By Audrey Schoen, LMFT
Therapist in the Sacramento area
March 16, 2020
Optimizing the Online Therapy Experience
If you are like most therapists in private practice, you typically perform most or all of your counseling sessions in person. Apart from the occasional phone session, your experience with telehealth was limited. Transitioning your entire practice to telehealth can pose a lot of challenges. We can all remember how nervous we felt seeing our very first clients, wondering how this was all going to work. Often therapists experience similar feelings when doing their first online sessions.
A couple of weeks ago I shared my tips for setting up your online practice in a previous article. But that is only the beginning. Now you are faced with the task of asking clients to make the move as well, and some may have reservations. Your doubts, discomfort and anxiety will come through in your voice and language choices, so speak confidently about telehealth. You don’t need to prove that telehealth is valid or effective. If you believe that it is, then your clients will too. This works best when you call each client to discuss the change, then follow up with an email. If they aren’t sure, encourage them to try at least one session to see how it feels, and then process the experience with them.
So how can you, and your client, create the best online experience?
Let’s take a moment to address the technical side, from a clinical perspective.
- If you have the option, upgrade your internet plan.
- Use an ethernet cable to connect your computer to your router. I have a very long one that is (temporarily) strung up along the ceiling.
- Good lighting is key. Multiple lamps and a ring or umbrella light are great additions.
- Close your tabs and programs, and remind clients to do so as well. This will help reduce lag.
You can still connect deeply with clients
- Setting up your computer so the camera is just above eye level helps put you in a position that feels more natural to the client. This helps with eye contact. Plus, you don’t want your client looking up your nose.
- Sitting back from the screen so your chest and shoulders are showing helps with body language communication.
- Using headphones, preferably plug in headphones, reduces noise problems and creates a more immersive experience, allowing you to feel more “in the room” with your client.
- Some find their own image box distracting. If you do, cover your face on the screen with a sticky note.
- Be aware of the disinhibition effect. This is the loosening of social restrictions and inhibitions that are normally present in face-to-face interactions. Pay closer attention to self disclosure and boundaries.
- Be mindful of transitions. Clients are likely home, and may need some help transitioning into a therapy space mentally. Similarly, you might take a few minutes at the end of session to intentionally close and transition. You can also talk to the client about what they can do before and after the session to make this transition more smoothly. This can be as simple as spending a few minutes with a mantra, meditation or breathing exercise.
Privacy can be a challenge for both clients and therapists. Especially with school closures.
- Privacy can be improved with the use of a fan or sound machine. Phones or smart speakers can be used as sound machines. Using headphones also helps.
- Finding a location can be challenging as well. Clients may use a closet, car, laundry room, bedroom, porch. Remember to lock the door if possible.
- If phone sessions are an option consider walk and talk.
- Both therapist and client can encourage other family members to watch tv or listen to music, though avoiding video streaming services over wifi is recommended.
- Have a code word if confidentiality becomes compromised.
Handle glitches with grace and ease.
- Glitches are to be expected so talk to clients upfront about this and have a plan for things like a bad or lost connection.
- Acknowledge them calmly in the moment when they do happen and bring the focus back to the conversation.
- Sometimes silence might be misinterpreted as a glitch. The use of “hmm”, an audible sigh and other indicators of thought and pause can help clients stay with the silence. You could also use statements like “let’s take a moment to sit with that.”
- Remaining flexible and adaptable models these skills to clients. You might meet your clients pets or kids
Manage your energy and reduce fatigue
- When seeing clients in-person, we get up between sessions to walk a client out and greet the next one. When online we can get stuck in our chair, so make a point to get up and walk around between sessions.
- Staring at a screen is tough on our eyes and brain. Going outside regularly and looking long distances throughout the day helps to ease eye strain and reduce fatigue.
- You are now looking at a screen for long periods so it’s wise to limit screen time when off work. If you have evening sessions, schedule an hour of screen free time before bed
- Adjust your display settings to reduce eye strain, including brightness, contrast and color temperature. Some operating systems have built in settings for this.
Doing something new can cause us to second-guess and doubt ourselves, so we end up working harder to try to make up for it. Trust yourself, trust your skills, and continue being the awesome therapist you already are!
About the Author
Audrey Schoen is a CA Licensed Marriage and Family Therapist. Her fully online private practice allows her to serve clients all over California. As the wife and daughter of Law Enforcement, she has a special interest in working with First Responder partners and couples.
