What I've learnt from 20 years as a virtual therapist

In the current climate, therapy will need to be engaged in remotely, though as a therapist, and for my clients, it really does not feel remote at all. 

I started working virtually in my therapy practice over 20 years ago. Firstly, by phone, when a client relocated and wanted to continue working with me, rather than starting her story all over again with a new therapist.

Then I was invited to join two therapists setting up a small company: PsychologyOnline, delivering CBT by Instant messaging (IM). Initially, I had my doubts and didn’t really see how text-based only therapy could deliver the results of face-to-face sessions with a client, but deliver it did. We took part in an NHS research trial with Bristol University, delivering CBT online. Successful results were published in the renowned medical journal Tthe Lancet (Volume 374, Issue 9690, Pages 628 - 634, 22 August 2009).

I enjoyed the jolly band of therapists I worked alongside, and am proud to have been amongst the first in the UK to work with what I call "Text-Talk".

I like the variety of face-to-face, phone, and Text-Talk sessions, and have offered all three methods ever since.

The benefits of virtual therapy

Virtual therapy has been very successful for many reasons, including:

• Geography is not a problem. My clients can talk to me from anywhere in the world.
• You save precious time travelling. No traffic tribulations and the weather is of no consequence.
• You save on travel costs.
• Protecting the environment from fuel emissions.
• When you are not well enough or able to travel, you can still benefit from counselling.
• Some clients feel self-conscious face-to-face and feel more confident and freer to talk in virtual sessions.
• Some people prefer the anonymity, as witnessed by the good work the Samaritans have done for years via phone.

Video counselling

Video conferencing seems the obvious way to most closely follow the face-to-face model, and it can work well, but only with a very good signal and matching broadband speed. Video is particularly vulnerable to connection problems. A video out-of-sync with the voice is not useful, and we can waste time trying to fix technology. When using video, I set up a standby means of contact: IM, email or telephone call to continue.

Telephone counselling

In my opinion, the telephone is superior to video. I can listen carefully to my client because we do not have the distractions of video: “I’ve lost you”, “I can hear you fine but cannot see you”, “the signal might be better downstairs”.

I have a reliable landline with good handsets and a tip-top headset, which may sound strange to you, but brings the client right into my space through my ear. I can listen to tone and inflection of voice, hesitation, what you are saying or perhaps not saying, without visual distraction... Have you noticed how the mind can run off into stories about a person’s appearance, rather than the content or meaning of what they are saying? The phone cuts that right out. 

Online counselling

Online therapy is an exciting departure from traditional face-to-face treatment. Though at the outset, many in the profession regarded virtual therapy with suspicion at best, and sometimes a good deal of hostility, they may be eating their words now. Client and therapist meet in a chat room in real-time, and text back and forth instantly so the conversation can flow, unlike email.

The benefits of therapy through instant messaging

There are many benefits to IM counselling in particular, including:

• The obvious advantage is accessibility anywhere with an internet connection.
• A big advantage over talking therapy is the lasting word-for-word text record of the session which you can take in more in your own time. You can refresh your memory on exactly what was said and revisit the ideas and learning at any time in the future.
• In text sessions, clients feel less self-conscious and reveal more of what’s troubling them sooner than in front of a therapist.
• Clients like the anonymity of meeting a therapist who they will not bump into in their local supermarket, or during their day to day lives.
• The very act of writing accesses a part of the brain that enables you to be more objective. Some people learn better from reading than from hearing ideas.
• Clients are not distracted by the person of the therapist e.g. they do not have to think about the therapist’s wardrobe, fantasise about therapist’s mood and get lost in wandering in their minds anywhere other than the issues discussed.
• It cuts out stereotyping by first impressions of dress-sense, age, race and class.
• Interestingly, some clients feel safer in a public space such as a cafe. The phone is too noisy, but instant messaging works perfectly for clients enjoying the buzz of a public space but in their own private bubble.
• Instant messaging also overcomes a problem I encountered recently with a client in lockdown with family. In a situation where you are uncomfortable with being overheard – you won’t be.

Considerations of virtual therapy

Virtual therapy does require a place from which you can connect with me uninterrupted.
One client used our session as a transition time between work and home, by calling me from their car overlooking the park. They benefited so much from this that they took time most days to stop and stare on the way home. In fact, the car is often used as a private space for a session.

At home, everyone must be informed not to interrupt you while you are in session. Treat the time just as if you were sitting in a room with me where we will not be disturbed. If you are unaccustomed to taking space for yourself, it will be good personal development to learn the skill of creating healthy personal boundaries. You are entitled to time alone to unwind, reflect, exercise or just be free of the demands of other people.

Incidentally, this will become ever more important for those unaccustomed to working from home, as other people will need to respect the fact that you are not on a perpetual weekend. A "Do Not Disturb" hotel-type sign hung on the outside of a closed-door is a fun way to indicate and remind family or room-mates that you are unavailable though at home.

Of course, there are security of data risks and confidentiality issues which have to be considered and the therapy agreement needs to address this.  

When new clients are unsure about virtual sessions but I have no face-to-face availability, I suggest giving phone or internet meetings a trial run. Nine times out of 10 when I do have space to meet in person, they prefer to continue with our virtual sessions.

Believe it or not, I can just about remember life without the internet. What a miracle it is when used wisely. Right now, in this "stay safe, stay at home" world, I cannot imagine how we would manage without it. But we would of course. With our creative brains, we adapt. These days, for obvious reasons, virtual therapy has come into its own.