“Skypotherapy” became the norm in March 2020 and it’s tough. I wasn’t planning to write this article for a long time but then there was a pandemic(!) and most of us started doing remote therapy over the video calls, phone, email, text, and so on. This isn’t meant to be a comprehensive look at the subject, just some quick tips to help out therapists who have transitioned to online counselling.

Telepsychology is isolating for therapists (especially newer ones), exhausting in its own special/awful way, difficult to do well, blurs work/home boundaries if you’re practicing from home (and perhaps even on your personal computer), harder to build rapport and share deeper moments, harder to co-regulate, miscommunications are easier to occur than normal, you can get interrupted by technology issues on either end, it opens up new jurisdictional and safety issues, and it’s much easier to get distracted! 

We want to treat our clients with dignity and give them the attention they deserve. Unfortunately, many therapists have been telling me they feel guilty that they get distracted more often during online therapy, and that they’re struggling with a new set of challenges doing all online work. Here are some ways to reduce distraction during online therapy, as well as more general tips:

• Take breaks between each session and physically leave the room for a few minutes 

• Ask your clients how this transition to online therapy has been for them, what you two can do to make it more effective 

• Change your settings so you can’t see your own video feed—so you can only see the image of your client but the client can still see you on their end (much less information, not distracted by noticing what expressions you’re making etc)

• Have something you can fidget with offscreen, like play doh or an interesting object, a footstool  (I have a 10 pound medicine ball under my desk that I love to roll around for this, also lets me change posture often)

• Don’t have your phone (or tablet or similar devices) nearby, and put them on silent or airplane mode, or use monitoring software to ‘block’ certain apps on your phone during work hours

• Consider using a separate login profile on the computer that is for work only, so none of your personal/social accounts are logged in to distract you, nor are personal browser tabs open etc

• Reduce any noise nearby that you’re able to, both for the client’s benefit but also so you’re more able to focus

• Allow yourself to be at least as imperfect as you are in person. Being online can give a strange sense of needing to constantly be in a state of perfect concentration for the entire work day

• Some therapists like to have somewhere specific to rest their gaze when they’re not looking at the client, such as a window, plant, or some even use a muted relaxing/non-interesting video online (the video is not something I’d go for though)

General ideas:

• Many WFH (work from home) people find transition rituals in to and out of work time helpful: changing into work clothes and changing out as soon as you’re finished work, walk around your block before/after work, shower after work, exercise after work to cleanse or wipe the slate clean, and so on. Anything that helps you create separation between work time/space and home

• “Work only” space when possible: to help with boundaries and leaving work at work, if at all possible, do your therapy in a separate space. If you don’t have space for this, do your best to still create a separate atmosphere during work hours to compartmentalize: set up a temporary room divider panelled screen (or even a sheet), face your computer or chair in a different direction, and so on (this point and the previous one, about rituals to separate work/home, seem to be the most common suggestions I hear from WFH veterans)

• Check in with colleagues regularly, to normalize and support (give and receive) and to share good tips and coping

• Have your work space at a window if possible, or at least have some plants and/or nature art up

• Have session note or rough note paper in front of you on the desk

• Experiment with leaning toward certain microskills more often, like summarizing etc so clients can be very certain you’re understanding them

• With children, consider creative ways to connect. I know therapists who do forms of art therapy with kids in online video games like Minecraft (though make sure the software/tech you’re actually communicating through meets your local guidelines)

• Consider normalizing the experience for clients by saying you’re somewhat new to telepsychology as well, that we have to be careful to make sure we’re understanding each other etc. It’s a good way to discuss preferences and collaborate to improve the relationship (and it’s humanizing)

• You’ll find that by lacking all the extra visual cues of having a client physically in front of you, you may pick up on more and different things: clients’ tone, cadence, rate of speech and breathing, and so on.

• Screen share to collaboratively track topics or brief notes

• Use a blue light filter on your screen to help with eye strain (download a program called f.lux on Mac and Windows) 

• Consider a standing desk option, if possible for you. It’s fairly easy to just set up a temporary one and do some sessions sitting, some standing. I know some sports psychologists who have weights right next to their desk—at the office. They use them between sessions and even as part of interventions, so do whatever works for you

There are other concerns that I’ll mention below briefly but trend outside the scope of this article. 

Research shows that online therapy is generally equal in effectiveness as in person therapy , but honestly, I dislike doing it and find it much harder to connect to people. Particularly during a pandemic, the services therapists provide are important and it’s amazing that we’re still able to help people. However, I repeatedly hear new therapists in the field that they prefer being in person over teletherapy, and being in front of their computer and a camera all day is draining. 

Who you’re allowed to do therapy online with varies by jurisdiction. Some places it’s okay as long as the therapist is physically in the region they’re licensed in, though oftentimes the client must also be in that same jurisdiction, and so on. Check with your licensing body before proceeding. A related concern becomes confirming their current address and being able to safety plan effectively, both knowing where to send emergency resources and also what resources to refer them to in their local area (obviously this becomes more challenging the larger the area). Having pre-established backup forms of communication is important because tech glitches happen at the worst times—imagine your internet goes out in the middle of safety planning with a high risk client in a first session. 

Privacy via using appropriate and secure software is essential, as is having a private space for the hour for both the therapist and client. Have a good plan for any regular outcome measures you use, as many clients won’t be able to (or won’t want to) fill them out and scan/email it back to you all the time, plus that’s a ton of extra emailing/admin work every week for you.

It is more challenging to ‘hold space’ in online therapy, but it’s still very possible

Unusual issues have become more common, since we are often connecting with clients when they’re at home: sometimes children burst into the client’s room, or clients answer video calls without being fully clothed, or they’re wearing a hat etc that partially obscures their expressions (over poor quality video this can be challenging). Clients may think it’s reasonable to speak to you while in public or while doing a task (housework, outside chores etc). Regardless, try to imagine this new shade of weirdness that you’ll likely encounter and do your best to roll with it.

As a community, we are getting through this and from what I’ve seen, therapists are doing a wonderful job sharing ideas and supporting each other. Online therapy does get easier over time. Take care of yourself!

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