Many psychodynamic clinicians report being unusually tired after a full day of on-screen appointments. There are many reasons why this is the case, including the demands of attention, empathy, and relational dissonance.
Feeling present with one’s patients on screen, i.e., an experience of “telepresence,” requires focused attention on the technologically-mediated representation of the other while purposefully avoiding all the potential distractions in one’s immediate environment, like a bird flying by your window. Fighting distraction is a special challenge if you look away from the screen to move your eyes as you would in person in search of space for imagination and reverie.
Some find having their own image on screen a useful reminder of how the patient is seeing them, while others find it a distracting trigger for anxious vanity and prefer to turn their own image off. If it’s too hard to stay focused, consider switching to telephone or use audio-only on your computer.
Maintaining “telepresence” also requires effort to not wonder about, or even check, emails, texts or social media messages lurking in the background of the computer or phone you are using.
Shared embodiment feeds empathy. In the absence of automatic and intuitive processes like implicit imitation, affective micro-attunements, and mirroring, it takes more work to find the other’s inner experience.
The limitations of screens make empathically connecting much more difficult. While you get to see aspects of patients’ lives previously only discussed, that doesn’t make up for the extra effort empathic immersion requires on screen.
Even when attention is optimally focused and empathy achieved, with telehealth there is also a dissonant physical experience lingering in the background. The body knows it is sitting alone in the absence of the other. Resolving that relational dissonance takes additional effort.