How to think about psychotherapy in a digital context

Advancing Telecommunication Technology and its Impact on Psychotherapy in Private Practice

“…He describes how VOIP (or ‘teleanalysis’, as he terms it), reduces the journey to therapy to just one click of the computer mouse, making it seem more like a magic game than making a real, serious connection. Once a computer session is started there are questions about how we as therapists relate to the computer screen and to this ‘virtual space’ (Balick, , p. 32) imagined to exist between us and our clients. There is a self‐consciousness associated with using a video camera reinforced by simultaneously being able to see a picture of oneself on the screen as one talks.…”

“…The experience of feeling less emotionally attuned to the person at the other end of the line coupled with the self‐consciousness that comes from observing oneself can heighten the feeling that the conversation tends towards a narcissistic or solipsistic exchange. Balick (, p. 32) makes the point that in feeling less emotionally connected to the person at the other end of the line, there is a greater opportunity for participants in computer‐linked conversations to experiment with projecting different identities. One respondent thought that the couple he worked with using VOIP used their screen to present an over‐idealized image of themselves to themselves and to their therapist: that of being a linked couple (they used one video camera and sat closely intertwined on a sofa at home), which was at odds with the reality of their non‐relating.…”

“…This raises important questions about whether it is appropriate for therapists to access data that have not been personally volunteered by clients. Putting aside the therapeutic implications of whether therapists act in this way, there seems little doubt that prospective clients (especially younger ones) are increasingly browsing websites to access therapeutic services and are using the internet to research the backgrounds of prospective therapists (Balick, ).…”

Therapists' and counsellors' perceptions and experiences of offering online therapy during COVID‐19: A qualitative survey

“…Theory and research on the phenomenon of physiological coregulation in therapy dyads (Kleinbub, 2017) has suggested that reduced access to non‐verbal information might have a negative impact on therapeutic relationships online, with some therapists reporting that they feel less attuned to their clients (Gilmore & Ward‐Ciesielski, 2019; Hoffmann et al., 2020; Interian et al., 2018; Sucala et al., 2013). Furthermore, online therapy has been reported to increase clients' self‐consciousness, exacerbated by clients being presented with an image of themselves on screen (Balick, 2014). Technical failures (e.g., loss of Wi‐Fi connection) can also disrupt the sense of contact between the therapist and the client (Cipolletta et al., 2018; Interian et al., 2018).…”