Everything you need to know about your first remote CBT session

Speaking with a therapist for the first time can be scary. You are opening up to a stranger, whilst hoping that your therapist will use what you tell them in a helpful way. Remote CBT sessions mean that you are doing the same thing without the proximity of face to face interaction. This can be a challenge for some as it is harder to trust someone when you can’t fully perceive how a therapist is responding. Some, however, love remote CBT sessions for the added benefit of being less visible.

Due to present circumstances, I have spoken with most of my clients over the phone and through online video calls. Many of them mentioned how well sessions flowed because we focused on what was said without any added distractions. This represents a major advantage and can be especially helpful when you can talk to a therapist from the comfort of your own home.

How does CBT work?

CBT is pursued in a very structured way. Initially, we focus on gaining information in order to create a hypothesis as to how your problems are maintained and how they developed. From that, we can then look at which concepts would be most helpful for you to practice in between sessions. We then focus on appraising how the in-between session exercises went and from that, further tailor the treatment towards you. A CBT therapist, therefore, acts as a catalyst for you to make necessary changes, whilst helping you develop a toolkit based on techniques and concepts.

This way of working lends itself especially to remote CBT sessions and can be pursued using any method of communication ranging from text-based to video chat.

Text-based CBT

Pros

Text-based CBT is more anonymous which can be beneficial for very socially anxious clients. The distress of seeing a face, presenting yourself or having to talk over the phone is removed. The pressure of having to engage in a common conversational flow is also absent. You’ll have more time to think before you express yourself, and also have a written version of the conversation between you and your therapist to refer to.

Cons

The downside is that many markers which are helpful for the therapeutic process are not visible. It is not possible to see when a client makes small movements due to an uncomfortable topic and changes in tone are also not recognisable. The intent of what was said is also harder to ascertain. Someone could be joking about something whilst coming across as being serious.

Audio-based CBT

Pros

The benefit of not seeing someone can again appeal to socially anxious and other relevant client groups. The added benefit of being able to just focus on expressing your difficulties with fewer distractions can help increase engagement. The obvious delays of text-based communications are also absent.

Cons

It is easier to understand and interpret communication when you can see the person you are talking with. These types of sessions require more focused attention as it is not possible to re-read what was said.

Video-based CBT

Pros

This is the closest step towards in-person, face-to-face therapy. You will be able to see your therapist, which will provide you with the added benefit of interpreting what is said easier, whilst being able to connect on a more comprehensive level.

Cons

Anxious clients can find such an intimate form of communication harder. Many socially anxious clients can find the added pressure of being seen as a hindrance and therefore find it difficult to open up and engage in a natural, conversational flow with their therapist.

Remote CBT sessions can be very beneficial as they allow you to engage in therapy with the added benefits of heightened anonymity, whilst avoiding any kind of distress and typical hassle involved with face-to-face interactions (travelling etc.). But really, there is no form of remote CBT which is “the best”. Your individual circumstances will indicate which type of remote CBT would be most suitable and remember, most therapists are happy to shift methods of remote delivery if these turn out to be more beneficial for you.