~ November 2021 ~ New enquiries about therapy for sex addiction have doubled in lockdown. But when an addiction seems to be intrinsically linked to online relationships, how does remote therapy adapt?
For someone like Ben, who has been a sex addict for more than a decade, therapy sessions are as habitual as going for a haircut. When he first sought help, many years ago, a weekly appointment was crucial to turn around the compulsive behaviours and spiral of depression that had taken over his life.
Today, an hour of therapy each month is more of a check-up, which ensures his recovery is well maintained. But, thanks to the pandemic, things are different: what once involved travel and a few hours away from work is now conducted on a smartphone during his lunch break.
“Because my wife and son are at home as well, I have to ask for an hour of undisturbed time,” Ben explained. “At first, I would hear a noise outside and think, ‘Is this really private?’
Then I remember that my wife doesn’t want to hear the conversation. You feel a little more self-conscious at first, but you get used to it.”
When the bulk of your job entails sitting in a room, quietly listening to another person, social distancing is bound to make life awkward.
Across the country, therapists are in high demand, but with the comforting space of a therapy room largely off-limits, mental health professionals have had to accelerate the use of video conferencing. For those who struggle with forms of online addiction, these conditions are especially tough.
The various lockdowns have made typical stress relievers, such as sports and socialising, harder to access, whilst providing plenty of time to stay at home and face the temptation of online gambling or pornography.
At the Laurel Centre, a specialist provider of sex addiction and porn addiction therapy, new enquiries have doubled from around 200 to 400 in the space of a few months. Some former clients have returned after suffering a relapse during lockdown.
With so much at stake for those seeking help, it’s tempting to wonder whether online therapy for online addictions would only make the problem worse.
“With many of our clients, they’re used to online relationships: that’s the problem,” says Paula Hall, clinical director at the Laurel Centre. “Part of the challenge for us is to reshape the way people relate to the experience of being online. So, in one way, it makes sense to be doing that in a virtual session.”
But Dr Mark Griffiths, professor of behavioural addiction at Nottingham Trent University, pointed out a crucial delineation. “If someone is an online sex addict, they’re not addicted to the internet, they’re just addicted to that specific behaviour,” he explained. “The majority of online gamblers gamble offline as well. It’s not just limited to one medium.”
Six months ago, Paula was worried that online sessions could be triggering, but after many months of having no choice but to embrace the technology, her outlook has quickly changed. “The ‘triggering’ issue has barely come up and things are much better than I anticipated.
Everyone has gotten so used to Zoom calls now that the initial awkwardness has melted away. It feels like we’ve managed to turn ‘video conferencing’ from something of a euphemism for our clients into something really positive.
What was once a little-used alternative to face-to-face therapy has grown dramatically in a short space of time. Therapists are quickly acclimatising to online sessions, but certain questions still linger. Can a Zoom call really replace the intimate seclusion of a therapy room? And what gets lost in the transition from an intimate physical space to the screen-distance of a video call?
For Ben, the ease and flexibility of online sessions has been welcome, but he misses elements of the in-person experience: “I feel you lose a bit of the intimacy,” he explained. “You can’t read the therapist’s body language or facial expressions quite as easily.
It’s also less obvious that you have their undivided attention, because you don’t know what they might be looking at on their screen. With my therapist, our relationship stretches back a long time, so that trust is definitely there. But I wonder if it would be an issue for someone just starting therapy.”
The mixture of unforeseen positives and new concerns is something Paula Hall identified as well: “In a lot of ways, it’s been great,” she said. “
There are insights you get which you wouldn’t otherwise: you get to see into people’s homes, they can show you their pets. That helps to build connection quite quickly.”
But the suddenness of the appointments, she added, can be jarring. “Normally, when someone has an appointment, they have time to prepare during the journey there. They have time to decompress on the way back,” she explained.
“Now, some of our clients might be going straight from a session to a work call, or walking downstairs straight back into family life. It can be really intense and we’ve had to encourage people to build time for reflection into their schedule.”
Having gotten so used to this new way of working, it’s tempting to think that the therapeutic experience might have moved seamlessly into an online setting, but that isn’t entirely true. “The big difference is around silence and how that works in therapy,” Paula explained. “It’s much harder now to communicate empathy non-verbally.
When you’re in a room with someone, you can hold the silence, you can nod your head, let them shed a few tears. But in virtual sessions, it’s different. You feel compelled to say something, you have to focus quite carefully on how your words do the work.”
The Laurel Centre isn’t alone in having to adapt quickly. Dr Henrietta Bowden-Jones helped to set up the UK’s first NHS clinic for problem gambling in 2008 and, in 2019, was set to do the same for online gaming with the National Centre for Gaming Disorders. After opening to patients in November 2019, the centre was only finding its feet when March’s national lockdown was announced.
“We were forced into virtual services,” Dr Bowden-Jones said, “but it’s been fantastic. It’s reduced zero attendance. Previously, working with young people, you might have an issue where they don’t have money for the bus or no one’s around to give them a lift to the appointment. But now people don’t opt out because it’s so much much easier. It’s worked extremely well.”
The positives are not limited to attendance either. Dr Bowden-Jones has found that virtual participation actually feels less awkward for some of their younger attendees when it comes to group work. “We have found people are really enjoying being part of the Zoom communities.
You don’t have to share your details; you can turn off your camera if you’d rather not share your face. We think it’s made a big difference, the young people really enjoy it.
It’s something of a stereotype of psychotherapy and psychoanalysis that the therapy room itself is an almost sacred space; a bounded environment which, like an operating theatre, is designed for the extraction of unwanted materials.
But, for many therapists, having been thrown into a digital substitute with little choice, the ease and similarity of online sessions has been something of a revelation and the same is true for those seeking help.
“Zoom has been there for a while. It’s just that people are more accepting of it now,” explained Dr Paula Hall. “Previously, people wouldn’t have seen it as ‘real’ therapy, but perceptions have changed really quickly. As far as we’re concerned, it means we can provide our services more widely. We’re not limited to a geographic area any more.”
One of the great hidden benefits of the shift online has been demystifying the therapy room; putting patients at ease with the idea that therapy might be convenient or unintimidating. It’s more than possible that, rather than being an inconvenience that has to be worked around, the rise of online therapy is instead a positive step forward.
One which welcomes therapy into our homes, however indirectly. After all, added Dr Hall, “walking over the threshold of a therapy office is a lot scarier than clicking on a Zoom link”