The other day, therapists working with Circle Counseling considered how we are going to manage the new reality of teletherapy. I’ll get to that.
But first, I’d like to think about what is happening to us humans in the age of virtuality, of which teletherapy is a part. I am not sure what virtuality means, completely, but how I am using it is:
you and me, individually, connecting to the great power that is the internet.
You and your screen,
you and your headset,
you and your Oculus, etc.,
accessing experiences, products, and representations of people
outside of embodied, mutual physicality.
I did not bother looking for a better definition. It would be nice if we shared one. We need some kind of common understanding for this new experience, but that will be hard to find. Because part of the facts of living in our new condition is that each of us has our own experience and resulting definition of what just happened. And we don’t need to explain it to anyone, just conform to the rules that let us into different parts of the internet.
There is a new creation occurring
I decided I needed to get serious about what I, my family, partners and clients were experiencing in the solitude of our virtual lives when I happened upon an article in the New York Times about a Japanese man, Akihiko Kondo, who is among a growing number of people who have intimate relationships with animated, but inanimate, characters. He married a fictional character in 2018: “Hatsune Miku, is a turquoise-haired, computer-synthesized pop singer who has toured with Lady Gaga and starred in video games.”
Mr. Kondo is one of tens of thousands of people around the world who have entered into such unofficial marriages. Some of the characters they marry come from manga. Manga is a style of graphic storytelling which is a mainstay of Japanese publishing and popular worldwide. A child of one of my acquaintances lost their job because they are an “otaku.” In their case that meant they were addicted to manga stories in a way that made them unable to relate to reality. Their experience gives me sympathy for Mr. Kondo. I wonder who among my loved ones is losing their hold on reality right now.
The younger my clients are, the more likely they are to feel disembodied. Some are more comfortable with virtuality than merely human reality (as in the many young men who have difficulty with sex because they are acclimated to porn). Many are avoidant, mistrusting of “reality,” which is so uncontrollable. I’ve noted a vicious cycle. Their relationship with virtuality is often about controlling their anxiety. But virtuality ends up controlling them and creating more anxiety. Those feelings, in turn, require deeper commitment to what controls them.
I am pondering what our wholesale adoption of teletherapy, which I can accomplish in pajama bottoms and never leave the confines of my home (perhaps ever), is doing to the people we want to help. Is using the medium attaching them more securely to it? Can they ever receive what I offer if they never make the effort to know me (or themselves) as a living breathing human? Or is it OK to marry a fictional character?
Where is teletherapy leading?
I practice teletherapy and now have clients from all over the country. NPR is constantly recommending the latest in teletherapy businesses. And even though I am sounding suspicious, I know I have provided helpful therapy screen to screen — sometimes to people who would not have received it otherwise. So is there really a problem? Is there any line at all from teletherapy leading to manga addiction, much less a direct line? I don’t know. I just have a hunch there might be something worth considering.
Months before the omicron variant hit, researchers were producing articles on how teletherapy was radically changing the practice of psychotherapy. Even as my comrades were talking about what we are going to do, I got on my other screen and found an article from March of 2021 titled, “Will We Ever Again Conduct in-Person Psychotherapy Sessions?” A few of us had already decided, “No.” Others wondered if they wanted to get back in an office. And others were dismayed the question was even being asked because they needed off the screen.
Keep in mind, the researchers I uncovered were writing about research done a full year before Omicron was discovered in South Africa and quickly turned the world upside-down again. Two and more years of adaptation to lockdowns and social distancing is more than enough to solidify a new approach.
After more than a year, the researchers reported positive experiences with online psychotherapy. Long before the pandemic, some cognitive–behavioral therapists had positive attitudes toward teletherapy. Psychodynamic people, like me, were less enthused. In their study, the participants stated the pandemic changed their attitudes toward teletherapy. Over 60% said they now preferred it.
However, 70% of the participants agreed that remote work is more draining. Nevertheless, 78% agreed with the statement: “Remote therapy can be as effective as in-person therapy.” I think screens can suck the life out of us, and I believe the powers that run them are intent on doing just that. But I don’t feel drained by remote work. What’s more, even though I think good work is done virtually, I don’t think it is one to one comparable with what happens in person. I guess that puts me in the 30% of something.
This little piece of research and just looking around will tell you teletherapy is here to stay unless some compelling reason forces us out of the arms of virtuality the same way we were forced into it. We’d have to break a habit.
There are reasons we won’t break the habit
Many clients prefer teletherapy. Thus, I have met entire families as they interrupt mom’s session. I’ve had sessions in several cars. Every session begins with making sure the connections work. Many sessions are interrupted by some glitch. But no one needs to go anywhere and sessions can fit into the catch-all schedules we concoct now. Why rent an office if you can work from a free one?
Vaccinations have made a big difference since the researchers were talking to their participants. But health concerns remain. Many of us can’t risk carrying home some unknown virus to our aging parents, who now live with us instead of virus-ridden care facilities. You may be concerned about what it means to your own health when you think about signing up people you don’t know for therapy — some populations would be more likely to be carrying the virus! If masks are required when new variants strike, that makes in-person therapy not much better, if not worse, than online.
Insurance for teletherapy was set to expire as the pandemic waned. But it appears people will be reimbursed at the same rate for teletherapy by providers. The new online businesses advertising relentlessly will take a chunk of the increase therapists might have realized. But if you already have an established practice on your own, the cost of not needing an office is a nice, needed pay raise.
There are reasons we probably should break the habit.
I wrote my dissertation on an ethical issue, and I often lean into those questions. Teletherapy makes me wonder, “Is confidentiality affected by teletherapy?” I don’t mean “Is Google somehow listening?” But few of my clients have a devoted space to do quality work. Babies come to therapy. Children interrupt. Any number of devices need to be quashed. When at home or in a closet at the office (unless you see execs with a corner suite) there is a sense of holding invasive things at bay. It is distracting. And it is often not private. Confidentiality provides safety. An office overseen by a caregiver who provides it for caring is a benefit.
I also wonder if doing therapy out of my home is boundary breaking. Maybe you blur your background and hope your head stays in focus. Or maybe you have constructed a background that makes your circumstances appear neutral. But we know where you are. I think many people do good work by visiting people in their homes to do therapy. Some people have little office buildings in their backyard. Good work is done many ways. But I wonder if it serves the unique process of a client when they are enveloped by the personal world of their therapist. Granted, the office can do that too. But at least the office is, by definition, a place where professional services are dispensed, often by a person licensed to give them.
My main issue with not breaking free of virtuality has to do with community. When our therapist group was sharing I felt hungry for more togetherness and most of them voiced similar feelings. Let’s talk about cases. Let’s have dinner. Let’s build some love. We are starving. Yes, we are just coming out of the weirdest two years ever, perhaps. But our starvation is the future if we conform to the changes the pandemic accelerated. I think psychotherapy is best accomplished in the atmosphere of the beloved community Dr. King preached. Attachment issues are best repaired in a place where people attach. Psychotherapy is about our bodies, not just our minds instructing our reactions and feelings. I think people feel it if therapists are not lone rangers, logging in from wherever with whoever.
The new atmosphere of virtuality is an ongoing dialogue worth having. Elon Musk did not spend $44 billion on Twitter instead of climate change action for nothing; he probably wants to be the chief oligarch. The internet domination system is the future. I’m having the dialogue about virtuality quite practically this week. On one hand, just less than half my appointments are in person this week. But on the other, we are flying to Toronto out of a conviction we need to show our faces at an important conference. It is hard to spend the money, time and energy to travel when the governments still feel like protecting their borders (especially getting back into the U.S.!). But really being there and building something planted in creation makes a difference, I hope. Maybe I will have more to say about what not being virtual is like next week.