Why your therapist should not (only) be a screen...

You may have heard the ads on all the podcasts - find yourself a therapist quick, on your computer, within the next five minutes. If you’re feeling lousy, this can seem like a great idea. Or maybe you have a therapist far away whom you’ve kept up with online. This too can be a good idea, at least initially.

But as a therapist who’s done both screen and in-person work over the past ten years or so, there is nothing like having your patient in the room with you. And as a patient, there is nothing like leaving your space to go to a real therapy office - not your home office, not your bedroom - a therapy office. This is especially true if you’re an expat/immigrant/not in your home country.

You need to get out into the world and interact with it, no matter what. I sound like I’m nagging - but this is also a part of maintaining your mental health as an expat.

Figuring out how to go places is figuring out how to live in the Real World, not on the internet.

This is not easy for those who live so remotely that there is no one speaking your native tongue within a 100 kilometer radius - but even then, I would encourage you to do a mixed therapy framework of online sessions and office sessions.

Why?

Here’s a rundown in no particular order of importance.

1. There are things that only your presence in the flesh can reveal to your therapist. We make use of all of our senses, though not always consciously. I will notice more how you breathe, how you tap your foot - all the things that let me know how your body is processing your mental state. I can more easily see if you’ve slept well, if your skin color is okay - the basic things that must be attended to in order to get anything out of psychotherapy. This is the foundation of any psychotherapeutic work you do. Any responsible therapist will take these into account.

2. Leaving your home is part of therapy! Your session begins when you put yourself in the mindset of going to your session. Anything that is in your mind - or not- is grist for the mill. The train or car ride, the walk, the wait - all of it helps you to begin to attend to your inner world. Even if you aren’t doing it consciously, it will benefit your psychotherapy. As an expat, your impressions of the world around you are part of integrating - so consider it a bonus therapeutic exercise.

3. You will be working with a local person who knows what the heck you are talking about. You will share the same weather, the same traffic problems. You will both know what it feels like to live and adjust to your particular place. You will speak with someone who’s experience in lived reality is aligned with yours in a way that you won’t get from a screen therapist.

4. You will get better therapy. Unfortunately, many of the platforms rely on very inexperienced therapists. They require simply that the clinician has had three years of experience (but this isn’t checked - they could have worked in geriatrics or dentistry - that is to say, not in a psychiatric setting). There is no supervision requirement for their practitioners. The therapists tend to be very inexperienced because they are paid very poorly on the platforms, and they are guaranteed to get patients quickly. This means that in order to make a living they need to see thirty to forty patients a week on the screen. This makes it very difficult to give someone quality attention. Some platforms require therapists to use a standard protocol for the sessions they provide. In other words, they don’t listen to you as an individual - they apply a therapeutic protocol given to them by the platform.

5. You will be getting better therapy. … I will say the same thing, a bit differently. A local therapist knows local doctors and psychiatrists, has a link to the local hospitals, can call up a colleague to get you additional help quickly - should you need it.

Please please please consider doing a mixed-frame therapy if you live remotely - that is to say, far away from a therapist who speaks your language.

A mixed frame, as I practice it, could be coming for sessions in-person every other week and the other times online. This can absolutely be worked out between whomever is roughly in your neck of the woods.

Good luck out there, and I would love your feedback.