I’m a lifelong insomniac. Until college, I preferred any bed that didn’t leave me alone in my own, a tendency my parents long suspected therapy could solve. I’ve since spent close to a decade chasing sleep and experimenting with methods that span the therapeutic spectrum, from seeing my mother’s own behavioral therapist, a warm woman (but an obvious mistake), to a short stint with an Jungian therapist on the Upper East Side whose rotating screensaver of Galapagos wildlife I would watch, reclined on her tufted-leather couch; to a few sessions with a male psychiatrist who I associate with Paul Auster novels and a low-level depression that I thought Zoloft could solve. (Couldn’t!)
It took me until August of last year to commit regularly to weekly sessions, at a discounted rate reserved for “creative types,” with a young therapist who I now know, after a quick Google search, is a licensed marriage therapist specializing in anxiety, life transitions, and identity development. (My trifecta!) At first, I was wary of seeing someone who wasn’t my parents’ age or older, and my trepidation only grew after a series of run-ins with her at my Brooklyn farmer’s market: she’d stand, exotic produce in hand, dressed elegantly in outfits foreign from her in-session uniforms, surrounded by a cadre of other hip thirty-somethings. I’d hide, crossing the street so as to avoid an awkward exchange. More than facing the fact that my therapist might actually be cool, I was having trouble accepting that she too was a person with a life outside of the room we found ourselves in on Tuesdays at 10 a.m.
Come March of this year, running into my therapist became the least of my worries. Seeing her at all was impossible, and so we pivoted, like everything else, to a virtual model. Our first session, done via Doxy, was strangely intimate: me in my bed, my laptop propped up on a stack of pillows, and her in her living room, surrounded by plants, a bright yellow lamp beside her, her back facing a window overlooking our shared neighborhood. Two people, just out of bed (well, half of us anyway), surrounded by our things. I rebelled against the new format at first, cancelling more frequently and more last minute, acting as if I was obliging her when she called. As if I wasn’t the one paying for her time. I was wasting both our time, and cheating only myself.
But: the world was collapsing and I, useless and confined to a new stay-at-home reality, was watching it from my window. And so, as if roused from a bad dream, I awoke to the reality of my privilege: I had someone else to talk to, and someone to safely welcome into my home. Suddenly my therapist was there on the couch, sitting beside me; she was there when my electrician showed up unannounced; there when my boyfriend accidentally entered the room (a mistake he knows never to repeat). She was becoming someone like a friend, an intimate confidante, a bystander to my life as it was unfolding in real time. And whether it was my newfound commitment, or the forced intimacy of telehealth, I was making breakthroughs. I even found myself looking forward to our sessions.
Curious to find out if others were having a similar experience, I took to Instagram to poll my followers. The response was both overwhelming and divided: I received a flood of messages, voice memos, and emails written (mostly by women) in either vehement opposition or enthusiastic favor of therapy in its remote incarnation.
One subject parked firmly in opposition is Kelly McGee, a 29-year-old living in L.A., who, after four years of regular sessions, has cut back to seeing her therapist on a bi-weekly basis: “It began to feel like a scheduling conflict instead of something that’s being worked into my week,” she said. “It’s harder to be vulnerable when there’s this performative aspect of being on camera.” Julia Crockett, a 34-year-old movement specialist in New York, has also lessened her sessions. She was blunt about her distaste, but wary of quitting altogether without an alternative: “I hate it,” she said of her Zoom therapy. “But also, the world may be ending? So I’m like…I guess I should still go.”
It isn’t just the discomfort of being on camera that people don’t like. Mina Naderpoor, a 26-year-old L.A. resident who has been in somatic and cognitive therapy for a decade, explained to me that as someone who deals with issues like body dysmorphia, sharing a physical space with her therapist is very important: “When you’re on Zoom, they can’t see your physiological responses to things. Like, if my hand shakes in response to something,” she said. “It’s hard to be validated virtually because they can’t see my physical being. I’m a floating head.” Not to mention the fact that not everyone has a space they can carve out for themselves. Naderpoor has roommates, and has had trouble finding an environment that feels private or safe once a week.
On the other side of the divide, I spoke to three people who have increased their “visits” since the pandemic began. For Maddie Weinstein, an actor and New York City resident, therapy is now free, thanks to a recently waived copay, so she has decided to double up on her sessions. And she’s enjoyed the access that FaceTime has given her: “[My therapist] will pick up in her kitchen and be like, ‘hey sorry, I needed a seltzer.’” This makes the exchange feel “less awkward and staid,” she said. Jenny Osman, who works for the city managing food access for City Hall, said she “hated” virtual therapy at first, but has also recently increased her visits to twice a week. She, like me, has found that she’s made the most personal progress over the last seven months. However, she does worry that seeing her therapist virtually can sometimes lead to misunderstanding: “There are just more opportunities to feel hurt or confused by a comment or piece of feedback,” she said.
Yaya Mazurkavich Nuñez, a 29-year-old creative producer, was diagnosed with bipolar type II five years ago, and has been in and out of therapy since she was 15. She had stopped in 2017, but started again in June of this year “when the uprisings began,” she said. “I knew I had to start seeing someone again at that point.” Mazurkavich Nuñez was also having trouble leaving the house, an anxiety that began to manifest itself after her cousin passed away and was only exacerbated by the pandemic. She has found telehealth invaluable—during this period in which going outside can feel stressful—after starting sessions with someone new. “She’s Middle Eastern, she’s a mom, and I feel like, for the first time, there’s someone who really wants to understand who I am.” Typically, Mazurkavich Nuñez explained, her psychiatrists would take 15 minutes “to solve you.” Instead, she’s found “this therapist wants to go deeper; our sessions are 45 minutes long, sometimes an hour.” Mazurkavich Nuñez is unsure if she’ll ever return to therapy in real life. “I don’t have to worry about the logistics of getting there with Zoom, which is huge.”
The polarized split was surprising. But what I found more interesting was the willingness of these women, some of whom I’ve never met before, to open up honestly (and urgently) to talk to me, nevermind their therapists, about their most private issues. I wanted to find out if the professionals on the other side of the camera were experiencing the same kind of divide. With an almost myopic confidence, I approached my own therapist first, jumping at the opportunity to flip the script and ask her how she’s adjusted to the shift. After she kindly and swiftly declined to comment, I reached out to Dr. Jordana Jacobs, a licensed psychologist based in New York.
Dr. Jacobs was thoughtful and measured in her response, emphasizing the trade-off that has come with going virtual. While she might not be able to feel her patients’ presence in the same way, she’s beginning to see them in a “wider context” as they walk her around their childhood bedrooms and introduce her to their spouses and children. She’s also noticed that doing therapy at home makes her patients more likely to take action on their issues. “They’re talking about long-standing, unhealthy dynamics with their parents and then, when the session ends, immediately walking out of their rooms and attempting to change them.” Julia Makanoff, a registered associate MFT, views telehealth as an innovation, a “window into [her] patient’s lives.” She’s even noticed many of her patients taking more emotional risks as a result of being in the safety of their at-home environment.
Beyond the pros and cons of telehealth, therapy has never been more important as Americans experience increased rates of anxiety and depression amid the pandemic. Mental health start-ups like Frame and Talkspace are responding to the moment by providing new digital structures that normalize therapy for all. So while this virtual model has not yet been resoundingly embraced, it has huge potential for creating increased access to mental health help, even when social distancing is a thing of the past.
I don’t remember my last session in person. But I do have distinct memories of the office itself: the stack of magazines (if my therapist is reading this, I admit I considered stealing The New Yorker every week), the evaded glances in the waiting room, the air purifier in the corner, lazily exhaling a yogic blend of eucalyptus and patchouli, the pleasant neutrality of it all. And it’s that neutrality that worries me: Because it might mean I’ll never return. And if I don’t, what other reasons to leave my home, to enter into the outside world will I lose when this is all “over”?
Dr. Jacobs seemed less worried about the future of therapy: “Zoom is not replacement, but it’s an effective and meaningful temporary substitute,” she said. “At a time when we need connection perhaps more than ever, I am tremendously grateful for virtual therapy—both with my patients and my own therapist—and have been continuously surprised by how rich, dynamic, and fruitful treatment can be online.”