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In our current global situation, many of us as psychotherapists, counsellors, counselling psychologists, and the like are having to resort to working online or over the phone with clients. I’ve been interested to see how we have reacted and adapted to this change, from both client and therapist perspective. I also wondered about the differences in this style of therapy compared to the traditional face-to-face format, and which of these people prefer, or don’t in some cases. I spoke to a qualified therapist with a number of years’ experience working in this way – Mel Riley to find out her views and what she had noticed.
The first and foremost consideration for therapists was safety and confidentiality; I did notice almost a sense of fear about ‘getting it wrong’. I wondered if this could again relate to my previous article about being ‘seen’ and judged by other therapists. I can understand to some extent, as our work must always put our clients first and we are guided by our professional bodies in this way. However, you could argue that a refusal or reluctance to move clients to this alternative way of working for the time being could be potentially more damaging to the therapeutic relationship.
Trying to adapt and normalise this way of working for clients is key; trying to keep it as close to the previous relationship as possible in order to minimise disruption. Contracting and discussions to ensure boundaries are respected and adhered to is also important. Remembering, finally, that we are all just doing our best to keep our clients safe in a brave new world.
There is a fair amount of debate over which platform is the safest, GDPR compliance, end-to-end encryption, etc. I have noticed therapists saying they prefer to use Zoom, as it is widely regarded as the safest and most secure platform, however Mel reported that a number of her clients prefer to use Skype – they find it more accessible and easier to use. There seems to be a mismatch between what the therapist wants and what the client wants from online therapy. I wondered what impact this could potentially have on a client using the software for the first time and the impact it would have going forward into the session. I wondered if a certain platform or selection of platforms to use wasn’t available, whether this could potentially put some clients off.
Another important consideration is that not everyone is able or feels comfortable using online or telephone methods for therapy. Two main client groups this affects is the older generation who have not been brought up around technology and so may lack understanding in this area but may also be fearful or wary of using such an unknown method of communication. The other, perhaps somewhat surprisingly to some – Mel reports is the younger generations and teens. This is due to the reliance on communicating via the written from, texting, email, social media, and the like.
It is a quick and effortless way to communicate which is why it is preferred by so many. Another thing I found interesting and may relate to why online working is not preferred by some, both from my own personal experiences and from what Mel reports from her experience is the relational aspects of online working. Therapists have reported feeling exhausted and drained after conducting online work. This could be because maintaining relational depth in this setting is more difficult and can take more effort on behalf of the therapist.
Noticing body language becomes impossible when only seeing the top half and head. This can make it harder to notice when a client is using defence mechanisms or distractions or is dysregulating. There is a lack of facial expressions over the phone. I personally noticed a disconnect in eye contact: my eyes are drawn more to the face on the screen as opposed to looking directly at the camera. This can cause the therapy to feel more intense from the increased need for concentration on both parts. It can also be hard to tell what a silence is, and what is a potential computer freeze or something similar.
Mel reports some clients find this way of working very freeing, however. There seems to be a decrease in pressure for some, particularly with over the phone, as the therapist is mainly only relying on what is spoken and tone of voice.
Some clients also find the lack of face-to-face relationship almost like there is some distance between them and the therapist, which in turn can lead them to feel more comfortable disclosing more and being more open and honest. It’s important for the therapist to consider how they hold and contain this for the client and keep them safe.
Another consideration is the setting. Both parties need to ensure they are in a place where they will not be disrupted, for example walked in on by a partner or family member. They need to ensure they can hear each other clearly, and that they are in a comfortable space, preferable neutral with no distractions.
I asked Mel what she felt were the big advantages of online therapy. It can be handy to reach wider range, and diversity in clients, which can help to increase caseload if in private practice. It also gives a greater variety in experience for therapists wanting to develop their work. It is also beneficial for a client’s convenience, for example if a childcare issue occurs, a medical appointment, travel disruptions, car trouble – can all make it difficult to travel to a face to face appointment. If the session can be conducted online, these issues are almost eradicated.
The commuting time is also reduced, which gives clients greater freedom in which therapists they can choose to work with and access, particularly if they are wanting to access someone who specialises in a specific subject. It can also be useful for therapists working with families and couples therapy particularly if they are separated or live far away from each other, even in other countries.
I asked Mel what she thought would happen to the future of our profession and our way of working after the pandemic subsides. The likelihood is that a few of us may adopt a combination of both face to face and online working. There will certainly be another period of readjustment that needs to happen, or it could end up feeling overwhelming.
The importance has to lie on what our clients want from us and how they want us to proceed as a profession. I finish with two brilliant quotes, first from Martha Crawford: And we are still all just human beings in authentic relationship, trying to hear and understand and accept and respond to each other with open hearts in a less than ideal world. That is always the case.’
And from Victoria Baskervile: ‘Our challenge right now as psychotherapists is to hold and contain our clients while holding and containing ourselves. The external threat is the same for both which offers a different and challenging lens for the inter-subjective relationship.’
These quotes both capture accurately the challenges we are experiencing both as clients and therapists.
*** Image credit: Freepik
Becky Simpson is a psychotherapeutic counsellor from the North East of England. She currently works for a trauma and crisis charity. Becky also has experience across a few settings including the NHS.
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