“Hello? Can you hear me?” was not something I thought I would be saying in the middle of my counselling session. Yet here I was, in my room, trying to hold back my tears after I exposed my emotional vulnerabilities with the only consolation being my frozen therapist on Zoom. This was not the first time it had happened, nor would it be the last, but I have come to accept it as an unavoidable part of online counselling. It is exactly one of the reasons why, as soon as I am able to again, I will be choosing to go for in-person therapy as opposed to sticking with the current virtual way of working.
When the first lockdown struck the United Kingdom last March, it was a shock to the system for everybody. It hit at a particularly bad time for me, as I had just received a diagnosis of anorexia a few weeks before which subsequently surged me towards a mental health crisis. I had been studying law at the University of Oxford, and so the academic pressures from my degree were also mounting. To receive this news felt like the blow to the system that pushed it to shut-down.
It was clear that I needed help immediately, and with everything shutting down, the only option available was online. Although I knew it was going to be far from ideal, I also knew that some form of support would have been better than nothing. What I was not as prepared for, was just how difficult I would find the experience and how detached I would feel.
Telepsychiatry, and online interventions in general, have been discussed before in a blog in InSPIre the Mind. I know that there are potential advantages of this approach, such as improving the likelihood of a patient attending an appointment; for some patient groups, online consultations may actually be preferable to face-to-face consultations.
But my experience was different.
I reached out to my first therapist on email, and not too soon after we began our work together. The initial process of going to therapy is always going to be slightly unsettling, especially if you struggle with a mental health problem, as opening up may not be something you are used to, and you may have difficulties even with simply accepting your problems and getting to grips with them. It was something I had trouble with and trying to vocalise these doubts with an unfamiliar face on a screen made the words coming out of my mouth feel even more alien. There was nothing human or personal about this connection that made me feel like my therapist was someone I wanted to confide in — for all I know, I might as well have been talking to a stranger on the street and it would have felt no different.
Although my therapist became more well-known to me as time went on and eased some of my tensions, it was not long before I experienced them again as my therapist announced that she was going on maternity leave and would have to stop our work. And so, I completed my first course of therapy without ever having met my therapist in-person and knowing her only as an onscreen figure. Not exactly the personal relationship that one would hope to achieve when undertaking something as intrinsically intimate as counselling.
Moving onto my second therapist made the initial introductions a little less daunting, as I now had experience of it. Little did I know that a new wave of problems would arise.
As mentioned, I had been diagnosed with anorexia last year and it was one of the issues that I was seeking help with. A big part of this was linked to my own body image issues, and one of the major downsides of doing online calls was seeing myself reflected by a webcam in a less-than-flattering angle. During a more conventional therapy session, I would not have to focus on my appearances at the same time as expressing my anxieties around them, yet I felt that I had no choice but to stare at myself and pick out my own flaws in the video setting. Additionally, my therapist had no idea of what I looked like beyond my face, and so while I could talk as much as I wanted to about my dissatisfactions with my body and the way I looked, it was difficult for them to envision this and I subsequently felt misunderstood.
Virtual counselling created an environment where my insecurities felt amplified, which was the exact opposite of what I was hoping for.
Not only did I feel more self-conscious and exposed, I also frequently found myself at the mercy of the strength of my Wi-Fi. Although the occasional buffering video on YouTube had never stuck me as a major inconvenience previously, it hit a different chord when my sessions lagged and froze, leaving me feeling abandoned. More often than not, the technological glitches would happen just as I had poured my heart out and was in need for some comfort, but the silent reality left many of these desires unsatisfied. It is not a scenario you can imagine happening in a therapy room; you would not dig up your past traumas and deeply hidden thoughts for there to be a complete absence of reaction, and you would likely leave any therapist who did fail to respond. However, this was taken to be inevitable in an Internet setting and creates a situation which is fair for neither the therapist nor the patient.
Amidst this unresponsive cyberspace, I find myself yearning for face-to-face therapy where I wouldn’t have to enter every session already feeling anxious about the myriad of problems that could arise.
My mind has tried to develop a protective mechanism against the technological difficulties by stopping me from diving into what is hurting the most, yet these are the precise parts that need to be addressed if I am to move on fully.
My online therapy sessions feel akin to fixing the surface scratches; at first glance, I appear to be better — yet as soon as anyone tries to prod deeper, they will realise that the inner system is still dysfunctional. The full repair that’s needed can only be carried out in-person, where my therapist can keep a watchful eye out for anything that may derail by observing my body language and offering immediate support when I hit a wall. I am too scared to tread into the most uncomfortable parts of myself if I cannot be sure that I will have a safety guide to prevent me getting hurt or lost, and this is something that online counselling cannot offer as all parties involved have to rely on the unknowns of technology.
Although virtual counselling may be better than having no support at all, it does not mean that it is a perfect alternative to working in-person. We need to work together to find better ways to help, whether that would be through socially-distanced appointments, investing in better facilities or providing additional support services. Like many other aspects of our lives, it cannot be denied that the virtual experience simply cannot replace the physical version and so to expect online counselling to be the solution for the ever-increasing amount of mental health issues would be a major misjudgement. If we continue down this route, we risk being confronted with a mentally unwell generation who lost connection with help — much like my Zoom calls.