TIFT #83: Is Videotherapy Inferior?

tift Aug 15, 2023


Subscriber "Dare to Share" **


Hi Jeffery,

I’d still be interested in your thoughts about online therapy as a continuing platform for therapy. It’s an issue for me because my therapist has decided to work only online. This means I will never meet her in person since I started with her in December 2021 when she had stop seeing clients in person on what seemed to be a temporary basis. I think she likes the lower cost, lower hassle aspects of online. We Zoom twice a week and she has been very helpful to me and I think we both expect that therapy will continue. To me, never to meet is bizarre and inhuman. Once? Once a year? I’m a 2.5-hour drive from her so frequent visits are not possible. My guess is there will be a gradual return to in person therapy just as workers are returning to offices. Or else a bifurcation will develop with a tiered system with online as a lower-cost, lower-quality alternative. What do you think?


Dear Subscriber,

The main thought I have to offer, one not so often noticed, is that the human drive to connect is a powerful force intent on overcoming barriers, technical and otherwise. How many important connections have been made by telephone with audio alone. Today, video adds the problem of eye contact. Does one look at the camera or the face? Even with imprecise eye contact and blurry, two-dimensional images, we manage to connect. It is our nature to “read” subtle bodily responses through the fog of technology. To me that’s why Zoom has generally worked better than one might imagine.

After all, every human encounter has barriers. Empathy requires crossing the gap between individuals. Translating between cultures and transporting ourselves into lives far different from our own, we manage. We are made for that. Zoom is simply another layer of colored glass.

I have participated in therapies as far away as China, where in-person was simply not possible. We have had intense sessions of trauma therapy and other in-depth encounters. In one of those therapies, the client sought out remote therapy because she was not ready to tolerate the immediacy of face-to-face. For the others, Zoom just didn’t seem to create a barrier to doing serious work.

Where there’s a choice, I personally offer both. I prefer face-to-face for the initial evaluation in order to take in as much information (of all kinds) as possible. Quite often, clients choose video. I charge for my time and consider the question of technology as a complex matter with pros and cons. I also find, as do many colleagues, that too many Zoom sessions in a row is tiring. I think it’s the extra mental load required to traverse the barriers to connection.

Your idea of finally meeting in person is an important one. The wish to make the connection closer is one of the driving forces in psychotherapy. At times it is of overriding intensity (See the TIFT called, “Attachment to Your Therapist" located between #45 and #46). Assuming a competent therapist, it is important to explore together what an in-person meeting would mean, how the two of you might react, and, most important, will you go ahead and arrange such a meeting. All I can recommend is that you talk about it together and consider a real meeting. I don’t believe there are rules, only pros, cons, and what is naturally human.

** Readers are invited to weigh in via comments. And please DARE TO SHARE your troublesome therapy issues via email to jsmd@howtherapyworks with "Dare to Share" in the subject line.


Jeffery Smith MD


Photo Credit: Emily Camp, Unsplash

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