When the covid epidemic hit clinicians quickly learned that they could see their patients without having an office. In my building there was a mass exodus as therapists of every ilk ditched their offices for home studios. The area around the dumpsters was piled high with furniture books and all manner of equipment that had been used to treat patients in an in-person modality. My building, having been largely abandoned, has slowly been filling up again with the majority of therapists continuing to see their clients remotely. Being a member of a clinical team providing therapeutic services for Intensive Outpatient and Partial Hospitalization Programs, I was on Zoom calls that represented “Hollywood Squares”. There were clinicians who were seeing patients from destinations across the globe and in every known time zone. I have to wonder if we have not lost something in adopting the policy that anywhere is fine for conducting therapy. Business has long held that it is essential to “press the flesh” to make deals and create partnerships, spending a good portion of their yearly budget on travel and lodging. There is also some research out there that has shown that working from home makes for more effective / efficient task completion. I think we are still trying to figure out what works. I have encountered potential clients that are very invested in having an office to go to for their sessions. They cite the privacy and focus it affords them. I am in no way against remote therapy, I was using it prior to the COVID crisis. But it was always with patients whom I had established an in-person working alliance. There is something that is difficult to define about the in-person effect. Seeing in person a clinician I worked with in IOP and/or PHP but had only known through Zoom was like seeing an apparition; a kind of phantasm or cartoon character come to life.
We each looked at each other, squinting and staring, trying to grasp the uncanniness of the experience. The typical comments were things like “you look taller” or “I imagined you to be… younger, older, shorter, slimmer; one had to be careful not to say something potentially insulting.
The old policy regarding phone sessions was that they could be conducted if an in-person therapeutic relationship had been established. I am thinking that this is a good policy to return to. There are many intangible sources of clinical information that come through when you are in the room with someone. I have experienced this through hybrid treatments where I saw a patient via zoom some days of the week and in person others. The in-person sessions always felt more productive with the patient making some comment to that effect as we wrapped up. They would also comment on the loss of that quality in subsequent zoom sessions. I kept my office and renewed my lease as my peers fled their offices. The benefits for me are a well defined space where I know my role and nothing is expected of me but that function. My space is not confused with other activities or other modes of being (like on vacation). I also find it important to know that home is home and my role there can be parent and spouse exclusively. I think also that the space I provide for my patients reflects something of me and gives them something to internalize of the experience of being heard and understood. I think too it allows for a commitment to being in the role of patient and the associated transition back to “Person-in-the world”. For those who have never had a session in a therapy office, (this number is growing) I invite you to at least try it to see if it does not offer a deeper, more rich experience of being listened to, heard, understood, validated, and accepted.