Therapist Toolkit: A Clinically Minded Transition to Virtual Sessions

By Sarah Trance, LMFT

If you’re a therapist or mental health counselor, you’ve likely been thrusted into virtual sessions during COVID-19 and I know it's not ideal. I think we can all agree that face-to-face sessions feel better to us; our norm in many ways, and during time of crisis and chaos, it makes sense to crave your normal. But, we’re in a time where it’s vital to focus on the silver linings! I'm learning that there can be some great aspects to telehealth including our ability to have access and give care to our clients, continuously. So, how do we make this work?! I've compiled some tips over the last few weeks based on my own experiences, feedback from colleagues and open dialogue with clients on how to transition to or begin virtual sessions:

• Be transparent with the unexpected transition and validate their efforts and willingness to continue their work during a global crisis. That’s a HUGE step!
  
  
• Consider setting up the session and controlling the environment in a similar way you would in your office. What do you think you need? How can you help the client(s) create a safe space? I'd suggest asking the client to sit on the couch with their upper body being shown in the video. Ideally, they're alone and in a quiet, private space where they can concentrate and do work.
  
  

                  -We need to note the current crisis, cultural aspects and NYC living
                    situations. This isn't going to be possible for all clients so how can you
                    process with them what will and will not work?

                  -Be straightforward in what you're hoping for, set your boundaries but be
                    willing to be flexible – it’s needed right now!

                  -Make note of something that feels like a ‘clinical issue’ versus ‘necessary’
                    during this time (re: what does it mean if the client is eating during
                    session or are chatting from their bed?

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• Ideally, with couples/families, all members are in the same room, sharing a screen/computer. You can also encourage clients to use a white noise app on their phone if they're worried about being overheard by their child or roommate.
  
  
• What happens if there's a glitch? How do you want to mitigate that and/or what is your back up plan in the event that there's an internet issue?
  
  

                  -Consider having a text or email ready in the event that your video is
                   disconnected, and you need to reset. Discuss this in advance with your
                   client so you can all feel prepared.

                 -Make a plan with the client. Expect for glitches! When do you roll with it
                   and when do you need to reset your app, internet or switch to another
                   mode (phone, Facetime or another HIPAA compliant app)?

• Do you have an in-case of emergency contact and do you know where your client is currently located? Consider this for unexpected emergency issues.
  
  
• During the session, you'll have to rely on your eyes and your words (much more than usual) to track what's happening. This can be exhausting -- try to find ways to nurture yourself here. Be prepared to have to concentrate harder and be more active [The bright side is we get to wear sweatpants, have our pets around and also be in a more relaxed setting].
  
  

                  -Consider a few things to help including more frequent breaks between
                   sessions or taking notes to stay engaged 

• Ask for permission to slow down or go back. Ask for confirmation of what you're observing (again, be very transparent). We need the clients’ help in intervening because we can't use our own bodies to guide the room through energy.
  
  

                  -Ask for help or for a pause.

• Consider using how you're feeling to help heighten the work they're doing. Be willing to share what happens for you when they have a special moment or are in vulnerable places. How are you responding or reacting to their sharing? In the midst of all this stress, it can be a really important way to help the client feel safe and connected to you.
  
  
• We are systems therapists. While we want to maintain our boundaries, consider the fact that we are seeing our clients in their personal space. We are physically in their system through the computer screen. When appropriate, you can encourage the meeting of children, pets or even a quick virtual tour if it makes the client feel comfortable and more connected to the work. Welcome what they're showing you -- it's a gift! There is an opportunity to really see the client in their system that we wouldn't normally have when in-office.
  
  
• Leave time at the end of session to talk and process how it's going. If it's a new client, do they feel heard and understood by you? If it's a client that you already have a relationship with, how does the transition feel? What else might they need to feel safe or to feel supported? Telehealth is new to us, too, so it's useful for us to track how it's going in order to adjust what may be working for the client and also what's working for us, as the therapist.
  
  

There are many factors to consider now that mental health services are remote. But remember, we are all in this together and just figuring it out. Give yourself permission to be upfront and honest while trying new interventions. Give yourself the kindness that you deserve right now. In unchartered waters, we won’t know what will or will not work until we take the leap and try!

             “You are not working from home; you are at work
                  during a crisis trying to work” -- Unknown

Check out these resources for more information and support:

Transitioning to Telehealth Resource via AAMFT: Here is a free e-course -- https://www.brightervision.com/transitioning-to-telehealth-aamft//

Working Remotely During the Pandemic: Boundaries Matter – A blog from AAMFT.

Support for the Therapist: Who Prepared Us for a Pandemic – A blog from AAMFT

Best Teletherapy Platforms: Pricing, Features and Rating Comparisons – A blog from Zencare

Headspace – Free for healthcare workers with NPI

The Gift of Therapy by Irvin Yalom -- Book for therapist