Male mental health professional giving therapy to a woman

Five months ago, the decision to switch to tele-therapy was made for us when our communities went into lockdown. Regardless of how we philosophically or clinically felt about the pros and cons of online therapy, if we wanted to continue our therapeutic work, we accepted the fact that subscribing to an online platform was a reality and a necessity. Many of us opted for the free, one-month plan, assuming that we’d be back in our offices by April. Now, many clinicians have paid for upgrades and are contemplating the benefits of a year-long subscription instead.

I’ve always been vocal about not wanting to do online therapy. I didn’t believe it could energetically feel the same as face-to-face work. I predicted it would be more physically uncomfortable and exhausting to stare, immobilized, at a computer screen all day. I didn’t think clients could do the same kind of deep work, gain the same insights, or feel as connected to me.  I questioned the logistics and practicality of doing expressive modalities online. I was right on most counts.  It doesn’t feel the same and it is more exhausting. Some expressive modalities can be adjusted to an online format and others don’t seem to translate as well.  But my clients have surprised me with their ability to continue to do insightful and meaningful work, and they claim to feel as connected to me as they do when they’re in my office. So, although my preference will always be in-person sessions, I am now willing to admit that tele-therapy can be effective and is certainly a better alternative than not seeing clients at all.

The question is no longer, “Should I do tele-therapy?”  Now the question is “When do I return to my office for face-to -face sessions?” As I interact with colleagues I am constantly asking if they have resumed in-person therapy.  Most have not although they very much want to.  Those who have returned feel constrained by the necessary physical distancing, the time it takes to “disinfect” the office in between clients, and the fact that they are having conversations with three-quarters of their faces obscured by a mask. As hard as it feels to “connect” through a computer screen, it’s even harder wearing a mask.

If, for any reason, returning to in-person sessions feels premature, uncomfortable or unsafe, give yourself permission to wait and continue to do the work online.

Although most clients adjusted to online work, after five months, some are starting to pressure their therapists to resume in-person sessions. It’s important to know that professional boards have gone on record saying you are not obligated to resume face-to-face visits until you believe it is a safe endeavor for your clients and for yourself. There are guidelines that need to be followed, and if following them feels too burdensome or compromises your clinical efficacy then you need to acknowledge that. If seeing clients in your office evokes anxiety about your health or their health, if wearing a mask effects your comfort level or ability to communicate clearly know that those are legitimate concerns. If it feels frustrating to be in your office but to not allow clients access to art supplies, grounding objects, or other manipulatives consider the impact of that.  If, for any reason, returning to in-person sessions feels premature, uncomfortable or unsafe, give yourself permission to wait and continue to do the work online.

If you are contemplating a return to in-person sessions here are some factors you are urged to consider:
  • Your age and any personal underlying health issues, as well as the medical conditions of your household members
  • Your clients’ ages and any of their underlying medical issues, as well their family members’ potential health issues
  • Your clients’ risk-taking behaviors including high-risk occupations
  • The extent to which your clients continue to abide by social distancing and wearing a mask
  • Whether your office space is large enough to accommodate physical distancing
  • Whether your office is well ventilated enough
  • Your ability to keep common space, restrooms, and objects in your office contamination free
  • Your ability to space out appointments so there is never more than one person in your office
  • Your clients’ willingness to use hand sanitizer and have their temperature taken

What is your opinion about teletherapy vs. in-person therapy? Are you ready to make the switch? Let us know your thoughts in a comment.

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