In an effort to keep our clients and ourselves safe, most therapists have switched to video and phone sessions during the COVID-19 crisis. For many clients and clinicians, the transition has been surprisingly smooth. However, some of us are uneasy with the idea of talking to a health provider on the phone or by video. Whether it be due to technical concerns, doubt about one’s ability to connect with a therapist through a screen (or speaker), or just the normal apprehension we have toward new ways of doing things, it’s understandable that someone seeking help would be hesitant to give teletherapy a try. That said, there are several ways to make the experience more comfortable and more conducive to a strong therapeutic connection.
At a Distance, but Face to Face
In some instances, you will have the choice between conducting therapy by phone or through video. When possible, it’s generally better to meet with your therapist by video. Video sessions have obvious benefits over sessions conducted by phone. The non-verbal communication that occurs in session can be of great therapeutic significance. Furthermore, being able to look one another in the eye goes a long way toward facilitating rapport and maintaining the organic rhythm of the therapy session. As such, it's best to use a decently large screen, like a laptop or tablet, so that you and your therapist can see each other clearly.
Ultimately, teletherapy should capture as much of the traditional therapeutic dynamic as possible. Over the past few years, several companies have popped up that offer therapy by text. In my opinion, these should be avenues of last resort. The quality of the relationship between a therapist and client is the most important determinant of therapeutic change, and I am skeptical of the ability of text-based platforms to facilitate the necessary empathetic connection. Furthermore, this form of communication fully eliminates the possibility for therapeutic use of non-verbal cues. In addition, recent accusations of data mining against companies like TalkSpace raise significant concerns about their ability to safeguard clients' privacy.
Addressing Technical Snags
Technical difficulties are perhaps the biggest barriers to video therapy. Simply put, smooth video sessions require good internet connections. Luckily, most connection issues can be cleared up relatively easily. For example, lagging video can often be resolved by closing unused windows and applications or by turning off other devices using WiFi. You also may want to consider using an ethernet connection in lieu of WiFi. If you don’t have an ethernet cable, they can usually be purchased for under $10. With an ethernet cable, you can plug your computer directly into your router, which generally provides a faster and more reliable connection. If your router is located somewhere that doesn’t provide adequate privacy, a WiFi extender is another option. Extenders increase the reach of your WiFi coverage and can improve the internet connection throughout your home. Video sessions can also be conducted by smart phone. While the smaller screen isn’t ideal, data connections are sometimes more reliable than traditional internet connections.
Finding the Right Physical Space
There’s a ritualistic aspect to therapy. Typically, we going to a specialized space—separate from our daily lives and with different rules and norms. It’s almost as if we are physically stepping out of our routine in order to be able to observe our lives from a distance. Also, therapists usually give a lot of thought as to how their offices are set up, typically with the aim of creating a calm, inviting, and restorative environment. When engaging in teletherapy, the onus ends up falling on clients to create such spaces for themselves.
If possible, it can be helpful to have a designated “therapy zone.” Having a specific area in your home where you can speak to your therapist is a great way to create that distance between regular life and therapy. Of course, not all homes have unused space. If that's the case for you, you can experiment with using your space in a different way. For example, you could sit in the kitchen and dim the lights, or stay in your bedroom but sit on a different part of your bed—anything to approximate that experience of stepping out of your day. It’s also important to try to create an atmosphere where you’ll be comfortable. Take into consideration the chair you're sitting on, the lighting of the room, and any avoidable distractions.
Privacy is also an important consideration. Therapy is a deeply personal process. We say things to our therapists that we don't necessarily want anyone else to know. When therapy is conducted from home, clients may have to take special steps to avoid being overheard by others. Ideally, roommates, partners, and family members will be open and receptive to requests for privacy. When possible, it’s best to get them to commit to staying away from the place you’ll be for the duration of your session. You can also increase your privacy with the addition of a masking sound. White noise machines are small, discrete, and commercially available. However, a cheaper option may be to download a white noise app on your phone and place it outside your door during sessions. If you have no other way to secure privacy, it may be an option to do therapy from your car via smartphone.
Of course, there’s no privacy strategy that is going to work for every situation. Figuring out a plan to secure your privacy is something that you and your therapist can workshop in an early session.
Because teletherapy is conducted at a distance, it may seem unnecessary to find a therapist close to home. However, I strongly recommend trying to find a clinician who practices in your area. For one thing, there are laws and restrictions against practicing outside of one’s permitted jurisdiction. So, if you keep your search for a therapist local, you’ll be increasing your chance of finding someone you can work with. It should also be recognized that we live in unpredictable times, and there’s always the possibility that in-person meetings become the norm again sooner than expected. In which case, you’re better off driving 15 minutes to see your therapist than 50 minutes. That said, even if you never end up going into the office, having a therapist who is familiar with your community is ideal. Therapists who operate close to where you live will have been a better understanding of your environmental context. They will be more familiar with the systems with which you interact and better able to act as an advocate should the need arise. They’ll also have a better handle on what resources are available to you and will be able to make better, more informed, referrals.
Giving yourself Credit
As we adapt to our current conditions, we are tasked with figuring out new ways to maintain our wellness. It’s natural to be apprehensive about the unfamiliar. However, by becoming more informed about teletherapy, you’ve taken a first step into new, and potentially rewarding, terrain.
Thomas Shooman is a mental health counselor practicing at Resolution Psychotherapy in Poughkeepsie, New York. Thomas’ clients include individuals dealing with anxiety, grief, and obsessive thinking. He enjoys helping people navigate uncomfortable circumstances and find solutions that are in line with their personal style. Thomas is a member of the Association for Contextual Behavioral Science and the International OCD Foundation, and he is currently accepting new clients. For more information or to schedule a session with Thomas, please visit www.resolutionpsychotherapy.com or e-mail firstname.lastname@example.org.