I’ve been working remotely since the middle of March. While most of us seem to be using video chat platforms like Zoom and Doxy.Me, I find video so inferior to phone contact that I’m not using it at all in my practice. Surprisingly, all my clients have refused the video option too. Why?

Obvious reasons include not having access to the internet (common in our rural community); not owning a computer, tablet, or smartphone (also common); not having the skills (the elderly, the tech challenged); or simply being too ill to manage being online.

A less obvious reason, but possibly more compelling, could be this: clients make themselves vulnerable enough when they shower and dress to come in and see me in the neutral space of my office. Video chat takes away any sense of safe neutrality by letting me peer into their homes—which violates their privacy and arouses a variety of trust-undermining feelings, such as shame, anxiety, and humiliation.

“It’s a mess! I don’t want you to see the house,” one client admitted. Meanwhile, I can work from my office (I’m the only one there), which means my personal privacy is protected while theirs isn’t. Would seeing me in my personal space level the emotional playing field? Not likely. It would only be a distraction, yet another challenge to keeping the focus of treatment on…