Embodiment in online psychotherapy: A qualitative study

Abstract

As a result of the COVID-19 pandemic, many therapists and patients have been required to switch to online sessions in order to continue their treatments. Online psychotherapy has become increasingly popular, and although its efficacy seems to be similar to face-to-face encounters, its capacity to support the implicit nonverbal and embodied aspects of the therapeutic relationship has been questioned and remains understudied. OBJECTIVES: To study how embodied and intersubjective processes are modified in online psychotherapy sessions. DESIGN: Taking the enactive concept of participatory sense-making as a guiding thread, we designed an interpretative phenomenological analysis to examine the experiences of embodiment in online therapy. METHODS: We conducted phenomenological semi-structured interviews with patients and therapists who have recently switched from face-to-face encounters to online modality. RESULTS: Adjustments in verbal and nonverbal behavior, gaze behavior, management of silences, and displacements of non-intentional and pre-reflective patterns onto reflective ones are reported as necessary to compensate for changes introduced in the online modality. CONCLUSIONS: From an enactive perspective, such adaptations manifest regulatory processes aimed at sustaining interactive dynamics and coordinating the primordial tension between relational and individual norms in social encounters. PRACTITIONER POINTS: We examine different aspects of embodiment that practitioners should take into account when switching from face-to-face to online encounters with their clients. Online communication systems can alter aspects of the therapeutic relationship, such as its structure, its fragility, and its significance. Video calls afford new forms of intervention such as integrating the experience of patients with their self-image, incorporating information about their habitual environment into the process, and adopting less confrontational therapeutic styles.

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