The relationship with the therapist is an important, some say the most important aspect of psychotherapy. Many of the core difficulties that bring people to therapy stem from some difficulty with intimacy. The psychotherapeutic relationship can provide a corrective experience to promote the personal growth and the character development that is needed. Intimacy an essential part of psychotherapy. Therapeutic intimacy differs markedly from the experiences of intimacy in ordinary life, it is proscribed, contained and for a specific purpose. In a sense it is artificial yet genuine for all that. Can therapeutic intimacy happen in cyberspace?
We are close in cyberspace. When you write and post using the Internet I can see inside your mind when you are in solitude. You can quote and link to my words and send them to others. You can save what I write, print it or delete it. You can respond to any word of mine at any time, we have equality as author and reader.
There is an over rated idea that because there is no body language in cyberspace that there is a lesser quality in the relationships. To quote the Ethics Committee of the APA (This was from the 1995 version and removed from it in 1997):
"On the other hand, Internet is a methodology without nonverbal cues, and appears to be a more limited medium for the delivery of therapy services than telephone or teleconferencing."
But is it? Cyberspace adds dimensions of intimacy, a sort of intense virtual eye contact, even as it removes physical cues, perhaps because it removes those cues.
Using email we develop a cyber-language in addition to the actual words we use. This language is more obscure in the face-to-face world, if it exists at all. When we meet face to face I can't see your email!
Emails have SHAPE. The paragraph and line length and use
of space all have impact. The use of quoting means I
can get an impression of a dialogue. The flow of emails
through time has a form. The conversation develops a shape
of its own. There are cues in the email addresses people
use, the naming is often highly symbolic and different
addresses may have built in meaning. Emails have a subject
line. As the posts accumulate in their folder there
is a list of subject lines which often tell their own
Speed of light delivery combined with luxury of languishing over a letter, both features of time in cyberspace. While like a letter, email is not a letter. A letter is not instantly available once it is sent and the flow of a letter exchange is a different means of relating. We can't have a discussion by letter, we correspond. We have email discussions.
The flow of email discussion is created by the participants. The flow adds meaning, in the way body language adds meaning in face to face contact. We notice the silence in email flow.
An email is solitude compacted into a small capsule. Writing, though designed for the reader is a mirror for the writer. The client and the therapist can meditate on their own, and each others words in their own time. Email takes us into the asynchronous realm, where we are not together "at the same time" but we are in an eternal now, where we can have a virtual connection at any time. I can be with their words longer than they took to write them - or shorter - depending on what I sense is right for this moment. Online chat, of course, is different - though the transcripts can be saved. Chat in real time, (live or over the phone or in IRC) restrains us by having to work at our mutual speed and by having to be awake (and even alive!) at the same time. In my own practice I prefer email as the main modality - the ability to be with my client is enhanced.
Options of who we relate to are instantly and constantly
available. Email is social.
This may sound like a long way from intimacy in
psychotherapy online, it is not. You can instantly
surround oneself with peers, or experts, or learners who
are interested in the things you hold dear. While the
therapist keeps the therapy totally confidential the
client can send it where they choose. If you are concerned
about the quality of your therapy, you can send it to a
professional body for review .This is an instant safe guard
to over-developed intimacy that is possible in
psychotherapy. While there may be less safe-guards online
in some ways, the prospect that a record of the whole of
the therapy may be posted anywhere safeguards against
inappropriate closeness. That possibility enhances the
The container for face-to-face psychotherapy therapy is
governed by hourly appointments at a physical place.
Time and place become more fluid online and so the
containment of the therapy has to be created more
consciously. In this way it is akin to ordinary
life! Yet appropriate boundaries need to be formed, this
involves skills on the part of the therapist that are not
included in usual face to face training.
I celebrate the return of text implicit in email. Words are digital and liberated from lead, paper and ink. No matter how ubiquitous graphics and images become, text will remain. I have seen it happen in video conferences, where, for all the images and sound, there is the request: Send me an email! Synchronous encounters, face-to-face or via video or audio will need to resort to asynchronous textual modes for specific needs, sometimes intimacy needs.
Writing activates the imagination, the psyche, the soul. Words like the eyes, are windows into the soul. Text is a channel for intimacy because it is linked to the collective unconscious. The love letter and the poem are testaments to this idea. When we are in emotional pain -- writing is a way to cathart, to heal, because we link to our depths via the words. Writing to others can connect us at this depth.
Written words display their epistemological roots. Words are like just the surface icon for the archetypes of the unconscious. The written word, when we have time to focus on it, is so bold we shy from its impact. The :-) smiley in email, supposedly to make up for the lack of facial expression -- is there to dilute the power of words. We feel exposed when we read what we have written so we add the smiley, a digital fig leaf.
Words add a level of imagination to the things they describe. What we call things matters, it matters particularly in relationships. The words we use to interrelate create the tone of our connection. This happens in verbal speech, of course. While writing on a computer, because of the ability to edit text as we write, we have a moment of surplus reality, a world around each sentence as we work with it. While writing we heighten the scope for imagination. Intimacy is not in the physical presence, even when we are physically present. Intimacy happens in a shared imaginal space.
Words, written in silence, are a meditation. We don't loose the sound of the word in our mind's ear. We do not need to loose the actual sound either, for greater impact emails that are part of psychotherapy can be read our loud, the power of that can be dramatic.
With digitally enlivened text, in silence, in our own time and rhythm, we are entering a qualitative leap in communication. Just how this impacts the soul, the hidden flows of life may not be fully understood for a long time. Yet in online psychotherapy we are leaping into the new realms of connection, learning and exploring as we go. Face-to-face psychotherapy in its many incarnations from Freud onwards has consistently evolved, and our understanding is still expanding.
Re-written from an article begun 23 March 96 - Last Edited: Saturday, 26 April 2003