Online Therapy: What It's Really Like
Having a client in front of me was all I ever considered before March 2020. My training as a counselor, like many grad school programs, assumed that I would only be seeing people in person. I never imagined I would do counseling remotely! As a counselor, I pay close attention to my client’s body language. I notice how they sit on the couch, what they do with their hands, if their foot jiggles nervously, when they take a deep breath, etc. I do this because it gives me valuable information about what is going on in my client’s “internal world”, meaning their emotions and thoughts. I use this information to inform my approach in counseling. Additionally, confidentiality is incredibly important to me as a counselor as well as to my clients. Being able to control the environment of my office is a real benefit to seeing clients in person. My office is very cozy and quiet, and I utilize blinds on the windows and white-noise machines in the hallway to create a feeling of safety and privacy for my clients.
When it comes to online therapy, there are definitely a few obstacles!
Technology challenges can be very disruptive. You can probably imagine what it might be like for a client if they are in the middle of an emotional story and they look up and see their counselor frozen with a strange expression on their face or dropped from the session altogether! Situations like that take repair to the connection, both the call connection and the relationship connection. It’s also somewhat limiting to only see my client’s face, and not see what is going on with the rest of their body. Finally, it can be difficult for some clients to find a place where they feel they have enough privacy to really be open with me. Clients often have their sessions in their cars, as that is sometimes the quietest and most removed setting they have access to while they are at home.
Online therapy has some immense benefits, as well!
One thing that is somewhat unique to counseling (as opposed to a traditional doctor’s office visit) is that the appointments tend to be on a consistent basis at a consistent time. Your counseling appointment might be at 3 pm on Tuesday every week, for example. It may be easy to leave work at 3 pm for a doctor’s appointment a few times a year, but when we’re talking every week it might be significantly harder for many clients. Online therapy is particularly suited to alleviating this difficulty by taking away the travel time on either end of the appointment. Clients can zip out to their car for an hour and have counseling from their front seat, for example, and essentially call it their lunch break. If you’re someone with a private office or if you’re working from home, it’s even more convenient; just shut your door and you’re in your counselor’s office!
Another benefit is that online therapy widens the pool of possible counselors that may be available or specializing in the services you are looking for as a client. For example, if you are looking for a counselor that specializes in perinatal mood disorders and you live in a tiny rural town you may have to either drive a long way to find a good fit in person or settle for more of a generalist local to you that may not help you as fully or quickly as you would like. With telehealth, you can search for all providers in your entire state and find the counselor who will best serve you.
I am a huge supporter of anything that lowers the barriers to getting counseling services. If telehealth makes things easier for people to get the help they need, I am all about it.
When beginning online therapy, what should you keep in mind?
Just like I had to upgrade my technology (webcam, lighting, microphone, etc.), I sometimes think that would be helpful for my clients as well. I don’t mean they need a professional setup in order to meet with me, but it might help them to focus more on their issues in counseling rather than having to hold onto their phone or worrying about whether I can hear them clearly.