Finding Closeness while Socially Distant: Clinical Considerations for the Therapeutic Frame and Process in Teletherapy

Abstract

Teletherapy provides affordances and possibilities for treatment, with clear benefits for increasing access for patients who live in remote areas or who have decreased mobility. It allows for more flexibility in treatments, keeping patient and therapist connected when breaks in continuity might be counter-productive. Some patients are able to more openly share with their screen therapist than they can in-person. Other patients experience greater accountability for their treatment as they are jointly in charge of setting it up. In many cases, these changes have deepened and broadened the scope of therapeutic work. Yet, these benefits may obscure complexities and foreclose understanding important elements of the treatment dynamic that change within teletherapy. For instance, we know that teletherapy requires the challenging task of maintaining connection and attunement without cues from being bodies together in a room, and yet paying more attention to these essential elements over a screen can impede connection instead of enhance it. In this chapter, we focus on the subtle alterations in the therapeutic encounter that have already begun being incorporated into teletherapy. The chapter casts light on the changes occurring in two critical aspects of the therapeutic encounter: the therapeutic frame and the therapeutic process. With regard to the therapeutic frame, the way teletherapy requires modifications to time, space, privacy, and boundaries will be introduced. Next, changes to the therapeutic process will be discussed, paying attention to how eye contact, affect, silence, intersubjectivity, and the content of a session may be impacted. Clinical perspectives will be provided for each of these elements, with clinical examples derived from the findings of a qualitative inquiry in this area. The chapter concludes with clinical considerations for increasing skills and awareness of therapists conducting teletherapy.