As social distancing looks set to consider for some time, I’m writing to introduce you to the idea of online CBT with a therapist and how to make the most of your online CBT therapy session. Many clients wonder what is it really like to have therapy when you’re not in the same room? Having spent the past few weeks working online with clients, and having attended various workshops on this, I want to outline for you some of what I’ve learnt so you can benefit the most from your session. I work as a CBT therapist, so this article is aimed at online CBT therapy.
Online therapy has been around since long before the coronavirus pandemic, and has been well studied. Studies have shown that online CBT therapy can be as effective as face to face therapy. But understandably you might have questions about this way of working. That’s fine, I did myself to start with! To clue you in, I’ll first outline some of the benefits of online therapy and some of the potential limitations before outlining how to get the most from your session and how you can offset some of the possible disadvantages.
The plus points of online therapy are clear, it’s convenient for you from the comfort of your home, saving on time and costs to travel or park, and is easier to access for clients suffering from social anxiety or currently unable to leave their home for any reason. It is at the moment the safest option in terms of not catching or passing on coronavirus. For those who are working or looking after children, the ability to be able to schedule in a therapy hour without travel time to a different venue may mean the difference between being able to have a therapy session or not at all.
Many of the drawbacks which are often worried about can be offset with good practice, some of which include concerns about confidentiality, not being in the same room as your therapist and unreliability of technology. I’ll cover these below in my tips for making the most of online therapy. In most cases, if you are committed to working towards change through therapy, there is every chance you can get as much from your online therapy session as if it were face to face. Here’s how…
1. Where do I sit? Find a place in your home where you can talk privately and without interruption. If there are other people in your home, if you can, ask them not to disturb you during your session. If necessary, put a note on the outside of your door to ensure you are not interrupted. Helpful family members offering to make you a cup of tea are obviously supportive, but we want you to have this hour to yourself with your therapist, free of distractions, feeling safe that you can say what you want to, as if you were in the confidential environment of a therapy room. Switch notifications and phone ringers off. As much as you can, make your room into your home therapy room. As for those kind offers of cups of tea, perhaps they could be a nice way to prepare for your session (it’s okay to have a refreshment to hand if you choose) or perhaps they would be welcome when come off your call to take a pause before whatever is coming next. At my end, I work in a private room with a notice on the door, so it’s a confidential environment.
2. What do I need? You need a good wifi connection. This is a prerequisite. Without this, I would go so far as to say this is the biggest potential drawback to online therapy. Calls dropping out, time lags with speaking, unsynched voice and pictures make a session tricky. You can minimise this problem by asking others in the home not to overload your network during your therapy hour. Find the best wifi spot in your home and claim it for your therapy hour. If you have poor internet in your home, I probably wouldn’t recommend online work. But it is always worth trying to see.
Making sure that you regularly update system software and apps on your devices is recommended so that virus protection and software privacy is kept up to date on whatever platform you are using. Whilst initially there were privacy problems with Zoom (a popular online meeting app), these problems seem to have been overcome by the developers. Password protection is also recommended for privacy. Nothing is 100% risk free, but my perspective is, even if we were working face to face, we could worry about people theoretically listening at the door or bursting in by accident. This would be highly unlikely, just as the likelihood of someone remotely listening in to your therapy session online is highly unlikely. But by being aware of the risks, you can best manage these.
3. Use headphones and a microphone. This seems to cut back on the tiring nature of online work. First, you can hear better. It also cuts out feedback which can be distracting if you can hear your own voice echoing back. I always wear headphones if this is a problem.
4. If you’re not using a laptop or sat at a desk, I recommend you get a stand for your tablet or your phone. This will mean you can be handsfree to take notes and be more at ease. It also makes me feel less sea-sick than if you are bobbing around with your phone!
5. Think about your position in the screen. You don’t have to be too close-up. Head and upper body in frame is best. In fact, it helps your therapist to be able to see more than just your face, so we can see if you are looking particularly tense in your body or fidgety.
6. Does it feel a bit intense? I think it can sometimes. It’s okay not to stare at the screen the whole time. In real life we are not staring at each other close up like this for an hour, so it’s absolutely okay if while you are talking you want to rest your gaze aside, or look down at your notes.
7. Is the screen a barrier to therapy? There is not a definitive answer to this, it’s more down to personal preference. Many young people are used to chatting and talking online and are comfortable with technology and its ups and downs and comfortably ease into working online. It is also true that some people may have had previous negative experiences of working online. I can’t answer to this, but it may not be the online aspect which was the problem.
8. Working online may make it easier to discuss your problems. In some cases, online therapy is a bonus. Just as some feel that not meeting in person is a barrier, some clients may feel more open to discussing their problems as it feels somehow safer. Perhaps this is you?
9. Will online therapy take longer? This is difficult to say. During the current pandemic, perhaps yes, but this may be down to underlying factors, such as a client’s general stress being higher at this time for multiple reasons, as well as isolation and the difficulties this can bring with it.
One specific factor during this time of coronavirus, is that during social isolation some of the behaviour change work which is necessary for recovery and managing your problems may be held up as there are less opportunities to practise. We can manage this by being more creative about how you might set challenges for yourself online instead of the real world, or by using your time outside the home to engage in challenges as often as is permitted. As lockdown eases, this is less of a problem.
10. Is online CBT as good? Success of therapy is down to many factors, your relationship with your therapist, whether you connect with them and feel they ‘get you’, whether you are prepared to engage and do the hard work required in CBT and having a realistic and achievable goal which you are invested in working towards. Most of the hard work required in therapy, whether you are meeting your therapist in person or online happens in the real world, and has little to do with the ‘online’ part.
For me there is one final proviso about online therapy, and this is only my personal opinion. There are certain situations where someone is at high risk of harm, where I would not recommend it. As a private practice practitioner, I’m not available to offer support outside of sessions. Online therapy may not be advisable for complex and serious problems where crisis situations might arise.
I hope this article has helped to give you some tips and answer some of your queries about online therapy. If I can help, please let me know.
For further information, why not read 5 ways to make the most of your CBT therapy session.
Ali Binns is a CBT therapist based in Bath and now offering online CBT therapy.