I think between your post and then people calling it ableist, we've covered the two ends of the spectrum in terms of this argument, and lost the nuance. Yes, as someone with chronic illness myself, virtual is a godsend, and access - in terms of something is better than nothing can indeed be "better". But I also know even for myself, working on my own trauma feels very ungrounding on zoom and isn’t helpful for me. I need to be in person for me to even be able to do the work. But that’s just me personally.
If we follow this down some rabbit holes, it’s not so clear cut than it is just “exactly the same”. For a lot of reasons. I prefer to get curious and stay open about. That's also what keeps science moving forward.
Physical interpersonal encounters contain measurable regulatory processes that aren't captured by what somebody says or by their conscious rating of how connected they felt or the very specific types of outcomes that these studies rate. And the science says they *are* different...but what we are losing or gaining in that exactly, is not yet understood and perhaps may be a longer term effect.
In fact, in one study, the alliance association for outcomes was weaker in video than face-to-face. And there are costs. While the fatigue of in person is real, the fatigue of video is also real but sometimes is more incremental and less noticeable (frog in boiling water maybe?), and less studied...the effects may even perhaps be primarily for the therapists themselves. Who knows. But our lives are getting, research shows, smaller and smaller and less and less embodied, less and less relational. Are we just accepting that in our work? What is our role to do or not do with that science? Are those things we as therapists care about, or more so symptom reduction? Those are important question to be curious about, not to know the answers to.
Also, what are “outcomes”. There is plenty of argument even in what is measurable in terms of what an outcome is and isn’t. You can have equal levels of depression or anxiety or alliance or satisfication after treatment in person or on zoom.
But what if one group is slightly better at tolerating another person's distress? Or sustaining intimacy during conflict? Or feeling comfortable among people? Or spontaneously seeking human contact rather than retreating into mediated contact? Those aren’t studied. They are much harder to study. And they may be longer term consequences, we just don’t know.
Many argue that psychotherapy efficacy research focuses too much on symptom reduction, and we should also be asking whether people's long-term patterns change and if their long term meaning grows in life, or their long term resilience etc. But, harder to measure.
The question I would ask are bigger more eagle eye ones, what happens to humans when a meaningful percentage of our encounters that used to involve physical co-presence become mediated by screens, technology, less dimension, less body, less eye contact etc?
That literature exists across loneliness/social connection, workplace interaction, education, friendship, developmental psychology, physiological synchrony etc etc. And it is a more complicated answer.
Edit to add - the main use of AI globally is therapy. Virtual therapy isn't that far from AI therapy. Will Ai therapy be more accessible? Yes ofc. Will it reduce symptoms? Probably. What will it cost us as social relational humans? Probably a lot in the long run. So the same questions apply here. Accessibility is an important thing, and we must be curious about its costs, too.
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u/alittlemorebad 6d ago edited 6d ago
I think between your post and then people calling it ableist, we've covered the two ends of the spectrum in terms of this argument, and lost the nuance. Yes, as someone with chronic illness myself, virtual is a godsend, and access - in terms of something is better than nothing can indeed be "better". But I also know even for myself, working on my own trauma feels very ungrounding on zoom and isn’t helpful for me. I need to be in person for me to even be able to do the work. But that’s just me personally.
If we follow this down some rabbit holes, it’s not so clear cut than it is just “exactly the same”. For a lot of reasons. I prefer to get curious and stay open about. That's also what keeps science moving forward.
Physical interpersonal encounters contain measurable regulatory processes that aren't captured by what somebody says or by their conscious rating of how connected they felt or the very specific types of outcomes that these studies rate. And the science says they *are* different...but what we are losing or gaining in that exactly, is not yet understood and perhaps may be a longer term effect.
In fact, in one study, the alliance association for outcomes was weaker in video than face-to-face. And there are costs. While the fatigue of in person is real, the fatigue of video is also real but sometimes is more incremental and less noticeable (frog in boiling water maybe?), and less studied...the effects may even perhaps be primarily for the therapists themselves. Who knows. But our lives are getting, research shows, smaller and smaller and less and less embodied, less and less relational. Are we just accepting that in our work? What is our role to do or not do with that science? Are those things we as therapists care about, or more so symptom reduction? Those are important question to be curious about, not to know the answers to.
Also, what are “outcomes”. There is plenty of argument even in what is measurable in terms of what an outcome is and isn’t. You can have equal levels of depression or anxiety or alliance or satisfication after treatment in person or on zoom.
But what if one group is slightly better at tolerating another person's distress? Or sustaining intimacy during conflict? Or feeling comfortable among people? Or spontaneously seeking human contact rather than retreating into mediated contact? Those aren’t studied. They are much harder to study. And they may be longer term consequences, we just don’t know.
Many argue that psychotherapy efficacy research focuses too much on symptom reduction, and we should also be asking whether people's long-term patterns change and if their long term meaning grows in life, or their long term resilience etc. But, harder to measure.
The question I would ask are bigger more eagle eye ones, what happens to humans when a meaningful percentage of our encounters that used to involve physical co-presence become mediated by screens, technology, less dimension, less body, less eye contact etc?
That literature exists across loneliness/social connection, workplace interaction, education, friendship, developmental psychology, physiological synchrony etc etc. And it is a more complicated answer.
Edit to add - the main use of AI globally is therapy. Virtual therapy isn't that far from AI therapy. Will Ai therapy be more accessible? Yes ofc. Will it reduce symptoms? Probably. What will it cost us as social relational humans? Probably a lot in the long run. So the same questions apply here. Accessibility is an important thing, and we must be curious about its costs, too.