This is part of a series of short posts on Covid 19. These are my thoughts, and I wrap them in an acknowledgement that the opportunity to think about and discuss these topics is evidence of an immense amount of privilege. I also know that if those of us with privilege are to use it on behalf of those who have less, we need to be caring for our own mental well-being. To that end, I share these musings.
As I look around me, after over two months of shelter-in-place, I’m noticing how differently people are experiencing changes in their lives. One of my favorite memes making the rounds right now talks about how we may all be in the same storm, but we aren’t necessarily in the same boat — the pandemic is impacting life in so many different ways depending on one’s life circumstances.
Change in methods of work is one arena where there are vast differences between folks, depending on their jobs. For people who are part of the information economy, things have changed a little, but the tools with which they do their work are basically the same. Among folks who are still working (and a hug of acknowledgement to those whose work has completely ceased), I see that teachers and therapists are some of the most impacted by huge changes in how they accomplish their work. I send a hug as well to all my (literal and metaphorical) siblings in education, with awe at the speed with which they have had to retool basically every aspect of what they do. And that brings me to therapists.
First, know that the therapist community has been scrambling along with everyone else to find ways to provide services that are even more critical than usual to clients, ongoing and new. If you’ve been in therapy recently, then you already know that face-to-face therapy has basically ceased (at least in communities where the shelter-in-place guidelines are strict, such as where I am in Silicon Valley). I was fortunate in that I’ve been offering video sessions for a number of years now, so at least my personal learning curve relative to technology hasn’t been as hard for me as for some colleagues.
There have definitely been some hiccups: some clients are just not comfortable with either phone or video sessions, and have decided to take a hiatus. Sometimes technology doesn’t function well, and sometimes the machines spoil the sense of connection that is vital to establishing and maintaining therapeutic rapport. It’s been hard to adjust to so many screen hours, for both clients and providers (see many articles on zoom fatigue).
Unfortunately, too, it seems that teletherapy will have to be the norm for many therapists and clients for quite a long time. As my colleagues and I discuss the circumstances under which we can realistically provide a safe space for ourselves and our clients, it’s becoming clear that many of us are likely to stick with virtual-only sessions for months and possibly years to come. This raises a particularly sticky problem for younger children who might normally do play therapy. However, we humans are a creative problem-solving bunch, and as time goes by, I’m confident we’ll solve that problem as well.
There is a silver lining to all the struggles around moving to teletherapy, for both clients and providers. Many restrictions about licensing boundaries and technology are being reconsidered throughout the country. My hope is that we will eventually work something out between states for reciprocal licensure, allowing practitioners of different sorts to offer virtual therapy to whoever needs it, regardless of location. That would finally begin to address some equity issues around access to mental health care as well. So I will hope that comes to pass, sooner rather than later.
In the meantime, here are a few ideas that have helped my clients get more comfortable with teletherapy (keeping in mind that each therapist will have their own take on what kinds of adjustments are possible for them, and which they are not willing to do):
The phone is your friend! For some people, talking on the phone feels more connected than video. For others, it may not feel as connected but they are so burned out by video the rest of the week, they would rather take a break. Still others mix it up depending on the circumstances of the day. Phone is also a decent addition to video when the audio feed on the video is too laggy — so you mute the video and do a phone call at the same time.
The car is your friend! One of the hardest things about therapy during the shelter-in-place is that clients are not only stuck at home, many of them are stuck at home with a house full of other people, some of whom they may need to talk about. Several of my clients now do either phone or video sessions in their cars. Some of them stay in front of their homes, others drive to someplace nearby, even to someplace beautiful like a park. This adds to their sense of confidentiality, and a little beauty doesn’t hurt either.
The internet is….sometimes….your friend! So this is one that has been tough. The quality of connections is quite variable, although a few tweaks on the client end of things have been helpful. Some folks have rescheduled their sessions, or work meetings, to reduce the total amount of bandwidth the household is using at any given time. Some hardware upgrades have helped as well, or wifi amplifiers closer to where the session happens have been added. I keep two platforms available at all times, and that can help too.
Asynchronous communication can be your friend! Several of my clients have added some email or texting to the work we do during our sessions. This has helped enormously. Communicating in emails can give clients more time to reflect on topics, and it can also save a lot of time when there is a lot of material to share. Texting, even briefly, can significantly reduce feelings of isolation and overwhelm. As a caveat, if you want to set this kind of thing up with your therapist, be sure you both have clear expectations about how frequent contact can be, and what level of response your therapist can give. I tell my clients that I always see their texts, and will always respond, but frequently won’t be able to for several hours.
Chat windows are your friends! When you are using a video platform, don’t forget the utility of the chat window. It can be great to add phrases or content that the client doesn’t want to say aloud. This is another workaround for when the client can’t have enough privacy. They can hear the therapist privately, on their headset, but may not feel comfortable speaking certain things aloud — enter the chat window. It’s also great for sharing links and resources realtime.
Car-to-car therapy is your friend! My own therapist came up with this idea, to allow for an “in-person” feel without exposure risk. Find a parking lot where both the client and the therapist can drive and park their cars nose-to-nose. Then have a phone session, with each person staying inside their own car, but able to see each other the whole time, in real time. This has proved to be another good option, when the distance of telehealth is interfering with the sense of connection necessary for good therapy.
So if you are having struggles with feeling connected to your therapist, please let them know. We are pretty open to trying different things, and would be happy to make whatever changes we can to ensure that you are getting the support you need.
May you be well in mind and body,
Mika