Online Counseling: Why I'm a Huge Fan (For the Most Part!)

The early weeks and months of the COVID-19 pandemic feel like a huge blur to me, especially when I consider the drastic changes I had to make in my private counseling practice.  There was so much to think about and to consider, and so much unknown about the virus at the time. To further compound things, I was newly pregnant with my third child. My head was spinning with questions and concerns. How will I keep my practice afloat? What types of precautions should I take at my office? Should I move everyone to virtual? What if I’m putting my baby and family at risk? What protocols and documentation do I need to put into place, to limit exposure and mitigate harm? How long will this thing last?

 

There are so many memories that come to mind when I think about those early pandemic days. I remember using a measuring tape to place my “therapist chair” the required six feet from my “client couch”. I worried about the air ventilation in the building. I bought tons of hand sanitizer to position throughout the office. My office suitemates and I taped off chairs in the waiting room to create further social distancing. We all bought masks in bulk (if we could still find them), and I remember how strange it felt to hold my first session wearing one.  The news was filled with reports of the rising death toll and hospital wards struggling at max capacity. I recognized my incredible privilege, and it was undoubtedly still a challenging, disorienting, and anxiety-producing season.

 

Like many other mental health professionals, I soon found myself transitioning completely to online therapy. At that point in time, I had only provided virtual counseling for several of my college-aged clients who had moved away but remained in state and wanted to continue our sessions. To move my entire case load online felt foreign, yet strangely bonding at the same time. Clients were working and living straight out of their homes, just like me. We were all going through a global crisis together, navigating an entirely new world than the one we had existed in mere months ago. Yes, I missed the in-person interactions, the ability to fully observe body language, and the comforting atmosphere of my office. However, over time, virtual counseling became second nature, and I was (and am) so grateful for it.

 

A significant portion of my practice remains online. Not everyone wants virtual sessions, but for those who do, it can be a game changer. As with most things in life, it’s important to know the advantages and disadvantages, and to make the best decision for your mental health. There is research that indicates online counseling is just as effective as in-person counseling for certain individuals. More research is needed, especially in these post-pandemic years, to fully understand the best methods of treatment delivery for various mental health conditions (e.g., online, in-person, a combination of the two, text-based counseling services, web-based psychoeducational programs with interactive components, etc.). The possibilities are exciting, and I feel lucky to be a part of the field as it undergoes this transformation.

 

If you are determining whether virtual or in-person counseling is right for you, here are some pointers for your consideration:

·      One of the most significant advantages of online therapy is accessibility and a reduction in time spent commuting to sessions. Hands down, this is perhaps the biggest reason my clients cite for wanting virtual sessions. Rather than reserving a 90 minute or 2 hour time slot for a 50 minute session, clients can quickly log on between work meetings, childcare responsibilities, or anything else they have going on that day. Further, there might not be a specialist for your condition or that practices a certain modality within your geographic location. Online counseling widens a client’s therapeutic options immensely.

 

·      Another advantage is the comfort and familiarity of one's environment. Many clients find it easier to open up and discuss difficult topics when they are in a safe and familiar space. This comfort can enhance the therapeutic process, fostering a more open and honest dialogue between the therapist and the client. Some clients are very intimidated by the thought of driving to go see a mental health professional. Online counseling can significantly reduce these barriers to treatment.

 

·      Online counseling will most likely not be indicated for severe psychiatric conditions or for those in acute crisis. Individuals dealing with acute mental health crises or severe psychiatric disorders may not receive the intensive support they need through virtual sessions. These cases often require more direct and immediate interventions, which are challenging to provide remotely.

 

·      The full scope of body language can be missed in virtual sessions. Nonverbal cues, such as subtle shifts in posture, hand gestures, and other body movements, play a crucial role in communication and understanding a client's emotional state. While video calls allow for some level of visual interaction, they often fail to capture the finer or full details, potentially impacting the therapist’s ability to fully grasp the client’s emotions and reactions.

 

·      For some, virtual counseling could collude with avoidance patterns. (For example, this could be the case for the client whose depression prevents her from leaving the house, or for the client with a highly distorted body image who doesn’t want to be fully “seen”.) There are pros and cons to virtual counseling in these instances. Virtual counseling may be a great way to start the counseling relationship, a less intimidating way for the client to get started… Then, as rapport and trust are established, a therapeutic intervention could include attending in-person sessions. However, if the client insists on virtual sessions, it could maintain a cycle of avoidance that does not best serve the client. I know for many clients who use their laptops or smart phones for virtual sessions, they can become easily distracted with notifications going off or alerts coming in. Again, this is just something to consider and to help inform your decision-making. An effective therapist will fully address and explore these dynamics with clients.

 

 

Certainly, it is important for both the strengths and limitations of online counseling to be examined. Every single person has unique needs and preferences to consider. Nonetheless, the expansion of online therapy has been a significant step forward in making mental health care more accessible and adaptable to our changing world, and I will always be ALL for that.

I’d love to hear from you! What have been your experiences with virtual/online counseling? How has it impacted your life?