The Unexpected Benefits of Phone Therapy: A Therapist's Reflection

Rediscovering the Power of Voice in Therapeutic Connections

After a month of staying at home because of the coronavirus, my seven-year-old son burst into tears. The reason was his longing for his friends at school, he said. "But why aren't you ready to join the Zoom meetings in your class?" I asked. "Or are you just messing around on Zoom with E?" My son shook his head: "Seeing them on the screen is much worse," he explained to me, "because all I think about is 'Why can't I meet with them?!'"

I was speechless for a moment. I knew what he meant: Like most of my colleagues, last month I stopped seeing patients in my office and switched to various video calling platforms. But unlike many of them, I quickly moved on to another revolutionary technology, albeit one whose revolution took place about 150 years ago—the telephone.

Zoom and similar apps have many advantages. The first of which is the ability to improve one's appearance with the push of a button in the mornings when even your phone refuses to recognize you. This advantage is second only to the virtual background that allows you to conduct professional conversations while you speak from a bowl of spaghetti and Vongole. But apart from these two, multi-participant video calls also have many disadvantages, at least to me as a therapist.

The Italian management lecturer Prof. Gianpiero Petriglieri recently tweeted that he finally understood why video calls are so exhausting: "It's the seemingly reasonable denial of everyone's absence... Our minds are sold the idea that we're all together, while our bodies feel that we are not. Dissonance is an exhausting thing, and it is easier to bear the other's presence or their absence than to constantly bear the presence of their absence."

"During a physical meeting, our body processes so much information that it receives from the context of the event, that a video call is a bit like a blindfolded meeting. We receive little sensory information and cannot imagine enough, and this lack requires a lot of effort." Petriglieri helped me understand the strange feeling I felt after conducting video calls, which is similar to the one I had when I finished eating ice cream with artificial sweetener—the initial admiration for the perfect imitation was replaced by a strange aftertaste and a feeling of emptiness and hunger for the real thing.

"How would we manage without Zoom?" we wonder in recent weeks. But the answer to this question is that we would get along very well. The essential advantage of the phone over video is that we don't expect a phone call to replace a meeting in the physical world. If a face-to-face meeting is a real and satisfying dessert, like Italian ice cream, then a video call is diet ice cream. A phone call, on the other hand, is more like ending a meal with a glass of cognac or a plate of cheese. This is a completely different possibility for a therapeutic meeting that does not try to imitate the original but produces a qualitatively different experience.

These qualities are known to anyone who has ever been surprised to find themselves bringing up a sensitive topic for discussion while driving a long car ride with their spouse, and they are also found in the psychologist's treatment room. It should be remembered that therapy did not always consist of two people sitting upright facing each other with a tissue box between them. On the contrary, initially the patients actually lay on a couch with their eyes closed.

The couch has played an important role in psychoanalysis since its early days. Freud and his colleagues believed that talking while lying down would encourage the elicitation of free associations much more than direct observation of the analyst. About a hundred years later, emotion-focused therapists (like me) know that when a patient is freed from the task of observing the therapist, it is easier for them to connect with their most painful feelings. This happens mainly in individual EFT, where we use the empty chair technique: the patient sits in front of a chair and we help them imagine different parts of themselves sitting there, depending on the emotional barrier they are trying to break down.

The lessons from psychoanalysis and EFT highlight another disadvantage of video calls: an extreme focus on looking into each other's eyes. The visual frame that is considered ideal when using Zoom—from a person's upper ribs to their last unruly hair—creates an extremely limited field of vision that in reality would be reserved for an intimate conversation with a partner in bed, each on their own pillow. In this way, a false intimacy is created because it does not arise from the social context, and it also robs us of other sensory aspects that are an essential part of such an encounter if it were to take place in real life.

Our brain spends a lot of mental energy trying to resolve these tensions, which are not present when talking on the phone. Assuming both parties take the phone call seriously, phone sessions can be incredibly intense. This difference is so great that it makes me see face-to-face therapy sessions differently.

Another thing is that eye contact can burden the patient and the therapist also because of the content they discuss. For example, a patient may worry that her therapist looks tired, or she may be overly aware of the possibility that the therapist will notice that she hasn't had a pedicure in a long time. These concerns can have significant psychodynamic consequences, but they may not be as urgent as the issues that would arise if the patient could stop looking at the therapist and being the object of observation during a session, and could dive deeper into her soul.

Right now it looks like things will soon start to go back to normal, and in the world of therapy, this means we'll be meeting face to face again. I look forward to it, but I know very well that telephone therapy has changed me as a therapist, and there is a part of me that laments the loss of the strong and free mental space that telephone therapy made possible. However, I am very happy for my son, because with all due respect to the phone call, it is still not the ideal medium to play football with classmates.

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