When fellow therapists learn that my entire practice is online, I usually get a look of surprise, followed by the question, "But doesn't that take away from the work?" I'm happy to report the answer to that is a big "Nope." Providing virtual support during an event like the COVID-19 pandemic has been an effective way to both help clients during times of heightened anxiety and stress as well as to continue to work. If you're questioning if now the time is to go virtual for this or another reason, chances are you're ready.


Transitioning to virtual support has been made easy by those who have come before us in the remote therapy world, and we now have a straightforward check-list to use when preparing. The main question I get from clinicians is how to make the process feel positive, supportive, caring and individualized for clients. Here are some useful ways that I have found to make the transition reflective of the great work you already do in your office.

Continue building your therapeutic alliance

• Don't apologize for the transition. This is not a loss for your client, this is a wonderful opportunity for people to remain connected and continue with the work during a time that might otherwise feel quite stressful and alienating for your client.
• A beautiful way to frame this is by expressing your continued dedication to your client by offering comfortable, safe, ongoing, individualized care through the transition to a virtual session. You can do this in session or in an email, making room for any type of response the client may have.
• Don't make this a big deal. It doesn’t have to be and may reflect your uncertainty more than that of your clients.
• Allow time in the session before transition for any questions your client may have.
• Create a written safety plan you can share with clients that includes any changes necessary if the session is not happening in your office. For example, if a client needs hospitalization and you would normally do this from your office, outline a different way to support this circumstance from their home.

Make the Most of Your "Home visit"

• Generally, your client will be taking your session somewhere in their home. This is a powerful opportunity for you to experience some of what you talk about in session in real time with your client. For example, a client struggling with insomnia and difficulty with nighttime anxiety may have listened when you suggested a mindfulness or restorative yoga practice in session, but what does that actually look like in your client's room?
• Use the client's comfort in their own home to practice different skills that may be less achievable in an office. If you use any guided mindfulness, meditation, or somatic techniques in your work, allowing the client to find the space that feels comfortable for them and to use their own pillows, blankets, and any objects of comfort to help can be really wonderful.
• Pets! In-home therapy animals. My clients respond well to having their cat or dog pop in and out of session, or even curl up on their lap when talking about particularly difficult topics. One of my clients even has an iguana who has made some surprise appearances – an in-home co-therapist of sorts.
• Be open to anything your client may want to share about their home environment. This is a great way to learn more about who you've been working with.

Make the Tech Comfortable

• Create a clear, organized email that has all necessary instructions for your client to access services, including links to the HIPAA compliant video platform of your choice. Bullet points are your friend here. Practice first by logging on to the platform as if you were your own client – include instructions based on your experience. Helpful information includes: Does the client need to provide any demographic info? Can they access the video platform on their phones, or just their computer? Do they need to download anything first?
• Have a video platform backup. Frequently tech doesn't work the way we intend. Have two video platforms available so that you can switch if needed. Provide this information to the client in the email you send.
• Plan for your first virtual session to start 5 minutes early. It might take the client some time to get things sorted on their device and it really helps to have this time built in, so the session doesn't feel rushed.
• Add a section to your consent form around teletherapy that your client can sign electronically. Again, this is straightforward and doesn't need to be anxiety-provoking. You can even purchase paperwork for this from private practice consulting groups.

Get Creative

Expanding the ways we are able to connect with clients also opens the door for innovative ways to engage in our work. Experiment with a shared online journal, have your client securely email you an art therapy exercise, try having a session in which your client can be by an open window, or even outside in a safe and private space by a patio or balcony if the weather is good.

The Case of Jane

For many of my clients, a virtual connection allows them to express emotions more readily. For example, Jane came to therapy seeking support around a relationship she found to be unsatisfying in ways she had difficulty articulating. I sensed that there was something Jane wanted to share and was very aware of my efforts to provide safety, so that she felt comfortable doing so. It wasn’t until she was alone in her home during a video session, sitting comfortably on her couch, that Jane was able to share some of her feelings around her sexual identity that she had never expressed before. She later remarked that the ability to experience therapy in the safety of her own space allowed her to access a part of herself that she had been struggling with acknowledging.


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Overall, transitioning to virtual support has had little impact on my work. In fact, being able to provide safe continuity of care during such a challenging time has enhanced what I have been able to do with my clients.
 


File under: The Art of Psychotherapy, Online Therapy, COVID-19 Blogs