients who live in other cities or small towns, it’s taken some of the stress off on my end due to the convenience of the approach, and it’s forced me to get creative in some of interventions I use in session. And while teletherapy isn’t as much of a compromise as I feared, it’s also not without its drawbacks. I’ve noticed that for some clients it leads to less commitment and respect for the therapeutic space. I’ve had clients begin their session from the bathroom of a friend’s house, the inside of their (parked) car, and even outside of a mechanic while they were having their car worked on. I’ve had to set boundaries around such therapeutic spaces in ways that I’d ever considered before, but on the other hand I’m also given the opportunity to meet clients where they are rather than strictly on formal terms. I’d like to give an overview of the ways I’ve adapted to being a teletherapist, and I hope that it will be useful for both professionals and people considering starting the process for themselves.

Making Space

I’ve been much more conscious of my personal space since I started working through Zoom. Since there’s no need to have a physical office at the moment, I’ve conducted sessions from my home, often on my living room couch; the same place I relax, watch TV, read, and in safer times entertained guests. I believe that being a professional therapist means having very strong boundaries and building mindfulness of one’s personal and professional lives, and I think I do a good job of this. I’ve noticed that I can last longer in more high-stress work environments than some colleagues and that I’m able to take a break before I reach a point of burnout. I try my best to be aware that I’m not “taking anything home with me” from my work, but what does that mean when you work from home?

In all honesty, I’m surprised that it doesn’t seem like more of a conflict than it is. I truly haven’t felt unnecessarily drained or found it difficult to distinguish my personal from professional life. I’ve experimented with having sessions in an office area in my home, but I haven’t noticed any real difference in what it feels like. All that being said, I may be a unique case. I can imagine that for some therapists that seeing clients virtually in their own home would feel overwhelming and maybe even inappropriate, and it’s up to each clinician to be responsible for how they handle these boundaries. And even though I don’t feel drained from this overlap right now, I’m also frequently checking in with my own emotional state and gauging what feels acceptable and comfortable.

Creativity

One outcome I didn’t foresee is how teletherapy has allowed for more creativity in my interventions in session. A portion of the work that I’ve done since lockdown has been with adolescents, and in working with younger clients I find that it’s more important to have more directed activities to engage in to keep their attention and strengthen the therapeutic relationship. When I met younger clients in person, we would often color, play board games, cards, or word association games while chatting. And while some of these types of interactions are still technically possible, I have definitely had to adapt. One of the most effective means that I’ve done this is by taking advantage of screen sharing. I’ve collected various well-known pieces of art and shared images of them with clients in session, eliciting their feedback. I’ve found it to be a really good way to start a conversation, especially if the piece of art is evocative of a certain emotion or relatable situation. Additionally, clients are able to draw over these pieces of art on their side and add things to them, which introduces an element of further interaction.

Perhaps the most ambitious and unorthodox thing that I’ve started since beginning teletherapy has been using Minecraft as a therapeutic tool. For those unfamiliar with it, it’s a highly popular video and computer game in which one can create and alter a virtual world essentially comprised of various types of blocks. I’ve found that this approach has a high level of appeal for adolescents due to their likely familiarity and affection for the game. In order to prepare for a Minecraft therapy session, I ask the client to share their screen with me and start the game in creative mode. This allows them all the necessary tools to create and alter a 3-D landscape. From there, I’ve found that many prompts used in sand tray therapy therapy are just as applicable to Minecraft. This approach is fascinating not only because it allows for unrestrained and enthusiastic creativity, but it allows therapist and client to virtually inhabit the constructed space. This can lead to some very insightful discussions and cognitive reframes.

The Illusion of Distance

All in all, teletherapy has given me a much better perspective on how interconnected our world has become. It’s one thing to speak to a loved one on Facetime or communicate with a stranger on the internet through text, but developing a therapeutic rapport with individuals I may never meet in person has been a memorable experience. I’ve learned that, despite its drawbacks, therapists have the ability to connect with and intimately help virtually anyone with access to a smartphone or computer with a camera. I wonder to what extent Covid will permanently change the landscape of therapy, and if this might look something like the new norm. I’m happy to discover that I personally wouldn’t mind having a few long-distance clients on my caseload.