Having psychotherapy online is both the same and different to working in person, where therapist and client are sitting together in the same room. I hope this information helps you think about how to transition from face-to-face to on-line sessions smoothly and optimally, or allow yourself to consider online work if you have reservations about it. If there is anything you would like me to consider or add, do let me know!
When you visit a therapist for a face to face session, the therapist manages the space you come into; ensuring a confidential space, a space that supports you to move into a headspace to support your therapy. Now, the onus falls more on you to manage your own environment, which now is likely to be your home. This page is designed to support you to prepare yourself for an online session, be that via video or phone.
Privacy – this is fundamental to your therapy. When you come to therapy at a venue away from your home, where soundproofing has been thought about and optimised, this is taken care of. Now, whilst we are required to stay at home and engage with people online rather than in person, you need to think about how you can ensure you can speak openly and without fear of being overheard. You may need to ask others to respect your privacy by doing things like turning on entertainment in another room, listening to something on headphones (be aware that if you wear headphones you might tend to speak louder than normal), leaving a radio on outside the room you are in, or asking housemates to take their outdoor activity whilst you are in your session. You can put a post-it note on the door of your room to tell others that you are busy and can’t be disturbed. Just remember to take it down at the end of the session (unless you need a few minutes before re-engaging with the outside world).
Make yourself comfortable, but not too comfortable – if you can, try to sit in as session-like a position as possible. Sit somewhere where you can sit comfortably for the full 50 minutes. You might sit in a comfortable, supportive chair, but avoid places you associate with relaxation, such as your bed or the sofa where you sit to watch TV. And avoid standing or pacing up and down whilst in the session, even if that’s what you tend to do when talking to others in this way.
Your environment – Many clients come to appreciate the room they have therapy in almost as much as the therapy itself. Now, the onus is on you to create a space that offers similar consistency, containment and calm. Aim to be consistent by sitting in the same place for each session and ideally make it a place you only sit in for therapy. Think about what you can see when you look beyond the computer screen. Is it calming or are you looking at a pile of ‘stuff’ that begs to be sorted out? We all know that’s not conducive to feeling calm!
Things you might need in the session – my list would include tissues, glasses, a glass of water and my mobile phone (well-charged) in case we get cut off from a video session and need to move to phone instead. You might want to have sight of a clock to help you be aware of time. I suggest avoiding drinking tea or coffee during a session – save that for afterwards.
The time before and after a session – Avoid having a large meal immediately before a session – indigestion or postprandial sleepiness are not conducive to a good session! But do have a snack if you think you might be peckish during your session. Please remember that just like for face to face sessions, I will stop any session if I identify that you have been drinking alcohol or are under the influence of drugs. And finally, make sure you use the loo before the session!
Transitioning into and out of sessions – Now that you have lost the transition space of travelling to/from sessions, it’s important to build this into your schedule around an on-line/phone session. Where possible, aim to have 10-15 minutes to get ‘in the zone’ for your therapy, or transition into everyday life once the session is over. At the very least, get up and walk around your living space, stretch and/or engage in some breathing exercises.
What to wear – be sure to dress as you would if you were coming to a session across town. We all know by now how much harder it can feel to change from lounge clothes or pyjamas during lockdown, but it will help you to get into a therapy headspace if you dress as accordingly. There is one exception though - I do recommend slippers!
Technological hygiene – turn off or put to sleep all devices other than the one you are using to make the call, including watches, laptops and other phones. That might involve asking others in your house to do the same, so that there is enough Wi-Fi for the video call. This is as much to help you be fully present for the session as to optimise your Wi-Fi. However, if you are expecting an important call, such as one regarding the health of a loved one, it’s fine to have your phone to hand. If using a laptop or PC, do quit from all programs other than the ones we are using and turn off all notifications if you can. It might be a good idea to use headphones for a phone session, so your hands are free. If using a computer for audio-only, please turn off your monitor or completely darken your screen.
Adapted from: Russell, G. I. & Essig, T. (2019). Bodies and screen relations: moving treatment from wishful thinking to informed decision-making. In Gorvin, A. & Mills. J. (eds.) Innovations in Psychoanalysis: Originality, Development, Progress. Routledge, London.
