I offer online psychological therapy using secure video platforms, such as zoom.us and Coviu. 2020 has seen online therapy becoming the norm, as the world has been confronted by the COVID-19 pandemic. It is not new, particularly to people living in remote rural areas, where access to face-to-face psychological therapy is limited. There is a growing body of evidence supporting the efficacy of online therapy for a range of mental health difficulties.
Many therapists have had to learn how to navigate this "online" world and to build their confidence in using these platforms. It is much easier to establish a therapeutic relationship and build rapport with the patient when you meet them face-to-face. Traditionally therapists have had "control" over the physical space (consulting rooms) in which they work. The consulting room is regarded as providing a safe and contained space for difficult feelings to be thought about with another. It easier for the therapist to attend to the verbal and non-verbal aspects of communication, and to support the patient should they become overwhelmed and distressed.
Furthermore, engaging in therapy requires a capacity to talk about painful thoughts, feelings and experiences, rather than understandably engaging in repetitive patterns of behaviour as a way of avoiding underlying pain. It is this avoidance which ironically contributes to distress. Psychological therapy requires helping the patient become aware of patterns of behaviour, thoughts and feelings which are contributing to their struggles.
Although it is harder to build a therapeutic relationship online, it is absolutely possible. With the current technology we have available, we can attend to both the verbal and non-verbal aspects of communication. I would encourage therapists to check in more regularly with the patient as to whether they have accurately understood them. It is important to set the scene for the therapeutic work to occur. This could include encouraging the patient to identify a quiet, private space, free from distractions and interruptions from others to meet with you online. If both patient and therapist can use the same room to conduct online therapy, it helps to provide some consistency and containment. I encourage patients to let other people know in the house that they are in a private meeting. Meeting at the same time each week, helps to create a predictable and reliable space. I talk to patients about "getting ready" as if they are going to meet me in the office, that is to get dressed for the session. I encourage patients to make time to prepare for the session, as well as wind down afterwards as this can replicate "travelling" to and from therapy, where there is time to process the session and to get back into the daily activities of their lives. I make sure that I have the contact details of an important other, so that if the patient becomes distressed and requires additional support, I know who to contact outside of crisis services. I talk about therapy eliciting painful feelings and that the patient may understandably try and avoid sitting with these feelings, which is easier to do when engaging in online therapy. It is important to talk about what to do if there are difficulties with technology. It is good to have some alternatives available, like Whats App or Face Time or else it may be necessary to revert to the telephone. These are some of the thoughts I have for setting up online therapy.
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