Navigating Couple Therapy on Zoom: Unique Challenges and Opportunities

How Emotion-Focused Therapy Adapts to Virtual Sessions

Couples have asked me several times in the last few months if we can hold the meeting on Zoom when each of them is in a different place. Every time I explained that it was highly not recommended, and every time I was met with astonishment. I can understand that surprise. Apparently, if we manage to hold the therapeutic meeting when it is split into two different locations, then why not hold it from three? But the truth is that this question actually clarifies the unique elements of couple therapy, which allow it to move to a standard Zoom (both partners in their home and me in the office) with relative success.

The focus of change in couple therapy is the ability of the couple to respond to each other effectively. All therapeutic work is aimed at this. When the couple comes to therapy, they are characterized by an inability to help each other out of stressful situations. In practice, when one of them feels emotional distress, their partner is "infected" with stress in most cases and reacts with their own stress instead of balancing it. During the treatment, we help each of them personally identify their uncomfortable feelings, stop fighting them in a way that makes them worse, and start communicating them to their partner in a more effective way.

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But in the interpersonal process, the emphasis is on the ability to recognize the distress the partner is in and to regulate oneself enough not to follow them down the emotional waterslide but to help them come to their senses relatively quickly. Our main means for this is to bring each of the partners to a state where they are connected to their feelings and feel relatively safe, and then direct them to each other. The most dramatic instruction in emotion-focused couple therapy is: "Now please look her in the eyes and tell her again what you just told me about the fear you feel when she comes home and doesn't treat you." This "technology" is based on the bodies of the couple—on the face, on the emotional expression, on the breathing, on the muscle tension.

You can see the partner rolling his eyes on the screen. Photo: Oleksa / Shutterstock

Turning the vulnerable partner to the other is just the "preparation for the air conditioner." The therapeutic action itself occurs when the other party responds to the vulnerable partner. This reaction is the innovation. When instead of rolling his eyes, he places a soft hand on her. When instead of remaining with a fixed look, she smiles at him with a loving look or kisses him on the head. Here, too, the technology is extremely primitive: touch, look, physical approach on the sofa.

All of these can only exist in a flat way if the couple are not in the same physical space. On the other hand, they exist very successfully even if the couple are together but do not share the same space with the caregiver. This is because, unlike individual therapy, in couple therapy, the main emotional process takes place between the couple, and the therapist (only) mediates it.

Another unique quality that couples therapy has when it moves to Zoom lies in the strength of the triggers that the different behaviors of each partner constitute for the other. The need to gather in the frame of a computer or even a phone forces the couple to sit closer to each other than in the clinic. This physical closeness creates more potential for intense emotions. These can be strong negative emotions such as anger and disgust, of course, but the temporary closeness can also evoke a longing for more of it on a daily basis, and it can also help couples get off the tree in moments of escalation, since the distance required to place a palm on each other with one soft touch is shorter than usual.

The intensification of the triggers is good because in emotion-focused therapy, you focus on the emotion—that is, on its identification, on the ability to bear it without running away from it, on the ability to communicate it. For this, we need as much active emotional material as possible during the meeting. Amusingly, the number of triggers increased not only thanks to the huddle on the sofa but also thanks to the indicator on the screen. The patients see themselves, and they can see their partner, even though they are sitting next to each other, and their expressions while they themselves are talking. That is, they can see their partner roll their eyes, when they talk, swallow saliva, or stifle a yawn—reactions that might have escaped them in normal face-to-face therapy. And any such reaction from the partner is potentially an emotional reaction, which has a chance to set the room on fire, in the best sense of the word.

The therapeutic action itself occurs when the other party reacts to the vulnerable partner. Photo: vladans / Getty Images/iStockphoto

In addition, one of the dramatic differences between face-to-face therapy and Zoom therapy is, of course, that anything can happen when people meet face-to-face. In general, even if we call it therapy, at a certain level, every meeting between two humans is a meeting of two monkeys in the savannah. Such an encounter can always, theoretically, end in a physical interaction with extremely dramatic consequences, from erotic contact to murder.

This possibility is avoided when we meet on Zoom. Such a decrease in tension and excitement has different effects depending on the nature of the encounter that goes from 3D to 2D. I think that musical performances, for example, suffer a lot from this transition and are more like pandas that refuse to breed in captivity, even if they were given a beautiful cage with an amazing imitation of their natural habitat. But in couples therapy, I think there is a great potential advantage in this decrease in the intensity of the danger and the excitement of the process that can happen in front of the therapist. This is evident mainly in the weakening of the tendency to position themselves in front of me like hawkish parties who come to a meeting with the arbitrator or come to inform on each other to the kindergarten.

Another unique advantage of Zoom couples therapy is that the session often ends with less fear of what is going to happen immediately after the session ends. Many times at the end of a powerful meeting, at least one of the partners (the one less inclined to regulate themselves by emotional detachment) expresses stress from venting to the world outside the room and is disturbed by the contrast between the therapeutic space and everything that happens outside of it. But in Zoom, as soon as the camera closes, the couple is still in their home and can continue to hold together the emotional momentum gained during the meeting, which strengthens their ability to integrate emotional and cognitive insights gained through sweat and tears.