Transitioning to Online Therapy: Tips and Insights from a Professional

How to Navigate the Shift from In-Person to Virtual Therapy Sessions

As part of the many changes we are experiencing these days, more therapists are avoiding personal meetings with patients and switching to online sessions. This transition can be smooth and trivial for some but significant and stressful for others. To ease this transition, I spoke with psychotherapist Diana Glazer (MSc), who has extensive experience working remotely.

Glazer is a psychotherapist specializing in CBT (cognitive behavioral therapy), EFT (emotion-focused therapy), AEDP (accelerated dynamic experiential therapy), and schema therapy. She speaks Spanish and has been using remote therapy for years, providing answers to patients and counselors from Spanish-speaking countries.

Embracing Technology for Therapy

The main tool that Glazer uses is Zoom, "a friendly and secure software that, for $15 a month, allows me to manage an organized schedule for meetings. I assign each patient a private 'room' where all our meetings take place. It makes it very easy for technophobes and gives this way of working an elegant and less improvised feeling."

While we do not own shares in Zoom, this suggestion encourages therapists to consider new work practices adapted to the current situation. Remote therapy can also occur via WhatsApp video call, FaceTime, Skype, or a regular phone call. It is also recommended to check with your professional insurance if it is necessary to add a section for remote care.

In our conversation, Glazer and I distilled the relevant components for each remote therapy session, allowing everyone to adjust based on their technology.

Getting Started with Online Therapy

"It is important to work with a computer that has a good camera and to be equipped with headphones, which provide a sense of intimacy. The patient should also use headphones. Those starting remote work suddenly can do so on the phone and without headphones."

Glazer emphasizes preserving the therapeutic setting in remote work. This term refers to the deep meaning attributed to consistency in the structure, space, and conditions where therapy takes place. The transition from in-person to computer-based meetings undermines these elements.

"To soften the shock caused by the change in setting, it is important to preserve it even when working online," she explains. "Every time we meet with a patient, they should see exactly what they saw in the previous meeting." This means choosing a consistent location for online sessions, avoiding improvised settings.

Creating a Suitable Environment

For those who are undecided, Glazer recommends choosing a quiet corner acoustically and visually, minimizing distractions for both participants. She advises not to sit close to a window to avoid difficulty seeing and not to work lying down or on the sofa but to sit upright and relaxed in a chair.

The ideal is to conduct these conversations from the clinic, but if that's not possible, consider holding meetings after the children go to sleep and discussing the need for silence with family members. Patients should also have a quiet and private corner for the conversation.

Remote therapy requires flexibility and logistical planning. "If I'm conducting the meeting from a space the patients don't know, I spend a few moments at the beginning of the first meeting to walk around with the camera and introduce them to my workspace," says Glazer.

Ensuring Technical Readiness

Before starting each meeting, ensure that the laptop and phone are connected to electricity. If there is no outlet nearby, have an external backup battery ready. Make sure the Internet connection is working, and if it's not sufficient, practice connecting your laptop to your phone's Internet (hotspot). Any screen with a cellular connection can work: desktop, laptop, cell phone, or tablet.

The computer has a significant advantage—stability. For those working over the phone, Glazer recommends purchasing a tripod and placing it on a stable surface. Turn off the call waiting option so calls during the meeting don't disturb you.

If patients use a computer, they can put their phone on airplane mode during the appointment. When using Zoom, schedule a meeting in a virtual room and send the patient a link to enter your virtual space. Start the first meetings a few minutes earlier to avoid mishaps, and provide an instruction sheet for connecting.

Addressing Concerns about Quality of Care

Does remote work harm the quality of care? "The answer differs from therapist to therapist and patient to patient, but in many cases, this form of work has an even more intimate quality. Both parties see everything, just like before, and maybe even better and more focused."

For those afraid of failures and malfunctions, Glazer reminds that the current crisis is an excellent opportunity to demonstrate flexibility and ways to better deal with technological, economic, and medical anxieties. "Over time, you will find that you can solve most problems yourself, and in the worst case, switch from the computer to the mobile phone."

Glazer also adds, "Use a lot of humor and invite yourself and the patients to make a cup of coffee or tea and drink together. During the meeting, use your hands, and pay attention to the patient's facial expressions. It is recommended to verbalize what you see on the physical level, direct the patient to pay attention to their feelings, and name their physical sensations. These interventions are always recommended in therapy, but they have added value when working virtually."

Special Considerations for Couple Therapy

Couple therapists and patients need to put more thought into planning online sessions. For example, the distance from the camera should be greater to see both partners simultaneously. Prepare for the possibility that partners may react differently to the format change. Find ways to make the transition easier for both and check if disagreements on the treatment format reflect deeper emotional gaps.

By following these guidelines, therapists and patients can navigate the transition to online therapy more smoothly, maintaining the quality and intimacy of their sessions