Creating A Clinical Office Space In Virtual Therapy

“ Absence sharpens love, presence strengthens it.”– Thomas Fuller


Bodies in the room constitute a rich, compelling and studious psychodynamic psychotherapy experience. When we resolve to practice psychotherapy online, being in the room collectively is absent. I have been conducting telephone and online psychotherapy for many years and have implicitly presumed that my patient and I are formerly united in the room, however, I recently initiated making the obvious difference explicit and conscious. What had invariably been my responsibility: creating a space for the practice of talk therapy; an office with boundaries, an area that is comfortable but not too cozy, a room with as few distractions as feasible, a sound machine to drown out voices coming from or into the waiting room, now becomes the patient’s responsibility during telephone or online therapy sessions. Creating and organizing the frame in psychotherapy is of the utmost paramount values in my psychodynamic practice. The physical frame is the outmost layer of a subaqueous frame of psychodynamic psychotherapy. It necessitates safety, requires discussion and calls for agreement. Designing a virtual frame comprises direct communication and expectation within the therapy relationship. Guidelines I may suggest are: how to determine a specific and consistent place in the patient’s environment to conduct the therapy session, should there be food and drink during session, or dogs and cats in the virtual therapy room, and who will call who and who will end the call. The purpose is to provide the patient with steadiness and containment and reinforce a framework. I also establish my frame to be in my therapy office for each session. When a frame for virtual psychotherapy is thought about and clearly discussed, the prospect for a compelling, constructive and progressive relationship is achievable.

Angela Wurtzel