Teletherapy exhaustion

Over these last few weeks, I’ve seen an uptick in articles about teletherapy exhaustion. And a new term is entering our vocabulary, “Zoom fatigue.” We have seen the recent transformation from face-to-face psychotherapy to teletherapy. We would be wise to pay attention to the issues with teletherapy fatigue. 

What we know about teletherapy

Below is a summary of some of what we know, either from the literature or from personal experience. (Numbered references are at the end of this article.)

  1. Teletherapy is exhausting because our brains are “prediction generators.” When the technology freezes or is out of sync, our brains work extra hard to “correct the errors” and fill in the missing pieces. This effort is exhausting. (2, 3, & 4)
  2. Humans are exceedingly attuned to facial expressions. Bad connections make accurate interpretation difficult. Furthermore, poor connections make it difficult for us to mirror emotions. Mirroring is a key ingredient in empathy. (3 & 4)
  3. Teletherapy offers more context than texting. Texting is the least effective method of conveying empathy and trust. (1)
  4. With good connections, “video and audio conferencing groups were nearly as good as face-to-face.” Nevertheless, these groups did show some evidence of what we term delayed trust (slower progress toward full cooperation) and fragile trust (vulnerability to opportunistic behavior).” (1)
  5. Trust formation patterns are negatively affected by spatial distortions. Trust is improved by a “faithful” video system. (5)
  6. In a corporate setting, “the experience of the other is flattened by a technological partition. . . . Reliance on a technological interface is susceptible to being unconsciously enlisted in the creation of a social defense.” (8)
  7. Eye contact during teletherapy is awkward. Looking or talking at one part of the screen means that we are not looking at the camera. Rarely do speakers look directly at the video camera. (4 and personal experience)
  8. We often are distracted from what is said by the rich visual detail on our screens. Seeing oneself on a screen is especially distracting, and for some inhibiting. (4 & personal experience)

Some ideas that help

  1. The more bandwidth on both ends, the better. A good connection helps reduce teletherapy exhaustion.
  2. Smaller groups improve connection quality and therefore are better.
  3. When you speak, look at the camera, like Mr. Rogers did. He was a master of reaching through the camera to his audience. Ignore the images of others on the screen when speaking.  
  4. Cover the screen image of yourself with a blank document. You are more likely to focus on the other if you are not looking at your face.
  5. Interestingly, with a good connection, empathy formation can be improved. Framing the video image to include the upper-body as well as the head raises empathy to the same level as face-to-face interactions. Therefore, in your setup, include more of your upper-body in the shot. Just a headshot makes it harder for others to read you. (6)
  6. Take a break between appointments. Focus your eyes on something in the distance.
  7. Some may prefer a phone call to video. For some, the lack of facial cues is better than faulty ones.  
  8. There are certain clinical situations where teletherapy can be more beneficial than face-to-face. For example, one case study I found was about a 13-yr-old with dwarfism. The analyst argues that “the introduction of screen relations provided the patient with a temporary respite from the narcissistic pain of being seen.” (7)

Currently, our mental health practices depend upon teletherapy. It looks like this may be the case for a while. And I have argued elsewhere that I believe teletherapy is here to stay. See Predictions for mental health practice after COVID-19. Therefore to reduce teletherapy exhaustion, requires awareness and perhaps some adjustments. 

The resources I am summarizing above

  1. Nathan Bos, Judy Olson, Darren Gergle, Gary Olson, Zach Wright. Effects of four computer-mediated communications channels on trust development. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. April 2002. Pages 135–140.
  2. Sheryl Brahnam. (2017). Comparison of In-Person and Screen-Based Analysis Using Communication Models: A First Step Toward the Psychoanalysis of Telecommunications and Its NoisePsychoanalytic Perspectives, 14:2, 138-158.
  3. Manyu Jiang. The reason Zoom calls drain your energy. BBC. April 22, 2020. 
  4. Kate Murphy. Why is Zoom terrible? New York Times. April 29, 2020.
  5. David T Nguyen & John Canny. (2007). Multiview: improving trust in group video conferencing through spatial faithfulness. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. April 2007. Pages 1465–1474.
  6. David T Nguyen & John Canny. (2009). More than face-to-face: empathy effects of video framing. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems. April 2009. Pages 423–432.
  7. Tom Wooldridge. (2017). Now I See You, Now I Don’t: Screen Services, Short Stature, and the Fear of Being Seen. Psychoanalytic Perspectives. 14:2, 193-205.
  8. Byron Woolen. (2017). How Technologically Mediated Interaction Risks Collapsing a Reflective Space in the Workplace: An Organizational Leadership Case StudyPsychoanalytic Perspectives. 14:2, 206-218.

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