Making online therapy work for your practice

Noel Bell

How can you be reassured that you are still delivering to the best of your therapeutic ability when working remotely? 

UKCP registered psychotherapist Noel Bell talks about how remote therapy can be an important part of your long-term therapeutic portfolio and shares some tips on how to make it work for you.

I had experience of using telephone and video conferencing web platforms before the lockdown so I have embraced the technologies even more to meet the challenges presented by the disruptions of the coronavirus pandemic. I have found that therapy undertaken in this way can be particularly useful for delivering psychoeducation, to maintain momentum when a client needs to travel for work, or to accommodate a disability or health condition.

I am not sure that remote consultations are suitable, however, when there is a risk that a client’s social avoidance strategies could be reinforced to the detriment of their emotional and psychological wellbeing.

Challenges to your client’s privacy

I have observed that some therapists can be overly concerned about upholding privacy and confidentiality in using video conferencing web platforms when in practice there may be more risk that they will have their client deliberations overheard in a face to face consulting room.

Privacy and confidentiality can be actually more secure using such platforms especially by ensuring that clients are communicating from a safe space and that all security features of the web platform are adhered to such as using passwords, enabling a virtual waiting room facility and utilising the ‘lock meeting’ tool.

Taking care of ourselves

I have become more aware of the need to attend to my own professional self-care as a result of using video conferencing web platforms exclusively for all clients. There are risks to physical health as a result of poor posture and less social routine. Therefore, more breaks are a vital part of working in this way. I have also realised that it is important to reach out and reconnect with colleagues on a peer support basis to compensate for the holding energy of practicing in a venue where other therapists are around and about

It has been my experience that remote therapy for some clients has a disinhibiting affect whereby they might overshare their personal material. In a physical face to face room they might be more circumspect about their pace of what to reveal and when.  Such oversharing may not necessarily harm the therapeutic work but it might potentially set up resistance in subsequent sessions.

Working around the limitations

Clients who have made the transition from face to face sessions to remote working have told me that they miss out on the routine of attending therapy in a familiar venue, when they have a different preparation for the session and perhaps benefit from more useful reflection time on their onward journey. It could be worth inviting them to consider the routine around their preparation for their session and the physical space they use for their remote session.

With online work there is no direct eye to eye contact potentially reducing the impact of the human connection. You could invite your client to try placing a web-camera at eye level and switching off their self-view to help boost connection and focus.

Additionally, there is greater emphasis on the sight sense so it can be worth experimenting with turning the camera off at points in the session (and even exploring a phone session) to see if a deeper connection comes about as a result. That said not all clients are sighted, nor are all practitioners – and therapy is still effective in these cases. Perhaps a lesson from adjusting to the social and professional disruption of the coronavirus pandemic is that therapists need to adapt to what works for them and their clients.