A global pandemic is stressful enough, but with public health concerns keeping millions confined (separately and together), mental health experts say these are especially vulnerable times for couples. “The issues couples are experiencing aren’t all that different from other times,” says Winifred Reilly, a marriage and family therapist in California. “The problem is, nobody has any space from each other.”
To cope with the added relationship strain, many have turned to virtual couples therapy. And even though some therapists are reopening their offices, virtual visits are likely here to stay, at least for a time.
It may not feel natural to hash out personal problems through a screen, but Reilly says knowing what to expect and how to prepare can improve the experience. Whether you’re pivoting to telemedicine from IRL sessions or starting therapy for the first time, here’s everything you need to know about virtual couples therapy.
Choose the right tech setup
Online therapy comes with a learning curve. Doing it with two people takes a little more planning, so it’s worth taking the time to set up a space that’s conducive to a productive session.
Marriage and family therapist Lauren Consul encourages clients to use a computer, rather than a phone or tablet, since it’s easier to capture both patients on a bigger screen.
Reilly recommends setting up your computer a few feet away so your therapist can see your whole body. During in-person sessions, therapists often use body language cues to plot out the flow of the session — for example, if your knees are facing away from your partner, your therapist might pick up on some tension before you bring it up.
If you’re not living in the same home as your partner, that’s OK. Dena DiNardo, a clinical psychologist and marriage and family therapist in Philadelphia, says both parties can log in from their own computers on a platform that allows group sessions.
Find a quiet, private space
Once you know what device you’ll use, choose a private, comfortable spot with minimal interruptions. Your home office, for example, might be better than your living room or the front porch (as long as there’s room for two, comfortable chairs).
If you have kids, privacy (and quiet) might be hard to come by. Consul recommends scheduling therapy during a child’s naptime or when you have childcare available, to prevent interruptions. Some therapists also see clients at night, so you may be able to opt for a post-bedtime slot.
For families with kids and no childcare, Reilly suggests putting on their favorite TV show or movie in another other room, assuming they’re old enough to be unsupervised for a bit. If your little one does interrupt, your therapist should be understanding. (They may be facing the same challenges at home too.)
Expect your therapist to be more directive or probing
During an in-person session, a therapist can more easily make eye contact and observe subtle body language cues, which DiNardo says can help guide the session. But screens can get in the way of nonverbal communication, so your therapist might ask more questions or give more directions to get the information they need.
If your therapist can’t see your whole body, for example, they might ask you to move your camera or describe how you’re sitting or feeling. All of these details can make for a more productive session.
Take time to debrief
When you go to a therapist’s office for couples therapy, you and your partner likely have a chance to debrief after the session. At home, there’s no built-in travel time, so you may not have the same opportunity. You may have to dive back into work, or your kids might demand a snack the second you walk out.
To give yourselves that debriefing time, Reilly suggests trying to avoid scheduling a work meeting immediately afterwards. No matter what your calendar looks like, take some time with your partner to process what happened in the session and how you both feel about it.
Debriefing is an especially important part of the process for couples who don’t live together. “In different places, you have to get more structured with what debriefing is going to look like,” says Consul. “Plan ahead how you can reconnect and talk about what happened.”
Expect some changes, but also some similarities
There are differences between virtual and in-person therapy, but you won’t find any differences in how your therapist bills the session. “Teletherapy for couples is legitimate therapy, and insurance providers have begun to realize that,” Reilly says.
In general, though, insurance coverage for couples therapy varies. Some plans include relationship counseling in their list of covered services, while others don’t specifically cover couples therapy because it doesn’t involve treatment of a diagnosed mental health condition.
If you’re using insurance, Consul says your therapist will take the same approach as they would for in-person care: submitting a claim for one person. If you and your partner are on the same plan, your therapist will bill the primary insurance holder. If you and your partner have different plans, then they’ll bill whichever plan they accept. No matter what, DiNardo says, they shouldn’t double-bill you — for insurance purposes, you and your partner are one unit. If you pay out-of-pocket, chances are the billing process will also stay the same.
And while the setup is definitely different and may take some getting used to, DiNardo says couples teletherapy can be just as or even more productive than an in-office session. Only with teletherapy does a couple meet with their therapist in the same space they argued earlier in the day.
Seeing patients in their natural environment may even save time in the therapeutic process. “They might more easily fall into their patterns and give me an idea of what they’re experiencing at home,” Consul says. “It can be a more raw and authentic understanding of their experience, which can help us go deeper faster.”