Teletherapy and the Therapeutic Relationship: How Teletherapy has Changed the 'Blank Screen' of Your Therapist
Therapists typically do not have photos of their families or loved ones framed in their office. The art on their walls is often abstract, not suggesting any strong likes or dislikes. Even the clothes therapists wear doesn’t reveal what they may have planned for after the session. I have always felt that therapists should be a neutral presence in the therapy room. Sometimes, we think of therapists as a blank screen, other times as a mirror.
The purpose of this intentional therapeutic presence is to make room for transference reactions that may come to life in therapy. Transference, first described by Sigmund Freud, is a psychotherapy phenomenon in which there is an unconscious redirection of feelings from one person to another. Transference is important in therapy because it allows for the unconscious to become conscious, helping to show clients how their transference reactions are actually their unconscious ways of making sense of the world around them—often in distorted ways.
Freud discovered that a therapist could provide deeper insight into the problems of their patients through the use of transference. Working in the transference means that both therapist and client do their best to set aside the natural human tendency to keep the psyche buried. In many of our other relationships, there is an unspoken agreement that we must keep our unconscious thoughts and feelings buttoned up. But in therapy, our greatest fears and worries are shared, processed, and explored. The only way for this to happen is if the therapist does her best to take away all of the things that she may do within her social relationships outside of the therapy room and maintain a neutral and objective stance. This is why therapists are discouraged from disclosing personal details of their lives or reacting too strongly to something. The therapist is to act like a “blank screen” or a “mirror” in the therapy room.
That is until recently…
During the stay-at-home order and with everyone in my practice, including myself, working from home, there are many unintentionally ways that therapists have been forced to reveal themselves. Our clients understand that we are providing teletherapy services remotely—like them we are working from home during this pandemic. There are also ways that our private lives become more public. From the makeshift offices that we have created in our homes to partners or kids heard in the background, even the quick appearance of a pet on the video screen; our clients have gotten a glimpse into our lives outside of the therapy room. Concurrently, we have also gotten a deeper glimpse into our clients’ home lives.
The other day, I was in session with a client when we were interrupted by the sound of my husband singing a silly, nonsensical song to our daughter—something that he would never do in public. But here we were—therapist and client—getting a very personal glimpse into a private moment. What does one do in that scenario? Do you pretend that it’s not happening? Do you acknowledge the noise? Do you laugh with the client over the ridiculousness of the song?
In response, my client shared a memory about one of her parents singing to her as a young child. Had it not been for my husband and these strange circumstances, I may not have learned this about her. And at that moment, we were deeply aligned.
I have had many moments with many clients during the past several weeks, where we have been connected on a deep, human level. The fears and uncertainties that my clients are experiencing are similar to those that I am, the world is. Many clients are checking in with me, asking how I am doing and holding up during this time. While the role of a therapist is to maintain the integrity of the therapeutic relationship and support clients, there is also an understanding that everyone is experiencing a similar struggle, and with this comes the freedom to act more human, even in the therapeutic space.
The reality is that clients are getting a small insight into their therapist’s inner world, no matter what we try to do to hide it. The intentional mystery of your therapist, the one deliberately there to help facilitate a patient’s transference, is being interrupted by a singing husband, a screaming child, the beep from a washing machine, the presence of a pet and the understanding that everyone—even your therapist—is working from home right now.
As far as transference, it still comes up in the therapeutic space. And the truth is, this has not harmed the therapeutic relationship with clients. In fact, it has brought humanness to the relationship. For the first time, clients have the opportunity to see a different side of their therapists, seeing the person behind their therapist: the person who has a family or a pet, the person who has household responsibilities, and the person who is also trying to cope during a very uncertain time. Perhaps this creates some hope in the therapeutic space that recovery is not only possible, it is inherently human.