How to Make Online Therapy Feel Less Weird

Coronavirus, and the countless ways it is messing up our already-messy lives, means those in therapy are going to need it more than ever. This includes me, an anxious overachiever who has been faithfully seeing my therapist twice per month. So when I received the email saying she would be temporarily discontinuing in-person sessions, I had to become comfortable with a new way of getting what I need out of therapy, and fast.

I had concerns: namely video and sound quality, delays, and not feeling connected emotionally to my therapist. In the end I chose a room that, come 8:30 AM, would afford me quiet and privacy—and space from my partner and pets. I chose a table in my den, and sat in the upright chair I use to work from home.

I’m fidgety in person and I struggle to make eye contact when I talk about the tough stuff. Once the time came, none of that changed. I still felt emotional, just as I would sitting in my therapist’s office, and she could tell when my mind wandered. Most importantly, despite a slight delay caused by the connection, I still felt heard and connected.

Anecdotally, I found most people's apprehension around making the switch to online therapy centres around a few key things: their home life being chaotic, discomfort at seeing themselves on the screen, bad connections and lags, and a general sense that a screen would detract from the inherent value of the session somehow—as though something conveyed through pixels is more "throwaway".

There's no use pretending like these things don't sometimes detract from the experience, just like construction work outside your therapist's window might do the same. But it's worth noting, as a starting point, that online therapy—or "teletherapy" as it has traditionally been known—does work. In fact, according to a 2014 study published in the Journal of Affective Disorders, "internet-based intervention for depression is equally beneficial to regular face-to-face therapy." Another study, carried out in 2017, concluded that teletherapy is "effective in the treatment and management of… depression, GAD and social anxiety, panic disorders, phobias, addiction and substance use disorders, adjustment disorder, bipolar disorder, and OCD."

I asked some therapists how you can get the most out of an online session.

Dr. Robi Ludwig, a psychotherapist based in New York and author of Your Best Life is Now, emphasises that online therapy "allows me to make myself available to a larger group of people in need, and to be more flexible with the hours that I offer.” If you've ever struggled to slot in sessions around your work and life schedule, this can work in your favour. So ask your therapist if they've expanded their hours, and make the most of having the luxury of more choice around your session time.

A “well-trained” therapist will make virtual sessions feel personal and connected, says Ginean Crawford, a New Jersey-based therapist. Which is to say, if you already feel connected to your therapist, you probably don't have a whole lot to worry about—they'll have the emotional intelligence to create a virtual connection, so to speak. “[They] would know how to create an environment that fosters emotional safety," says Ginean. "While much can be lost in communication via tele-health, therapists should be mindful of that, and express compassion and empathy authentically through words, tone and facial expressions.”

There's also a potential benefit around being in your own space—"an additional comfort that is felt from clients by participating in counselling from their homes.” If you feel uncomfortable, by the same token, then don't hesitate to tell your therapist about what's bothering you. "We'll see if there is anything we can do, within the ethical therapeutic relationship, to assist."

On the practical side, therapist Alanna Gardner, of Philadelphia, offers these tips: “Have a place that is safe and comfortable. Close all your open tabs and turn off notifications on the device you’re using, so you’re not distracted. Use headphones if you’re concerned about others listening in."

Gardener agrees with Crawford that this is a combined effort, and that you have every right to raise any discomfort you have with the switch to online. “Check in with your therapist if it isn’t working for you," she advises. "I've found that some of my clients need the safe container of a physical office to help them feel connected and grounded enough to have therapeutic services be productive for them."

Of course, "you can't force a client to move forward with therapy if they feel there isn’t [a solution]. It’s ultimately a client’s choice whether or not an online platform works for them. Therapy is an ongoing process of assessing what's helpful and what isn't helpful. Discussing the changes, risks and benefits can help to keep a pulse on that.

"Counselling is voluntary and clients can stop at any time. The difficulty with the pandemic is that we do not have many other resources to offer alternatives to tele-health.”

So start here—assuming you already gel with your therapist, and it's just a matter of getting used to the new format: Find a comfortable, quiet, and private space in your home. If you don’t have many options, even a closet could work. Then kick everyone off the Wi-Fi, or disconnect all devices but the one you’ll be using, so your connection doesn't lag. Then, if you are uncomfortable with seeing yourself, use a post-it to cover up your face, so that you only see your therapist. Got housemates? Let them know to keep loud music down because you're seeing your therapist—or "taking an important work call"; or "checking in with your socially isolated elders".

It's an adjustment for sure, but remember that the therapist on your screen is the same professional, attentive person (hopefully) that you've seen face-to-face. So be as open and honest as you have been in their physical office. Then, one day soon-ish, it will feel as though that office never closed.