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I’ve been in therapy for more than a few years. As a consequence of growing up in a home where I experienced continuous fear and felt uninvited to share my emotions, sitting in my therapist’s office was always the highlight of my week. It was the one place in the city where I felt safe to go, comforted to stay, and validated when leaving.
It makes absolute sense that I would feel disappointed when this safe space suddenly became off-limits to me as a result of social distancing. Tele-health abruptly entered the scene without giving me – or my treatment team – time to prepare. Based on previous personal experience, if phone calls were the only option, I’d take them over nothing at all, but I am currently privileged enough to have the video option. I’m deeply grateful for that. I appreciate witnessing the fact that my therapist is listening to me with all her attention – not flipping pancakes, matching socks, or playing Rush-Hour with herself. I trust her not to be busy with other things, but when I’m on the phone I don’t feel the same sense of security, and I miss out on that face-to-face connection.
Virtual therapy – whether it is via phone or video – has the upside, the funny-side, and the downside. I believe it is crucial to recognize each part.
The upside of virtual therapy:
Let’s start with the beautiful. I feel there are some great benefits to virtual therapy. It spares me from paying for parking – and maybe some others from parking tickets. It minimizes the amount of gas I use. It provides me with an extra hour, which is usually spent traveling back and forth. It spares me from the anxiety of rushing to get to my therapist’s office before the scheduled hour. It allows more flexibility with timing because my therapist and I both chat from home. And of course my favorite part… my pajamas can come along.
Then there’s the funny side. Such as meeting my therapist’s huge dog with the fluffiest hair I’ve ever seen. Like seeing her tilt her chair back and chill in her home office watching me rant as if I’m the newest entertainment – a show on her iPad. Like visualizing what the rest of her house looks like, now that I got a glimpse of her home office. Like schmoozing about awesome coronavirus memes. Like getting caught wiping my eyes with tissues through the window of my car by my younger twenty-two-year-old brother. When I reappeared, he said, “Are you okay?” I laughed it off by responding, “Of course I’m okay. Why shouldn’t I be?” Truth be told, crying is definitely the “okay” part of my routine. I wasn’t lying.
It’s healthy to focus on the positive of telehealth and bring some humor into the picture. At the same time, there are many aspects of in-person therapy that I miss. I feel it’s vital for us all to acknowledge this side of the coin as well, so we can feel validated, and possibly problem solve if there are factors that can be dealt with.
The downside of only meeting virtually:
On the ugly side of things, because the therapy is virtual, I can no longer prance into my therapist’s office, sink into the comfy cushions, kick off my shoes, and hide under my coat. I can no longer be protected from seeing my awkward-looking facial expressions because I see everything on the screen in front of me. Having my face stare back at me for a whole hour is highly uncomfortable for me, as someone who is in recovery from an eating disorder and battles negative body image. On top of that, I often feel frustrated with the confusing eye contact and lack of body language. She can’t respond to my shaking leg if she doesn’t see it. And I don’t necessarily notice every time my body reacts to my internal emotions.
I feel awkward knowing that people who live with me can potentially see/hear me having a private and vulnerable conversation with my therapist – she used to be mine; I could protect her and keep her for myself in a sanctuary that no other friend or family member had access to. Suddenly, my sessions are literally in the middle of my living space.
When I cry, she won’t gently place the tissue box on my lap as I cover the waterfalls that escape from my eyes. When the session ends, I can no longer look back at her one last time, give her a wink, and sigh as I tell her that I wish I could sleep in her office for the night. I can no longer appreciate the drive to and from therapy alone with my thoughts, and extend the session by a whole hour of traveling time.
So many aspects of my therapy experience have disappeared or have changed. By acknowledging these downsides, I’ve given myself the option to tap into my therapist’s empathy and the goodness of virtual therapy differently.
Virtual therapy is still therapy, and can still be incredibly meaningful.
I thought I would never cry on a virtual therapy session in a parking lot in the middle of nowhere because ‘phone conversations don’t compare.’ However, I learned that tears show up when you least expect them. More importantly, I internally accepted that you don’t have to be in the same room as someone to feel their sincerity and admit that they care about you. My heart filled with warmth when the tears appeared and I heard her say, “I wish I could offer you a tissue.” Another day, when I expressed my discomfort to my dietitian in knowing that she was staring at my face for an hour, she instantly replied, “I am not paying attention to how you look, but to the words that you say.” Her response deeply touched me.
I know that most of the world believes “Actions speak louder than words,” but in this case, I believe “Words speak louder than actions.” Particularly now, because I cannot currently hang onto the presence of my therapist and other mental health providers, I hang onto their words significantly more than usual. It’s the only thing connecting us.
We are no longer sharing the same physical space. There’s limited body language and eye contact. Therefore, what they say is all I have to get me through until our next session.
As clients, we must remind ourselves to internalize the kind words delivered to us and safe-keep them. At the same time, our therapists must make note that we may take their words out of proportion under these circumstances. We may notice things we haven’t noticed previously, or react in ways we haven’t reacted previously.
Perhaps virtual therapy isn’t so bad after all. Perhaps it will help me appreciate in-person appointments a thousand-fold when I am privileged to see my providers again.
…But what if I don’t like virtual therapy… Can’t I just put it on hold until we go back to ‘normal’?
Like every other human being, we may be tempted to give up – and for those of us suffering from mental health struggles and/or mental illness, that first step may look like stopping therapy, or putting it on hold.
However, if you have been making progress, or if therapy has made a positive difference in your life, now would be the time to push this priority to the top of your list, not shove it to the bottom!
That’s what I’ve been trying to do. By actively noting bumps along the way and taking some steps to problem solve, I’ve been making this therapy journey “mine”. You now have an opportunity to try this too.
Make it effective. Make it personal. Make it yours.
Top 3 tips to make your virtual therapy sessions work for you:
There are a few tips that have helped me, and can possibly ease the routine for your own virtual therapy experience. I’ve found these tips not only great for psychotherapy but for appointments with dieticians, psychiatrists, and other wellness providers, whether they are phone calls or video calls.
If you think these suggestions may be helpful in your own Telehealth experience, consider implementing them. If you are a professional, consider sharing and discussing them with your clients.
1 Designate a private space for all your virtual mental health appointments.
Creating a private space for myself where others cannot hear me puts me at ease to freely express my emotions and not worry about other people listening in. Ideally, it is best to have a place where you cannot be seen or heard by others. I could not find a space where I’d feel comfortable inside, so I designated my car as my new space. I used to drive to a parking lot a few blocks away until that was closed off because of new government laws. That led me to have therapy sessions in my driveway. While it’s disturbing because I am reminded that my “therapy sanctuary” is gone and my family members can theoretically see me, I try to stand my ground and prevent any potential “eavesdropping” into my therapy sessions.
It took me a while, and some trial and error to figure it out, but it’s comforting to radically accept that I’ve done the most I can and to know there is no perfect solution.
If you don’t have a fully private option, prioritize which of the two (to be heard or seen) is more important to you and get creative! If you don’t have space in your home, try a park or your garage. Another suggestion would be to put on a noise machine right outside your room so that others cannot discern your words. If you have trouble thinking of a space, brainstorm with your therapist for an idea so you can maximize your session together.
* Aside from the benefit of having a private space for your session, you can use it to your advantage even when you don’t have an appointment scheduled. You can enter the space and try connecting with the feeling of safety when you need an extra dose of comfort.
2 Go into your space a few minutes early and stay there for a few extra minutes following your session.
I always try to go into my car a few minutes early to gather my thoughts and jot down topics that I wish to discuss in the upcoming hour. This allows me to enter the session feeling calm and prepared. It makes the biggest of a difference.
I also stay there for 10-15 minutes afterward. It gives me a few moments to process what we just discussed and gives me a breather before jumping back into my regular routine. You can sit with your thoughts, or you can choose to do an activity to ground you. I’ve tried talking out loud to myself, listening to a relaxing song, and videoing myself chattering about what I took out of the session. Crying is always a great option as well.
*If you have therapy via phone calls and do not have the video option, you might find it helpful to start the session with a quick meditation guided by your therapist to ground yourself and visualize your usual therapy space.
3 Most importantly, express how you feel about your virtual sessions with your provider!
In our first virtual session, I told my therapist, “I really don’t like these FaceTime sessions.” She asked me why, we chatted about it, and then moved on. Another day I noticed it bothered me that it seemed like she’s always looking down and not looking at me. When I mentioned it to her, she successfully manipulated her screen so my face showed up at an angle where she could look more directly at me.
We need to share how we feel so our therapists can validate us, problem-solve with us, and ultimately provide us with the best that they can offer us during this pandemic. Get things off your chest right away; that’s what your therapist is there for!
Talking out my discomforts with my therapist helped us ease into the new routine together as a team. It is likely your therapist is new at this too. Work together to brainstorm how you can make your sessions as effective as possible.
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These tips have helped me maximize my virtual therapy sessions. Talk to your therapist about which ideas will help you maximize yours. This is a time of uncertainty, confusion, and fear and you deserve to receive the best support that’s accessible to you.
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