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When I started working as a psychotherapist, virtual therapy wasn’t even a thing.
I met with people in my office where we sat together in a safe and private space to talk about all things human.
It’s a flawed system, but it was, and still is, my favorite way of giving (and receiving) therapy. After all, there is nothing quite like being in an actual room with an actual person to build and deepen relationships.
But then the pandemic hit, and I, like most of us, had to completely reevaluate how I functioned in day-to-day life. I wasn’t a fan of virtual therapy at first, believing that by seeing clients online I was missing valuable information like subtle body language, but I have come to see that it has its place.
These days, I meet with about half of my clients in person and half online, and I’ve had the chance to learn how to make Telehealth work better—and what can turn it into a real disaster.
If you are someone who prefers to see your therapist online for whatever reason, here are five tips to maximize your experience:
1. Make your space, and your time, sacred.
In the past, it was the therapist’s job to ensure the sanctity of the therapy space. We (hopefully) created a calming environment which ensured privacy and acted as a respite from the rest of one’s crazy life. For me, the second I walk into my therapist’s office with its familiar well-worn pillows and snarled Spider plant soaking up the sun, my heart rate goes down, and I know…this hour is all mine. It is separate from any other place I inhabit, and as such, allows for the stillness of self-reflection.
It is much harder (but not impossible) to capture this feeling from our homes with kids running around, a disgruntled spouse/parent/roommate in the next room, the dog barking, or the dishwasher beeping to let us know it’s time to empty a load. The elements you should look to try and recreate are privacy, consistency, and quiet.
>> Privacy might seem obvious, but you would be surprised by the number of people who I’ve seen wandering around behind a client during a session! Who wants to share their deepest darkest secrets with a judgmental audience?
>> Consistency is key because it allows us to automatically get into the therapeutic mindset and develop an expectation that we will switch gears.
>> And quiet, well, I imagine you are as easily distracted as I am, and once you manage to grab ahold of an elusive thought you’ve been chasing down for months only to have it evaporate because the doorbell rings, it can be uniquely dispiriting.
So what’s the solution?
Unless you live in solitary confinement, you have to get a little creative. Sitting in your car while it’s parked somewhere off the beaten path is a great option—as long as you have reliable Wi-Fi. Choosing a time when no one else is home, shutting the door, and putting on good headphones works too. You’ll want to minimize all distractions and intrusions.
If all else fails and you have the room, set up a therapy station in your closet. Make sure nothing is calling for your attention, your laundry is done, your kids are occupied (hopefully with a caretaker), and you are able to be comfortable and focused.
Be on time, and plan to stay the whole session—you’d think that would be a given, but people are fairly casual about being online these days, and they will often arrive late or leave early. Don’t do that! You deserve the entire hour to process whatever issues you are hashing out.
2. Make sure your technology works.
If I had a nickel for every time the Wi-Fi went out during a virtual session, someone’s phone died, or there was a computer glitch, I could retire next week. Some of this is unavoidable, of course, but a lot of it is. Same way with your Bluetooth, your AirPods, or any other equipment you use to enable a session. Do your best to make sure everything is working before you begin—technological interruptions can ruin a session faster than than my dog stealing a donut. And also ensure that your therapist can see you. I’ve looked up a fair amount of disembodied nostrils at this point, and I’m here to tell you, it’s not great.
3. Do. Not. Multitask.
Here is a brief list of disruptive things clients have done during virtual sessions that I have rarely, if ever, seen done during in-person sessions:
>> vape or smoke nicotine or marijuana
>> drink alcohol
>> eat a meal
>> constantly check notifications on their computer
>> randomly Google things
>> talk to other people mid-session such as children or spouses
>> lie in bed
>> drive through a drive through
>> sit in the dark
>> do chores
>> put on makeup/fix hair
>> and my very favorite…introduce their therapist without warning to folks who “pop in” to session
A therapist on the receiving end of such behavior will often feel disconnected from a client and less motivated to help. We should, of course, be forthright and confident enough to set boundaries, but we are only human and can’t help feeling disrespected! In other words, it’s not great for the therapeutic relationship, the good health of which is the number one predictor of successful treatment.
4. Insist that your therapist treats the online platform as they would an in-person therapy space as well.
It saddens me to say this, but I’ve heard plenty of stories at this point about therapists—the very people we are paying to pay attention—also have other people visibly in a room with them during a session (which is not only unethical but illegal), as well as do things like check their phones, not quiet their barking dogs, and be unreliable when it comes to session times. Should someone you are working with do any of these things more than once (especially number one), I would consider finding someone new.
5. Consider how you will personally flourish.
We all have different strengths, weaknesses, and preferences. If you know, for example, that you struggle to focus, online therapy is probably not a great choice. If you have social anxiety, I’d also consider taking it off the table—it’s much more therapeutic for socially anxious people to navigate the real world of interpersonal dynamics.
If you are considering therapy for your child, I would almost always choose in-person. Children already have too much screen time and technology in their lives, and in my experience seem vitally nourished by seeing a therapist in real life. Oddly (to me anyway, who had to be dragged as a child into therapy), kids nowadays often crave therapy and look forward to that hour with “their person” all week long.
Couples therapy is another example where I think in person works better. There are such complex dynamics between couples, much of which gets lost in translation online, that it can be a real liability.
If it sounds like I am discounting online therapy for lots of folks…it’s because I am! But the people for whom it is a good fit, or for whom it is the only option, can generally benefit greatly. So who are these people exactly?
>> Those for whom a commute to therapy is either impossible or so inconvenient as to be unsustainable.
>> Those who interact online in essentially the same ways as they act in person and are completely comfortable with technology.
>> Those who are managing mild to moderate mood disorders, life transitions, grief, trauma, or chronic illness (as opposed to those diagnosed with personality disorders or other conditions which require more intensive support).
>> Those who are able to focus relatively easily for a whole hour.
>> Those who would not go to therapy at all if it wasn’t online.
>> Those who move and can no longer attend therapy in person but wish to continue working with their therapist.
>> Those with physical disabilities.
And of course…
>> Those who have COVID-19 or other contagious diseases.
What I love about online therapy is that it has opened up the playing field to lots of folks who otherwise wouldn’t, or couldn’t, seek treatment. It’s not an overstatement to say that we Americans are in the middle of a vast and complex mental health crisis. I believe in the power of talk therapy to answer this crisis and help countless individuals lead better lives—thus improving the lives of everyone they know.
If you are considering therapy, I applaud you for taking a step toward your own well-being. We are all works in progress and a little support from a compassionate, trained professional is often just what we need to get us where we want to be.
Be it online or in person, with the right approach, therapy can be a profound and uplifting endeavor.