An Opportunity Amidst the Crisis: Moving Your Practice Online By Anastasia Piatakhina Gire on 4/14/20 - 2:10 PM

In the current climate, shaken by the COVID-19 pandemic, therapists, like other professionals from the mental health field, are scrambling to adapt to the sudden transition of their services online.

Battered by this frenetic rush, many therapists may feel reluctant about the move. The pressure and an impending sense of urgency do not help the transition, which would otherwise be achieved over a longer period and in a more natural way. The Loss of the Couch, which I started implementing a decade ago (I am still well, thank you!), can feel more painful and frustrating: it happens in the middle of other losses that the pandemic has thrown at us.

Like what you are reading? For more stimulating stories, thought-provoking articles and new video announcements, sign up for our monthly newsletter.

Stoic philosophers — as timely as ever — taught us that the obstacles that we encounter are actually fuel for action and change. Marcus Aurelius wrote that “the impediment to action advances action,” and “what stands in the way becomes the way.” In other words, every crisis is an opportunity, and in every problem there is an element of a solution. Why not face this crisis-imposed transition in a stoic way?

What can help you turn this crisis into an opportunity for you and your clients?

  • Re-focus on the relationship. If you believe in the centrality of the therapeutic relationship, you may wonder whether it works online in the same way as it does in person. The good news, recently described by Mick Cooper, is that it does. As you negotiate this transition together with the client, it is natural to refocus on your relationship. Moving from the physical room to the screen is like changing the lens on your camera — from a wider angle to a close-up lens, that remains static, unlike the usual ‘shoulder camera’ effect of the normal human eye. The acuteness of the face-to-face closer shot may surprise you at first, with its unexpected intimacy. Why not use it for an active exploration with your client?
  • You and your client are both having to deal with the same major crisis. In normal circumstances, the client is the one bringing up an issue and the therapist helps her to cope with it. This time you are in the same boat. This unprecedented situation has a rich modeling potential. How you are dealing with this extraordinary situation will offer your client some information about you as a person, but also a precious example of how to cope with a crisis. This is a good time to think about self-disclosure. What information about your handling of the crisis could be useful to your client?
  • Another side effect of the transition online is the sudden shift in the power dynamics. In the traditional therapeutic setup inherited from psychoanalysts, sessions take place on the therapist’s premises. He has all control of the surroundings, chooses the disposition of the chairs (and therefore the distance between him and the client), the lighting, water, tissues… Online, this power is equally shared with the client. Each party has to make the same kind of choices about where to sit, how to position the camera and the light, what to drink. In addition, the client can make you disappear with one simple mouse click. This sudden redistribution of power, if addressed properly in therapy, can be extended to other client’s relationships and eventually become a source of empowerment.
  • Yes, in this transition we are losing the couch, as well as the possibility to offer our clients tissues and a glass of water. But as a compensation, it also brings some new sources of additional data. In the traditional setup, the client comes into your universe, or at least the one you created in your therapy room. By connecting in an online video session, you literally open a window into your client’s physical realm. This is a new source of valuable information otherwise not available to the therapist. Pay attention to where your client chooses to bring you — which part of his life he shows, and make the most of this rare access.
  • We all know how crucial the first session is. This is when we first engage with a new person, discover how it feels to be in the same room with them, hear for the first time about their life. Usually, we have only one shot at it. But your first online session with your old client will be a renewed first experience. This is a brilliant opportunity to shift the focus to the here-and-now and, maybe, even ask the questions that you were a little too tired or too settled into your shared routine to ask before.
  • The so-called online disinhibition effect addressed by John Suler in CyberPsychology and Behavior¹ can propel therapy forward. When meeting online, clients do bring up important material more quickly and discuss difficult, shame-triggering information more readily. The therapist has to be prepared to take it on, not to shield away from this unusual immediacy facilitated by the medium.
The pandemic is also a good time for things we have been postponing forever and ever. The kind of advice we generally give to our clients works for us as well. Consider peer supervision or an online peer support group, reflexive practice, or training in some area worth improving. Reach out to an expert in the field. Exploring the online medium within a safe peer relationship, especially if it is new for you, will help you get more confident and efficient in using it with your clients.

Once this acute crisis is over, many therapists will return to their therapy rooms, relieved to be reunited with their clients in the same physical space after a prolonged confinement depriving us of touch and smell senses. But many, once adapted to the new ways of connecting, will want to maintain some part of their practice online. After all, it will have allowed them to keep helping their clients during these difficult times.

This is an opportunity for the profession to catch up with technology and make therapy more widely available for those who are displaced, have a restricted access to healthcare, or who are just reluctant to come in person. The wisest of us will improve their skills and become more agile online to help their clients even more.


References

Suler, J. (20-4). The online disinhibition effect. CyberPsychology & Behavior, 17(3), 321-326.
 


File under: Therapy & Technology, Online Therapy, COVID-19 Blogs