By Susan Winter Fledderus
Psychotherapy and other forms of mental health care are considered essential services, and so every effort has been made to continue to provide them despite the current pandemic. Many organizations and agencies, including Shalem, quickly switched to online video sessions or telephone calls when the pandemic made meeting in person unsafe.
It has led to some significant changes and interesting experiences. In the early days of trying to find the best video platform, we endured disruptions when videos froze or sound lagged.
And there have been unexpected moments. My computer desk is in front of a window, and during one recent session a squirrel suddenly pounced onto the window ledge right in front of me. I jumped in alarm and yelped, leaving my poor client startled and concerned. I quickly explained, and we had a good laugh about it. It was a first, having a session interrupted by a squirrel.
Other therapists too are reflecting on the adjustments, and how for some, the toilet has become the new therapy couch. In many ways, meeting with clients in their own homes has added a personal touch, as I meet their pets or they meet me from their favourite chair.
But is it effective? Does it work to meet for individual or couple therapy by phone or video?
Traditionally Shalem has always focused on providing in-person services, with the view that it is preferable over providing care from a distance. Distance therapy was reserved for when there was no possibility of meeting in person, and even then, only used with clients who had met in-person previously.
But necessity forced a rethink of the way mental health services are being provided, and with it came a recognition that this work can be done well virtually. Shalem’s therapists have been providing phone and video sessions exclusively since March 17th, and 10 weeks in, we have to say that it is generally successful.
Therapists and clients are continuing to dig into important personal and relational issues; emotions are processed, insights emerge, and changes are being reported by clients.
The effectiveness of online or telemental health services has been verified by research, which shows that it is at least comparable to in-person services for treating individuals, couples and families for a range of issues including anxiety disorders, Post Traumatic Stress Disorder, and addictions.
Therapists Rebecca Jorgensen and Yve Gould, who have been providing couple therapy through video sessions for years prior to the pandemic, verify the effectiveness of working in this way, and were quick to provide online training to Emotionally Focused Therapy (EFT) providers just moving their practices online.
As with all therapy, outcomes of online therapy depend on how engaged clients are in the process and on building a good working relationship between therapist and client. For therapists, that means being as responsive in online conversations as we are in-person. That also means that for clients, shopping around for the right therapist is important to ensure you have a good fit of personalities and approaches.
Of course, there are both advantages and disadvantages to distance therapy. Advantages include the accessibility of the services, and no longer having to commute to the therapist’s office. Some clients also find it easier to share more personally and deeply because they are more comfortable in their own space.
For some clients, there is increased ease and privacy to meet with a therapist in their own home, while others find it challenging to find a confidential space in their busy households, and end up meeting in the bedroom, or even from their car.
Other disadvantages are the limits of not being able to see facial expressions and body language when meeting by phone. With video sessions, there is also the very real fatigue that comes from processing complex interpersonal interactions with fewer senses, particularly when the video quality is poor.
Online therapy is not recommended for some clients with active psychosis or other serious mental illnesses where inpatient treatment is required.
But generally, our experience at Shalem confirms what the research shows: online psychotherapy is effective for clients who would otherwise be seen in-person.
On May 19th, the Ontario government entered Phase 1 of pandemic recovery, which allows for in-person counselling to resume under safe, physically distant conditions. This would involve sitting farther apart while also wearing masks and/or face shields. It would include eliminating time in a waiting room, along with other precautions to reduce the risk of spreading the virus. It raises the question of whether a video session allows for better interactions than meeting in-person wearing masks.
In assessing the risks and benefits, psychotherapy providers, including Shalem, are recognizing that online and phone sessions continue to be the safest way to provide services in a pandemic.
While there will be safe processes put in place to begin resuming in-person sessions for those unable to meet remotely, the emphasis at Shalem for the time being will continue to be on providing online and phone counselling services.
So, if you have been putting off getting help during the pandemic, don’t be afraid to reach out now; you will be able to access effective therapy online or by phone.
Susan Winter Fledderus is a Clinical Therapist with Shalem Mental Health Network