Teletherapy During the Covid Crisis: Challenges and Opportunities

This pandemic has made strange bedfellows. Take the recent forced marriage between psychotherapy and technology. While it has been a long time coming, the current crisis pushed most psychotherapists to take the plunge into teletherapy (therapy conducted by phone or online) wholesale. They’d resisted it for years, and for plenty of good reasons--logistical, legal, even theoretical. But the lockdowns in response to the pandemic exacerbated mental health problems of already epidemic proportions in the US. To promote widespread delivery of services, legal restrictions requiring highly encrypted, secure platforms were waived across the country, with the result that a plethora of tools are currently in use. And hundreds of thousands of mental health professionals suddenly found themselves working remotely or not at all.

The wholesale adoption of teletherapy during this crisis provides an intriguing lens through which to explore pain points and possibilities for the design of remote interaction tools. Psychotherapy is conducted in myriad ways and contexts by practitioners of widely disparate training--much more than other forms of telehealth. For example, most therapists routinely face their clients, closely tracking gestures, micro-expressions and other nonverbal cues to help create and maintain an effective “therapeutic alliance”. Yet many psychoanalysts intentionally sit behind their patients (as did Freud), to avoid eye contact and minimize intrusions into their thought processes. And cognitive-behavioral therapists tend to focus more on training materials, such as readings and worksheets. In addition, many psychotherapists consider their physical office a kind of “sacred space” or “container” in which strong emotions can be safely expressed, processed and regulated. And some—especially somatic therapists—have relied almost exclusively on physical presence and even “healing touch”.

How have psychotherapists (of various stripes) adapted to practicing remotely during this crisis? How has it impacted their work--and their lives? What platforms are they using and why? How satisfied are they, and what unmet needs persist? This talk addresses these and related questions in light of some fascinating findings from ethnographic interviews and survey responses from over 2,300 licensed psychotherapists in California. In their response to the pandemic, psychotherapists are engaging in a large-scale natural experiment exploring the efficacy of a variety of remote interaction tools in diverse use cases. The crisis is revealing challenges and opportunities for psychotherapists and interaction designers alike.