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Dean Olsher LCAT

Teletherapy Best Practices: How to Connect Visually

Part 2: Now’s the time to lean in.

This is the second in a series of posts on ways to improve the online psychotherapy experience. Teletherapy is suddenly the new normal, and many people are understandably scared of embracing technology. It’s especially hard because strong therapeutic relationships rely on a concept borrowed from neuroscience called the social engagement system, which describes how we use our voice and facial cues to signal safety.

“When we use devices for communication,” writes therapist Deb Dana, “the important nonverbal elements conveyed in tone of voice, facial expression, and body language are often lost.”

That is true, but it doesn’t have to be. If we give some thought to how we use equipment that we already use every day, we can make up for the shortcomings of online psychotherapy.

Photo by Dean Olsher
Don't do this.
Source: Photo by Dean Olsher

Part 1 of this how-to series was about getting your voice in the other person’s ear. Today I’ll share why it’s important to let them see your face. Let's begin with what not to do.

The first thing you'll notice is that you can't see my face. It's cast in shadow. Also, I'm far away. These problems are easy to fix and do not require fancy equipment.

By making just a few small changes, it's possible to radically alter what the other person sees and, as a result, what they feel as well.

Photo by Dean Olsher
Do this.
Source: Photo by Dean Olsher

What's different? The first thing was to move over a few feet, so that the window was not behind me. I moved much closer to the camera and I put a small desk lamp on the table in front of me to add a warm light. I gave a little thought to set dressing and made my new Hilma af Klint poster the centerpiece of my virtual office décor.

Another difference that won't be immediately obvious to you is that for the first photo, I used the camera on my laptop. Even though it's the most expensive piece of computer equipment I own, it is seven years old. The camera on my significantly cheaper but much newer phone is noticeably better.

 Photo by Dean Olsher
You can improvise your own camera stand.
Source: Photo by Dean Olsher

Perhaps you already own an inexpensive stand for your phone. If not, you can improvise your own. This is what I did to make sure the camera was at the proper height for my face: I stacked some books and, to keep the phone from falling over, I put something small but weighty in front of it so as not to block the camera.

That reminds me of one reason why it's better to use a phone than a tablet. Your phone's camera is much closer to the screen, which is what you'll be inclined to look at. When the camera and screen are farther apart, as they are on a tablet, you'll be looking at the image of the person on the other end, but to them, it will seem as if you are looking off to the side.

You don't need special technical knowledge to do teletherapy. I have no training in photography–in fact, I listen to the world more than I look at it. It's possible for all of us to have a better experience online simply by thinking about things from the other person’s perspective.


Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W. W. Norton & Company.


About the Author

Dean Olsher is a licensed creative arts psychotherapist in New York City.