Loss and Gain in Lockdown Therapy with Refugees

As I neared the end of a recent phone session with a Syrian refugee client, I realised that my eyes were closed, and that my face was almost resting on the desk. I had been working so hard to focus on my client’s voice that I hadn’t noticed I was hunched over my phone with my eyes tightly shut in concentration.

In many ways, this seemed an apposite way to end my tenth week of lockdown offering Zoom, and sometimes phone, therapy to resettled Syrian refugees. That same day, I had facilitated a supervision group for the interpreting team, and they talked of how physically tired they all felt. They described using their physicality more in the interpreting process and concentrating harder to reflect nuances in tone. The interpreters also spoke about feeling more exposed to clients’ distress than when I was there to act as a buffer, and a greater sense of responsibility.

One interpreter also described experiencing a subtle loosening of boundaries on Zoom. She had noticed a client’s Arabic becoming more informal in sessions. Normally, the interpreter would sit to our left or right, the client and I would face each other, and I would rarely look at the interpreter. On Zoom, we all hold equal space on the screen. Talking about these themes in the supervision group has enabled interpreters to pull back subtly in session, and they have noticed as a result that the relationships have settled back into the pre-lockdown dynamic. It has reminded them to trust that the therapist carries the overall responsibility for communication, despite their crucial role.

There is much I am missing about being in a room with a client and our interpreter. Clients, too, are missing our physical presence and how that contributes to a neurophysiological experience of safety. Sometimes in my Zoom work with traumatised clients, I feel that progress is slow, and I worry that I’m far less effective. I am so used to being in direct physical contact with a client, receptive and involved. I often find myself putting my face close up to the screen when clients are sitting away from the camera. I’m learning to ask and ask again: are you crying; you are looking down; tell me what’s happening now…

I am also oversensitive to background noise in people’s homes and always checking about their privacy during sessions. Despite all the planning, a child sometimes wanders in! Often these moments can lead to a helpful conversation or deepen a new connection. Often they are funny and human. Watching a father’s face light up as he scoops up his daughter and teases his wife about his “daughter’s escape” helps me understand a little more about him.

In a Zoom session with a torture survivor I was assessing, she became distressed by something in the room. She threw the phone on the sofa, and we lost contact with her for a few seconds. It felt longer. Her days are full of these episodes and I’m not sure we could have prevented it or seen it coming. Because she was in her home, she could angrily throw the phone down and walk away. I wondered afterwards if she could have so easily done this in my clinical room, when the power of my role and the pressure of doing what’s expected in therapy might have hindered her. I am noticing that, while I fret about what clients might be losing in terms of a containing presence, they might also be gaining by being able to move more freely about the room.