Only Connect: how can clinical approaches help us negotiate flexible working?

By Devyn Glass, PhD Candidate and Research Fellow at the University of Sussex

As the world negotiates a return to physical workplaces, it is clear that the changing nature of the work environment will need careful management and planning. The pandemic has revealed the potential for a different way of working, and many are not prepared to return to full-time office work. However, most employees do value time spent with their colleagues and would prefer a more flexible way of working.

Some ways to navigate this lie in the findings of a recent project funded by the National Institute of Health Research (NIHR) Applied Research Collaboration (Kent, Surrey & Sussex), which aimed to compare attunement in online compared to in-person interactions. The Zoom or Room project surveyed and interviewed practitioners from health, education, and social care about their experiences connecting with and attuning to their clients or students online. The project also analysed video recordings of online and in-person therapeutic interactions to look for indices of attunement.

Video Interaction Guidance (VIG) practitioners contributed video recordings of intervention sessions with clients, and of supervision meetings with trainees. Inspired by Colwyn Trevarthen’s theories of intersubjectivity [1], VIG is a strengths-based approach to improve a relationship with someone who is important to the client. It is based on the Principles of Attuned Interaction and Guidance (PAIG) [2], which provides a framework to understand what creates successful attuned interactions. Interactions between VIG practitioners and their clients therefore provided an ideal opportunity to compare attunement online and in-person to help determine what makes or breaks attunement in online spaces.

Key findings from the Zoom or Room project

Figure 1. Principles of Attuned Interactions and Guidance (PAIG) [2]

Social connection and attunement are entirely possible online.

·       Findings from the video analyses indicate that warmth and responsiveness showed only minimal reductions in online compared to in-person interactions. Client responsiveness particularly was slightly lower in online meetings.

·       VIG practitioners are trained to facilitate warm and attuned interactions. These skills appear effective in an online environment.

·       One-to-one meetings can feel attuned and connected online; however, behaviour and communication need to be adapted.

·       Findings from the video analysis and interviews indicate that therapeutic conversations can be deep and complex online and practitioners reported feeling strong connections with their clients, despite having never met them in-person.

But something might be missing…

·       The interview results suggested there was a sense that the meetings felt different online and that it is more difficult to sense the atmosphere. One interview participant stated: “It’s as if you're having a real experience but then when you come out of it, it felt like you haven't”.

·       Many participants mentioned how it can be difficult to offer emotional support to someone from the other side of the screen.

·       The results from the interviews and the survey also suggest building rapport takes longer online and developing supportive social connections can be much trickier in group situations.

·       Participants also mentioned that online work takes away the opportunity for organic conversations, which can be essential for team building and innovation.

Adapting communication for an online space

·       Communication must be adapted for the online world and might be more effortful in some scenarios, or for those of us who don’t have interpersonal training.

·       Some conversations highlighted the importance of a skilled group guide in larger meetings, who looks for initiatives of the group, manages equal turn-taking, and directs the flow of the interaction.

·       Colleagues can create warm and supportive interactions online using the Principles of Attuned Interactions and Guidance. Being attentive, demonstrating they are listening, encouraging initiatives and responding to a partner’s initiatives can provide the foundations for an attuned interaction.

·       The practitioners interviewed highlighted the importance of naming what is happening in the interaction, explicitly discussing the differences of online work and naming what we see or how the partner might be feeling.

Looking to the future

All practitioners said they would prefer a blended approach to work in the future, and some said resolutely that they would not return to certain activities in-person (e.g., travelling for training). It is clear that while we can feel connected to others online, many would value the space and opportunity to interact with colleagues and clients in-person. The findings also revealed that practitioners saw the value in online meetings and that this can be different to meeting in-person. They are not a poor replacement and they can be just as, efficient and effective, if not more.

However, online spaces need to be carefully managed and not thrown together as an easy alternative, particularly for organisations who may be looking at how to save costs. The features of different platforms and devices should also be considered with regards to what they bring to the interaction and the task at hand, ensuring that clients and practitioners have the necessary software, hardware and internet connectivity. We have an ideal opportunity to shake up the way we work and to draw upon the value of flexibility for employees and businesses. Yet it is essential that we carefully consider what activities are required in-person and what are best placed online, and this should be done in co-construction with colleagues or clients to ensure it is in their best interests.

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This research was funded by the National Institute for Health Research (NIHR) Applied Research Collaboration Kent, Surrey, Sussex. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care

[1] Trevarthen, C., & Aitken, K.J. (2001). Infant intersubjectivity: research, theory, and clinical applications. J Child Psychol Psychiatry, 42(1), 3-48.

[2] Kennedy, H. (2011). Video Interaction Guidance: promoting secure attachment and optimal development for children, parents and professionals. The International Journal of Birth and Parent Education, 4(3), 23-27.