Therapy in the ‘New Normal’

Content note: childhood abuse

By Katy Evans

As we approach the ‘new normal’ following Covid, it concerns me that many therapists plan to continue working online and claim it’s no different to working in-person. Whilst some people find online therapy easier, for me as a survivor and disabled person, this could not be further from the truth.

When Covid began I was told I was ‘clinically vulnerable’ and my long-term therapist transferred our sessions online. Although not ideal, we muddled through and our years working together helped to cushion the change. Online spaces presented numerous problems for me sustaining a meaningful connection with my therapist.

Technology was a feature in the childhood abuse I experienced, both practically and through threats. Consequently, I have fear and deep mistrust about technology. I only have fragments of memories but the tiny light on my webcam fills me with undeniable terror. I struggle being seen by others through the medium of technology which makes online meetings difficult.

In therapy sessions having my emotions being seen through the webcam was especially triggering so we experimented with different options. My camera being off made it difficult for the therapist to understand my speech impairment which is especially hard when I’m upset, impounding the disconnection. The therapist turning her camera off meant I was inadvertently met with her beaming smile on the profile picture – a complete contradiction to the distress I was feeling.

I generally struggle with people looking at me and, in the room, my therapist was astute at placing her chair diagonally so it didn’t feel so confrontational and I had the option to look elsewhere. When working online we were both staring directly at the screen which made me feel on edge. Worse still was when the picture froze or the connection was lost. I was abruptly left alone with my distress, uncertain if that safe person was going to return which was reminiscent of the times I was abused. 

Like many survivors, I experience hypervigilance and being able to take in the whole room helps me to feel safe. This is not possible when I can only see a person’s face and shoulders on the screen. Worse still are the fake backgrounds or the soft blur of the surroundings which leaves me with uneasy feelings of power imbalance and suspicion from years of trickery by the abusers. My therapist panning her camera around the room helped install some safety. I imagine this isn’t something some therapists would feel comfortable with when working online from their home.

The biggest issue I encounter working online is that my difficulties with object permeance mean I can only feel a person’s presence when I’m physically with them. In times of distress a gentle touch of my hand from my therapist has kept me from spiralling into dissociation. This connection has been essential when deep seated shame convinces me I am unlovable and an awful person. The separation created by online spaces fuels this feeling of needing to be kept at arm’s length.

Before the pandemic I valued the container a therapy room provided. Suddenly traumatic content was being examined and discussed within my home. I could feel it lingering like a bad smell long after the session had ended. I had worked hard for years to create a sense of safety and calm at home, far away from the environment I grew up in but now the two worlds were intermingling and my safe place felt tarnished.

As a disabled person, I have embraced the wider use of the internet to attend events I wouldn’t usually be able to access. It was a relief to have a break from the daily barriers and ableism I experience every time I leave my home. However, I wonder whether a therapist who has not met me in person and seen the difficulties I encounter just getting to the room would be misattuned to the challenges I face as a disabled person living in a world not designed for my body.

Once it became clear that Covid is largely transmitted through the air, my therapist and I resumed our in-person sessions outside. That first in-person meeting was transformational and I covered so much ground, going into things I had been too hesitant to online. It was as if our relationship had gone from black and white to technicolour; everything felt richer, deeper, more meaningful.

I was sceptical about how working outside for the foreseeable future would compare to the privacy and containment of a room. There were sometimes problems with not being able to control the surroundings and privacy being harder to achieve when places were busier. However, I found being surrounded by the changes in nature hugely comforting. When I’m distressed, I can’t see that feeling ending. Sitting by the river with my therapist and watching the water pass by on a gentle current assured me that my feelings would pass and I now think about this river whenever I feel stuck.

As a wheelchair user and someone who’s default defence mechanism is freeze, I feel claustrophobic in rooms because I know I cannot easily get out of them. Meeting outside removes the barriers present in built environments which relaxes my nervous system and allows me to focus on the session.

Whilst online therapy works for some people, for others it risks compounding their trauma and isolation. In our need to seek safety from Covid and the largely growing realisation about the convenience of online working, let’s not forget what is at the heart of therapy: two people in a relationship sharing that space. It’s for each person to decide if that relationship works for them online. For me it doesn’t and I think we need to acknowledge this more within the rhetoric that it’s just the same as in-person therapy. Covid has forced me to find alternative ways of accessing therapy and working outside has had a positive impact. Maybe the ‘new normal’ will encourage people to have more nuanced approaches to therapy environments.

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