Technology has developed quickly in recent years and with it opportunities for support with mental health. The use of Skype or Facetime can offer support when people are unable to get to sessions for health or work reasons. It can also be invaluable if you live in a part of the world where face to face therapy isn't easily accessible. Despite considerable benefits, it’s worth reflecting on how technology is affecting our relationships, including therapeutic ones. The world is reflected by us and to us on a screen which can at times feel enriching. Our online life with it’s frustrations and gratifications can influence what we become used to in external reality. It’s immediacy can endanger the potential opportunity for reflection, the integration of feeling and thinking which is the cornerstone of therapy.

Alessandra Lemma has written a very timely book about this called "The Digital Age on the Couch" which clarifies and elaborates some of the ways the technology is changing the therapy process. The internet makes everything immediate; we are less used to waiting. If I want a pair of shoes, I can look online and buy them there and then. This is exciting and has accelerated the pace of life so we can fit more in. However, the process of going to a shop, trying them on and walking out of the shop was often tedious but it was alive in my imagination and memory. The delay or gap between wanting and getting something helped me imagine the shoes and keep the desire alive. The process arguably made wearing and enjoying the shoes more satisfying.

There are many gaps in therapy. Waiting between sessions or for a holiday to end can feel difficult when you need support. Lemma emphasises is that therapy arouses strong emotions in a context which is frustrating. The client has to wait until their therapist is ready to receive them. It’s comparable to communicating online. You communicate something or send an instant message and waiting for a reply, especially when you know it has been read can be excruciating. You may imagine the person reading your message rejecting it and disappearing out of your life. Online dating can be a fertile ground for these painful fantasies of how you are perceived by others. In that gap it’s easy to imagine the worst. Sometimes it’s only the memory of the real presence of a person and being with them in external reality that can make the waiting bearable

Likewise, the frustration of the gap between therapy sessions or when a therapist is away can be hard. The rituals and the constants of the therapy room can help build inner strength by helping to tolerate the frustration of waiting by remembering and internalising the process gradually. A silent walk on the stairs and the familiar beginnings of sessions are rituals that help embody the experience for both parties and enable therapy to feel safe as well as memorable. It is the context of the room, the therapist's physical presence and non verbal cues which provide necessary containment. Implicit communication (non verbal) is more difficult to read online even on Skype or Facetime.

The focus on emotion and how it is experienced in the body facilitates memory of the session and imagining the next one for both parties.The frustration and feeling of loss (you have to leave the room after an intimate encounter) can leave someone feeling unsupported and vulnerable. However imagining the next session and remembering the last in a way that is rooted in space and time and experienced physically helps with the waiting. This can help someone feel more real, able to tolerate the frustration and start to feel a bit more secure. The therapist can become an inner more benign voice than perhaps has previously been experienced.

The internet has potential to widen access to therapy through the use of Skype sessions which is positive. It can be exciting and people may feel safer to reveal difficult things. It can be positive experience so long as we are aware of how it affects the process. This can become part of the conversation so that we're using it in the most beneficial way.