Mental Health Awareness Week: How to make the most out of online or telephone therapy

When the UK went into lockdown, thousands of customer-facing businesses found themselves obsolete overnight. Hairdressers, masseurs and gyms – how could they possibly cater for customers virtually?

But for one area of the self-care industry, it quickly became clear that, while not without its challenges, the remote revolution could keep the industry alive. In homes all over the UK, people discovered that they didn’t have to stop seeing their therapist – they could take their sessions online instead.

For those who need urgent psychiatric care, or are experiencing a mental health crisis, even during lockdown there are still options to see NHS staff face-to-face (albeit with extra measures in place, such as personal protective equipment). Click here to find your local NHS urgent mental health 24-hour helpline.

For everyone else, telephone and virtual video sessions are now widely available. Hilda Burke, psychotherapist and author of The Phone Addiction Workbook, says: “While there’s no substitute for being in the same room with a therapist, there are, of course, cases where face-to-face therapy isn’t an option – whether that’s for financial or geographic reasons. More recently, in the past three months, the Covid-19 global pandemic has rendered online therapy a life saver for many.”

UK Council for Psychotherapy (UKCP) accredited psychotherapist Henry Adeane adds: “Phone and Zoom therapy will be around forever now to a much greater degree. And I think that’s a good thing.”

That’s not to say that digital sessions are preferable to face-to-face work, or that the former isn’t substantially different to the latter. But the technology means that, until lockdown restrictions are significantly eased, those needing to talk through their issues with a professional are still able to do so.

Here’s everything you need to know about getting the most out of online or telephone therapy.

These are different depending on the medium. Telephone therapy, as well as eliminating cues from body language and facial expressions, also poses a challenge when it comes to the art of silence.

“It can be dismaying for a client,” says Adeane. “They’re talking and then they stop – and the therapist might wait for a little while. In face-to-face sessions, the therapist might often give a natural moment of silence to reflect on what’s been said, and the client can tell they are attending to them respectfully and empathically. But when they can’t see you, it can feel a bit frightening; the client becomes worried that the therapist isn’t there, or that they’re not listening, or the phone’s gone dead.”

Video therapy eliminates this issue, but the technology can be harder to manage. For instance, if the therapist or client’s broadband connection is unstable, frustrations can quickly arise from frozen screens and unheard revelations.

And with both mediums there are issues around privacy and the therapeutic space itself. “Finding a confidential space can be tough for some clients,” says Oliver Jarvis, a therapist with a private practice in North London. “Sometimes people want to talk about somebody they live with, or to share something deeply personal that they don’t want others around them to overhear.”

He adds that, for face-to-face sessions, the therapist creates a therapeutic space that the client associates with the work – one that they are able to physically leave behind at the end of a session. “With distance therapy, they’re still in the same space where they might just have had a revelation, sometimes a painful one, and that can be challenging.”

It really is down to whatever makes you as the client feel most comfortable. That being said, the experts tend to prefer working over a video app such as Zoom or Skype.

“My preference is video,” says Adeane. “It’s a better experience for both the therapist and the client. You’re connecting when you can see each other.”

Jarvis agrees that the visual aspect of a video session is beneficial: “There’s so much of our communication that isn’t done just by words, and sometimes it can be therapeutic for the therapist to notice something,” he says. “For example, if the client starts crying, having someone acknowledge that can give permission for the emotion they’re experiencing.”

In some cases, the informality and removed nature of working remotely can actually enable them to be more vulnerable.

“I have a few clients who’ve previously found it quite difficult to open up in face-to-face sessions,” says Jarvis. “They’ve opted for telephone rather than video therapy, and it’s become easier for them to share what they’re experiencing – it feels like it’s the technological equivalent of the analytic couch [where the client can’t see the therapist].”

First and foremost, a confidential space is key – somewhere private where you feel able to truly open up. This can be difficult during lockdown depending on your living situation. Adeane says that some of his clients use their cars, while Jarvis recommends asking housemates or family members to occupy themselves in another room during your therapy sessions.

Hilda Burke adds: “Many of my clients take their phone outdoors as they don’t want to run the risk of a partner of child overhearing their conversation.” She also recommends shutting down all other devices and notifications so that you can be fully present.

As a step on from this, getting the room set up so it resembles a therapeutic space can be helpful. Adeane recommends ensuring a box of tissues and glass of water are near to hand, plus putting a clock somewhere visible so you are aware of the time boundary. “Make as much of a consistent ritual out of it as possible,” says Jarvis. “Have a space that’s designated for therapy – it could be as simple as a certain spot on the sofa – and make it as comfortable and with as few distractions as possible.”

From a technological perspective, making sure computer software updates are taken care of in advance, and that whatever video platform you’re using is up to date, is a simple way of ensuring things go smoothly. Finding a stable platform on which to rest your device and raising it so the camera is at eye level is also helpful, says Adeane, as it gives the impression that client and therapist are making eye contact. Jarvis adds that choosing to “hide self-view” – so that the client can only see the therapist and vice versa – is good practice, as it means you don’t get distracted by looking at yourself on the screen.

The “ritual” of travelling to and from therapy may be lost, but that doesn’t mean we shouldn’t try to replicate it somehow. Jarvis recommends setting aside time either side of a session “to go into the space and settle yourself before therapy begins, and then give yourself room to evaluate your emotions afterwards – even if it’s just five minutes.”

Finally, Burke advises planning a future in-person session: “If you’re starting therapy now, make sure to arrange with your therapist to do a face-to-face session once lockdown restrictions have been eased – there really is no substitute for being in the room together.”

Professor Sarah Niblock, CEO of the UKCP, advises ensuring a potential therapist is accredited by a reputable organisation, whose members are highly trained and regulated.

“Whatever the medium of delivery, the client’s welfare is sacrosanct so please make sure you are selecting a highly trained professional to support you,” she says.

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She emphasises the need to carry on with therapy if you were having face-to-face sessions before lockdown started as “stopping therapy suddenly is not advised”; for new clients, Professor Niblock says: “It is a good idea to speak to a number of therapists to find the best fit for you. Your therapist will work with you to find the best way to communicate with maximum privacy depending on your particular circumstances.”

Both the UKCP and British Association for Counselling and Psychotherapy (BACP) have directories of trained psychotherapists and counsellors.

The government website states that the NHS is open for medical services, including services relating to mental health. However, the website also urges people to continue to work from home when possible, while indoor meetings with individuals you do not live with are still not allowed.

As of now, in-person therapy sessions are likely to resume by 21 June.