A couple of years ago — long before COVID-19 was an unfortunate glimmer in the CDC’s eye — I made the decision to switch from in-person therapy to telemedicine.
As someone who has historically struggled with opening up to therapists, my hope was that I would find it easier to be vulnerable if I could hide behind a screen. What I found was that I was able to disclose more, and as a result, it deepened the therapeutic relationship.
Not only did this transform my therapy experience — it also unwittingly prepared me for the huge shift to telehealth that’s now happening in light of the recent COVID-19 outbreak.
If you’re looking to start online therapy, or if your therapist has moved their practice to digital for the unforeseeable future, it can be a jarring transition.
While it can be a big adjustment, online therapy can be an amazing and worthwhile support system — particularly in a time of crisis.
So how do you make the most of it? Consider these 7 tips as you make your transition to teletherapy.
One of the most touted benefits of online therapy is the fact that you can do it any time, anywhere. That said, I don’t necessarily recommend that approach if you can avoid it.
For one, distractions are never ideal when you’re trying to work — and therapy is rigorous, difficult work sometimes!
The emotional nature of therapy makes it even more important to have some space and time set aside to engage with this process fully.
If you’re self-isolating with another person, you could also ask them to wear headphones or take a walk outside while you do therapy. You might also get creative and create a blanket fort with string lights for a more soothing, contained environment.
No matter what you decide, make sure you’re prioritizing therapy and doing it in an environment that feels safest for you.
No matter what platform your therapist is using and how tech-savvy they are, it’s still going to be a different experience from in-person — so don’t be alarmed if it doesn’t feel like you and your therapist are “in-sync” right away.
For example, when my therapist and I used messaging as our primary mode of communication, it took some time for me to get used to not being replied to right away.
It can be tempting to think that some discomfort or awkwardness is a sign that online therapy isn’t working for you, but if you can keep an open line of communication with your therapist, you might be surprised by your ability to adapt!
It’s also normal to “grieve” the loss of in-person support, especially if you and your therapist have worked together offline before.
It’s understandable that there could be frustration, fear, and sadness from the loss of this type of connection. These are all things that you can mention to your therapist as well.
Some therapy platforms use a combination of messaging, audio, and video, while others are a typical session over webcam. If you have options, it’s worth exploring what combination of text, audio, and video works best for you.
For example, if you’re self-isolated with your family, you may rely on messaging more frequently as not to be overheard by someone and have as much time as you need to write it. Or if you’re burnt out from working remotely and staring at a screen, recording an audio message may feel better for you.
One of the benefits of teletherapy is that you have a lot of different tools at your disposal. Be open to experimenting!
There are some things you can do with online therapy that you can’t necessarily do in-person.
For example, I can’t bring my cats to an in-person therapy session — but it’s been special to introduce my therapist to my furry companions over webcam.
Because online therapy is accessible in a different way, there are unique things you can do to integrate it into your daily life.
I like to send my therapist articles that have resonated with me for us to talk about later, set up small daily check-ins instead of just once weekly, and I’ve shared written gratitude lists over text during especially stressful times.
Getting creative with how you use the tools available to you can make online therapy feel a lot more engaging.
If you’ve been in in-person therapy for a while, you may be used to your therapist observing your bodily cues and facial expressions, and sort of “intuiting” your emotional state.
Our therapists’ ability to read us is something we might take for granted as we pivot to telemedicine.
This is why it can be really beneficial to practice naming our emotions and reactions more explicitly.
For instance, if your therapist says something that strikes a nerve, it can be powerful to pause and say, “When you shared that with me, I found myself feeling frustrated.”
Similarly, learning to be more descriptive around our emotions can give our therapists useful information in the work that we do.
Rather than saying “I’m tired,” we might say “I’m drained/burnt out.” Instead of saying “I’m feeling down,” we might say, “I’m feeling a mix of anxiety and helplessness.”
These are useful skills in self-awareness regardless, but online therapy is a great excuse to start flexing those muscles in a safe environment.
With COVID-19 in particular, an active pandemic means that many of us — if not all — are struggling with getting some of our most fundamental human needs met.
Whether that’s remembering to eat and drink water consistently, grappling with loneliness, or being fearful for yourself or loved ones, this is a difficult time to be a “grownup.”
Taking care of ourselves is going to be a challenge at times.
It can be tempting to invalidate our responses to COVID-19 as being an “overreaction,” which can make us reluctant to disclose or ask for help.
However, your therapist is working with clients every day who undoubtedly share your feelings and struggles. You aren’t alone.
What should I say?
Some things that might be helpful to bring to your therapist during this time:
- Can we brainstorm some ways to help me stay connected to other people?
- I keep forgetting to eat. Can I send a message at the beginning of the day with my meal plan for the day?
- I think I just had my first panic attack. Could you share some resources for how to cope?
- I can’t stop thinking about the coronavirus. What can I do to redirect my thoughts?
- Do you think my anxiety around this makes sense, or does it feel disproportionate?
- The person I’m quarantined with is impacting my mental health. How can I stay safe?
Remember that there’s no issue too big or too small to bring to your therapist. Anything that’s impacting you is worth talking about, even if it might seem trivial to someone else.
A lot of therapists who are making the shift to telemedicine are relatively new to it, which means there will almost certainly be hiccups along the way.
Online therapy itself is a more recent development in the field, and not all clinicians have proper training on how to translate their in-person work to a digital platform.
I don’t say this to undermine your faith in them — but rather, to remind and encourage you to be your own best advocate in this process.
So if a platform is cumbersome to use? Let them know! If you’re finding that their written messages aren’t helpful or that they feel too generic? Tell them that, too.
As you both experiment with online therapy, feedback is essential to figuring out what does and doesn’t work for you.
So if you can, keep communication open and transparent. You might even set aside dedicated time each session to discuss the transition, and what has and hasn’t felt supportive for you.
Online therapy can be a powerful tool for your mental health, especially during such an isolating, stressful time.
Don’t be afraid to try something different, vocalize what you need and expect, and be willing to meet your therapist halfway as you do this work together.
Now more than ever, we need to protect our mental health. And for me? I’ve found no greater ally in that work than my online therapist.
Kid strategy of the week:
- Video: Inside Out: Guess the Feelings
- Scavenger Hunt: have the child search around the house for these items and share them with you:
Couples strategy of the week:
- Help couples figure out similarities and differences in their attachment styles, and process how their attachment styles may play impact their relationship dynamics.
- Attachment Styles Assessment: https://dianepooleheller.com/attachment-test/
- Video: https://www.youtube.com/watch?v=2s9ACDMcpjA
Adult strategy of the week:
- Many people are experiencing high levels of stress right now. Sometimes, we are not even aware of the ways that our bodies and minds are reacting to stress. Use this worksheet to recognize signs of stress and discuss coping strategies for reducing stress and establishing healthy coping strategies
Mindfulness/Meditation of the week:
● Loving Kindness Meditation
This loving kindness practice involves silently repeating phrases that offer good qualities to oneself and to others.
Let’s begin by settling into a comfortable position, whatever feels right for your body. Bring attention to your breath. Notice the still points between your breaths. Breathe in through the nose to the count of 4 and out to the count of 6. Focusing on the still place between breaths.
- Now shifting attention to our thoughts. Begin by taking delight in your own goodness—calling to mind things you have done out of good-heartedness, and rejoicing in those memories to celebrate the potential for goodness we all share.
- Silently recite a phrase that reflects what we wish most deeply for ourselves in an enduring way. Some examples are:
• May I live in safety.
• May I have mental peace
• May I have physical health
• May I live with ease.
- Repeat a phrase with enough space and silence between breaths so they fall into a rhythm that is pleasing to you. Directing your attention to one phrase and breath at a time.
- Each time you notice your attention has wandered, be kind to yourself and let go of the distraction. Come back to repeating the phrase without judgment.
- (Few more breaths) … now, visualize yourself in the center of a circle composed of those who have been kind to you, or have inspired you because of their love. Perhaps you’ve met them, or read about them; perhaps they live now, or have existed historically or even mythically. That is the circle. As you visualize yourself in the center of it, experience yourself as the recipient of their love and attention. Keep gently repeating the phrase of loving kindness for yourself.
(few breaths) Slowly transitioning out of the visualization, and simply keep repeating the phrases for a few more breaths. Each time you do so, you are transforming your old relationship to yourself, and are moving forward, sustained by the force of kindness and compassion inward.
By: Bridget Eickhoff, MA, Alison Dolan, Psy.D., LP, and Andrea Hutchinson, Psy.D., LP
Being a therapist can be a fulfilling and rewarding career. However, it can be hard to remember that therapists are humans who also experience anxiety, stress, and burnout. We took a survey of 30 clinicians at CARE Counseling asking what makes them feel successful and balanced at work. Here are the main points our amazing clinicians found that help them find balance when working with a full caseload.
- Create Boundaries and Stick to Them
- Let your clients know your boundaries for cancellations and follow through with the boundaries you’ve set or are set by your agency. Therapy should be a flexible time for the client to address topics that are important to them; however, aspects of structure are important in therapy to keep both your clients and yourself accountable.
- Start and end sessions on time so that you have time to complete documentation, grab something to eat or drink, use the restroom, consult with a colleague, and/or take a moment to regroup.
- Manage your Schedule Proactively
- Make your life easier by scheduling clients as recurring appointments and practice confirming the next appointment at the end of the session.
- You probably enjoy seeing clients and it can be heartbreaking to refer them out. However, back to that accountability point, close your clients who are not following the attendance policy (or use supervision and consultation if you need guidance) and give them referrals to help with barriers (e.g., closer to home, different hours, attending to a different piece of their difficulties, etc).
- Proactively reach out and ask for more clients if you start to notice your caseload looking low or you have inconsistent clients.
- Keep in mind, being proactive will help keep the number of intakes in the same week lower and documentation will likely feel more manageable.
- Take advantage of cancellations and catch up on documentation or check-in with a co-worker. If you are finding yourself racing towards burnout remember:
- You can use PTO and take a day or more to feel grounded again
- Ask if you can have a temporary block off time in your schedule to help you gain some extra time to feel like things are more manageable again
- Talk to management to see if there are ways to contribute to the team without as many client appointments.
- Try to NOT Take this Very Personal Job, Personally (easier said than done)
- For both you and your clients, use your intuition for goodness of fit. As you know, a healthy therapeutic alliance is a key factor for the overall success of therapy. At times, especially as a new clinician, it can be difficult to decipher between your intuition and anxiety. Clinicians should utilize supervision and consultation to explore types of clients who are and are not a good fit. Supervision and consultation are also helpful when you feel stuck.
- Sometimes, it can feel pretty personal when a client cancels often or ghosts us. Keep in mind, clients will cancel appointments for a multitude of reasons ranging from weather, illness, moving, and symptoms and this happens to the best of us.
- You’re Not Alone
- Consult with your peers and use supervision to feel balanced and confident with your caseload.
- While you are likely a compassionate person, remember you too may have times when you need to check-in on your own mental health. Remember everyone can benefit from therapy!
But let’s say, for example, you picked your therapist while you were in the midst of a crisis and now you feel like you’re too far into your treatment to leave. Or maybe you’ve gone a few times but you’re not really sure that you’re getting what you need from the interaction.
There are many reasons people find themselves in an established relationship with the wrong therapist or seeing someone they’ve outgrown. We asked experts for red flags that indicate you need to break up with your therapist and find a new one. Here’s what they had to say:
1. Your therapist fell asleep on you
Believe it or not, this actually happens.
“I have had more people than I can count come to my office and tell me that they’re coming because their previous therapist fell asleep,” Chloe Carmichael, a clinical psychologist based in New York City, told The Huffington Post. “And they’ve told me that it’s happened more than once.”
If your therapist ever falls asleep on you in session, take that as a sign that he or she is not fit to be working with patients and you should find someone new.
2. You feel like your therapist doesn’t support your goals
It is important that you feel supported. Carmichael gives the example of a troubled relationship: If your therapist thinks you should break up with your partner but you are seeking help to repair the relationship, have a conversation with your therapist about this, she advises.
“I would encourage the person to say, ‘I want to clarify if we should continue working together, because I want to clarify that we have the same goals. I want to stay with my boyfriend and sometimes I feel like you want me to break up with him. Is that true?’” Carmichael said.
This kind of conversation provides the opportunity to see if you and your therapist see eye-to-eye, learn about potential red flags he or she might be noticing and agree about the direction in which your life is going.
“You do not want to be with somebody who comes across as judgmental,” agreed Liana Georgoulis, a clinical psychologist and director of Coast Psychological Services in Los Angeles.
On the other hand, sometimes you won’t always hear what you want to hear, Georgoulis said. The right therapist won’t always agree with you. And, of course, any therapist has a responsibility to intervene if you’re in an abusive or otherwise dangerous situation.
3. The therapist claims he or she is an expert in every condition
Beware of therapists who say they’re able to help with everything or market themselves as a “Jack of all trades.”
Many therapists know which conditions they can help with, and also where they can’t, Carmichael notes. A good therapist will refer you to someone else if your condition falls out of his or her scope.
4. You’re not sure why you are in therapy
Therapy can provide tools for coping with everyday stress or a mental health condition. Make sure you are working with your therapist toward mutually agreed-upon and clearly defined goals.
“Sometimes there might be differences in what that work is or how to get there,” Georgoulis said. But ask the professional you’re seeing to outline the treatment plan so you have a good sense of what it is you’re doing together.
5. Your therapist needs reminders
You should not feel like you need to brief your therapist on events or facts you’ve already covered in previous weeks.
“If that happens every session, that might be a sign that you want to get a therapist that’s more organized or more attentive,” Carmichael said. “You shouldn’t have to lead the therapist.”
6. You don’t feel like you’re getting anywhere
Let’s say you went into therapy for anxiety and you’ve learned tools to help you cope better each day. So rather than talk about anxiety, you bring up other issues that you need help working out. But session after session, you just don’t see any progress in these areas.
“Sometimes you’ve just gone as far up the mountain as you can with somebody, and it’s justifiably time to say goodbye,” Carmichael said.
Georgoulis agrees. If you’ve been in therapy for a long time but the needle hasn’t moved on certain issues, bring this up to your therapist. If you are still in pain, or not feeling good, it may serve you to find another person to talk to, she said.
7. You know too much about your therapist’s life
When therapists tell patients information about their own lives to make a point or illustrate an idea, it’s called disclosure. Researchers have been debating where the line is when it comes to this technique for ages ― even Sigmund Freud grappled with it, The New York Times reported.
Here’s how Carmichael suggests approaching it: If the therapist is telling you things about his or her own life for an obvious reason and it feels helpful, it’s probably fine. But if you can’t figure out why the therapist is sharing certain stories, or if he or she is taking up your valuable therapeutic time, it could be an indicator that this therapist is not the right fit.
Carmichael suggests finding a therapist who expresses him or herself quickly and distinctly during your time together.
“There’s not room for long winded answers,” she said.
A core component of good therapy is the therapist’s ability to connect a patient’s thoughts, find patterns and then trace it all back to concrete changes in thinking, Georgoulis said.
“If a therapist is just letting you come in and ‘vent’ each week, that’s not a good sign,” she said.
Find a therapist who does more than just make you feel better in the moment or provide advice for particular situations.
9. You feel good after every session
“There’s a misconception, I think, that people are supposed to walk away from a therapy session feeling great and I don’t think that’s true,” Georgoulis said. “The work is hard and sometimes you leave therapy sessions feeling challenged or drained. Stuff gets stirred up.”
If you are always leaving therapy feeling like everything is perfect, Georgoulis urges you to ask yourself if you are truly doing the work. It could be a sign that you need a different therapist who can help you process challenging emotions.
So, what should you do?
Both experts say the best route to securing the right therapist from the outset is to interview several of them, be straightforward about why you need counseling and ask about specific treatment methods he or she uses.
Bottom line, there are many excellent reasons to go to therapy. But once you’re there, consider if the therapist is really the right fit for you. If it’s not the right match, do what you need to do to find the right person.
It’s worth it.
Therapists work for you. Read these signs to determine if you need to “shop around” a bit more to get the help that you deserve!http://www.huffingtonpost.com/entry/signs-you-should-break-up-therapist_us_58ed18f0e4b0ca64d919dd01?utm_hp_ref=mental-health