Benefits of In-Person Therapy

In this transcribed episode of the Shrink Think Podcast, Nathan and Aaron discuss the dynamics of in-person therapy and how it's different from telehealth or video therapy.

Aaron Potratz:
Hey everyone, welcome to the Shrink Think podcast. I'm Aaron and I'm here with my co-host, Nathan, and we are following up from a previous episode that we were talking about telehealth, a video sessions or video therapy. And if you have not listened to that episode, I want to encourage you to go back and listen to it. We were kind of talking about how it came to be, not like the original genesis of it. Computers were developed back in, it's not that, but some of the prominence of it through the pandemic and how it's being used and maybe how you can value it more today if you were engaged in telehealth or video therapy.

Nathan Hawkins:
I want to add to that. I think what you're saying there is important, but even while we were talking, we came to some conclusions of different ways that you need to actually be intentional with it. So don't assume that, oh yeah, you did one, I missed that one. I don't care. I already understand. Don't assume that it's worth listening to, not just because we're awesome, but because we are.

Aaron Potratz:
In fact, you might benefit from listening to it a couple of times, sharing it with your friends, subscribing. If you're on Spotify or Apple Music, really anything, just give us a review that would probably help you to absorb the material.

Nathan Hawkins:
Yes, I would like to you to give six stars, five stars is to American.

Aaron Potratz:
Exactly right. I think that six stars sounds a deadly. Anyway, so today we're going to be talking about not telehealth, but actually in-person therapy. And you might be thinking if you're listening, what's the point? Okay, so you go in, what are you going to talk about, how to lay down on the couch or talk about your dreams or no, but we want to talk about the in-person dynamics and how it's different from telehealth or video therapy. So Nate, why don't you get us started.

Nathan Hawkins:
Well, one thing that I try to do actually with clients, they'll come in and they'll say something like, oh, do you do virtual or in person? And I will say in person because I kind of don't want them to a person to kind of go, oh, thank goodness you're doing virtual. Let's do that. I try to convince people to come in. There just is a huge difference in attention and integration and there's a secret sauce that happens inside of the connection that we have one to another as these things that we are called humans.

Aaron Potratz:
It's like the Chick-fil-A sauce except it's in therapy.

Nathan Hawkins:
Yes. That’s

Aaron Potratz:
How secret it’s

Nathan Hawkins:
It is secret and I'm not going to talk anymore about it.

Aaron Potratz:
Thanks for listening. Have a great day.

Nathan Hawkins:
So in person does things that virtual I think honestly cannot do. I'll give you one example. Can virtual counseling when video and zoom, we learned something in the pandemic, which was people get what they started calling it zoom fatigue. And the reason why is because you are looking at the person on your screen and you're not having an eye to eye contact you. It cannot happen because the camera is in a different spot. So your eyes are trying to connect to this person but constantly has to, they have to give up. It's like your brain is giving up that connection. It would be like an internet connection that's spotty where you're just not quite, and so your brain after a while just got exhausted. We were getting tired doing this all day as therapists when we normally wouldn’t.

Aaron Potratz:
Like if we were too about the

Nathan Hawkins:
What you

Aaron Potratz:
To the,

Nathan Hawkins:
Okay, we'll stop annoying you

Aaron Potratz:
Because

Nathan Hawkins:
I know you are annoying.

Aaron Potratz:
Five seconds of

Nathan Hawkins:
I'm already annoyed.
Aaron Potratz:
I had that earlier today in my meeting. I don't need more of this on the podcast.

Nathan Hawkins:
Well, and that's the other thing too is we are not in six G for example, yet whether they're going there, and I say that because we still have these that for whatever reason just the video will just do that

Aaron Potratz:
Would freeze. It's usually something like,

Nathan Hawkins:
Yeah, you need to get done video for that. I know, but I'm saying the people need to see that. Anyway,

Aaron Potratz:
YouTube channel to watch that to point, I know this is about in person. I mean that's why I've got my camera situated to where my laptop, it's right above where my camera would be so that wherever I'm looking on the screen to see the person, I've got my camera close by there, so if my eyes are a little bit lower, it's somewhere close and then sometimes I won't even look at the screen, I'll look at my camera as though I'm looking at another person. It's just I'm looking at this camera. You can tell if you are the other person, if you're the client that I'm looking closer to where that is and you feel a little bit more connection. But yeah, it's not the same as when you're literally right now I'm sitting across from you and I'm looking directly into your eyes. I can see all of your facial expressions, your body posture, all that kind of stuff.

Nathan Hawkins:
Okay. So I know a lot of folks will do this, therapists will do EMDR virtually, and I'm not anti that for me, I've had a few sessions of EMDR in person with clients where they have all of a sudden gone into the fetal position on the couch because encountering some kind of memory or emotion and they let themselves go and just started crying really hard virtual. If I was doing EMDR virtually, which is completely possible, I personally as a therapist get nervous about if the person were to do that, I would just not see them. They would just disappear and I wouldn't know what I'm supposed to do. I don't know if there's something, are we call emergency services? What happened? Is this EMDR related? Is it something totally different like a freaking heart attack? Anyway, there are limits, so there's treatments in person that I could see that you can evaluate. There's certain situations with EMDR where I know I would be comfortable doing them, but then there's the times where maybe not and so in person just takes that all off. You don't worry about that. You're making more of your clinical decisions just like you always would. And I also think too prior to the pandemic, because one of the things we talked about in the other episode is the convenience factor and my pushback to that as well, you could make it before the pandemic, did your life change in your car so dramatically or in your house?

Aaron Potratz:
No, it's more like you experienced the convenience and you're like, oh, that was really convenient. I don't want to go back to the inconvenience. And it really was not an inconvenience. You made it work, you prioritized it and you never called it inconvenient. Or maybe occasionally you did, but you were like, it's worth it. This is what I do to get to my therapy appointment. But when you eliminate that on telehealth, now all of a sudden going back in person, it's this thing that was normal that was considered worth it or just part of the, it's baked into the cake. You're calling that part of it inconvenient and you're trying to dispose of it and get rid of it, which is actually in a certain sense, devaluing the entire process. There is something to be said, for example, getting in your car and driving to the appointment, preparing yourself mentally thinking about having a little bit of time and space to think about what are we going to talk about if you haven't already decided that. And then afterward having a little bit of a debrief for like, okay, what just happened? What do I need to synthesize and integrate from that appointment into my mind or into my life and then transition into the rest of my life? It's like a little buffer and insulation on either side of it that's actually quite valuable.

Nathan Hawkins:
Yeah, I think one of the things that several clients I've had do that come in person, I mean I can't make anybody do anything, but in these situations, I haven't even necessarily said you should do it, but they'll go out after a session and walk around the building in the parking lot. Obviously that's in the summer because Portland. But in just that time of being able to walk through something and then before you get in your car can be really helpful. And I would say honestly, 50% of the people coming in are thinking about what they want to make sure that they understand they need on their drive in and be like, okay. It's like they now have a routine, okay, I get in the car, what's been going on? I got a 20 minute drive. I'm not going to listen to the radio or listen to anything. I'm just going to try to understand what's going on in my own head so I know what to do. So that space is a big deal and it kind of naturally occurs a bit more when you're in person, I think.

Aaron Potratz:
Yeah, exactly. I've got a colleague, Dr. Er, he's a psychologist from India. Actually, I was talking with him about this before we were recording and he's like, oh yeah, I could share a couple of things about this. So I guess let's bring him on and ask him just a couple of questions about what it's like in terms of going to these appointments, being in person and what that's like in a different country.

Nathan Hawkins:
Well, I guess I'll just ask him, Ji, what do you prefer having gone through both? Are you more of an in-person? Therapist. Oh, you're a psychologist. That's right. You're a psychologist. Do you do stuff more in person? Do you do stuff equally telehealth, and do you have a preference?

Aaron Potratz:
Yes. First of all, I would like to thank you for having me on your show. It's quite an honor to be here. I really like the content you guys are putting out. I really like how informative and also entertaining that you guys are on this podcast. Oh,

Nathan Hawkins:
Thank you.

Aaron Potratz:
So thank you. Oh yeah, thanks for having us. It's really great. Really kind of you to say, yeah, I'm actually more of an in-person, kind of a therapist in India. We are walking to our appointments. This is great because you have time to move your body and when your legs are moving back and forth, it is kind of like you were talking about TMDR before. It is simulating this bilateral stimulation, which is good for the brain to process information. It is very helpful in getting you prepared for the session. Your mind can be clear and be processing all the things that is happening in your life to prepare you for this therapy appointment. And then afterwards you can use that time where you are walking from the appointment getting fresh air where your body, your brain can be absorbing all of this fresh breeze, this wind that is happening in your face.

Nathan Hawkins:
Yeah, okay. So do you really even use technology very much when it comes to video? We do the phone thing here. I know that you do. I know that you have phones, don't get me wrong. Of course you do. Yes,

Aaron Potratz:
Of course. We have telephones and cellular phones. People have smartphones. Yes.

Nathan Hawkins:
Is that how most of the telecommuting happens? Most of the virtual appointments would happen that way. Or would a person be at their own own place where they live doing it?

Aaron Potratz:
People are most likely going to be by their computers. It is not as common that people will be on their devices in their cars or going up for a walk. They're more likely to be somewhere that is private because they want that information to be very kept secret.

Nathan Hawkins:
Oh yeah, that makes sense. Well, and that's what in-person does, in-person provides privacy kind of more in a guaranteed way,

Aaron Potratz:
Right? I mean there's something to be said for when you leave your office or your home or whatever and you go into somebody else's office, a counseling like a clinic or whatever, and then you're in this room, the door is closed and you're in this space where, I mean when we talk about confidentiality, we're really talking about in this in-person space, everything is sort of housed there. And that's actually I think, quite important because when you're doing telehealth, if you're in your car, your office or wherever, your home office or whatever, it's kind of sometimes that difficult material. If you're working through something painful or difficult, there's something actually really great about being able to leave it in the counseling office and then to go back into your life. It's kind like, I dunno, sometimes we'll talk about having people leave that difficult material here.
Just imagine mentally that it stays here so that you can get a break from it and then come back to it in the next session. Dr. Er, is that something that you've experienced or I guess what's your take on that? Yeah, I think that is very good point that you are bringing up here. There is a compartmentalization that can happen when you come to the therapy office. The things you are talking about have a different quality to them because they're not in your space, they're in the space of the therapist. And so when you are discussing your trauma or your stress, your anxiety, your depression, these things take on a new meaning that you and your therapist create together that is unique and different to that relationship that is in person that you cannot have over video. So when you leave, it is like you've unpacked some bags and lightened your load, whether it is emotionally, mentally, physically, because your body contains it, you leave it in the office, you unpack those bags and then you walk away lighter. It is a great benefit to in-person therapy, in my opinion.
Nathan Hawkins:
Oh yeah. Peter Levine actually talks about, he calls it the felt sense in the book Waking the Tiger,

Aaron Potratz:
Great book.

Nathan Hawkins:
It's this idea that I think he uses the example where if you're walking through the forest and something changes in it and you're totally by yourself, you feel it, you just feel like, and you might even stop and go, okay, what just happened? You can just feel around you, the stuff that's going on. You can't do that in a virtual

Aaron Potratz:
Way.

Nathan Hawkins:
So when you are in person, you are sharing a felt sense. You literally can feel like the stuff that's going on in the room, each one of you is client and therapist. And that is something that is huge. It's not like, well, that's okay, I sacrificed that today. Pardon? No, that's not a good move, bro.

Aaron Potratz:
Right, right. And Dr. Ger, you're out of time. Thanks for being here. I just want to let you move on to your next meeting here, but I just want to say thank you for being here. We'd love to have you on our show

Nathan Hawkins:
Again. That was great.

Aaron Potratz:
Yeah, appreciate it. Thank you. It is quite an honor being here. I would really, again appreciate the work you guys are doing and keep it up. Thank you. Thank you. Appreciate that.

Aaron Potratz:
Thanks. So back to this point that you were making about the in-person, there's a vibe or I hate to use the word like energy, but it's like this relational thing and you could talk about mirror neurons, all that kind of stuff.


There's something that does happen when I'm in person with somebody and they make a little shift. I can't usually see it on video, but there's a shift, whether it's in their body or the energy changes, I can see some things on their faces. All these things that are happening that I'm gathering as a therapist, and then I start feeling it and I'm like, what is that feeling? Right? Oh, what's this? Oh, is there, I think there's disappointment or oh, you're feeling there's some shame that entered the room, right? I can feel that and then I can speak to it. This is the huge benefit of therapy in general, but also in-person therapy is being able to bring that stuff and then mirror it back to your client so that they can see and be reflected or see their reflection in what you're presenting back to them and then interact with that. Interact essentially with themselves a little bit better or have some greater awareness about themselves.
Nathan Hawkins:
Yeah, that is probably an entire piece there because I don't want to denigrate virtual counseling entirely. I'm not, definitely not doing, it definitely serves purpose.

Aaron Potratz:
Purpose. It's not entirely, it’s

Nathan Hawkins:
Just mostly, mostly, well probably my of come here, virtual counseling,

Aaron Potratz:
Come here, break the wrist, walk away.

Nathan Hawkins:
My interesting thing about that is I had a person that I was meeting with, I met with them when they were a kid, and then they reentered therapy as an adult, but virtually because they were in a totally another country. And it was one of those things where literally I was allowed to do it because it was COD, because the insurance stuff had left down and there was a military situation involved, which everybody was okay with. It was kind of weird that it got okay. It was like, I dunno, I guess you could call it once in a lifetime, but we're doing the video thing. I had not seen this person since they were a kid, so now I'm seeing them for the first time and I'm like, oh, yeah, that's kind of what it, so then anyways, time goes by and he comes in after probably two years of doing video stuff now, and I've seen him for the first time and I'm thinking, oh, this is going to be interesting to see how I feel about this. Is it still going to feel so awkward? And it didn't. I was like, oh, okay. It just was picking up where we left off type of thing. And so that connection definitely can exist virtually. It's just that when you're doing in person, the experience of it actually adds an entire other element that I feel like a lot of people are so willing to sacrifice and it's like, don't do that.

Aaron Potratz:
Yeah. I'll give you an example from my own experience with my therapist. During Covid, I saw her mostly video and actually entirely video. And I remember the first time that I could go in person and it was like, oh, I can actually meet you in person. And I did. And one of the things was like, oh, you're taller than I thought you are, or its, that's different because you just don't see any of that. But then it was also, it's interesting, I noticed my communication changing or shifting from the video from being a little bit one directional and it's not like I was just talking the whole time, but it felt more like I was talking at a screen versus when I was sitting across from her, it was more like, oh, now I'm talking with a person and we're having this dialogue. It just felt so much more different.
And obviously it is different, but I guess the thing I'm getting at is I thought telehealth was good and it was helpful, and I was like, this is great enough to keep doing it for quite a while. But then when I had this in-person, I was like, oh, oh, this is even better. This is way better. It's kind of like if you just relegate yourself to the lower, the lesser, if you have a choice, obviously we're talking about if you have the option right between the two. Telehealth is great, but in-person is way better. It was a significant difference because of that relational element that had an impact on me. And then all these things we're talking about the time she lives 30 minutes away from where I am or the office is 30 minutes away from where I am. So that time gave me some time to debrief, and that whole experience was just far superior.

Nathan Hawkins:
I think of it like a person, if you picture a lake and there's a dock and virtuals, you're out at the end of the dock. You can see the entire lake beautiful, and it's beautiful. It's great, and you can sit there with your legs kicking over back and forth as you like with person. It's more like you can get in the lake, feel all of what that feels like, and you can also get back out

Aaron Potratz:
Or hop in a sailboat or another, a motorboat and travel around the edges and see more of the contours of the outside of the lake or whatever.

Nathan Hawkins:
So

Aaron Potratz:
From different angles,

Nathan Hawkins:
Just a little metaphor analogy

Aaron Potratz:
For you, you can see the sunset from the other side because it's behind you

Nathan Hawkins:
From the dock. You could go to the store that's by the lake, true, get a little ice cream sandwich. Then you’re Spending more money and you're gaining weight. So maybe in person isn't as great of an experience, oh, my lanter

Aaron Potratz:
In person is going to cause you to spend money and gain weight. Right now you're virtually experiencing this and you're like, thank God I'm not there. But we are in person and experiences. You know what, guys? Have a great day.

Aaron Potratz:
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