Moving your therapy practice online - Part 2.

In Part 1 we covered all the factors you need to have in place to ensure you are working safely, ethically and legally online. Now we will cover some practical steps that will help you during the sessions themselves - This section mainly covers working over video link or instant messaging.

I have also written an article for clients who are transitioning to online work. Please feel free to share it.

Practical strategies to help you with your online work

As soon as you can:

- Inform your client how to download the software required and what you will do if there is a technical problem on the day.

Write a simple summary that will explain how the client can download the required software.

Technical issues do happen. Ensure your client knows what your back up plan is, e.g. if the internet fails I will message you on Signal. Remember this from part 1?

- Ask your client to set aside 5 minutes before and after the therapy session:

Online work means there is no journey time to or from the session. The usual markers associated with therapy are gone, such as the journey, the building you usually meet in or the room. Ask your clients to set aside 5-10 minutes before and after therapy to create space. They can use this time to pause, breathe, stretch or do anything that grounds them.

- Download the software you will be using and get some practice:

To ease your mind in initial sessions, download whatever you will be using as soon as you can and play around. This is where the peer supervision group I suggested in part 1 can come in handy as you can use this space to practice, practice, practice!

Before the session: 

- Set up your working area:

Find a quiet place. If there is any background noise consider using headphones.

For video calls, sit facing a window or place a light behind that computer so that you are lit from the front and not behind.

If you do not have a laptop stand, place books or other items under your device so the camera is in line with your eyes. Place the camera of your laptop or phone roughly one arms length away.

Make sure the backdrop to your video is either clear or has a soothing quality. If you cannot find a space to do this Zoom offers the option of a virtual backdrop. Warning: This can behave in strange ways. If you move your hands or head too quickly they may seem to disappear. Use with caution!

Even if you are speaking to your clients over the phone or text you may still benefit from this setup. It will keep you in the therapeutic headspace.

- Keep water and a pen and paper nearby. I don't want to teach you how to suck eggs but it’s amazing how easy it is to forget these things when you are outside the office and there are other things on your mind.

- Have all your psychology resources to hand. 

You may want or need to share resources with your clients during sessions. Have all your resources to hand.

I work almost exclusively on video chat on Zoom. I have every worksheet, article, educational video and poem I could need in specific files on my computer. On Zoom I can then either open the relevant sheet up on my computer when I need it and we can draw on it or fill it in together (yes! you can do this on Zoom), or I can drag and drop it into the integrated chat for my client to download. In part 3 I will show you how to do this (this will be released within the next 48 hours).

- Clear up your desktop:

Make sure the background to your laptop is neutral and that there are no personal files that you do not want your client to see. Zoom and some other apps allow you to share your screen. This works well if you want to look at an article together or create a shared formulation, but can be problematic if you share the wrong thing by mistake. This happens, so clear up your desktop and online filing system.

Close all unrelated internet tabs. For example, if you have your emails open on your web browser your client may see them when you share your screen. This could constitute a confidentiality breach, so, get rid of those tabs.

At the beginning of the session:

- Ask how your client feels about changing to online working:

Many people have messaged me asking for tips on how to manage this transition as a client and they have been genuinely worried about what it will be like. Take time to work through their concerns. It is ok to also say that online work is new to you too.

- Educate the client on the use of the technology and be ok with making mistakes:

This will soothe both you and your client. Also, if you make a mistake with the technology it’s ok! It’s amazing how helpful it can be for a client to see their therapist make a mistake with technology and survive it. 

During the session:

- Slow down to keep your clients safe:

The online disinhibition effect is widely documented. As people become quickly disinhibited online they may share more than they are ready to and after the session feel overwhelmed and exposed. It is our job to ensure our clients share when they are ready. Feel free to slow the conversation down if necessary.

This also applies to you as a therapist. So, take a deep breath and go slow!

- Don’t be afraid to get creative:

Online work requires us to adapt how we work. If you are used to creating joint formulations, drawing diagrams or anything else that is aided by being in the same room as your client you are going to have to come up with new ways to do this.

I have done behavioural experiments online with my clients out in the community, me on the phone in their pocket talking to them through their headphones. I have also asked clients to set up multiple chairs in their room before sessions so we could do specific kinds of therapeutic work. In short, there are all sorts of things you can do with online work and you will become more confident with this over time.

In part 3 I will show you how to use the whiteboard function in zoom, which is a gift if you usually draw or write things together with clients.

- Prepare for the end of the session:

Dedicate the last few minutes of the session to summarising and saying goodbye slowly.

Endings online can feel abrupt. You don’t slowly rise from your chair or walk to the office door. Instead the screen goes blank or the phone goes down. Lots of clients have talked about the shock of suddenly being back in their room after a call, so take your time to say goodbye properly.

- Save any notes, drawings or other content you co-created online in the session:

This seems obvious but it is very easy to forget to do this. For example, on zoom you can save the chat and anything you create together to both yours and your clients computer. If you end the call before you do this your work will be gone forever! Do not forget to do this.

After the session:

- Write up your notes and store them in a way that complies with your national data protection policy:

See part 1 for options of where you can do this.

You are ready to go!

You have got this. You are ready to see your clients online. If you make some mistakes do not worry. We learn from mistakes and from experience. Therapists are often extremely self-critical so be kind to yourself as you make this transition. You will get there.

In Part 3 will give you tour of Zoom and show you in a video how to use it effectively. Hopefully I will see you there! Click here to head to part 3 now.

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I am a Clinical Psychologist trying to get effective psychological advice out of the therapy room and into everyday life.

If you found this article useful and want to learn more about why you feel the way you do, and how to cope with whatever life throws at you… Pre-order my book “A Manual For Being Human”, which is out on July 8th.

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