A lot of practitioners have made the switch to telehealth sessions during the COVID-19 pandemic.
But seeing patients on a computer screen can be surprisingly exhausting.
Beyond that, it can introduce new clinical challenges to the session.
In the video below, Christine Padesky, PhD and Ron Siegel, PsyD will get into some practical ideas to help with the transition to telehealth.
Dr. Padesky: I’ve been also talking with colleagues in the last few weeks about doing teletherapy, and the difference from doing in-person therapy in the office. There are a couple things that have come out in these conversations. The first is, in terms of dealing with the fatigue factor that therapists often feel in the opening weeks of doing teletherapy, that does reduce over time. Some of the things that we can do to reduce it are, when we’re in our office, we’re not constantly just staring at our client’s face. We may be looking over their head, looking out a window, we might be glancing at something that we’re working on on a whiteboard, or something like that. Allowing our gaze to change is one thing that can make a difference. Another practical thing that can make a huge difference is wearing ear buds or some sort of device that allows us to hear more easily and a microphone, so the clients can hear us more easily. It turns out that one of the big fatiguing factors in online conferences is poor sound and poor audio quality. So, things we can do to improve that can make a really profound difference in our fatigue levels. The other thing is, I think it’s important not just to talk to colleagues about how to make teletherapy go better, it’s also really important to collaborate and talk with our clients about it. One of the big differences is we’re kind of a bigger talking head than we typically would be in the office, where there might be six or so feet between us, when we’re doing in-person therapy. One of the things that I think is really important is to ask our clients, “How close should we be to the screen? Would you feel better if I backed up further or would you feel better if I’m up closer?” Also, to not constantly be doing eyeball-to-eyeball work. I’ve done a lot of thinking over the years and have talked to my clients about the difference between eyeball-to-eyeball conversations and what I call shoulder-to-shoulder work, where we’re working on a piece of paper together. One of the things that I find really helpful in telehealth, as well as in in-person work, is not always to expect to be looking at each other because that’s very unsettling for a lot of clients who have intimacy issues, clients who are quite anxious or feel shame or guilt. To have someone looking at them actually makes them feel quite under the spotlight. So, it can be really helpful to break things up in session and say, “Let’s both get out a piece of paper right now and let’s make a list of some of the things we’ve been talking about,” and actually avert your eyes from the screen and write things out and have the client write things out. Of course, in CBT therapy, many therapists use the Mind Over Mood client workbook that Dennis Greenberger and I wrote. We’ve made it possible for therapists to either email or send the PDF copies of these worksheets to their clients so that you could actually get out a worksheet – it doesn’t have to be from that book, any worksheet that you commonly use with clients. If you’re both periodically writing and then talking to each other about what you’ve written, you’re then not doing all eyeball-to-eyeball work and I think it’s relieving to clients, as well as to therapists, to be working together with purpose on something that doesn’t involve just looking at each other constantly.
If you’ve started seeing clients via video, what practices have you found most helpful for telehealth sessions? What has been most challenging about seeing clients virtually?
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