The Virtual Couch: How I’ve decided to move my Psychotherapy practice exclusively online

Working primarily from a psychoanalytic perspective, rarely did I consider working virtually unless I truly knew the person very well and could trust that our therapy relationship had already stood a test of time and effort. There have always been candidates in my practice for whom I have maintained a distance therapy relationship with, some for over a decade. I have had evidence that utilizing technology such as phone or video, has been effective in maintaining not only the therapy relationship, but also, importantly, the personal growth and development of my patients. The tenacity and resilience in maintaining a therapy process through the use of technology, mourning the losses of “coming to my office”and experiencing “being together in the room” are not resolved easily or swiftly. These losses are examined, and reexamined as they materialize in the course of virtual therapy.

So, when the pandemic that we are living through immediately forced us all to realign our lives and in particular, our therapy practices, to one that is exclusively virtual, I believed that the adaptation would be possible, painful at times, and enduring. It became clear to me that as we struggle to make sense of our inner lives the parallel process of making sense of our external lives cannot be ignored. To me, it has to be integrated. This integration has equated in me deciding to completely shift my private practice from in person with some distance work to exclusively virtual in order to make sure that the safety of all beings is secure within the therapy frame.

What does it mean to work virtually from a psychodynamic perspective? I imagine it being similar and different. Similar in the sense that whatever it is on your mind, as a patient of mine, you are free to speak of. Different in the sense that when you speak and I listen, there is a different mirroring effect, in that we will not make “direct” eye contact and my attention and gaze will feel physically closer to you than if we were actually physically together in my therapy room. Simultaneously, I will experience your gaze to be closer to my eyes, creating a virtual lifelike realm. Participating in psychotherapy in an online medium requires me to candidly speak of and welcome my patients to fully convey feedback about our contact, connections and communications. Acknowledging our existence of being together while apart will surely have subjective relevance in our therapy process.

The most evident difference in a virtual form of psychotherapy is that I will no longer be providing my patients with the physical office space that organizes the frame, containment and safety for the unconscious to feel free from external intrusions that I once heralded myself to do with an office. Now, we, myself and my patients, together bear that burden. On my end, I will be in a room of my home that is completely confidential and mostly free of distraction. The video platform that I use is Zoom and their security policies can be found here. For new patients, especially, I will clearly explain the system of employing video conferencing, it’s limitations and usefulness, and provide you with as exact directions I would have if you were coming to my cottage in Santa Barbara. You’re being able to arrive is of the utmost importance.

Once we are together, as we would have been in my office, what is to be discovered is yet still unknown. As I move forward in this virtual journey of a new reality, I will continue to notice and bring forth in words what emerges psychically, emotionally and psychologically. In this moment in time, virtual psychotherapy is the safest way to practice. This also means I can offer specialized psychodynamic psychotherapy in a broader capacity which will wield further challenges and potentialities for growth.