Therapy through Screens

In spring of 2020 a global crisis—you may be familiar with it—compelled me to move my practice entirely to Telehealth. This transition was not smooth. Maintaining focus and connection in therapy was draining and brought up a number of unexpected feelings and thoughts. As a therapist I’d cultivated a discipline of meditative focus on the client, minimizing all the distractions in my room so I could keep practicing returning to connection. But with my laptop I had a relationship characterized by divided focus and multi-tasking.

One day, in a very embarrassing moment, a client called me out about not being present in an important moment, and I realized I needed to get my shit together. I turned toward colleagues for advice and, as I found what worked for me, facilitated a series of workshops for therapists having similar struggles. This writing offers the insights I’ve taken away from this work, for others who might need them.

Cookie the Pom

Hard Focus

A teacher from whom I learned ceremonial drumming introduced me to the concept of “hard focus.” Hard focus works to push away all distractions from that which it wants to center. In this state of being, one’s focus of concentration is narrow, constrained, and stressed.

Imagine encountering a rattlesnake in the middle of a casual walk, and rousing that snake to its alert and threatening posture. The kind of attention you might pay to this rattlesnake would be hard focus. Of greatest importance is tracking the snake and keeping safe. Your senses may be less attentive to other environmental cues, your body may be tense, and it’s likely you would not be daydreaming about other things or enjoying a conversation with a good friend on the phone. 

Hard focus connects to the stress state, when our sympathetic nervous system is activated and primed to react to threats. Even in situations of safety, practicing a hard focus—like trying learn a new skill under great pressure or studying for a test—cues the body to activate the stress state. This is useful to an extent, but it also contains a flaw known as “target fixation,” when our body instinctively moves toward whatever is the center of our focus. 

A race-car driver attempting to navigate around a flaming pile of cars would not stare at the cars to ensure safety, as it would mean steering subtly toward them. To be safe, one needs to focus on the safe part of the road, where you want to go, while being aware of the danger.

With hard focus and the stress state, people tend to become ungrounded and lose their posture. Often clients talking about scary or upsetting experiences will unconsciously lift their feet from the ground, like their bodies are trying to draw inward or withdraw from the difficult feelings. Or else the body might begin to tilt toward the stressful stimuli, like how our heads may bend toward the screens when engaged in an online argument. 

So the tendency toward hard focus goes with losing groundedness, stability, and the capacity for calm reflection and seeing the larger context. From my understanding of neurobiology, this state seems feels very much related to the left hemisphere of the brain’s capacity to analyze, pick apart, and focus on details, cut off from the right hemisphere’s capacity to look holistically at what is happening and maintain perspective.

Should one spend a day trying to do therapy in this stress state, it’s inevitable that one would end the day feeling more exhausted and more caught up with our parts of self that are afraid of getting it wrong or feel they have something to prove. We can feel so distressed by both our urgency to connect to the client and the constant reminder of the client’s physical absence that we struggle to relax and actually connect.

Wow, I upset myself writing that. 

So with all this happening through the screen, now we’re adding complex mental tasks like at a person’s face, reading memes, filtering through a wall of text, crafting appropriate responses. We begin to lose contact with the body and environment and get pulled more into this mental world of the Internet.

Screens and Stress

Screens now connect us, for good and ill, to so many important areas of life—relationships, work, politics, information, self-care and survival needs, all of which are rife with threats that activate our nervous system. A notification that you received a text message from a particular name could spiral you into panic before you’ve even opened the message. Casually scrolling through social media to catch up with friends could go quickly awry when one of them posts a confusing meme that seems to disagree with your core values. Anything you post online could be screenshotted and sent to be used against you in the future. 

At the same time, apps and social media encourage us to multitask, check out, and click impulsively rather than slow down into deliberate focus. One could spend hours literally cycling through the same three to six apps with very little stimulation, while the blue light activates the brain.

The confluence of all this within the same object turns the phone or laptop into a symbol of both activation and dissociation: a source of stress and the stress-reliever.

For a time, I wondered if reading text itself invites a left-brained hard focus. That might be true, but in practice I’ve discovered that reading a book is soothing in a way that screens are not. Reading a book for pleasure is enjoyable in part because at no point do you risk the book demanding instant feedback from you with threats to your livelihood and relationships.

You may feel deeply called out and seen by a book, and you may feel your beliefs attacked by a book, but the book is unlikely to post your reactions to social media or call your boss. The book is not going to yell at you for missing a text it sent you hours ago. Reading a book or watching television are not exactly passive, but it is boundaried and personal the way screens are not. 

Urgency, hard focus, stressed states then prime us, when reading social media, to look for content that further causes us stress. Often I use the metaphor of wearing colored glasses to illustrate what happens to us in emotional states: it’s like we see the world through glasses that have a red tint, so everything appears red. If I view the world as threatening, then my lenses see everything tinged with that emotional color. When I feel hurt, lonely, or angry, I’m more likely to see a social media post I would’ve otherwise found benign as a very personally targeted call-out. In my stress, I may overlook an important word that changes the entire meaning of the post.

The paradox is that there are red things. We can’t pretend there aren’t red things. But if we confuse the lenses with reality itself then we’ll react to everything as though it’s red and miss the nuance and the possibility of other colors.

Dog looking at a laptop, photo by Kyle Hansonhttps://unsplash.com/photos/1pyqUh8Jx3E

Softening Focus

So how does one navigate being aware of threats and risks while also focusing on the desired goal? This is what we’d call “soft focus.” In a soft focus, our attention is gentler and more expansive, taking in as much information as possible in an open way. After reading this sentence, take a moment to look away from the screen toward a blank wall or a sunny window, and try to pay attention to what’s happening at the edges of your peripheral vision for ten breaths.

What you experienced, especially toward the last half of those breaths, is a softer focus. You may notice it’s hard to fixate on what’s at the corners of your peripheral vision but also simultaneously you take in more visual information than you would simply focused on what’s in front of you. With practice, there’s greater capacity to hold a center and take in the whole circumference of your awareness.

For some of us, letting our gaze soften feels scary, like we’re losing control, because we’re used to the stress response as a safety mechanism. Yet in some ways we become safer with this soft focus, more aware of what’s happening around us and with a greater range of potential responses.

We also tend to feel much, much calmer. Stress states are self-perpetuating. The more tense you become, the more narrow your focus will be. The more narrow your focus, the more likely you are to be in states of worry, anxiety, upset, anger, or fear. What I’ve learned in doing trauma therapy for almost a decade is that our physiological stress response and what we might call our psychological stress response—our thoughts and memories—mutually encourage each other.

What this means, in part, is that learning how to calm the stress in your body goes a long way to soothing psychological distress. Breathing deeply, into your belly, while looking at the corners of your vision is calming. Breathing in, clenching your muscles, and then breathing out while unclenching is calming. These skills are simple and available to you right now, without you having to solve all your issues, which is so wonderful. The downside is that they require practice and it’s easy to forget about them when we get caught up in our psychological distress. So ideally we would work both ends of this for the greatest freedom.

Grounding and Centering

Put your feet on the ground or on a footrest, whatever allows your feet to make full contact so that your body can feel the support and stability of the ground.

Sit back in your chair. What I do is focus on my breathing and, as I exhale, let my center of gravity shift back into my core. Often it feels like I’m sinking more into my tailbone and pelvis, not so much leaning forward. Roll your shoulders up and back as though you’re tucking them into your upper back. Let the top of your head lift up and your chin tilt slightly down. 

Periodically check in to remember that you are in a body. Let your chair, floor, or posture be a physical reminder of your embodied presence.

Softened Gaze

Frequently, during sessions or video calls, look away from the screen. Either notice the edges of your peripheral vision for several breaths, or if you can, look off into the distance. I may look slightly above the video camera in my computer so that it appears I am offering eye contact while I am resting my eyes.

If you have headphones on, this is also an opportunity to focus on the sound of the other person’s voice. What I find is that when I look at the screen, I am aware of the absence of my client. But when I focus on the voice, I feel much closer to them—their voice is so close to my ears, and I can attune to subtle information coming through their word choice, tone, and speed.

Tuning In

Jungian psychologists speak of the “intersubjective field,” which is a construct representing the ways we inhabit interpenetrating psychic spaces at all times. You have your subjective experience, as do I, and we are enfolded in the larger subjectivity of our shared cultures, our shared regions and nations.

None of us is able to maintain a wholly objective perspective—nor would that necessarily be desirable. What we do have is a big soup of all of our different experiences, each of us activating ourselves and each other. The fear I feel might not be mine, it might be yours, but for whatever reason you’re unable to feel it.

Working with this frame means in part listening to my experience with the same curiosity as I would a client’s, and to be curious if what’s present for me is echoing what may be happening for them. What’s tricky is that it may be dressed up in my own issues—like chewing on an insult paid to me five years ago—but if I step out of the content and look at the process, there may be gold. “Oh, I’m feeling distracted and irritable. I wonder if that’s happening for the client.”

In summary, what I’ve learned is that trying to connect by screens is much harder than relaxing into my body and experience and trusting that connection is happening. Trusting allows me to relax my gaze, open up to all the information available to me with curiosity, and meet everything with calmness and curiosity. 

This requires a certain amount of practice and diligence, but I find myself more effective and less exhausted having done the work. 

The Gaze of the Sage

When practicing a soft, grounded, open focus, I am reminded often of depictions of the masters of spiritual and martial art traditions over the centuries. Their eye gaze often appears unfocused and distant, though they perceive so much. Or a spiritual being might have one eye clouded or covered, signifying their perceptions of the spiritual realms while the other eye perceives the physical. 

Image of Odin the Wanderer by Georg von Rosen

In this state we are calm, open, engaged, though we take life less personally. It is a difficult state to sustain, as so many of our parts want to focus on particulars, and our stress and wounding tends to bring us back to that hardness.

I am mindful, too, that my focus in this post has been on the screens but that none of this has happened in a vacuum. While adjusting to Telehealth, all of us were living through a global pandemic and civil unrest, which would be more than enough to engender stress and hard focus for survival. 

We are still working through the stress and reactivity of this. Recently I was on a walk in my neighborhood and saw some kids had chalked the ground with the words “all lives matter.”

Immediately I felt a tightening, an anger response, as a part of me now associates that particular phrase as a sign of ideological disagreement and threat. Yet as I kept breathing, I reminded myself that this was written by children. Responding to them with the anger and harshness I felt would not have served anyone.

As I kept breathing, I noticed that when I took off my red-tinted-glasses, I did not disagree with the phrase itself, only when it was used in particular contexts. In hard focus, however, we stop attuning to the context in which the present is happening and instead bring forward the context of all our related past experiences.

The work remains: to honor our wounds and stressors and be mindful of dangers while bringing our attention to where we want to go in the present.

Now that you’ve finished this, I encourage you to once again take ten breaths attuning to the edges of your vision with your feet touching the ground—or if that doesn’t work for you, whatever you can feel that connects to the gravity that anchors you to the earth.