Telehealth has transformed how therapists and clients meet, connect and build healing relationships. What once required a shared physical room now unfolds through screen, headphones and digital platforms. Yet at the centre of every therapeutic encounter, regardless of the medium, lies the quality of the relationships. Clinicians have long understood the therapeutic relationship to be the most powerful meta-intervention supporting clients’ change and transformation. It is also observed by Carl Rogers that therapeutic intervention needs to change when it comes to the client and therapist during psychological contact. Subsequently, Martin Buber’s concepts of the I-Thou relationship provide a powerful insight for determining whether a meaningful healing connection can flourish by telehealth, more importantly, how therapists can preserve it.
Through the Thou, a person becomes I.
— Martin Buber
What is the I-Thou Relationship
Buber, a 20th-century philosopher, described two ways people relate to the world: I-It and I-Thou. I-It is functioning, transactional and objectifying. In therapy, the I-Thou relationship is the moment when the therapist entirely sees the client beyond symptoms and history. It is the presence of the therapist that the client felt a sense of being understood and shared moments where the relational field deepens. Such relational quality is repeatedly shown to be a core driver of therapeutic change across modalities.
Can I–Thou Exist Through a Screen?
Its brief answer is yes, but it requires intentionality; however, telehealth builds both obstacles and opportunities for relational depth. When therapist and client are far apart, there is a possibility of increased distraction, and non-verbal cues become harder to read. The screen can flatten embodied presence, and a Wi-Fi glitch can interrupt a vulnerable moment. Moreover, the sense of shared space feels fragmented (common in traditional therapy). Telehealth also offers unexpected relational gifts for people who often feel safer opening up in their own environment. Many clients feel more in control, comfortable and are able to express themselves honestly. The intimate windows into someone’s house can deepen a sense of humanity, and therapists feel free to communicate without rigid office dynamics. This feels more emotionally available. Acknowledge that the I-Thou relationship doesn’t depend on physical closeness. It depends on the presence of a quality that transcends location. Presence through a screen is possible when both participants commit to showing up fully with openness and curiosity.
All journeys have secret destinations of which the traveller is unaware.
— Martin Buber
The Challenges Telehealth Introduces
However, telehealth can support relational depth, but therapists must be mindful of the unique challenges that can push interactions into the I–It territory:
- The Temptation to Multitask
Screens encourage split attention. Notifications, background windows and subtle distractions can weaken presence. An I–Thou relationship demands full attention as the client must feel that the therapist is with them, not just observing them.
- Reduced Embodied Prompts
Tiny movements of the client’s shoulders, the rhythm of their breathing, and the tension in their hands can be hidden. These cues often help therapists sense emotional shifts.
- Environmental Differences
The therapy room is traditionally a carefully curated neutral environment. Telehealth sessions may involve pets, children, street noise, or unstable internet. The shared sacred space is harder to maintain.
- Emotional Flattening
Some clients feel less emotionally connected when speaking through a device. The screen can act as a protective shield, which is helpful at times, but distancing at others.
These challenges do not prevent I–Thou moments, but they make an intentional and relational attitude even more crucial.
How Telehealth Can Enhance I–Thou Moments
Despite the limitations, telehealth can deepen human connection in surprising ways. Many therapists report that virtual sessions create:
- A Sense of Equality
Imagine the therapist is not sitting in a professional chair, and the client is not in a patient seat.
Instead, both sit in their lived environments with humans meeting as humans. This can reduce power imbalances and support relational authenticity.
- More Realistic Self-Disclosure
An indication of a therapist’s bookshelf with a plant in the background may soften the formality. These subtle reminders can make the therapist feel more relatable.
- Increased Comfort in Vulnerability
Clients often open up more deeply when they feel physically safe in their own space. The home environment can allow a more natural emotional regularity.
- Opportunities to Work with Real-Life Context
Rather than imagining a living environment for a client, the therapist may see it. This can help understand relational dynamics and sensory sensitivities which trigger in real time. When approached accurately, telehealth can become a space where clients feel seen, heard and see the core qualities of the I–Thou experience.
The Future of I–Thou in Digital Therapy
Telehealth is not going away. It has become an integral part of modern mental health care, but the objective of therapy with relational meetings remains unchanged. For the past years, the move to telehealth has been an invitation to return to the essence of human connection. Instead of the support of a shared physical room, the therapist must rely even more on presence and authenticity. These are amazing qualities that make I-Thou relationships possible. No matter in person or through a screen, healing occurs when two people meet with openness and humanity; something good is born. Telehealth doesn’t diminish the I–Thou relationship; it just simply challenges us to practice it more consciously.
“What you must do is love your neighbour as yourself. There is no one who knows your many faults better than you! But you love yourself notwithstanding. And so you must love your neighbour, no matter how many faults you see in him.”
— Martin Buber
