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How to Make Video Therapy As Good as the IRL Version

Kelsey Tyler
1 Question, 5 Answers is a column where we ask different types of healthcare pros to weigh in on the same issue.

More and more healthcare is happening online, which means both providers and patients are figuring out how to interact through screens without sacrificing quality of care. The learning curve can be especially steep in therapy, where a comfortable atmosphere and a strong personal connection are important components of effective treatment. But it’s entirely possible to have a productive, non-awkward session without being in the same room.

We asked five therapists how they connect with patients during video visits, and what patients can do on their ends to make sure teletherapy is a worthwhile experience. Here’s what they had to say.

Marianna Strongin, PsyD, PLLC

Clinical psychologist
New York City

I recommend a few things to my patients to ensure a productive teletherapy session, including a pre-therapy routine. Similar to the walk to therapy, I suggest using a few minutes to create movement as a way to prepare for the movement of the emotions to come. I also encourage my patients to turn off messaging or any other pop-ups that could take their attention away from therapy. Some patients put sticky notes on their own screen so their own facial expressions don’t distract them.

It’s also important to create room for a new type of experience. Many people expect a similar feeling as they had in the physical space and then can pressure it to feel the same. However, teletherapy should be a “new” experience which offers a new process and way of connecting. 

In order to have a really positive and productive session, I have changed the format of my teletherapy appointments so they are a bit different from the usual, in-person appointments. Since we do just about everything in our rooms now, including working, parenting, sleeping and now therapy, I have decided to start each session with a guided meditation. I meditate for five minutes with all my patients as a way to introduce and “come into” our therapeutic space together. Although this is something I generally don’t do in person, it felt necessary to create a new space together and be more intentional on the way in which we build our new space and the new type of work we are doing together.

Kelsey McLaughlin, MA, LMFT

Licensed marriage and family therapist
St. Paul, Minnesota 

I remind my patients to mentally treat telehealth sessions like they would any other therapy session. Because we are all juggling so many competing responsibilities from home, remember to schedule it into a phone or paper calendar. Second, I prompt patients before we start telehealth sessions to find a consistent spot in their home that feels private, comfortable and convenient. If they have children, we discuss making sure to coordinate care with their partners or other caregivers to ensure privacy and minimal distractions. I get creative with some who are unable to find a spot inside their homes. A few have found it easiest and most helpful to sit in their car.

I find having patients practice a brief moment of mindfulness, via breath work, body scanning and other self-soothing tools, helps them feel grounded and able to engage more quickly in our sessions. We briefly check in regarding how they are coping that week, and we discuss what they need from our session that day. Though COVID-19 can be a focus for therapy, I keep them focused on the goals we came up with together before the pandemic. 

I also name the elephant in the room: Telehealth is different from face-to-face sessions, and it can even be slightly awkward at first. I allow my clients to process their feelings about utilizing telehealth, and I address any concerns they have about it in our first telehealth session. Often I find that patients need me to validate the loss of not having the same in-person connection they are used to. Though it is not perfect, telehealth is “good enough” and far better than going without mental health support amid such collective uncertainty and anxiety. Thankfully, the adjustment to sessions via video is fairly fast.

As sessions come to a close, I have my patients name one thing they took away from our time together, or one thing they are looking forward to in the week. This has been a positive way to feel productive and focused with our time.

Ramon Lantigua, LMHC

Mental health counselor
Queens, New York

Therapy is often seen as a form of treatment where the therapist is assumed to be the primary catalyst to the client’s change, which could not be further from the truth. Just as the client sets the tone in traditional face-to-face therapy, they have that same ability to set the tone when engaging in teletherapy. 

One way that the client can make teletherapy beneficial is making themselves available for a certain time and day that they know will be a reliable time slot with minimal interruption. Unnecessary distractions delay the therapy process and may delay client’s from expressing themselves fully and genuinely. For clients who are new to teletherapy, it would benefit them to utilize the intake session or the first session to ask questions freely in order to feel as comfortable as possible.

For me, the first and most important element in making teletherapy beneficial is being patient. Therapy is about allowing the client to feel comfortable discussing the topics that brought them into therapy in the first place. This task is to be treated carefully in the traditional face-to-face session. Accomplishing this task via teletherapy requires that much more care and consideration for the client’s needs.

Another way the therapist can make sessions beneficial is simply dressing the part. While sessions are usually conducted from the comfort of my own home, it’s important to dress in a manner that creates a sense of professionalism to help build trust between client and therapist. 

One aspect of teletherapy that should be considered by both client and therapist is reliable internet connection and platform. Lighting is also important for both parties. A well-lit room will not only increase visibly on both ends but ease potential anxiety as both are able to see one another clearly, which improves overall rapport.

Heidi McBain, MA, LMFT, LPC, PMH-C

Flower Mound, Texas

Studies are showing that teletherapy can be just as productive and beneficial as in-person therapy. That being said, it is different seeing a clinician online versus in person, so know that it won’t feel quite the same if you’ve been seeing your therapist in person and are now transitioning online. There are some things you can do to make sure you have a helpful and successful session online. 

First, find a space in your house that’s private and comfortable for you, and bring in any item you may need such as a blanket or tissues; even a pet can be calming. Make sure you have a strong internet connection and good lighting so your therapist can see you well. It can also be helpful to use headphones so you don’t hear an echo on your video call. Be open and honest with your therapist about how you’re feeling and the things you’re comfortable with and things that might feel a little strange or different to you now. Also, try to keep an open mind about trying something new, as this might not be your first choice for your sessions, but it might actually come to be something you prefer to do long-term given the convenience and your comfort level being in your own space for your sessions.

To ensure I’m in a good mental space to help my clients, I do a five-minute quiet meditation, journaling and exercise before my first therapy session in the morning. I have a home office that I use for all my sessions, so it’s a consistent space for all of us. I use an ethernet cable to connect my computer directly to my modem, which helps with the overall connection. I also use headphones and have two eye-protection LED desk lamps for great lighting during my sessions and to protect my eyes. On screen, I’m the same as in person. I use empathy, validation and humor to connect with my clients from the start. If they seem uncomfortable about any part of their online sessions, we talk about it and address it openly.

Aimee Daramus, PsyD

Clinical psychologist

There are a few things clients can do to make telehealth more useful for them. They can think ahead of time about where they’ll find privacy to talk. Clients should feel free to contact the therapist if a change in appointment time would help you find the privacy to talk openly. Get in touch with us before the session if you have any questions about how telehealth works and if your insurance will cover it. 

Clients can also ask themselves how coronavirus is changing what they need from therapy. Maybe they were talking about anxiety, but now loneliness is the new priority. Maybe they were working on opening up about feelings, but now they’ve got more feelings than they know what to do with and need specific skills for handling strong emotions. If they’ll be logging in from home, think about both privacy and the opportunities. Would it be meaningful to show the therapist some art projects or introduce the therapist to their pet? If a couples or family session would help, talk to the therapist about that opportunity while the family is together in the same space and coordinating schedules will be easier.

The therapist can look for ways to help clients connect by role-modeling online socializing in real time and helping clients talk about thoughts and feelings at the exact moment thoughts and feelings are happening, instead of talking about things that happened in the past week. The therapist is going through a lot too, and having a lot of emotions, so they can role-model those coping skills and be in the moment with clients in a way that wasn’t possible before. The two of you can work on setting and respecting boundaries by talking about what it’s like to see into each other’s homes and to know something about how the therapist is coping. Session time shouldn’t be spent on the therapist’s issues, but on learning from them about how to handle new challenges.

Responses have been condensed and lightly edited.

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