Virtual Therapy - A Newer Option, A New Normal
Before COVID-19, the mental health world regarded telehealth sessions (where therapist and client meet from distant locations through internet-enabled video conferencing) with some skepticism. There weren't that many platforms that guaranteed security strong enough to protect clients' confidentiality. Technological distance felt scary for therapists whose clients were in acute distress. Most impactful from the clients' perspective, however, was that it was just not the same. It was hard to build the same sort of trust and rapport through a screen.
When we weren't able to meet in-person, however, circumstances forced advances in both technology and safety protocols, solving many privacy and safety concerns. Rather than feeling disconnected, many clients experienced virtual therapy as a trade-off, valuing the convenience of being able to access mental health care from their home, office, or even from the (parked) car. Virtual therapy removed barriers to accessing care for many (though there's still work to do here, for sure).
No matter the arc of the COVID-19 pandemic, virtual therapy is here to stay. While there has been an explosion of subscription and app-based approaches to virtual therapy, this post is specifically about therapy for my clients in my practice (and I am not on any of those platforms, for reasons that may make a whole 'nother blog post one day). Whether your session is virtual due to illness, or because virtual sessions are simply a better fit for your life, there are things you can do to ensure that you get the most out of your session.
Get Comfy
It's not only nice to consider your physical comfort during a telehealth session, it's really important. Therapy is all about integrating new ideas and experiences using your mind and body. Your body's comfort can make a big difference for how present you can be for your session, and how well you can integrate your work.
You get to define what "comfortable" means for you. If you're managing depression, for example, you may have a hard time motivating to shower and change clothes, and it might feel good for your session to be a motivator for you do so. If showering isn't available to you for health reasons, or if your session is following a long work day, it might suffice for you to wash your face and change into some sweats before your session begins.
Attending to your physical experience in a way that prioritizes safety and pleasure is a good idea. It can be helpful to keep a blanket, pillow, or even a stuffed animal nearby. Holding warm things with our hands can support our nervous system to feel safe, so making a cup of tea or filling a water bottle with warm water to hold can be nice. Keeping water and snacks handy is always a good idea.
Make it Different
One way to transition from your "regular" life into a telehealth therapy session is to mark the session as different from your normal life. We can do this with an action as simple as sitting on the floor instead of at the table (where we usually work on our laptop). If I usually talk on my phone while holding it, I can change things up by proping it up on some books or boxes, or even using painter's tape to secure it to the wall.
When thinking about making your session feel different, it might be helpful to consider all of your senses. By moving your location, as suggested above, you're likely changing what you see with your eyes and feel with your body. You can attend to smell by, for example, inhaling the scent of a lotion, oil, or perfume at the start and end of your session, or by opening your session by lighting a particular candle. To shift your auditory experience, you can play white, pink, or brown noise. Using gum or mints to activate your sense of taste can also be grounding and help you orient to being present.
Show Your Face
Your face contains critical information. Because much of our communication is non-verbal, and because, when on a telehealth call, it is harder for me to catch informative details like you fidgeting with a pencil or re-crossing your ankles whenever a particular topic comes up, I need all of the data I can get from your face.
Please manage your lighting. It's best if there is more light in front of you than behind you. This can be as simple as sitting facing a window while turning off the lights in the room. Other quick fixes include moving a lamp next to your computer (or wherever your camera is), or having your back to the wall so that you're facing the room's light source.
Please stay in frame. You'll want to position yourself so that your head and shoulders are shown in the view. If more of your body is visible, it's likely that you're too far away to allow your face show up clearly.
I am Still "In the Room"
While it's essential that you feel comfortable during your session, it's as essential to honor your therapeutic alliance; a therapeutic alliance is the agreement between client and clinician that you're working diligently to address your concerns and goals. As your therapist, it's my honor to bring my expertise to support your work. You can honor that expertise by treating a virtual session just as you would an in-person session. This is particularly true when it comes to levels of formality, presentability, and confidentiality.
Specifically:
Wear pants. And all other items of clothing that you would for an in-person session.
Be sober.
You should be the only one in the room/car (or both of you, if it's a couples' session).
Minimize distractions. Turn off your phone's notifications, and have a plan in case, for example, the dog starts bugging you for dinner or your toddler wakes up from a nap 90 mins early.
Specific Tips for Couples
I practice PACT for couples, which means my #1 goal is to teach you how to build and maintain a secure functioning partnership as a team. This means that for most of your session I ask you to talk to each other instead of talking to me. PACT is an efficient, active approach, meaning although you're talking to each other, I'm still prompting and intervening and questioning a whole bunch.
The ideal set-up for couples' work is one where you can comfortably sit and face each other while still easily turning to see me/the screen on occasion. For some, this might mean setting up at a kitchen table using chairs that are easy to reposition. Sitting on the floor can work well for couples whose bodies can tolerate it. Couches are only good if both partners can comfortably sit with their shoulders perpendicular to the couch back, facing each other, for extended amounts of time.
Your Healing is Still Yours!
One great thing about virtual therapy sessions is that, just like in-person session, you get to ask for what you need, express discomfort, seek clarification, and work with me to figure out solutions if we're working in a way that isn't working for you. An even greater thing about virtual therapy is that, when we protect your session and our therapeutic alliance, it's as effective as in-person therapy.