By now, we all know the drill: how to gauge a safe six-foot distance, where to get face masks in a five-pack, four ways to mime hugging. And these are just the everyday adjustments. As therapists, COVID-19 has propelled us into a vastly different way of practicing our craft, one that sometimes seems to require a dash of magic.
We’re talking about teletherapy, of course. At first, many clinicians assumed that this radical replacement for in-person contact would be a brief interlude, something we and our clients would endure for a few months before life went “back to normal.” But today, we’re continuing to work mostly or entirely online, trying to find ways to engage intimately with clients without being in the same room.
So, now that we’ve been at it for a while, what do we make of it? In this issue, we’re asking therapists to reflect on their experience—their initial trepidation, the inevitable missteps, and, for some clinicians, the eventual leaps of resourcefulness that have enabled them to stay connected to their clients and move forward with the work of healing. We look at the distinctive issues that arise in particular clinical situations: What special challenges confront a therapist who Zooms with couples? How does a clinician who relies heavily on body-based approaches deal with the constraints of being a talking head conversing with another talking head?
These essays make clear that virtual therapy is not a good match for all clients—or for all therapists. One author still swears by the phone; another carefully picks and chooses among clients she believes can tolerate the demands of online work. There’s screen fatigue, the struggle to maintain intimacy, and the need to negotiate family interruptions by both parties. None of us signed up for this. As one therapist writes, “We need to figure out how to work remotely without being remote.” Even for those who are embracing the change, it’s a stretch.
And, of course, it’s still evolving. The field hasn’t discovered a formula that makes teletherapy reliably “work.” The stories here demonstrate that whether a clinician decides to go the online route, rely on the phone, conduct sessions outdoors, or do something else, effectiveness depends largely on staying aware and flexible, with a willingness to roll with the moment as we navigate uncharted territory.
As I talk with clinicians about their experiences—both the frustrations and the unanticipated benefits—I can’t help but wonder about the future of psychotherapy itself. Once this pandemic abates, how many therapists will choose to return to their offices? After all, there’s the commute, the dressing up for work, the considerable expense of an office. Will the cost–benefit analysis veer in favor of not shifting back to in-person encounters? For some, continuing remotely, at least in part, seems all but certain. For most? We can’t know yet. What we do know is that we’re riding the first wave of a sea change in the field of therapy—nothing less. We’ll need to marshal all the creativity and skill we’ve got to become active, thoughtful participants in this process.