Lessons Learned from Pivoting to a Virtual Counselling Practice During COVID-19

So how does virtual therapy measure up to in person counselling?  After two months of only seeing clients online, I feel confident to say from my own experience that virtual counselling does lead to good therapeutic outcomes, and in some ways is more convenient and safe for clients.

At the beginning of the year, pivoting to an online therapy practice was the last thing on my mind.  I would have been hard pressed to see any silver lining of doing most of my therapy work online.   

Just before the COVID-19 pandemic hit, I opened my new counselling centre, New Pathways, after months of renovation and hard work.  It was my long time vision to build a welcoming space for psychotherapy and neurofeedback, conveniently located near public transportation.  After years of practicing in a solo environment, I was excited to open a shared therapy space to a community of like minded clinicians.

 It came as a huge surprise that after all this preparation I would have to transition to an online therapy practice and give up the idea of community based psychotherapy/neurofeedback practice, at least for the foreseeable future.   

One thing I have learned from my years of meditation and psychotherapy practice is how to tolerate uncertainty and adapt to change.  Of course adjusting to change doesn’t come without fear or resistance.  Mindfulness practice has given me tools I can rely on to meet those difficulties when they arise.   One of the biggest challenges was confronting my judgments about online therapy. Perhaps wrongly, I believed that virtual therapy was inferior to face to face counselling.  I only considered it an option under necessary and temporary circumstances.  Now, after a few months into this, I  do concede that my judgments were somewhat unfounded.

Meeting Mental Health Needs through Virtual Counselling

While I was reluctant at first, I did quickly adapt to an online counselling practice in March out of  a strong commitment to providing mental health services at a critical time.  Front line workers are at a huge risk of burnout.  Families are struggling under huge amounts of stress, balancing work, school, caregiving and economic uncertainty.  Mental health support is needed more than ever. There was no choice but to adapt to a new way of working and this was certainly challenging at first.

Many considerations need to go into establishing an online practice.  One needs to decide on a digital platform that meets security standards, and is user friendly.  Consent forms need to be drawn up to reflect the nature of online work.  And one needs to become comfortable with maintaining therapeutic focus on a screen for a long period of time.  The silver lining of the pandemic is it has given me a crash course in how to navigate the digital therapy world.

While many clients have adapted to online counselling, this has not been the case for everyone.  We have no idea how long it will be before we can safely do in person therapy.  Some people will be ready to come into the office before others, when the time comes.  Given this reality, I will continue to offer online therapy as an option, especially for those who need to minimize any risk to their physical and mental health.  Even when it does feel safe enough to meet face to face,  online therapy will need to be integrated as an ongoing option for clients.  It is not just a temporary measure during a crisis.  

For those who are cautious adopters of telemental health, I share some of my own misconceptions and what I have learned from doing regular online therapy for the last couple of months. 

1.   Telemental health is less effective and inferior to face to face counselling

Is online therapy effective?  Research shows that online counselling is just as effective as face to face counselling.  Therapy is all about creating a safe therapeutic alliance with your therapist.  If your therapist is comfortable navigating the online world, the digital medium should not interfere with a therapeutic relationship.  A therapy session is always conducted with the intention of being fully present to whatever shows up, even if that is frustration with not being able to meet face to face during these COVID-19 times.

2.  You need to be tech savvy to do video counselling.

You do not have to have any special tech skills to navigate video counselling.  If you do have any concerns then ask your therapist for some help on how to access the platform that is being used. It is okay to spend a few minutes at the beginning of the therapy session to answer questions and to have a back up plan if anything goes wrong.  In my sessions we always agree to hop onto a phone call if there is a problem with the internet connection.  That way we don’t waste any valuable therapy time figuring out technical difficulties.

3.    It is hard to feel emotionally connected in session.

You may find it more challenging at first to drop into emotions in a new kind of therapy environment, but it does get easier with time.  It helps to set up an environment in your own space where you can feel safe and contained.  With video counselling we can pay attention to small details that can facilitate a sense of connection and safety.  I make sure I have good lighting and adjust my position in front of the camera so that I feel close enough.  It is important to get feedback on what feels best for the client.

4.  Video counselling is not secure.

Just as with all forms of therapy, security and confidentiality are essential.  Therapists use a secure digital platform for online therapy so your information is completely private.  I always conduct therapy in a private physical space and use a headset to further minimize the risk that the conversation could be overheard.  

What Does the Future Hold for In Person Therapy?

Don’t get me wrong.  My preference is still to sit down face to face in a comfortable, quiet room with clients.  For now I am grateful for a profession where online counselling is an option, especially during COVID-19 times.  I do look forward to the day when it will be safe for clients and therapists to enjoy the space in New Pathways.  In the meantime, I continue to expand my offerings of online mental health services in various formats;  video counselling, online courses, , online mindfulness groups, and remote neurofeedback.

So is online therapy effective?  I would say yes, absolutely.  While video counselling is not perfect, it provides a valid way to offer  good mental health support for clients.  For those who are reluctant and still struggling with mental health concerns, try a session and judge for yourself.

Feel free to share any thoughts about the benefits and effectiveness of online therapy services.  This may help others who may be sitting on the fence.