Starting in the pandemic era, many people shifted to exclusively virtual psychotherapy, through platforms similar to Zoom. Although psychologists had already been researching and expanding the virtual platform, many patients were new to this process. I think virtual therapy is fantastic for people who might otherwise have difficulty accessing therapy: people who work a typical 9-to-5, live far from the nearest therapist, or would have other logistical barriers to attending therapy in-person. I can also acknowledge the setbacks of virtual therapy: for example, children and people with low technology skills or inconsistent internet may have more difficulty with this format.
Now that it’s been 2+ years of mostly virtual therapy, I’ve about seen it all in my practice. I’ve had technology mishaps, awkward misunderstandings, and any other situations you can imagine. Sometimes people don’t think about the many things that could go wrong in virtual therapy, so I wanted to provide a list for guidance. The therapy space is so vital, and minimizing interruptions can make a therapy session go so much more smoothly.
Set up a Similar Atmosphere to the Office
I really want the virtual space to be as similar to coming into the office as possible. When it’s very different, it’s difficult to get into the therapy mindset. Here are a few things to consider...
· Create a private space. Make sure you’re able to get somewhere that no one could be watching or listening in on your therapy sessions. Yes, this means no therapy at Starbucks. If this is challenging, try being in a non-moving car, study room at a library, or even a big closet (just make sure to get some air!). Use a white noise machine, if needed.
· Follow in-office rules. If you were in a therapist’s office, you probably wouldn’t randomly walk away to pet a dog or start making your dinner. Follow the golden therapy rule: if you wouldn’t do it in the office, don’t do it during your virtual therapy session.
Wear Appropriate Clothing
Remember in the 1960s when people would wear a suit to get on an airplane? You definitely don’t need to be that dressed up for therapy, but remember to treat it like you would any other doctor’s visit. I know this seems silly to say “wear clothes” but, sometimes, people are so used to the camera showing only part of their body, they’re actually not wearing full clothing. It’s also a bit too casual to wear pajamas.
With younger kids in therapy, they might take off their clothes at random. I’d suggest to their parent turning off the camera, redressing them, and then continuing with the session.
In your therapy session, you might be expected to bring in your “homework” from the past session, follow along with a book, or engage in an activity. Make sure, wherever you’re holding the session, that you have any needed materials and an ability to take notes, either on paper or a device.
Give Your Therapist Your Location
First of all, this is a legal issue for therapists. We’re only licensed in certain states, and so if you’re out of state, your therapist may not be able to hold the session with you. If you are in a different location than usual, you want to give the address to your therapist, just in case there is an emergency situation during your session.
Stay on Camera
Unless there’s an arrangement with your therapist to only use audio or a phone call, it’s really important to be on camera. You therapist needs to be able to see your facial expressions and body language to fully engage you in therapy. Sometimes people hide away when they’re uncomfortable, but then we can’t help as much.
For kids in therapy, if they run out of view, parents can help by adjusting the camera or following them so that we can continue to coach and guide through the situation.
Test Your Technology Setup
Before your first session, get on early and make sure your video and audio are working. If there’s a problem, you’ll have time to get tech support.
Nothing scares us more as therapists than turning on the camera to someone driving! Even though people these days are very used to talking on the phone while driving, this is still dangerous. It’s also not an ideal setup for therapy, as you’ll likely be too distracted to really engage in the session. I also wouldn’t recommend being a passenger while someone else is driving, because that doesn’t allow for privacy.
Just because it’s virtual doesn’t mean it’s something you can multi-task. You should not try to have your therapy session in the middle of another doctor’s appointment, a work meeting, or any other distracting activity.
Distract with Technology
Your therapy hour is not the time to catch up on texts with friends or play video games on another tab. You’re only hurting yourself if you’re distracted during the session.
For parents of kids/teens in virtual therapy, you might want to check in on them occasionally to make sure they’re actually paying attention – and haven’t signed off of the session!
Do Anything that’s Illegal or Inappropriate
Don’t light up a blunt at the start of your session. Don’t bring your therapist (on camera) into the bathroom with you. I’m sure unmentionable things have happened... Just be careful and respectful!
I hope this provides some guidance toward virtual therapy. It can have so many benefits when used appropriately!
What else would you add to the list of do’s and don’ts?