Bringing the Feelings Home
Some names in this article have been modified to preserve anonymity
“What would this have looked like in 1988?” wonders Caroline Hanna, a social worker in the public healthcare sector who I interviewed via Zoom in September 2020. “Would you call in from a landline?”
“This” refers to mental health counselling, which can no longer take place in person due to the COVID-19 pandemic. In our digital era, the switch to virtual counselling has been quick, even with the added pressure from an isolated, anxious population on the sector’s capacity. Anyone with a cell phone can call their social worker or other mental health professional. Video-calling, though slightly less accessible because it demands specific software, has caught on as well.
Even before the pandemic, both these technologies were in use for years in mental health care. However, their sudden ubiquity raises new problems.
If you don’t have a “Zoom-bomber" story, one of your classmates or teachers probably does. Therapists and social workers, some only recently thrown into the world of digital counselling themselves, must clarify with clients the degree of privacy they can ensure on any given platform. According to its website, Zoom’s Healthcare Plan is compliant with Canadian federal privacy laws as dictated by the Personal Information Protection and Electronic Documents Act (PIPEDA). However, because the platform was designed for general use, rather than confidential medical use, it may have blind spots. Competitors are quick to point out that Zoom’s Guide to PIPEDA and to the American Health Insurance Portability and Accountability Act focus on securing the content of meetings, but not basic contact information stored in Zoom (name, email, phone number). Other platforms, like IIT Reacts, were specifically designed for healthcare and promise more comprehensive confidentiality.
Video-calling has off-screen repercussions as well. People don’t want to be overheard by their kids, or worse, by their abusive partners. Under those circumstances, a phone call from the car or a public park becomes the best option. Social worker, psychotherapist and couple and family therapist Jeremy Wexler (disclosure: my father) lost numerous clients as soon as his practice moved online.
Professionals are more optimistic on some aspects of telehealth. For example, telehealth eliminates some of the stigma and inaccessibility of counselling. In an era of unprecedented openness to mental health treatment, it seems only logical that therapy enter the home. These are, after all, struggles of daily life, and it no longer seems fair to cloister them in offices and hospitals.
Normally, a client would need to see a psychiatrist in-hospital if they were referred to one by their therapist. The trip could feel daunting. Now, it is as easy as clicking a button. On the side of accessibility, taking time away from the house is challenging for many young parents; their free time might consist only of a short lunch break. People also have mobility issues, particularly in a Montreal winter. Marginalized community members can call in to a therapist who shares their lived experience, despite not living close to one.
Wexler, for his part, has his reservations. He recalls something a couple once said to him: “It’s the metro ride over to your office where the real work gets done.” The therapist’s office is a safe space, a confidential space, a space to express your feelings; the time spent there is for you, to work on yourself. The commitment is far more tangible when you physically place yourself there. Do these distinctions lose their meaning when logging into therapy from the same old desk? The partitioning of spaces is an important part of the work Wexler does.
Jackson Ezra used to do in-person social work, but has had to adapt while training in couple and family therapy at McGill. In class he learns to maintain a familiar office in which clients feel safe, down to keeping the same friendly books on the wall. He and his classmates brainstorm on how to apply old lesson plans to new circumstances. Keep a consistent backdrop for your sessions. Encourage clients to set themselves up comfortably. There can even be an opening and closing ritual, like lighting a candle. That way you acknowledge the abnormality of the situation, associate a physical action with the ‘space’ of the session, and create a material connection from one end of the call to the other.
Therapists train to be aware of their physical presence and that of their clients. If couples are on different screens, you can’t evaluate nonverbal cues such as eye contact, seating in relation to one another, or physical affection. Lagging internet interrupts fluid conversation. On the rare occasion that things get heated, there’s no digital equivalent to standing up and talking in an authoritative, calming voice to defuse a situation.
According to Ezra, fixing this broken telephone starts with asking more questions. “And how does that make you feel?”, like a therapist in a New Yorker cartoon.
Sometimes the intimacy of a home environment even improves communication. Issues that seem too trivial to mention in a CLSC office come up naturally sitting on your own bed. Ezra’s client mentioned that his son was upstairs sick, and that segued into a conversation about his concern for his child.
It’s not always the professionals asking the questions, either. A client was worried for Hanna after seeing on the news that the Health Ministry was suspending vacation for health workers. Normally, clients know a minimal amount about their social worker or therapist’s life, but the pandemic is far from normal. I’m going through it, you’re going through it, and your therapist is going through it. It’s a shared experience, instead of a shared space, and it can make up for some of the humanity lost through the network. “I try to make my calls from a closed-off area, but they know I’m working from my basement, just like they are,” says Wexler.
He was expected to start sessions in-person as of mid-April. Clients were concerned, both for him and for themselves. About 70% chose to stay online, and he suspects that that number won’t drop to zero even after a vaccine is distributed. The growth of online mental health services has been accelerated by the pandemic, not manufactured by it, and technology is already improving on its previous shortcomings. Telehealth offers too many advantages to end with the novel coronavirus.
A version of this article was first published in the Dawson Plant, September Edition 2020.