by Shelley Eves
The term ‘therapeutic relationship’ describes the relationship between therapist and client. A strong therapeutic relationship is what makes effective therapy possible and is an important ingredient of any intervention.
An ideal therapeutic environment for developing a strong therapeutic relationship might be envisioned as a quiet, safe space (usually the therapist’s office) with uninterrupted and focussed allotments of time on a regular basis: the ideal environment to show interest, care, and commitment to the therapy.
Given that the client base for T4R is detained on Nauru, PNG or in onshore detention centres, we and our clients do not have the luxury of the ideal therapeutic environment. We rely on communicating with each other across language and bureaucratic barriers using phones and messaging apps. Our messages to each other are often typed through the imperfect ‘google translate’ as a way of bridging language gaps.
Yet strong therapeutic relationships and alliances are still forged. Therapeutic alliance depends on both therapist and client factors. These factors include personal attributes, attitudes toward therapy, and communication skills, among others. The T4R therapeutic relationships have formed through dedication and determination on both sides. We feel an outrage at the duress experienced by, and lack of mental health support offered to, this group of refugees and asylum seekers. This outrage fuels our dedication to making this kind of virtual therapy work. And our clients show us generous amounts of patience, trust, and a huge leap of faith in sharing with us when they have experienced significant long-term abuse by the Australian government. This has cemented a strong alliance and a commitment to the work we are doing together.
Before volunteering with T4R, I would have assumed that the quality of therapy taking place via apps and phone calls would lead to a weaker therapeutic relationship than I experience in my regular, face-to-face therapy work. While there are difficulties in the delivery of therapy via technology, I have been surprised by the strength of the relationships I have formed with my clients, and by the speed at which they formed. There were aspects of using technology that surprisingly sped up the process, rather than slowing it down.
The use of mobile apps has meant that we are communicating with clients at all hours of the day and from wherever we are- at home, at work, even out with friends. For me, this kind of communication is similar to the way I communicate with my friends and family, which increases the feeling of intimacy and familiarity I feel for the T4R clients. In addition, to aid in replacing the nonverbal cues gained from face-to-face therapy I sometimes need to use emojis, photos and GIFS to portray certain emotions and reactions. This again adds to the familiarity of relationships.
This style of communication also meant that the frequency of messages is increased and the access to each other is largely unlimited- we can cover a lot of ground in a short amount of time. It also means the client can access therapeutic assistance in the moment they require it, such as being coached through a panic attack or having in-the-moment advice and support, rather than having to remember information from a session and apply it later.
Another difference between face-to-face and technology-based therapy in this context is the need for increased therapist self-disclosure. Therapist self-disclosure, usually limited and infrequent in therapeutic relationships, is more frequent in this type of work. Due to the justified lack of trust in Australian health workers our clients have developed over time, building trust is necessary to begin and maintain effective therapeutic intervention. I have clients who have experienced abuse, gaslighting and unprofessional behaviour from health workers in Nauru and Manus. Our clients’ mental health has been treated with high doses of antidepressants, anti-psychotics, and sleep medication. Their mental health concerns have been dismissed or even used against them by the authorities. Any chance of success at having a meaningful therapeutic intervention was largely given up on by many of our clients. For this reason, I have been willing to share more about myself and my life to reassure my clients and give them a sense of who I am and why I am volunteering for T4R.
The first time a client asked me to send him a photo of myself, I baulked at how personal that felt and how inappropriate it would be to send a selfie to a client in any other context. However, I realised that in most therapeutic situations, clients know what their therapist looks like and see their face every session! I realised this was a reasonable request and now I feel comfortable sending photos and in return love receiving photos of my clients going about their day. This has led to a stronger therapeutic relationship due to the trust that has been built up and the warmth and familiarity established.
While we would likely enjoy the luxury of being able to regularly meet face-to-face with our clients for therapy, the use of technology in the delivery of therapeutic intervention has not hindered our ability to form strong relationships with our clients, and in some ways has even helped it. I am grateful for the relationships I have with my clients and the hard work they do every day to survive the horrendous situation they are in. They are amazing people and I long for the day they are free.