A week plus into the Singapore Circuit Breaker - the label chosen by the Government to describe the restrictions to curb the COVID-19 contagion - we have all had some time to adjust to a new way of living.
As a therapist who mainly sees clients face-to-face and is accustomed to also working online, I too had to make adjustments to support my clients.
Many of the clients who saw me regularly before the lockdown have pressed the pause button on their therapy, some naturally transitioned to the online sessions, and a few reluctantly gave it a go.
There are many misconceptions about online therapy, and while it is a different experience from in-person therapy, the gaps are not as wide as many believes them to be.
The impact of a well-curated online session can be as profound as an in-person one.
I was deeply reassured, yet not surprised, when the clients who reluctantly gave a go to online sessions, all summarised their maiden experience with a statement like, "Oh, this is a lot better than I thought! I am quite surprised!"
Having regularly worked online over the last 5 years, I am well aware of some of the challenges clients face on transitioning to virtual sessions.
Here are some recommendation that clients and therapists have found useful in creating an impactful online therapy experience.
The context within which we meet is crucial, in the exact same way as when we meet at the office. Every detail contributes to our experience and paying attention to the smallest of details can make a really positive difference.
Select an environment that affords you all the comforts to feel relaxed and guarantee privacy. I use a small room in my home, which I set up simply, without clutter and with all the tools needed for my work.
Some clients use their bedroom, others meeting rooms at their office, others their lounge, kitchen or home office. It does not matter which room you choose, as long as you can make it comfortable and private.
For comfort, I make the temperature of my home office to my liking; I keep the room decluttered and the desk tidy; I invested in a professional office chair (my back is still thanking me for it); and I oriented my desk in such way that the natural light source is in front of me and clients can see my face uniformly lit; I keep my background neutral; and I have my favourite water bottle at arm's length, so to keep myself hydrated at all times.
For privacy, I have a lock on my door that I can use if I fear an involuntary interruption; I use headphones (more on this later); I inform any household member that I am in work-more (more on this also later).
There may be additional requirements that you have as a client or therapist, the core objective would be comfort and privacy.
Without the amazing technology gadgets, tools and platforms we have access to today, we would not be having this conversation, so let's look at what makes an effective technology set up.
Probably the most important thing is to make sure you have a powerful enough internet connection to sustain a good quality audio-visual feed throughout your sessions. There is nothing more disrupting and frustrating than being constantly interrupted by an unreliable connection.
Choose an online platform you feel comfortable with and that affords you a good level of security as per your preference or country requirements. The generic Skype, FaceTime are both good, you can also choose video conferencing facilities, like Zoom, GoToMeeting, Webex, Join.me or specialist therapy platforms like SimplePractice or TeleHealth. No matter your choice, make sure the video link is based on a private meeting, rather than a meeting ID anyone can login to.
Use the largest monitor you can afford. I find this helpful for all involved. As the therapist, I am able to better distinguish clients' facial features and gestures, and better capture some of the nuances that, when visible, speak so loudly to a therapist. Furthermore, if I am conducting a couple's session, with a large monitor, I actually need to turn my head left or right to look at client A or B. This helps me feel more engaged to that particular client, but I also had feedback that it helps clients know who I am addressing, which in turn makes them feel more connected. The larger monitors also engage more of our visual field and may reduce much of the environmental distractions, which can create the feeling of being in the same room.
One limitation with large monitors, however, is that the camera is usually far enough from the eyes of the person on your screen that at the other end it looks as if you are looking elsewhere, even when on your side of reality you are looking straight in the eyes of the other person.
It's not a huge limitation in day to day therapeutic experiences, as I found that with headphones it is easy to be heard by a client even when speaking slowly and softly to allow a slowing down of pace and emotions.
Speaking of which, I deeply recommend using headphones. Having the sound directly delivered to your ears immensely reduces environmental noise and further creates the feeling of being connected.
For couple sessions, I usually recommend that clients use a 3.5mm headphones splitter (see photo), so they can both wear headphones and have a synchronous experience, as if all in the same room.
Communicate to your household members clear boundaries, so they understand if / how to engage with you while you are in session. My preference is to pretend that I am in the clinic, and therefore not at home, and therefore not available. This allows everyone to know that session time is sacred and respected as such.
I dress up every morning before entering my home office, with the same outfits I wear when I meet clients at my clinic. This helps me create routines and boundaries that make it easier not to blur the experiences of home and office. For clients, just be comfortable and wear whatever makes you feel most relaxed and at ease.
As you enter the online therapy space focus on the fact that you are dedicating the upcoming hour to one thing only, you, if you are the client, your client, if you are the therapist. This is no different to an in-person session, of course, but I find it particularly useful to remind myself of this so that my monitor, headphones and home environment disappear and I am totally present to my clients. A small adjustment, but I find it super helpful.
Online etiquette shouldn't be much different from the in-person version, but at times the different quality of sounds, or delays / disruptions on the connection can create a somewhat artificial experience. This can indeed deduct from the overall focus and connection between client and therapist. When it happens, and it surely will, stay calm, acknowledge it as necessary and re-establish a connection to the shared space as quickly as possible.
There is a lot more that could be said about online therapy and I am sure you have already thought of several alternatives to what I presented here. Please let me know your useful comments as I would love to enhance my and my clients' experience online.
If you have the curiosity to try, book a session online and maybe you can be surprised too.
In the meantime, I wish you and your loved one well and I hope you are finding the stress to navigate this period with openness and peace.