It’s been about a year and online therapy during the COVID-19 pandemic may have worked for me, but I couldn’t have been more pleased to finally return to the office this past summer. Zoom therapy simply isn’t the same. Though it’s extremely beneficial that online therapy is so accessible, the difference is noticeable among therapists and patients. Many therapists find themselves missing body language cues that gauge patients’ needs, and without the ability to lend a tissue during a difficult time, therapists can feel powerless. And on the patient’s side, a space where one can speak freely without fear of eavesdroppers is difficult to recreate. As a patient who spent many years in-person, and a year and a half on Zoom, I’ve seen the difference a setting can make. There are just some ways Zoom doesn’t measure up.
The Before
I’m kind of an expert in therapy. Ever since sixth grade, I’ve been sitting in waiting rooms decked with white noise machines and arrays of magazines. I know the feeling of being anonymous, wondering who the person in the room before you is or what they’re dealing with. And I know how that anonymity quickly changes upon entering the office opposite a warm, inviting face, ready to listen and ready to grow.
Therapy has long been a necessity for me, though it didn’t start out that way. When I was eleven, my parents forced me to go. Arriving early to my first appointment, I remember the beige waiting room walls, matching beige couch and leather-bound chairs scattered about the room. Those 15 minutes took a decade to go by. I remember being told that a therapist and a doctor were different, but sitting there with other patients in that waiting room, they felt one and the same.
The visit itself I don’t really remember; it’s funny what sticks out in the distant past and what doesn’t. But over the course of about one year I went to therapy every week, playing board games and venting about how I didn’t like gloomy weather in autumn.
It wasn’t until ninth grade that I realized how much I valued that year of therapy. At the height of confusion around my anxiety, I begged my parents to let me go back. I craved the space, the energy, the feeling of lightness after leaving each session. I wanted the assurance I would be okay because I wanted to be. And I was, ending my second stint of therapy after two great years. My third came halfway through sophomore year of college, this time in a new city with a therapist I got to choose. It was my first “adult” therapy, and I know it won’t be my last.
And then there was Zoom
When COVID-19 hit, however, things changed. No longer could I sit in the beige waiting room with the chilled water cooler. I couldn’t stare at the posters on the walls, listening to the white noise machine purr in the corner. Instead, I found myself arriving at FaceTime appointments right out of bed, the opposite of fresh-faced. And with the few extra levels of separation between my therapist and I, the concept of a “safe space” seemed to fade.
In Zoom therapy, I could discuss almost everything, but the key word is “almost.” Before, I would be able to talk about anything and everything I was going through. Yet when I Zoomed from my house during the beginning of the pandemic, I was anxious that someone might be able to listen in, even if they weren’t trying to. My family promised they couldn’t hear me during my sessions, but I worried they still could. To improve my comfort level, I’d use a hushed voice or avoid certain topics altogether, which isn’t really the point of therapy.
Eventually, I figured out that if I FaceTimed from my car at the beach or a nearby park, I felt less anxiety. And when I returned to campus in the fall of 2020, I found solace in my bedroom — a space where I felt more comfortable sharing my thoughts. But even that wasn’t perfect. Often, I would log off of Zoom and feel clouds still hanging over me, as opposed to stepping outside an office building, taking a gulp of fresh air and heading to Starbucks.
I’m not the only one who had concerns about the effects of the pandemic on therapy; psychotherapists themselves have also been worried. A July 2021 study published by Frontiers in Psychology surveyed 1,257 psychotherapists and identified four major points of concern about the effectiveness of online therapy: Emotional connection (difficulty with emotionally connect to the patient), Distraction (therapist or patient being distracted during sessions), Patients’ privacy (private space and confidentiality), and Therapists’ boundaries (professional work space and issues with boundary setting). Another 2020 study, published in Cyberpsychology, Behavior, and Social Networking, reported that mental health care professionals find it more difficult to establish a rapport with clients online because it’s harder to gauge nonverbal cues through a screen than in person.
In the end, I’d say that Zoom therapy worked for me. Likely, this is because I was meeting with a therapist who I had seen in person for over a full year before the lockdown, and because I knew the benefits of therapy regardless of the imperfections of the changed platform. But I know a lot of people who didn’t feel the same way, friends who began therapy during the pandemic (often due to the pandemic) didn’t experience noticeable benefits because they hadn’t known anything other than Zoom. They never felt waiting room silence or sat on comfy in-office couches or took a tissue from a box with inspirational quotes on the side. I feel lucky to have attended therapy all the years that I had before COVID-19. I also feel lucky to have had a pre-formed relationship with my therapist. Without that, I’m unsure if I could have continued Zoom therapy either.
In-person again, finally
The good news is within a few months of being fully vaccinated, I received an email from my therapist saying that I could visit her in the office. I jumped at the opportunity, excited to be back, but a bit nervous after having been away from it for so long. I didn’t know what it would be like, whether it would still be impactful, or if I had romanticized it.
On a sunny, hot day in early July, I tested the theory, parking in front of the office and meeting my therapist at the door. We both donned smiles that melted away our masks. I walked down the staircase lined with books, and smelled the familiar scent of air-freshener that hardly has a smell at all. I sat on the couch, crossed my legs, placed my water bottle and purse on the floor by my feet and looked across at the three-dimensional person opposite me. And then I spilled the tea.
I can’t underestimate the difference an office makes in therapy. And although Zoom appointments helped us all make it through some pretty dark times, going back to the office was one of the unexpected highlights of my summer. Let’s add that to the list of things we didn’t realize we missed until we got to do them again.
At the end of July, I had my last session with my therapist from college. It was difficult to say goodbye, but with a 3D hug and some well-wishes, we parted ways. I’m not sure when I’ll find another therapist, or if I even need one right now. I’m realizing in grad school that I’m stronger than I ever thought.
So for those of you who are considering therapy, but are intimidated by the in-office visit, let me offer my unsolicited advice: try it! You never know what good might come your way. I certainly didn’t expect that playing board games in sixth grade would have led to such a pivotal piece of my life’s puzzle.
Studies Referenced:
Békés, V., et. al. (2021). Psychotherapists’ Challenges With Online Therapy During COVID-19: Concerns About Connectedness Predict Therapists’ Negative View of Online Therapy and Its Perceived Efficacy Over Time. Frontiers in Psychology.
Feijt, M., et. al. (2020). Mental Health Care Goes Online: Practitioners’ Experiences of Providing Mental Health Care During the COVID-19 Pandemic. Cyberpsychology, Behavior, and Social Networking.