In the Room Where It Happens
Remember life before remote working, QR codes, and delivery apps? Me neither. But almost six years ago, the Pandemic ushered in many changes to what feels “normal” now. Among those changes was the wide adoption of “Telehealth” therapy sessions and virtual mental health care became a normalized component of our lives.
As a couples therapist who now practices almost exclusively via Telehealth, I’ve thought a lot about the differences between seeing clients in person versus online. Several benefits of therapy via Telehealth are obvious. Your travel time to your appointment is the distance to your nearest smartphone or laptop. Rural communities gain access to needed care by bridging vast distances and provider shortages. And individuals who are immuno-compromised can receive care without entering high-risk environments. But I have found there are a few subtler benefits as well. One such benefit is the “co-creation” of the therapy space.
When clients go to a traditional therapy appointment, they enter the therapist’s space. Likely there is a waiting area that is probably intended to be calming and comfortable, and the same can be said for the therapist’s office; both realms are created and controlled by the therapist. Now contrast this experience with Telehealth; both therapist and clients simultaneously “enter” each other’s virtual space. Both clients and therapist provide a small window into the physical space they are inhabiting. Both therapist and clients are choosing what is visible in the background. In this regard, there is a reciprocity experienced in Telehealth that is never achieved in traditional therapy, which leads me to another subtle but tangible difference in Telehealth that I think goes largely overlooked. Eye contact.
When clients are in a therapist’s office, they are typically sitting approximately six feet from the therapist. During Telehealth, however, the perception of the distance between clients and therapist is much shorter; usually it is just the faces that fill the frames. Eye contact feels closer; more direct. And eye contact is a fundamental component of non-verbal communication; it plays a crucial role in establishing trust and a sense of understanding. Whether or not Leonardo da Vinci was correct when he proclaimed that ‘the eyes are the window to the soul,’ eye contact releases bonding hormones and neurotransmitters, and activates the brain regions for attention and emotion, precisely what is usually needed when engaging in couples therapy.
So while Telehealth may have been born of necessity, it has matured into something quietly powerful. The screen does not dilute intimacy in the therapy room; in many ways, it concentrates it. When couples meet me online, they are not stepping into a neutral office—they are inviting me into the room where their real lives happen.
Couples therapy has always been about what happens between people. Telehealth simply brings that “between” into sharper focus—through shared space and mutual presence. And when couples are willing to show up, look at one another, and stay in the room where it happens, meaningful change is still very much possible—sometimes even more so.