My view: Mental health works best when not conducted via screen
Before the covid-19 pandemic, the idea of a world full of video calls, virtual business meetings, and Zoom "happy hours" was reserved for science fiction movies.
Versions of telehealth certainly existed, but use of online health care services was rare. The pandemic changed all that.
This was especially true for mental health services, with one study finding that nearly half of all patients went from in-person care to telehealth by December 2020. The same study suggests that teletherapy is here to stay. An estimated 731,000 Oregonians live with a mental health condition, which underscores the urgent need for accessible and impactful mental health care. Last year alone, 42% of adults in Oregon reported symptoms of anxiety or depression.
While virtual sessions helped us bridge the gap during the difficult days of lockdown, there are major drawbacks to a virtual-only approach when it comes to mental health care. This is true for people of all ages. Therapy with children in particular becomes incredibly difficult online since many of the standard therapeutic approaches for children depend on an in-person interaction between child and therapist.
This is largely because children do not communicate like adults. Where adults can talk through experiences and feelings, children often do not have the capacity to identify and express complex emotions. Instead, they communicate with their bodies and their behavior. Providing good therapy to children through video calls, then, becomes a significant challenge. A child cannot move naturally when they must sit and face a camera, nor can a clinician interact with the child effectively with a screen in this way. Because of these obstacles, many child therapists were the first to return to in-office work as the lockdown lifted.
Yet even for adults, there is something lost in virtual sessions. A therapeutic interaction limited to a flat screen becomes just that: two-dimensional. A deeper understanding of our neurobiology also suggests that our brains don't receive the same benefit from a video interaction as they do from an in-person experience. In several studies, it's been established that while we have a reaction to a live person on-screen, we don't experience the same neurological stimulation that comes with an in-person interaction. This means fewer of the neurochemicals that lead to relatedness and create connection — certainly a problem for therapy.
Then there is the "Zoom fatigue" we know all too well. Due to the lag time that comes with video calls, our subconscious mind determines that something is "off" and we work twice as hard to maintain an effective interaction. We over-communicate through our facial expressions to compensate for the lack of body language, and we strive to maintain "eye contact" even though the true "eye" is the camera. This becomes even more complicated when a therapy session involves more than one patient. Couples or family sessions become infinitely more difficult for a therapist to navigate effectively.
Finally, there is the experience of "going to therapy" itself. Each of us has a cognitive bias that places us squarely in the center stage of our own fast-paced life drama. We naturally get caught up in our routines and come to believe that the way we see things is the way things really are. It's easy, then, to get stuck in a rut that only deepens the busier our schedules get and the more we keep doing the same old things.
The therapist's office is a neutral space where we can take a deeper look at ourselves, our relationships and our world. When therapy becomes just another call scheduled between Zoom meetings and emails, we can lose the deeper "pause" that lets us see beyond the current moment and create greater change.
Let us make no mistake: teletherapy is here to stay. It is an invaluable tool that has expanded access to care for many patients, even after lockdown. However, let us also keep in mind that teletherapy is only a tool and that it has its limitations. At its core, mental health care is about healing of the parts of us that make us most human, and the essence of being human is connection. Teletherapy is a great resource for linking us together across distances, but we cannot underestimate the value that comes from being face-to-face, sharing a moment, and sharing a space.
Nick Norman is a licensed independent clinical social worker in Seattle and the business relationship manager at Mindful Therapy Group, a network of licensed, independent mental health clinicians serving Oregon and Washington.
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