As a therapist I felt a strong responsibility to ensure I diversified my skills in order to offer clients the absolute best therapy possible over virtual means. This included attending various training webinars on adapting the main therapies I use in my practice; EMDR, Somatic Psychology, Parts Work, Brainspotting and yoga therapy online. This included training from leading experts in their fields, such as Mark Grixti, Arielle Schwartz, The EMDR Association and The Minded Institute. Alongside therapeutic adaptations, as part of my work for health and social care staff, and for clients who have experienced Covid-19 directly, there were various forms of training and development available on ICU matters, Psychological First Aid and Trauma work. I have been fortunate to access some of this as free training and am grateful for how much has been made available.
As part of this up skilling for online therapy, I have found using EMDR virtually to be extremely effective and have changed my way of delivering this, which I will likely continue for face-to-face sessions later. I am completely confident that I can offer as effective therapy online now as in person and this opens up many more opportunities, enabling greater choice for clients, rather than relying on those therapists available in their geographical location.
Factors to consider
There are different factors that therapists need to take into account for clients accessing virtual therapy in their own homes and these should be considered too. Clients usually have a journey to a different environment for therapy, perhaps a short wait in a waiting area where they can ‘arrive’ to their therapy session and a journey home afterwards to process before they enter their front door. I have made efforts to check in with clients that their space is confidential and they feel ‘safe’ enough to benefit from virtual therapy, checking on their comfort, letting them have a few minutes to get their devices set up correctly and those kinds of more practical elements. In addition, it is more important to ground clients at the start of therapy, and I use short exercises for this, based around interoception and exteroception and some somatics. I also tend to ensure there is a transition out of therapy at the end of the session before they return to the realities of their lives.
Clients and I will discuss barriers or blocks which might be related to the environment openly just as we would discuss any other types of blocks in sessions, for example, if they have children in the house and feel distracted even if they are in a private space.
I have heard therapists concerns about ‘bringing clients trauma into their homes.’ Whilst I acknowledge this point around boundaries, I believe most clients already have their trauma intruding into their homes and the rest of their lives, through distressing memories, nightmares and in some cases flashbacks which is why they are seeking therapy in the first instance. I think to help people through this, be open and transparent, and use our skills responsibly and sensitively to help manage these boundaries with clients is much more valuable than to use it as a reason against online therapy. I believe clinically that therapy with masks is likely to be more triggering, activating the parasympathetic nervous systems threat response, especially in relation to some of the particular traumas clients may have experienced. Seeing others in a mask and feeling the constriction of wearing a mask could trigger very frightening memories of experiences in some.
Client Experiences during the Covid-19 Pandemic
During Covid-19, I have seen an increase in difficulties with alcohol, exacerbation of previous anxiety and control related conditions, including eating disorders, increased family and relationship stress, financial stresses, and new anxiety or depressive disorders triggered by the changes to lifestyle and health fears. In health and social care professionals and clients who have experienced trauma, in a minority of cases, Post Traumatic Stress Disorder (PTSD). I have also seen people using this opportunity of lockdown as a time to access therapy for things in their lives that have been problematic for a while. This is such a brave and beneficial choice to make and I commend them. For many, this has been a time of reflection and that includes looking at aspects of our lives which we want to change and if needed, reaching out for help to do this. I am privileged to often be in a position to support people with making these changes to their lives, and will continue to do so to the best of my ability, whether that be virtually or in person!