Since my first session, I've had a surprising shift in my preconceptions of TeleHealth and online healthcare. Sitting at home with a cup of puer tea in my favorite foldy saucer chair while my patient appears on my laptop, seemed odd at first. My largest draw to this platform being just that, getting to be at home--my baby sleeping in her cradle swing somewhere off screen (but under the vigilance of mommy-sense) while I discussed cognitive dissonance and acknowledgement of the self. But... But... But...
My desire to be with my child after I gave birth outweighed the concerns I had with the idea of not seeing a patient face to face; and I had a few. Would the quality of care be affected? Is it as thorough? Will I be able to "read" them without the physicality of presence? Will things get lost in translation? Is it too easy? Too convenient? Is the concept too strange? Will there be a lack of connection? A passivity, an apathy, a disconnect to the relationship and the work? Nope.
What I have experienced so far challenged my perception of reality, progress, and conventional mental healthcare. First of all, I learned presence transcends physicality. To be present is simply a willingness to see what is in-front of you and acknowledge what it offers. And that's what another person senses about you as your presence--how willing you are to be and see them. How much you embody who you are, and how much you recognize the same in another. The latter determining how "strong" your presence is perceived to be, whether it be negative or positive.
Second, there are requirements for initiating and maintaining presence. A major one being: a sense of safety. That's where TeleHealth comes in. Allowing someone to choose their space in which they will be asked to look at their pain, I believe, is monumental in determining the amount of effective depth someone will apply to their inner work. Choosing their space allows for that extra level of safety and comfort that may be lost when entering an unfamiliar office with unfamiliar provider. Expectations interfering with the ability to hear, see, or simply be. Sitting at home, with their own warm or cool cups while I pop up on their screens, sets my patients up to be in a more present state, open to curiosity. A level of ease that may have taken a few in-person sessions to develop otherwise.
Third, the level of presence determines the effectiveness of the session. Safety and comfort provides the makings of a relaxed state; decreasing the amount of extra mind chatter so a person can be more present to the work than they would have been in a more agitated state (ie stressed from just surviving traffic, not knowing what's expected, keeping track of the time to go pick up the kids, agoraphobia, social anxiety, etc). I was surprised at the level of progress between appointments, I thought it was "too fast." But, by removing the extra small annoyances (or big) that occur with making in-person sessions possible, it increased the amount of engagement and focus.. This lead to more profound realizations of the self as they applied what they had learned. A parasympathetic state allows for more blood flow to the brain, less fog, less chatter, and more receptive to learning--consciously and subconsciously.
Those who live with the effects of trauma, or are hobbled by fears, anxiety, social limitations, pain, even level of ability; can benefit greatly from access to mental health services directly in their homes or place of safety. Where they can maintain their privacy and allow themselves to look at their vulnerability without needing to hurdle difficult obstacles to see their provider. TeleHealth so far has proven to me that, for the right circumstance, it can be just as or even more effective than an in-person session. It does not limit the main ingredient in the therapeutic relationship--presence. I am now more comfortable, sitting in my own place of safety, knowing that the work is just as impactful. And, I get to be closer to my baby.