As the one year mark of the pandemic has come and gone, and most of us are still conducting therapy sessions virtually from home, author of Uncommon Teletherapy Suggestions offers us some further thinking in a follow up to our special series on COVID-19 (read Part I here and Part II here).

By Andrew Hartz, Ph.D.

A few months back, I wrote for Analysis Now about how teletherapy has impacted psychotherapy during the COVID-19 pandemic, but there’s much more to say on the subject.

Consider the Unnameable

We need words, myths, symbols, and metaphors to make sense of our world, and our patients do, too. Without a vocabulary to describe our experience, we often can’t metabolize it. When we’re ensconced in impinging phenomena that defy language, we often end up feeling irritable, adrift, or lethargic—all things my patients have reported feeling in response to the pandemic. 

Tele-space is full of unnameable bits of experience. What are the missing pieces, the novel sensations, the new emotions that emerge, as we conduct therapy sessions over the internet? Is there an odd tonality, a disjointed rhythm, a missing grace? Are there moments of tele-transcendence?

Two terms from religious studies come to mind: “secrets” and “mysteries.” “Secrets” are things we know but can’t put into words. They might be emotions or sensations that few have experienced, or they may be more common experiences that people rarely notice or can’t articulate. “Mysteries” are things we can experience but not know. We feel them, but they defy our ability to conceptualize. Mysteries are beyond ego-level thought. 

It can take a long time for a culture to develop myths and language for new experiences, but it’s worth a shot now. I’ve noticed how programs I recently closed on my computer can linger into teletherapy sessions. I was just watching stand-up comedy and now I’m watching my patient do a bit. It’s as if my closed browser windows have ghosts that persist in my mind, haunting my unconscious. There’s a faint palimpsest of the Excel sheet that was just open, or the news article I was just reading.

Occasionally, I’ve found the computer camera to be aggressive. Doxy’s head-on camera angle occurs rarely in movies. Whenever used, it’s only to depict a monstrous point of view—the robotic gaze of the Terminator, or Clarice Starling cornered in Buffalo Bill’s night vision at the end of The Silence of the Lambs. In video games, this angle is reserved for first-person shooters, like Doom and Halo. The artists must know it evokes surreal horror by merging our own eyes into the machinery of the camera. We feel at once more aggressive and more attacked. 

I relate to my computer in many different ways: as a friend, a toy, a vortex, an appendage—an enemy. I have a specific transference to this device at any given moment. It can be alien, yet something with which I also share a profound intimacy. This techno-transference reflects how I am feeling toward my patients and myself.  

Teletherapy Cannot Replace In-Person Therapy

Insurance companies argue no difference between teletherapy and in-person therapy, but who can’t tell the difference between in-person tears and Zoom?

A friend of mine can’t wait to go with his family to the movies. He has a huge TV screen at home and a large comfortable sofa. No new movies in theaters can’t be streamed at home. He prefers to pay $50 to sit in traffic, wait in line, and watch a movie in a dirtier, less comfortable seat. Here is what else he stands to gain: the noise of other people’s phones during the film, chatter, irritable theater staff, and that special sticking of his shoes to the floor. His desire may not make sense to the rational mind, but I agree. The racket and dirt of real life is priceless. 

I’m reminded of psychologists a century ago denying that infants needed human touch. Evidence of the day suggested Skinner’s baby box would do. Today, that same logic argues that we don’t need in-person interactions to address emotional pain. We deny essential human needs and instead fixate on data points.

Science moves slowly, and it may be decades before researchers gather evidence of social micronutrients patients miss by doing Zoom. By the time the data are collected, we may have a population desperately deficient. Do we really have to undergo a deprivation experiment to accept that in-person therapy has value?

I find myself fantasizing of a dystopian future in which everything that can’t be named, measured, or digitized gets deleted. With the help of psychoactive drugs, everyone numbs out to their own gnawing sense of impoverishment. But, my guess is that a society based exclusively on classifiable data wouldn’t just be hellish; it would collapse. If we removed everything unnameable, the system would get sick and break down. Hopefully psychotherapy will preserve space for unnamable human needs.  

Being Digitized and Humanized

Marx’s theory of commodity fetishism claims that industrial capitalism pushes us to treat people like objects and objects like people. Objects are “fetishized” and increasingly valued at the same time that people are mechanized. 

In the digital age, electronic devices have become our attachment objects, while people are now downloaded and deleted like apps. People turn to their screens for reassurance in times of stress, but they can erase someone they dated without so much as a comment. Maybe Marx’s prophecy is being fulfilled in ways even he couldn’t have imagined.

Sometimes, I think about patients opening Doxy and finding me living inside that box on the screen. They begin our session the same way they take off in a game of Mario Kart. When the session is over, they close the app and I vanish. 

But I’ve also found my role valued now more than ever. Patients inquire more about me. There’s intimacy in our shared experience of COVID-19. Some report feeling more comfortable sharing thoughts and feelings over Doxy. Perhaps the digitizing of therapy has enhanced our value and our humanity as therapists in spite of, or—paradoxically—even because of our digitization. 

 

Andrew Hartz, Ph.D., is a clinical psychologist in private practice in NYC. He is adjunct professor in the clinical psychology Ph.D. program at LIU Brooklyn, and he is Writing Fellow at Heterodox Academy. He completed his clinical training at Columbia University Medical Center, Mount Sinai Hospital, and at the William Alanson White Institute.

 

 

If you enjoyed this post, we recommend:
Special Series on COVID-19 by Justine Duhr, MFA, and Robert Levin, LCSW
Thinking Analytically in the Time of COVID-19 by Sandra Green, LCSW
Minding COVID-19: Re-establishing Communication Through Mentalizing by Troy Becker, Psy.D.
How Can We Wake up From This Bad Dream? by Irina Simidchieva
An Elegy for My Office From a Psychoanalyst Working Remotely by Blair Casdin, LCSW
Psychoanalysis in the Time of Plague: This *Is* Psychoanalysis! by Veronica Csillag, LCSW