As a therapist, I never wanted a home office. My commute is annoying at times, but it creates a clear demarcation between being on and off. Besides, my office is private and comfortable. There's a leather chair with an ottoman for me and a couch with ample cushions for clients. Ironically, without ever having thought about it, we probably sit approximately six feet apart. Although many therapists choose to work from home, I like that aspect of my personal life to remain private. I don’t even tell clients the name of the town where I live.
Then the world was turned upside down by a pandemic, and I made the decision to work remotely. I repurposed a guest bedroom into a makeshift office, setting a table for my laptop and dragging in my favorite chair from the living room. The walls are nearly the same green as the ones in my office, which is comforting.
Like most therapists, I’ve always kept a physical distance from my clients—other than the occasional handshake upon meeting, or hand on the shoulder upon leaving after an especially intense session. But being in the same room, hearing each other breathe or sigh, watching the tears flow or the sound of someone shifting in their seat, creates an intimate closeness nonetheless.
I had no idea how that would translate to remote work with clients. Even if we could see each other through a webcam and hear each other’s voice, what would it mean emotionally to not be in the same room? I was surprised at what I found. Instead of feeling distant from my clients, it seemed as though I’d entered a new realm of closeness with them, which put our relationship in uncharted territory.
I was in their homes and they were in mine. I came to know them in new ways. One client introduced me to her husband on screen, another sat in bed without makeup (a view of her I’d never seen before), and another exclaimed, “I have those same glasses!” when I took a drink of water. Still another client commented, “I love all the windows you have.” As I saw the artwork on their walls, their choices in furniture, and many of them wearing more casual attire than ever before, the physical distance between us seemed to shrink.
But there were challenging adjustments to make, too. I changed my hours to help people meet during times conducive to their privacy. I was now talking to my 4 o’clock Thursday client at 7 a.m. on Tuesday. And staying in my professional mindset while throwing a load of laundry into the washer between sessions was new to me.
Quickly, I also realized the pacing of a session is different on a video platform. Some clients who are chronically late to sessions, without the stress of driving or finding parking, were now in the “waiting room” early. The initial minutes of a session that often consist of someone taking off a coat, settling into a seat, and exchanging pleasantries, and that have always allowed me to assess their overall state of mind, were gone. Now we sat face to face from the outset.
I also found it harder to end sessions smoothly. In person, there are ways of signaling that the time is drawing to a close, motioning to get up or diverting my eyes to the clock. I always try to give a warning, so clients have time to finish their thoughts and collect themselves before reentering the world. I also caution clients not to jump onto their phones right after a session, to try to build in transition time for themselves. But now, transitions for most of them were shortened by family members hanging out in the next room.
For me, the most jarring part of using the video platform was seeing myself during the session. Not since my training days have I actually observed myself in my role as a therapist. It was distracting to watch myself listening. Getting rid of that feature was imperative to improving my ability to pay attention to my clients, and I asked them to do the same, if possible. After all, reducing self-consciousness is at the heart of a good therapy relationship.
Some of my clients chose just to talk over the phone. But the majority chose video, which allowed me to better assess their overall well-being. It felt a bit like an old-fashioned house call. A common way I evaluate my clients who suffer from depression is to ask them, “Is your house doorbell ready?” In other words, would you be embarrassed to let someone into your home without notice? In the past, I’ve always relied on their self-report. Their answers provide a concrete way for me to understand how much their self-care has slipped. These days, with no one going in and out of each other’s homes, it’s easy to imagine dishes piling up, beds unmade, and dust bunnies galore.
Video enhances my ability to assess how well my clients are functioning. I’m hopeful that by inviting me into their home each week, they’ll be motivated to shower and tidy up, all of which contribute to better mental health.
Pleased by how quickly I adapted to the ins and outs of using video, my appreciation grew for how connected we could stay no matter how long I had to work remotely. I’m also recommending my clients use video to stay connected with others in their lives. I suggest everyone, especially those who either live alone or those who feel alone in their living situation, have frequent video chats with another person besides me. This interaction will bolster their well-being between sessions.
It bothers me not to be able to tell my clients when we can resume sessions in my office again, with its comfortable furniture and cozy privacy. No matter how accustomed I become to working remotely, I know I’ll gladly get back in my car and return to my office when this is over. What’s more of a question is, will my clients feel the same?
Maggie Mulqueen, PhD, is in private practice in Brookline, MA. She’s the author of On Our Own Terms: Redefining Competence and Femininity.
Photo © iStock/MamikaStock
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