through movement

Online Therapy

Is Online Therapy Right for Me?

In the time of Covid-19 our world has turned into a virtual one where connection and support are sought online. Not everyone finds making contact with others online easy or satisfying but there are some positive and beneficial aspects to remote therapy which may surprise you. In deciding if online therapy is a viable treatment option for you it is also important to consider the possible challenges this could pose and what you may need to hold in mind or work on to make the therapeutic process as comfortable and useful as possible. Below are some of the upsides and downsides of online therapy and how to know what to expect. Please be aware that online therapy is not recommended for complex and serious psychiatric illnesses where close and direct treatment is vital and crisis intervention may be needed.

The possible upsides of online therapy

  • There are no travel costs which overall may make the therapy more affordable.
  • Travelling can have financial implications but it can also be stressful and unpredictable. Traffic or parking concerns can create anxiety and delays which may impact arriving to therapy on time and in a stressed state. The social interactions on public transport can also be emotionally demanding and managing overcrowding and sudden schedule changes can influence how and when you arrive to the session. Having online therapy minimises these uncertainties giving you more control over being able to start on time and from a prepared state.
  • Online therapy offers accessibility to those who may not be able to travel or have mobility or physical health needs which may make accessing mental health support challenging.
  • As the therapy is online you can receive it in the comfort of your chosen location, e.g. at home, work or even in a secluded and confidential outdoor space rather than having to travel to the therapist’s practice.
  • There is no waiting in the consulting waiting room or having to negotiate social interactions before or after the session.
  • It can be easier to explore and share feelings online as you may feel less self-conscious as the therapist is on the screen and not in the room with you.
  • There are ways in which you can take a break from high intensity emotional moments by looking away and having control over how much of you is seen.
  • You will be using your own props to support you in the somatic process (i.e. things in your own environment that can offer comfort, sensory feedback, creative outlet or support) rather than using the therapist’s resources. This means you build relationship with the objects in your home that can be used by you between sessions, thereby enhancing your resilience toolkit.
  • As you are in your own environment you may be able to incorporate significant objects or resources in the therapy process, e.g. writing or drawing in a meaningful notebook; using personal objects to highlight or offer background information to an important moment in time; or sharing music or a video that helps you to express yourself more deeply.
  • When the session is finished (rather than travelling home) you may be able to choose how to transition back into your day, maybe taking time to move, write, draw or go for a walk to look after yourself before going back to your life and responsibilities.
  • Sessions can continue wherever you are in the country or the world (when current travel restrictions are lifted). If you have to travel for work or leisure and can find a confidential space, sessions can continue as usual without interruption.

Alongside the positive aspects of online therapy there are also some challenges. However, with careful and negotiated consideration these “challenges” can be harnessed as a helpful springboard into a potentially successful therapeutic process.

Some of the challenges and considerations of online therapy

  • That because you do not travel to the therapy it can be difficult to prepare for it or transition into a reflective space.
    • It can be helpful to bracket some time before the therapy hour to help prepare your mind and body for being in the session. Some people find it helpful to light a candle or change the lay-out of the room you are using to signal entering into a reflective space which is separate to your work or living space. This time can also help you to collect your thoughts and feelings so you are more in touch with what you may like to bring to the session, to get a glass of water, get physically comfortable (in your body and in your seating arrangement) and prepare the technology you will be using so entry into the process is as smooth as possible.
  • As you are in a familiar environment you could find it difficult to focus on yourself and the therapeutic process in a way that may be more possible in a neutral space.
    • It may be helpful to choose a room or an area that is as free as possible of distractions which includes noise, visual triggers (reminders of work or study and personal objects and photographs) as well as turning off mobile phones and social media and email notifications on the device you are using for the therapy.
  • You may feel uncomfortable with the therapist seeing your private space as the screen will capture what is behind you in the room.
    • If this feels problematic take some time to think what you would feel able to share and do a test call so you can ‘see what the therapist would see’ when online with you. You can consider removing personal objects or photographs and creating the most neutral background as possible.
  • You may live with others and not have a private space you feel ‘free’ to speak openly from.
    • It is important that you feel able to speak freely as this is an essential aspect of the therapeutic process. Living in a shared house or family may mean you need to be thoughtful about when you schedule the session, e.g. when you know others will be out of the house or asleep. Using headphones can also help to create further layers of confidentiality as well as letting others know, if they are at home during the session, to activate background noise in their own rooms (such as television or music) to block out anything potentially overheard.
  • You worry that seeing yourself on the screen during the session will make you feel self-conscious and distracted impacting on your ability to focus on the therapist and your internal process.
    • On some platforms you can hide yourself from view which may make it easier to focus on just the therapist and your thoughts and feelings. Where this is not possible you could consider sticking a post-it note over the portion of the screen where you can see yourself. In some cases, integrating your thoughts and feelings about your discomfort of seeing yourself can be a valuable part of the therapy process, so consider discussing this with your therapist to see what the best way forward may be for you.
  • If you feel emotionally overwhelmed in the session, it could feel “lonely” and hard to connect with the therapist as they are not in the room with you.
    • At times significant memories and associated feelings can arise in the therapy leaving you feeling potentially emotionally charged or even overwhelmed. This may cause you to look away or cut off from the therapist as you try to manage your intense feelings. It can be helpful to talk to your therapist about how they can best support you should such an occasion arise and to have a plan in place to minimise risk and make you feel as resourced as possible.
  • Non-verbal cues or signals which may have been more obvious if you were physically together with the therapist in a room could be unnoticed, leaving you feeling missed.
    • As around 93% of communication is non-verbal, the majority of what we express is in the movement of the body, face or tone of the words we choose. Sometimes online the smaller more nuanced non-verbal communications can be missed as the whole body is not always in view. It is important to negotiate with your therapist how you will incorporate the body in the therapy and bring attention to what is being communicated on a non-verbal level. Further, to discuss how you may be able to let your therapist know if they have missed something that feels important and to build the trust to share and explore how you feel.
  • There may be greater resistance to exploring somatic responses to psychological material as the body can be literally cut out of view.
    • It can sometimes feel easier to talk about things than to feel them or to explore them in the body. This can be true in person or online. When working online, how far you are sitting from the screen, can determine how much of your body is in view or even in mind. This may make accessing somatic material more difficult. It is important that you agree with the therapist that they can bring attention back to your body to help you stay in touch with your felt sense and body responses. It is also recommended that you have space to move back from the screen (so you can be more fully seen either sitting or standing and moving). Using a chair with wheels can be helpful as you can adjust your proximity with ease and flow, moving closer or further from the screen as needed.
  • Technological failures can occur where the internet connection drops or a device runs out of charge, interrupting the flow of contact or the momentum of personal disclosure.
    • In preparing for the session, connect your device to a power source or at least ensure that it is fully charged and able to last the duration of the session. To minimise lapses in internet connection during therapy sessions in can help to make sure you are in a space that is as close to the router as possible. It can also help, if you live with others, to make sure they are not putting expectational demands on the broadband at this time (downloading large files or multiple devices streaming). It is important to discuss with your therapist what the agreed protocol is if the video session fails and if you will move to a different platform or service to finish the session on. It is also recommended to use as large a screen as possible, as this makes the therapist more visible and can mean you are more able to relax into the session as they are clearly heard and seen.
  • Again, as you are in your own physical space, it can be difficult to boundary or bracket the therapy once over and transition back into your life and responsibilities.
    • As mentioned earlier, it can be difficult to prepare for or enter the therapy session when you do not have any travel time to assist in the transition. In the same way ending the session can lack definition as you are already at home and creating distance from the therapy material can be difficult. It can help to bracket time after the session to give you space to process and self-care before returning to your responsibilities. If you have a ritual to begin the therapy you can also use the same process in reverse to help exit, e.g. blow out the candle or move the furniture back to its original position. It can also be helpful not to schedule demanding appointments or activities straight after the session so you can take the time you need (to reflect, draw, move, walk, rest) and not feel under pressure to socialise or perform.

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