Over the past three months, we have all made adjustments to every aspect of our lives, especially the work environment. Mental health professionals are no exception. Since March 13th, I have been working from home and using video platforms to connect with my clients. I’ve gotten used to it, and I am making the best of the situation. But I have concerns about continuing to do so, and I think they are important to discuss. If teletherapy is going to become more common, we need a reality check regarding the risks so that we can engage in it without compromising the safety and trust of the client-therapist relationship. This requires explicit dialogue between the client and therapist about how the teletherapy sessions will take place. Here are some questions therapist and client can discuss to make sure that teletherapy is as private and productive as possible.
How private is the client’s teletherapy environment? Therapists must not assume that because the client is alone in a room or a closet that they can talk freely. Clients should not have increased anxiety that what they are sharing will be overheard by members of their household. Having an intentional discussion about this issue could affect how therapy sessions will be conducted. Perhaps there are certain topics that can’t be addressed over telehealth. Or perhaps the client needs to think about words or phrases that can be used to communicate during session as a sort of “code“ for discussing sensitive topics. Therapists can ask clients to take the lead in opening up the discussions, so they don’t accidentally ask questions that clients wish not to discuss over virtual therapy. There are ways to minimize the risks of violating privacy, but they must be addressed in advance.
Are there distractions on either side of the call that need to be minimized? Unlike an office, where distraction can be more easily problem solved by altering the environment, home life is a much different scenario. Many therapists who work from home have spouses, children, or pets that may unexpectedly appear. While, in the abstract, watching videos of babies interrupting meetings can be cute, this may not be the case during a difficult or emotional conversation that a client is having with their therapist. For mental health professionals, doing our utmost to ensure that the client’s 50 minute session is protected is extremely important. Perhaps it means we go to our office to do telehealth. If we don’t have that option, it may mean that we schedule clients when children are sleeping or when there is someone else to watch them. It may mean that pets are confined to a room during working hours with food and water. It’s unfair for a therapist to expect their clients to focus if they are not also motivated to do so. Clients also need to think carefully about scheduling. If possible, sessions should be at a time when there are likely to be fewer interruptions and when the client has the energy to participate fully in the session. In addition, although it can be tempting, do not multi-task or pause your camera. To the best of your ability, give these 50 minutes the same attention you would if you were in the therapist’s office. The therapist and the client should acknowledge these potential pitfalls of teletherapy and have an intentional conversation about how they can work to make the most out of sessions.
How do we stay professional? Even if you’ve maximized privacy and minimized distractions, the fact that you’re in your personal space changes the nature of the sessions. While having a window into those personal paces might be intriguing, noticing each other’s environment doesn’t need to become part of the therapy session. Instead you should be continuing to focus on the client’s therapeutic goals. Therapists can let the client take the lead and refrain from mentioning details that the client doesn’t address first. Clients in turn should avoid commenting on their therapist’s space. Together you can set explicit goals at the beginning of each session to help you stay focused. You might even consider setting up a Zoom background.
We now have the option to do therapy remotely, thanks to modern technology. But just because we can, doesn’t mean that we should. Conducting teletherapy is very helpful in keeping therapy consistent during a crisis. But it is certainly not a model that I would advocate maintaining instead of meeting in person, when that is possible and safe. When we must do it, however, being cautious and thoughtful about how it is conducted is essential. Maintaining a standard of privacy and sensitivity can make the difference between preserving or alienating the therapeutic relationship.