I’m Not Ready for My Closeup!
Or, Adventures in Sudden Teletherapy.
Posted July 6, 2020
(Note: this impressionistic account was dashed off in the early days of the bewildering telemental health explosion. Now, with a few months of practice under his belt, the author feels much more at ease with the challenges and approaches the sudden loss of connectivity with a practically Zen-like equanimity… most of the time.)
I’m reminded so of David Bowie’s “Five Years,” the opening song of his 1972 masterpiece “The Rise and Fall of Ziggy Stardust and the Spiders from Mars,” as I, along with untold numbers of fellow mental health practitioners, have been suddenly plunged into the world of telemental health mere weeks ago.
The song’s apocalyptic refrains describe a world suddenly made aware it has but five years remaining until its end. Even with the pandemic, I personally feel we’ve probably got a bit longer than that. It’s just that five years was my estimate for the amount of time in which I thought I would gradually transition from in-person to give or take 100% virtual delivery of therapy. In reality, it happened more on the order of five minutes, as soon as various recommendations and declarations about social distancing and curve flattening began to fly. Still, paraphrasing Bowie’s chorus just a tad, captures well my initial outlook:
We’ve got five minutes, what a surprise
Five minutes, stuck on my eyes
We’ve got five minutes, my brain hurts a lot
Five minutes, that’s all we’ve got
In truth, I’d done a bit of online video therapy in the past, on a few different platforms. I have to say I was not what you’d call…smitten by the experience. Connectivity, video and audio quality, the ability for the person on the other end to find a suitable place from which to participate (one session with a patient sitting outdoors after a fight with a significant other, as traffic whizzed by and apartment neighbors tromped through every so often, was particularly dreadful). These deficiencies left me feeling hopeful that the tech and the development and adoption of appropriate norms would improve in the next five years, combining to make the experience a lot more patient and therapist-friendly.
But circumstances removed the optional component and the ability to wait on hoped-for developments, teletherapy is suddenly here and ubiquitous. I still remain confident these needed changes will come, but it likely won’t be soon enough to save the neophyte online therapists (and at least a few patients) from plenty of sturm and drang.
I’ve trained myself (mostly) to avoid looking at my own image in the picture-in-picture and instead at the camera, or at the patient’s image. In stray moments though, catching a glance to make sure I haven’t leaned out of the frame, I can’t help but notice my recent weight loss has left me with something of a wattle under my chin. I try to push this thought away as I strive to remain “present” with many miles separating myself and my patient. It’s a delicate balance, trying to remain my therapist self while also taking on a new and strange role as a stage manager of my stilted little televised interview program.
I noticed early on that teletherapy is somehow more strenuous than the regular in-person variety. I’ve heard a number of peers say the same. Eventually, I noted that my problem is possibly my rudimentary “set” which requires me to sit awkwardly at the edge of my already uncomfortable chair to be picked up by my iPad’s camera as it sits perched upon a folding card table as I strive to be both seen and heard (the ideal combo for this sort of thing).
I look into getting an external lapel microphone that will likely allow better voice quality and allow me enough cord to sit more naturally and comfortably. I find one on Amazon, but it doesn’t qualify by their criteria as an “essential” item and the vague delivery estimate is somewhere upwards of three weeks. Three weeks? My back is starting to protest. Can I sit this way that long and still avoid the grim visage one would expect to see on a mid 19th-century daguerreotype?
I consider pleading my case to customer service about how this seemingly inessential item is really essential-ish. I wonder, “Will I even still be doing this in three weeks’ time?” I watch highlights of the daily update and place the order, resigning myself to the fact I’ll still be doing this in three weeks’ time and probably a lot longer. (Wow, talk about prescience, eh?)
Another thing I’ve observed already is that attempting to conduct a session with a very young person who has been trapped indoors for a few weeks is something akin (I imagine) to the experience of strapping a Go-Pro on a particularly restless spider-monkey who has recently downed a pot of black coffee. A bit hyperbolic, this description, but I have so far been in one memorable instance rendered a little nauseous by one distracted youngster spinning faster and faster in an office chair, and on another occasion intermittently either blinded or plunged into darkness as another young homebound patient wandered fitfully around an upstairs game room with afternoon sunlight pouring in through the windows of the otherwise shadowy room. I’ve been introduced to a significant number of pet cats and dogs (who always seem to stop doing the “funny/cute” thing they were just doing before the camera was trained on them). I’ve inspected a generous number of ceiling fans, views of the room from the floor, and occasionally the dark and cobweb-bedazzled back sides of couches, as smartphones and tablets have tumbled from animated patient’s hands. Small children often seem to become quite taken with their ability to watch themselves make faces on screen.
I’m fond of the words of the Argentine author Julio Cortázar, “All profound distraction opens certain doors. You have to allow yourself to be distracted when you are unable to concentrate.” I’m seeing a lot of distraction, but I’m so far dubious on the opening doors part.
A couple of teenagers have succeeded in throwing me for a loop by turning their cameras off, apparently allowing them to see me, but not I them. Hmm, I wonder, is this in some way a metaphor for the unapproachability of the adolescent male, the walls and barriers they construct, that hints at the myriad challenges of true therapeutic connection? Were they doing this less obviously in our office sessions? Or, were their rooms, like those of most adolescent males, merely disaster areas? I let it pass and instead just hope the connection holds and take comfort that there’s less chance of being blinded as the camera goes to white-out as it careens around a room and hits sight of a window.
In the end, I’m just glad that I have moved away from doing play therapy. I can only imagine the challenges my play therapist colleagues are probably facing trying to hold a tele-session congruent with play therapy modalities: “Stevie…Stevie? I think your mom’s phone fell over again. Stevie? Play is your language, Stevie, and if I can’t track what you’re doing there, buddy, I can’t ‘hear’ you… Stevie, did you leave the room, Stevie? Mrs. Smith? Mrs. Smith!? Hello? …That’s some fine ceiling fan you have there…oh, hello there, kitty.”
To find a therapist, please visit the Psychology Today Therapy Directory.