Reflections on online therapy and lockdown

A recent return to in-person sessions (following months of working exclusively online) has been a relief for myself and, seemingly, a number of my clients. 2020 has been a year of loss and uncertainty, and I shared the concerns of the authors of numerous articles about how to ‘survive’ the national lockdown. What I and many others spent the following months talking about was an unanticipated loss which took an enormous toll – the loss of routine. 

I asked two of my clients if they wouldn’t mind sharing some of their experiences of working online and returning to in-person sessions. Names and some details have been changed to protect their confidentiality.

Mark is 31, has been working from home since late March, and lives in a house with two friends. I recently asked him if he could describe his experience of working with me over Zoom.

"I’ve been sitting at my computer for eight hours by the time I start thinking that I have a session with you. I live in a shared house and my space is pretty cramped as it is, but I’ve been forced to create an office at home. I have a desk, a chair, a lamp and my Father Ted mug in the corner of a room where a wardrobe used to live.

"The thing about working from home I’ve noticed this year is how it’s changed in my mind. I’ve gone from working at home to living in work; my laptop, screen and ‘work area’ a constant reminder of the work I haven’t done or what’s waiting for me. 

"I’m writing a response to an email conversation with my line manager and I notice it's already three minutes past the hour and I’m late. I fire up Zoom, sign in and start the call. I’m anxious and can’t stop thinking about the email so, while we’re talking and starting the session, I’m slowly typing my response, hoping you haven’t noticed. 

Unfortunately, you say I seemed distracted. You ask me about it which jars me from my half-concentration and instead focusses me on the session. I decide to leave it and focus on me.

"Five minutes later, in the corner of my screen, another email from my manager. He wants to know if I’ve looked at his other email. It sets my heart racing a little faster.

"Our session ends and all I can think about is the now nine unread emails I have. And I can’t help but think that, if this were a normal year, I’d have been on the tube by now without access to all this until the morning. Yet, it feels pressing and urgent. I’m annoyed at myself for not taking the time to clear up my lunch plate.

"I delete my draft email – it's now irrelevant because the conversation has moved on since then – and reply to the latest comments, and log off. I’m tired and anxious and I’ve worked more hours and moved less than I ever would have done at work. I try to think about what we talked about in the session, and I can barely recall a word. Our online sessions have helped me so much, but I can’t wait until all of this is over."

Jennifer is 36 and lives at home with her two children aged five and eight. She is a marketing manager for a large fashion brand and our sessions returned to being in-person prior to the second national lockdown. I asked her to describe what she felt was the differences between the two.

"The first thought that comes to mind when I think about coming back to in-person sessions was just a sense of relief. I remember when I first came to see you. I talked about how it felt like I’d been inflated with tension, and now I felt finally able to take a big exhale of breath getting in the car, a big exhale of breath when I parked outside your house, and an even bigger exhale of breath when I finally sat down in the room.

"I always feel like I’ve got a million things to do at once; whether it’s looking after my children, or the unread emails I’ve got to answer, or all the virtual meetings I need to sit through when I’d rather be doing something productive, and my life has very little structure. Knowing I had a fixed appointment helped enormously, and what really struck me as I drove to your office was how much time I suddenly felt I had.

I had 10 minutes to gather my thoughts ahead of the session, and then 10 minutes on the way home to think about what we’d talked about.

"We’ve talked a lot about the differences between online and in-person therapy in recent months, and I really appreciated you talking about how it was an experiment for you too. It’s been really useful, a lifeline really, but something felt missing being online. There’s something about the smell and stillness of your office which makes me feel calm and just walking down your garden to the room, I feel a sense of a return to normalcy.

"It’s not ‘normal’, of course. This week, my office confirmed that no-one will be back in full time until April 2021 at the earliest and an internal meeting agenda has the idea of semi-permanent working from home as discussion point number one. Something to talk about next time I see you, I think."