• Long-term therapy client Paul Steen describes the transition from in-person therapy to online therapy as a result of the Covid-19 lockdown

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have been seeing my psychoanalytic psychotherapist for about 18 months, and I currently see him twice a week. The most obvious difference about before the lockdown and now is the shift in ritual. I liked the process of making sure I arrived on time, was “going” somewhere, going to therapy. 

The rituals were important to me. Entering the room was a transitional moment. And I was being in a room very different from my own. The bland decoration, the couch, all these details were a sort of preparation, a set of switches that turned on the process. 

So not being in the room with the therapist was at first quite disconcerting. The lack of presence. the absence; always a problem for me. Having said that, my therapist took a lot of care, it seemed to me, to make himself be present. We now conduct the session face-to-face, rather than me on a couch, not seeing him. It changes the dynamic, inevitably. It is less intense because I am sitting in my own room. 

It is difficult to let go of conscious thinking. There is too much that is familiar in your peripheral vision. Too much “me" around. The impersonality of the therapist's room is replaced by the familiarity of mine and all the objects that I have chosen to surround myself with, which in a way is what you want to break free from when you are in therapy. 

But the other side of this problem is that you have to focus hard on the process, the strange intrusion of the therapist into your everyday realm makes you work hard to concentrate. 

So, pros and cons. the therapist points out that not being in the room is more difficult. I think he means that it is diluted because he is not physically there. And that him "being there" for me is an important part of trust. I think this is probably right. Any reduction in being there is going to have a negative impact. But after several sessions it is beginning to have its own form, its own rituals, and one adjusts. I wouldn’t personally want this as a permanent way of doing therapy but under the circumstances it works sufficiently well to justify doing it.  

Further reading

Welldoing.org therapists offering discounted online therapy to new clients

Online therapy: some considerations for beginners

Can online counselling be effective?

How to prepare for an online therapy session