So You have Questions about Online Counselling?
©Jeremy Tomlinson, M.Ed., R.M.F.T., R.S.W., EMDRIA Certified
Very suddenly so much shifted for us culturally. For more than a year most of us have encountered uncertainty, discomfort, strong emotion. There have been different day-to-day challenges and tensions: in some households, people sharing space to work from home and attend school, and for people who live alone, the isolation of so much time alone, less or no in-person contact with friends and family. For frontline healthcare workers, the stress of over a year of intensity with an uncertain end, and the discomfort of wearing personal protective equipment all day, as well as the stress when returning home to family members and the procedures to manage that. Many of us have felt the precariousness of our employment or become unemployed, or moved to reduced hours and reduced pay.
We soon learned that responding quickly to change to maintain both our physical and mental health was important. Up to March 2020, the vast majority of psychotherapists chose to meet only face-to-face with clients. But with the arrival of the health and safety protocols, we rapidly shifted our practices to accommodate telephone and videoconferences. Many of us have not returned to in-person meetings. Many of us who do meet face-to-face still meet with most clients by videoconference.
Here are some things to consider as you reflect about whether Online Therapy is right for you.
Concern about a Lack of Connection
Client J.: "When I meet in person with my psychotherapist, I feel his presence. There is almost an energy in the room that helps me to have the difficult conversation."
Client M: "My therapist seems to notice nuance when I am in her office. She'll comment about my facial expression or notice a shift in my body. I can't see how that would work by videoconference."
These were also some of my own biggest concerns as a therapist when I switched to videoconference sessions. It's okay to feel skeptical – in fact that's how I felt too when I first launched into this approach. But I realized right away that there can be a very strong therapeutic connection and that we can do very similar therapeutic work including noticing subtle shifts in a client's response.
Ideally your therapist is doing a variety of things during your therapy session:
- Listening to your story/situation/problem and providing support, compassion and empathy.
- Assessing throughout the meeting how they can be helpful to you.
- Providing grounding and safety to be able to confront difficult issues. Often that feels like a particular energetic presence.
- Looking for what's behind the words – what emotion, what body sensation, what history of trauma or history of success can help, or is getting in the way, of you moving forward.
- What one of my non-therapist friends calls my capacity to read other people. We therapists tend to notice subtle changes in facial expression, tone of voice, body language and we're curious about whether those may be clues to what's getting in the way, or what can facilitate moving forward.
Does that feel different by videoconference? Likely, yes.
Can it still happen by videoconference? Absolutely. It's up to the therapist to adapt and find different ways to engage with their clients
Can I still feel that sense of energy through a computer screen? It surprised me as I shifted my practice how strong that energetic connection can be virtually.
How do I know if a particular therapist is right for me?
How you will assess this for yourself for videoconference or phone counselling, will be similar to how you assess if the person is the right therapist to meet in person. For more about this see How do I know I'm seeing the right psychotherapist.
By videoconference you should assess whether:
- you can sense the therapist's presence and attention
- the therapist is noticing you enough – your emotion, your discomfort and your success
- you feel supported
One other factor to consider is the location of the therapist. Each jurisdiction may have different legal or ethical guidelines around the provision of psychotherapy. If the online therapist does not live in your province or region, you may want to check if/how they are professionally regulated to ensure ethical care.
How Do I Know the Technology Used by my Psychotherapist is Safe/Secure?
Each jurisdiction will have guidelines on which videoconference platforms are acceptable for psychotherapy and that may differ from province to province in Canada, and may differ again in other countries outside Canada. Many of these platforms quickly adapted and upgraded to accommodate the nuances of psychotherapy. Some of these platforms have been designed specifically for use by psychotherapists or medical professionals with issues of privacy in mind.
- Ask if the videoconference platform meets those standards of security and safety.
- Ask whether your confidentiality will be maintained by the platform so you ensure the privacy of your healthcare.
- Ask whether the platform keeps any of your personal information after the meeting.
Some of the platforms you use to chat with your friends and family will not have the same security measures as these do. Your therapist should be using one that ensures your confidentiality.
The platforms used for these purposes tend to be quite user-friendly. In fact, you may have already used one for family events and other meet ups with friends or for work. Even if you don't have much experience (or confidence with) new technology, the platform will likely be easy to use. As well, the psychotherapist will provide access to a meeting in an accessible format. Ask the psychotherapist about this.
If you are uncertain, the psychotherapist can phone you at the start of the meeting to help you as you set up the first time.
Virtual EMDR Therapy
Many of my clients meet with me for EMDR Therapy. It's an approach that is helpful to manage traumatic experiences or other upsetting experiences that are lingering in the body, or when anxiety is troubling. The therapist helps the client to process the difficult memories using eye movements, ear tones or self-tapping. As well, we use EMDR Therapy to increase strength and resilience. All of that can happen, and happen well, through videoconference.
When looking for an EMDR therapist to do virtual work, make sure
A short time after the first lockdown in North America, EMDRIA, the EMDR International Association, released guidelines for virtual therapy. They hastened the release of the document to address our rapid shift to virtual work at the start of the pandemic. The upshot is that the organization feels that while in general it is preferable to do EMDR therapy in person, that under certain circumstances it is acceptable to provide the therapy virtually.
They emphasize the importance of the EMDR therapist being especially mindful of creating a safe infrastructure to do the work and to monitor grounding and self-care even more robustly when working virtually. As well, EMDR therapists will make decisions on a case-by-case basis how to use the approach, especially with new clients we have not before met in person. Our intention in the work is likely to be different: to help our new clients to manage their current response (including triggers) and how that it is being influenced by their histories. In many cases, we won't use the full protocols because we want to manage what is upsetting in the here-and-now. But we will be flexible and use our assessment skills to figure out what we think is the best way to help. Your role will be to just be as open and honest as you can be under the strange circumstances.
Are There Advantages to Online Therapy over In-Person Meetings?
What therapists like me with little experience with online therapy prior to the pandemic had not predicted, was how quickly our clients would adapt to this approach, nor all the reasons people would benefit from and prefer this approach.
- The commute. As many of our clients are also working from home, being able to meet with the therapist between their own virtual work meetings and 'travelling from one room to another' rather than travelling by vehicle or public transit has been very helpful and reduced some stress. I live in a large city, so it was not uncommon for clients to travel an hour each way to meet with me, so this shift is a distinct advantage for many of my clients.
- Childcare. Likewise with children doing some or all of the schoolwork virtually, for many parents it is possible to meet without figuring out other childcare.
- Safe, familiar environment. Being surrounded by the familiarity and comfort of home, to wear comfortable casual clothing, to sit in a comfortable spot at home, to have comforting familiar objects within reach – these aspects can all enhance safety and groundedness to facilitate the sometimes difficult work of therapy.
- Pets. I have been amazed how often pets just knew it was time to join their person in therapy. When my clients have felt sad, fearful or vulnerable, pets have often known it was time to enter the room, to come close and nuzzle, to provide a source of comfort. Some clients anticipate the support their pets provide and bring their pets to session so they can be nearby. Several cats, dogs and rabbits have attended session with my clients over the past year.
- The screen may provide a buffer that actually enhances connection. This paradox I did not anticipate. For some clients, the screen actually allows enough psychological safety to take more risk and be more vulnerable. With a few of my clients who are trauma survivors, we (both my client and I) have noticed a greater depth to our work once we started working online, which we both attribute partly to being at a physical distance. Paradoxically this has led to a stronger energetic connection in our work.
Phone Versus Video
There are a few reasons you may prefer phone counselling rather than videocounselling:
- Being watched on a screen may feel intrusive.
- Seeing your own image on screen may feel difficult.
- You may have a difficult issue to discuss and you are concerned about feeling judged or ashamed, and working just by voice may make that issue easier to speak about.
- You may be a person who gets distracted when too much is going on, so working just by voice may reduce the amount of stimulation.
While working by phone, the therapist will not have all the same cues to assess your situation, he/she will tune in differently to your voice tone, breathing, pace of speech and so on. In the absence of visual cues, the therapist will ask questions differently to understand how you are feeling.
For you to decide
For now therapists can't provide face to face support.
- Would you benefit from support and therapeutic listening during the crisis?
- Have feelings or memories been activated due to how you have been feeling during the ebbs and flows of the pandemic? (This is common. Some of our usual ways of keeping those things tucked away tend to be harder to access in times of crisis.)
- Are you noticing difficulties in your family and relationships more acutely while you are living in close quarters?
- Are you living alone, feeling uncomfortable with a lack of social contact?
- Do you have time and space to work on historical issues?
Virtual therapy may be what helps.
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Jeremy Tomlinson, M.Ed., RSW is a therapist in Toronto. He specializes in EMDR therapy, couple therapy and sex therapy. Many of his clients are survivors of childhood sexual abuse or have experienced attachment issues in childhood, are survivors of adult sexual assault, or are living with symptoms of depression or anxiety. He currently has a virtual practice in a home office.
To read more about professional guidelines for virtual EMDR Therapy: