Alone Together: Navigating Online Therapy During COVID-19

by | September 23, 2021

In September 2020, I suffered a mental breakdown so severe that it took me a year to completely heal. When talking about it, I tell friends, “I think I went mad.” They laugh, shake their heads at the inherent Nigerianness of that statement, dismissing it as a joke.

I am unable to pinpoint an exact turning point, a moment of Nirvana when the pain lessened, but I woke up one morning, 11 months later, to notice that for the last month, peace and contentment had been filling me. Many times, the realization moved me to tears. I had no idea that my heart and body were capable of such serenity.

That September, I had far too many blackouts; flashbacks from past traumatic experiences that were so poignant and palpable that they sometimes became hallucinations. There were panic attacks and crying sessions. My heart felt like a heavy towel drenched in water. The pain overwhelmed me.

It was not that I did not realize or acknowledge that I needed help. Neither was it that I did not take any steps to seek the help that I needed. It was that I did not find the help, no matter how far and wide I searched, or how long I spent on the internet.

Even though the COVID-19 pandemic has taught us how to navigate a world of limited physical interaction, one area that remains challenging is online therapy.

After September, I located a therapist who held our first session over zoom. She was kind and friendly. “What would you like to talk about today?” she asked gently. I paused, started to talk, stuttered, and then stopped. I could not find a way to properly articulate the horror of what I had had to go through the past three months. Finally, I joked, “Turns out you can’t survive trying to kill yourself and then just go back to life like it never happened.”

“Wow,” she joked back. “Who knew?” We both laughed.

For the next hour, I attempted to roll out the tangled mess in my head. At one point, it felt like my heart would burst from my chest. Like violent waves, memories seemed to crash against my body.

At the end of that session, I left feeling unsupported. I had gone to the therapist because I needed to feel held. I hadn’t felt that way in so long. Perhaps my expectations had been unrealistically high, perhaps not. But I came away feeling uncertain and empty. The therapist seemed genuinely sorry for me, but she was at a loss as to what to say to help me. She let me know she couldn’t help me and said I would have to figure it out myself, as what worked for person A might not work for person B. It was not brutal, but it was unhelpful.

How are other people finding therapists?

Mental health care in Nigeria has been described as prohibitively expensive. However, free online therapy and counseling programs continue to spring up everywhere as initiatives of, mostly, non-governmental organizations. During the COVID-19 pandemic last year, many Nigerians turned to them. However, personal experience, as well as conversations I have had with some individuals who have used these services, indicate that many are having trouble navigating these programs.

Cynthia*, 26, signed up for a free online session during the lockdown last year. The service was provided by an NGO. She feels that the session was more counseling, rather than the therapy it was described as. “I’ve since had [IRL] therapy, which came after the online therapy. When I compare both, to me, the online therapy was lacking in a few ways. It didn’t feel as good as the [IRL] therapy,” she says.

Faruk*, another friend, had a therapist who preached to him during an online session, asking him to give his life to Christ. The experience further devastated him.

However, some users have successfully navigated online programs.

Hafsat*, 28, found her sessions helpful. “The person they assigned to me from the organization was actually pretty decent. There was even a disclaimer that she wasn’t a licensed therapist but talking to her really really helped,” she says.

Deborah Oluniran, a professional psychologist, says that in her experience, offering therapy online has been easier and she prefers it.

“It eliminates the possibility of certain biases coming up if it were a physical session,” she says. “For example, age. A lot of my clients do not know what I look like, hence they are more comfortable sharing with me.”

IRL Sessions

Two months ago, I went to the hospital to address my recurring anxiety disorder. I had had the condition for years and had been on medications for it, on and off. But it intensified and began to affect my breathing. I spoke to a doctor who gently asked me what was wrong. I told him about surviving Nigerian law school and what the stress had done to me. He told me about his own experience at medical school and how he had failed the first time. I said I could trace the marked increase in my anxiety to the night I received my scores from law school.

The doctor listened with empathy and kindness, not pity or condescension, but a recognition and reaffirmation of my state. When he lacked words, the warmth of his eyes and the nods of his head were enough to hold me. He reminded me that what mattered most was that I had passed and was now a lawyer. He also reminded me that the nature of the profession I was venturing into might increase the frequency of my panic attacks: moving applications in court, trying to figure out cases, waiting for the judge to either accept or reject my applications. I had not considered this problem.

It seems that a key factor determining whether or not the therapeutic experience will be successful is one’s openness to it. It has been difficult for some people to open up in online sessions, especially because those who are in pain might be unsure of what silence from the professional means. They may be unable to find reassurance. They might seek a clue in the therapist’s face but be unable to find one. Not every psychologist seems to be able to cultivate a sense of trust and safety in offline sessions, and though that does not necessarily speak to them being under-qualified, it affects the overall success of the sessions. The expectations that people also approach the sessions with might be playing a role. Cynthia* thinks that they should be called counseling sessions instead. R* says that her own experience was easier to navigate as she knew that it was a counseling session “and not therapy therapy.”

During the session with the doctor at the hospital, as I sat across from him in that office, masked and several steps away in accordance with social distancing, I realized offline sessions would always be better for me. There is no substitute for certain kinds of togetherness.

Hauwa Shaffii Nuhu is an essayist in Nigeria, with work published on Popula, African Arguments, Minority Africa, Muslim Girl, The Republic and elsewhere. She’s a 2018 writer-in-residence at the Ebedi Writers Residency.