The postmodern era has brought about changes in society: a reduction and practically elimination of geographic barriers, different forms of communication, increased isolation between people in close proximity, more individualistic lifestyles… in relation to these changes, it is important to note that the way therapy is conducted has also been altered in some fields. The field of psychotherapy has experienced the expansion of different types of online therapy: therapy through chat, email, real-time virtual therapy through various platforms (Skype, Hangouts, video calls through WhatsApp)…but is it really as effective as in-person therapy? There is no doubt that online therapy can have some advantages, especially in cases where people have reduced mobility or when individuals who have started therapy move to other locations. However, some characteristics that have been highlighted as advantageous in this type of therapy may not be so. For example, one particularity that is emphasized as favorable is privacy. By not having to go to a center or psychology clinic, the patient can conduct the session from their home, workplace, or any other location. However, there are numerous cases of people seeking professional help who are afraid of social interactions, sharing spaces, or even feeling a lot of shame about themselves. Being at home or in other „controlled” places could become a dysfunctional refuge. Benefits of In-Person Therapy Despite the modern trend of implementing online therapy, most therapeutic processes are still carried out in person, and there are many advantages it offers compared to other types of interventions: Metacommunication. A fundamental aspect of therapy is the signals and symbols that inevitably appear in the communication between therapist and patient. This aspect is essential to achieve a deep level of human communication. While it is important to listen to what the patient says in their speech, even more information is provided by what the person expresses through nonverbal communication. This includes movements, attitude, gestures, eye contact, body position, and even the overall context. A significant part of the communication act involves what is not verbally said, particularly unconscious information. This type of information can only be fully gathered through in-person therapy. In cases of video therapy, some of these aspects can be observed but many others are left behind (since only the person’s face is seen, and sometimes in a blurry image). In chat or email-based therapy, metacommunicative components are completely sacrificed, and the therapist has to interpret the messages they read without being able to attend to anything other than the words. Throughout psychological studies, it has been emphasized that there is not only one type of mental representation. Freud distinguished between thing representation and word representation in any experience that a person has with themselves or others. The former refers to the inscription of sensory and motor schemas of various kinds, while the latter refers to discursive forms through beliefs, ideas, convictions, etc. This classification allows for differentiation between lived experiences – emotions, action schemas regarding relationships with oneself and others – and heard experiences – what relates to discourses, justifications, explanations, or one’s own knowledge about themselves and others. Warmth. When the therapist and patient share the same physical space, it can bring more closeness and warmth to the therapeutic process because there is no need for any element to establish the communicative act (computer, phone, Wi-Fi network…), but rather with the mere presence of both individuals (or more in cases of couples or family therapy), the therapy can begin. Safe space. Despite the belief that there is no safer place than one’s own home, in therapeutic terms, this is not always the case. First, as mentioned earlier, the home could be a dysfunctional refuge in cases where the patient has strong feelings of shame, depression, agoraphobia, fear of establishing relationships with others, etc. Second, disruptions can occur at home, for example, someone knocking on the door during a session, a phone call, other people in the house who impede total freedom of expression, etc. In an in-person session, this does not happen because during the session, the space completely belongs to the patient without any interference from others. On a more unconscious level, a sense of safety is created on a psychological and emotional level when the patient always goes to the same place, at the same time, on the same day of the week, with the same furniture in the office, the same scent, etc. This is related to the process of changing certain neural circuits on a psychic level. This control of environmental aspects by the therapist (background music, lighting, temperature…) contributes to the sense of security that the patient feels. Fluidity. Knowing each other physically and understanding the other person’s presence helps make sessions more fluid. Previously, the amount of information provided by nonverbal communication was mentioned – movements, gestures, postures… Similarly, being able to be with the professional will provide a lot of information to the patient. The Importance of the Therapeutic Relationship Psychotherapy is composed of a special type of bond or helping relationship where the patient can convey their issues to a therapist capable of responding empathetically, thus initiating the therapeutic relationship. Freud was the first to talk about the relevance of the therapeutic bond when he stated that transference precedes intervention. Thus, the importance of the therapist-patient relationship within psychological interventions began to be emphasized. This bond has been defined as the presence of an alliance or interpersonal commitment in the therapist-patient dyad, reflecting the contributions of both parties in an intersubjective process characterized by different stages or levels of therapeutic work. Within this bond, it is important to highlight the presence of an intrapersonal experience characterized by the individual’s experience in the context of interaction with others. In this experience, the participation through different roles played by the therapist and patient is highlighted, along with personal experience regarding variables such as perceived control level, self-esteem, etc. This is manifested in intersubjective interaction through different levels of openness or resistance in the bond. It is an interactive system of mutual influence whose dynamics involve the intrasubjective level, the internal world constituted by the individual’s prior experiences that are manifested in the relationship with the other, and the intersubjective level, the interrelation between the subjectivities of the dyad’s components. Until a few years ago, clinical intervention focused on the material and information provided by the patient’s discourse without considering the material facilitated by relational experience. However, in recent decades, various researchers have made different contributions (Stern and implicit relational knowledge, Fonagy and implicit memory…), highlighting the relevance of experiential phenomena. As a result, these contributions have been included within one of the main types of memory highlighted by neuroscience, procedural memory. This type of memory refers to action-emotion schemas, automatic ways of being with others, or automatic emotional reactions. This type of information cannot be verbalized or narrated by the patient, but it manifests itself in the context of interaction with the other person unconsciously. Therefore, the therapist’s task is to detect this knowledge in order to intervene on it…
Terapie față în față sau terapie online? – Aesthesis | O abordare modernă și convenabilă!
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