Can You Hear Me Now? A couple thoughts on telehealth.
By now, most of us have had at least one conversation with someone who sounds like they’re trapped inside a tin can floating in space. Their face is pixelated, their dog is barking in the background, and somehow their Wi-Fi is both too slow to support Zoom and fast enough to stream five seasons of NCIS in 4K. Welcome to telehealth.
What once seemed like a temporary fix during a global emergency has settled into our reality like a stubborn coffee stain—permanent, widespread, and oddly effective. And that last part is worth paying attention to. Telehealth isn’t just surviving; it’s thriving. And as mental health professionals, we’ve had to develop a new skillset that no one taught us in grad school: the subtle art of building real human rapport through a webcam.
Let’s talk about that.
The Data Doesn’t Lie (Even if Your Webcam Freezes Occasionally)
For those of us who were initially skeptical—maybe muttering things like “you can’t replace the sacred space of the therapy room”—the evidence might feel a little inconvenient. Because the research shows pretty clearly: telehealth works.
A meta-analysis published in the Journal of Anxiety Disorders (Poletti et al., 2021) compared virtual and in-person therapy outcomes and found no significant difference in the effectiveness of treatment for anxiety, depression, and PTSD. Let me repeat that. People got better at the same rate, whether they were on a couch in your office or sitting in their car in a Target parking lot (which, for reasons unknown, has become the de facto safe space for millions).
Another study in Psychological Services (Simpson et al., 2021) showed that clients reported high satisfaction levels with telepsychology services, even among those who initially preferred in-person sessions. As it turns out, not fighting traffic, skipping the waiting room, and wearing pajama pants to therapy can do wonders for one’s mental health.
Telehealth is also helping us reach folks who might have never walked through the doors of a clinic—rural communities, people with physical disabilities, single parents, and those who simply don't have the time or resources to make it to an appointment across town. According to the American Psychological Association (2022), telehealth use surged more than 1,000% during the COVID-19 pandemic and has maintained elevated levels ever since, particularly among providers serving underserved populations.
The short version? This isn’t just a pandemic workaround. It’s a permanent expansion of the counseling landscape.
Now for the Tricky Part: Building Rapport Without a Real Room
Despite all the data, the emotional truth remains: building a meaningful therapeutic connection over video feels like a weird magic trick. The screen acts like both a portal and a barrier. One moment you’re connected, present, alive in the conversation; the next, you're looking at a glitchy version of yourself in the corner window wondering why your forehead looks so big.
So how do we build rapport in this strange, digital medium? Not by copying and pasting our in-office style, that’s for sure. Telehealth rapport-building is a different beast. And it's forcing counselors to grow in ways that are subtle, demanding, and very real.
1. Presence Looks Different on Camera
In the therapy room, presence is often conveyed through physical cues—leaning forward, soft eye contact, mirroring posture. On Zoom, it’s all about the micro: nods, vocal tone, and intentional silences that say, “I’m still here, I’m listening, I care.” In some ways, we’ve had to become more precise with our empathy. There’s no comfortable silence if the client thinks your screen froze.
Clinical psychologist Dr. Marlene Maheu of the Telebehavioral Health Institute emphasizes “camera consciousness,” a term that sounds made up but is annoyingly useful. It means learning to focus your attention directly into the lens, rather than at the client’s video square. It’s unnatural, sure—but it makes the client feel seen. Which is kind of the whole gig.
2. You’re Now Also Tech Support
If you’ve ever coached a client through unmuting themselves while also holding space for their trauma narrative, congratulations—you’re a telehealth counselor now. Technical troubleshooting has become part of our therapeutic skillset. And oddly, that initial shared awkwardness can foster a kind of rapport all its own.
“Let me walk you through how to adjust your settings” has become the new “So how was your week?” It’s a soft entry point that humanizes both of you, and that sense of mutual imperfection actually builds trust. We’re all just doing our best here—with our bandwidth, our lives, and our healing.
3. The Space Is Theirs Now—Literally
One of the hidden benefits of telehealth is that clients are, quite literally, in their own environment. Therapists can now observe how someone interacts with their space. It offers data that’s often more authentic than what we’d get in the sanitized confines of an office.
For some clients, being in their home means they open up faster. The couch is their couch. The cup of coffee is theirs. They don’t have to pretend. That sense of control can reduce anxiety and deepen trust.
The downside? We’re also competing with distractions—kids, dishes, the UPS guy, the siren call of TikTok. Rapport, in this setting, requires clarity and intention. We have to earn their attention, not just assume it.
4. Small Talk, Big Impact
In a traditional office setting, rapport can be built organically—during the walk from the waiting room, while offering water, through those transitional micro-moments. Telehealth compresses everything. You go from “Connecting…” to “Tell me about your childhood” in 0.2 seconds.
That means we need to consciously reintroduce small talk. A minute or two of light, human conversation—“How’s the weather over there?” or “Is that a new poster behind you?”—can do a lot to break the ice and establish trust. It also signals that this isn’t just a sterile transactional interaction. It’s a relationship.
Telehealth Requires More of Us, Not Less
There’s a persistent myth that telehealth is “easier” or “less effort” than in-person counseling. Anyone who’s done it for more than five minutes knows better. It’s a different skill set. And like any skill, it takes time to build.
We have to be more intentional with our tone, more expressive with our affect, and more creative in how we use time and space. We have to learn new technologies, adjust to new boundaries (no, we will not be texting you at 11pm), and rethink how we handle crisis situations when someone is 100 miles away and we’re not sure where their nearest ER is.
But here's the thing: we're adapting. And that’s kind of beautiful.
We’re proving that connection isn’t about the medium—it’s about the message. It’s about the consistent, deliberate choice to show up for another human being. Even through a screen. Even with a glitch.
And yes, even if the dog won’t stop barking.
Sources:
Poletti, B., Tagini, S., Brugnera, A., Parolin, L., Pievani, L., Ferrucci, R., & Compare, A. (2021). Telepsychotherapy: A Meta-Analytic Review. Journal of Anxiety Disorders, 82, 102437. https://doi.org/10.1016/j.janxdis.2021.102437
Simpson, S., Richardson, L., Pietrabissa, G., Castelnuovo, G., & Molinari, E. (2021). Videotherapy and Therapeutic Alliance in the Age of COVID-19. Clinical Psychology & Psychotherapy, 28(2), 409-421. https://doi.org/10.1002/cpp.2523
American Psychological Association. (2022). Trends in Psychology Telehealth. https://www.apa.org/monitor/2022/01/special-report-telehealth
