Therapy via Telehealth. How?

April 25, 2021 6:21 AM

Do you do therapy/counseling via telehealth? How do you make it work for you?

I've been in-and-out of therapy/counseling many times over the years (severe, deep, lifelong depression, anxiety, etc.) My most recent stint was a surprisingly productive time using the resources of a local university's practicum clinic. The deal with that, of course, is you have to change therapists (all phd candidates) every year or so because they finish their schooling and move on. That, surprisingly, has never been a problem. In fact, the time at the clinic has been the most productive therapy I ever had. It was extremely intensive stuff. Very experiential and digging deep. Not the usual CBT stuff.

My most recent switch to a new therapist, though, coincided with the arrival of COVID and the clinic's switch to telehealth sessions exclusively. I gave it an honest shot, but I just couldn't make it work for me. I found the environment too distracting and found it was a barrier to making a solid working connection with the therapist. After their xmas break, I opted to not return to the program.

Flash forward to today...I feel I really need to get back to therapy. Coincidentally, my health insurer now offers access to no-cost-to-me telehealth mental health. It's really tempting, as it addresses the primary reason I went to the university practicum clinic initially; cost.*

But, the fly in the ointment here is my previous experience with telehealth-based therapy. I just couldn't adjust to the environment. I seem to respond better in the traditional environment of being in a room together. It helped me focus, and it pushed me to get through my steep defenses and be more intimate in our talks. I just couldn't get through to that place in my prior telehealth sessions. That damned camera made me feel more like I was on display and performing. I just couldn't. And, I bailed.

Anyway...If you've used (or are using) telehealth successfully for therapy, how did you do it? Any tips or tricks for making the experience more direct and intimate like an in-person session? What didn't work for you?

(Assume I have access to a private space for any telehealth sessions. Also assume that space is full of distractions because it's my office/studio and there is nowhere else to go)


* - I originally started using the university's practicum clinic because there was (and is) no way I was able to afford the high copay for a "real" therapist every week. The practicum clinic was a pay-what-you-can affair.

posted by Thorzdad to Health & Fitness (10 answers total)

I have the opposite experience with my office. I do my teletherapy sessions in there, which forces me to be physically attentive (limited slouching in my desk chair as opposed to the couch) and mentally attentive (I’m conditioned to see this as concentration space, and I’ve got all my note-taking stuff at my fingers).

I also think that the relationship with the individual is important. My therapist and I are both pretty easygoing and funny, which makes conversation flow easily. I’ve had therapists I didn’t click with, and that definitely makes it harder. Standard advice is to keep looking intil you find that click.
posted by kevinbelt at 6:51 AM on April 25, 2021 [2 favorites]

I've been doing therapy over Zoom since early this year, and for me it's been ok. My therapist is local and covered by insurance but I've never met her in person because Covid. Initially I had thought I'd switch to in-office once it was safe, but it has been really handy to just log on as opposed to the hassle of getting to an appointment. To be honest, I'm not sure if the online aspect has interfered with the intimacy level of the session, though. I tend to be uncomfortable with intimacy and emotional stuff anyway so it could be that having that slight remove is making me feel more comfortable rather than less... but also maybe I'm not feeling pressured to dig deep? I dunno... I kind of feel like she is not doing the kind of therapy where you talk about your childhood and whatnot. But maybe it does have something to do with being on video instead of in person.

I'm also having telehealth sessions with a diabetes educator. One difference between those sessions and the therapist is that the meeting with the diabetes educator is set up so I only see her face on the screen. It feels friendlier to me to see her face close up and life-sized, as opposed to the therapy session where there is a split screen where I see both faces. I have to purposely ignore my face so I don't get distracted by how weird I look. (It just occurred to me that maybe this is a setting I could change on my end... )

The other thing I wanted to mention is that my husband's long-time therapist went to remote sessions due to Covid, but for some reason she doesn't like doing video sessions so they have a phone call. He lies down on our couch like a cliché of a therapy patient now, and they talk for an hour by phone. He is pretty satisfied with the arrangement and really appreciates not having to make the drive to her office. He's been working from home for a year, and her office is much closer to his work than to our home. It would be a significant commute if he had to drive there now. So maybe doing therapy by phone would make a difference for you?
posted by Serene Empress Dork at 7:07 AM on April 25, 2021

I'm a therapist who does all her sessions via telehealth and has gotten completely used to it and now finds it less distracting than working in person. Here are some thoughts:

First of all, are you facing a computer screen just as if you were working on that computer? Is there any other device you can use, even your phone, so that you can turn it so that you're not feeling as if you're at home, working? Even turning around so that you're facing in another position might help (you mentioned the distraction of your home office surroundings as a major negative factor). (after trying several options, I now work in a completely different place than my office)

Then, are you set up so that you're forced to see yourself in a little screen within the big screen? If so, try to make it so that you're not looking at yourself. OR tell the therapist what you see when you look at that little you on the screen. Could be interesting.

Next, was the therapist looking directly at you (at the camera), or were they at an angle? This is a main issue that bothers some people but not others. I don't think you can change this, but you can make yourself aware that, even though the therapist doesn't seem to be making eye contact, the therapist actually IS looking at their image of you. But it is an adjustment (for me, the biggest one).

Be aware that the "distractions" really have to do with issues of privacy, of being seen more closely (because they can see you in context - "how you live" - so it's not just feeling less intimate -- it's also more intimate). As always, I think the best remedy is to take the time to discuss all these issues with the therapist. This discussion could lead in some really fruitful directions, as you allow yourself to "go with" your discomfort and see where it takes you.
posted by DMelanogaster at 7:13 AM on April 25, 2021 [3 favorites]

I've switched to online therapy this past year because of Covid. It's not bad, still works, and it was easy enough to get used to even if the tech issues/internet issues can be annoying sometimes, but wowwww I miss being in my therapist's office just for the psychological comfort that used to bring to me.

I think the main reason why therapy has continued to work well for me is because I was already working with this therapist before switching to online. If I were starting over with a new therapist, it might have been difficult to build up this level of trust because there is something to be said for being in the same room with a person and feeling their "energy" first-hand. Even the smallest things impact this very subtle process of trust building, I think. I've joined a writers' group online since the pandemic started, and that's a new one... but it's another place where I feel exposed and vulnerable while sharing my writing. And I've noticed how the weird pauses, lack of syncing, overlap of talk, etc. that happen during online communication have a powerful impact when I'm feeling that way! I can spiral into a few seconds of thinking OH NO THEY HATE IT AND I SUCK AND I'M A TALENTLESS HACK ACK! Whereas with my therapist, when there's pauses or lack of syncing or overlap of talk, I had built up enough trust before to automatically know that it's not him, it's the technology.
posted by MiraK at 7:35 AM on April 25, 2021

I've been doing teletherapy since last year. I don't think it would have worked for me if I didn't already have a long term relationship with my therapist. It was weird at first, but once the tech side was worked out, I really like it. I do my sessions sitting in bed. A lot of what we're working on right now is work anxiety and setting boundaries. I don't think it would work if I was still doing the trauma work.
posted by kathrynm at 8:36 AM on April 25, 2021

I have been doing teletherapy -- my first therapy in decades -- and I have to say I completely love it. But one big issue for me was figuring out, after a session or two, that I will get into the whole process a lot more heavily when I minimize my own image and use full-screen for the therapist. So all I'm looking at is her.

As for minimizing your own distractions, if you can use a laptop or phone (as opposed to a desktop), find a closet if you can, or how about inside your car? Just take away as much external stimuli as you can.
posted by BlahLaLa at 8:56 AM on April 25, 2021

I had to switch to therapy-by-phone last year and just a few months back my therapist abruptly retired and I had to find a new one. EEEEE. However, after one Zoom session (just so I knew what she looked like) we've switched to just talking on the phone and honestly that works better for me. I can be outside walking around--easy to do in an isolated way where I live--or I just lie down in bed and talk. I'm not near any of my office stuff and while I'm looking forward to getting back in the office, it's a lot better for me, this will work for now.
posted by jessamyn at 11:09 AM on April 25, 2021

The therapist has to comfortable with telehealth, I've done remote sessions with 3 therapists and had to quit the one that was a therapist I had first seen in person in part b/c they never really got their video setup dialed in and it was very hard for me to get into it or feel like they were present when I could hardly see and hear them. Having a comfortable and private set up really makes a difference as well, if you can avoid doing it in a place in your house where you're going to be distracted or concerned you might be overheard.

On the 'can't really get into things b/c I'm distracted by my face on the screen' problem, which I've definitely had, you can often hide your view of your self without turning off your video for the therapist to see. In Doxy and Zoom this is a little setting you can find if you click on your image once the video has started'. it's super useful for "zoom fatigue" in general, I hardly join a video call now w/out using it. I close all my apps/tabs, and maximize the video and it helps keep the focus on just the call.
posted by snowymorninblues at 12:59 PM on April 25, 2021

I had to experiment a bit to find what works best for me for remote therapy. Things I have tried, with mixed success:

- Video calls with and without headphones
- Hiding self view
- Calling from different places in my house
- Phone calls indoors
- Phone calls from my car, sometimes parked somewhere more scenic than my driveway
- Phone calls while walking outside
- Doodling/coloring/taking notes to keep my hands busy
- Closing my eyes while I talk if it gets too hard otherwise

Sometimes I have to remind myself that I can experiment for a bit without making any kind of final, black-and-white decision. Remote therapy doesn't have to work for me always and forever. But for now, it's what's available, so how can I try to make it work for me today?
posted by pril at 1:02 PM on April 25, 2021

I’m a therapist who does telehealth and sees a therapist through telehealth. I think about my sessions with my therapist as being like video calls from the space ship back to earth in science fiction movies set in the near future: you know, the choppy, grainy video on a small tv screen. No one is worrying about how they look, the video is almost beside the point. It’s just the best technology can do for now in terms of connecting two people who would rather be together in person.

In more practical, less imaginative terms, I keep a pen and paper handy. I fix myself a comforting drink, usually tea. I make sure I’m in comfortable clothes for the space. I really like my office, so I do it from there, at my desk, but I have clients who sit on the floor, on a bed, in a closet, etc. (As long as it’s private and they’re comfortable, I don’t care.) Sometimes my dog sits with me, and I’ve met a lot of my clients’ pets, which is a fun way to get to know them.
posted by theotherdurassister at 8:27 PM on April 25, 2021 [1 favorite]