Where to start? In recent months, counselling for clients and the therapists changed almost overnight. Until March this year, I was a self-confessed technophobe, who had very little experience in counselling online. This had been limited to occasional sessions if clients were unable to travel to the office. It was not my preferred way of working and not something that I had necessarily wanted to explore further.
Overnight we faced a situation where the lockdown restrictions meant that online or telephone were the only options available to continue sessions. I understood that this was something which not all clients were keen to try, and the result was that many took a break from sessions. Some have since returned as this situation has continued for longer than I think any of us anticipated. I am grateful to the clients who were prepared to give it a try and we have learned together how to make this work. Occasional technical glitches and learning to use technology sometimes made it a stressful situation. I also embarked on 80 hours of additional training in online and telephone counselling.
Yes, online counselling is different to face to face sessions and I share the wish expressed by some clients who I had previously worked with face to face, to be able to return to working in this way. Although different, I have learned that video sessions are not lesser. I have actually learned to love it. Some clients have said that they would prefer to continue working in this way, even if face to face sessions can resume. My hope is to be able to offer both online and face to face sessions.
One difference in working online is that we cannot see the whole of the person and as someone who works very much with the body in mind during sessions, this has been a tricky transition. Generally I can only see people from the shoulders up but have on occasions been able to see half a face, up someone’s nose, the ceiling or just their ear as they adjust to using the video camera. Lots of the body signals are lost and therefore the focus becomes much more on words and what is not said. Sometimes more clarification is needed and silence feels more tricky (is it a thoughtful moment or has the screen frozen?) Sessions have been more tiring for the clients and for me. Sometimes the work has felt incredibly intense and sometimes it has felt as though there is an invisible barrier between us.
Another difference is that clients get to see a glimpse of my home and I also see theirs. I have met cats, dogs and parrots. I have spoken to clients in their cars, on their beds, in their lounge, in their children’s rooms, in kitchens and bathrooms. Many clients have appeared more relaxed in their home environments but many have also found it difficult as they are afraid of being overheard or interrupted by family members. There have been interruptions from the pets, family members and delivery drivers.
Now that I am looking to return to face to face work, there are further adjustments to be made. Current guidance from Professional Membership bodies, insurance and the Government is unclear. Do we have to wear masks if socially distanced? My feeling on reading the guidance is that this is a requirement although counselling and psychotherapy are unhelpfully not specifically listed. If masks are required, I wonder how clients will feel about this. Will this be seen as a barrier? Will it be something to hide behind? Will something be lost in not being able to see the whole of someone’s face? I personally feel that a lot can be expressed in someone’s eyes, tone and body language and of course what we lose by not seeing half of someone’s face, we can gain by being able to see more of their body than is visible on the computer screen.
We may face a situation whereby face to face sessions resume but then we are forced to return to online sessions if there are further lockdowns. I understand that this creates uncertainty.
I have created a whole new therapy room, I have painstakingly written a risk assessment, We can socially distance, there will be lots of cleaning, I am spacing out appointments to allow for cleaning and ventilation. I am so excited to share the new space with my clients.
I am however mindful that this is still an ever changing situation. What suits me may not suit my clients.. what suits one client may not suit another. Many people are still cautious about going outside of their safe bubble and may prefer to continue online. I am happy to do this. I wonder how it may feel for some clients to know that the room will be cleaned after they have gone. Some may feel reassured by this but some may struggle with feelings of them somehow contaminating the space. We can of course continue to talk about all of this. Whilst we negotiate these changes, the one constant is the relationship between us. Whether we meet online or face to face, that relationship is the anchor, a certainty in amongst all of the uncertainty and change. My aim is to be available for my clients in whatever way makes them feel the most comfortable and safe.
In relation to the actual work, I have been in awe of how much resilience my clients have shown and how adaptable many are to change. The actual virus and impact has taken a back seat in much of the work as clients continue to concentrate on the issues which brought them to therapy in the first place. It pops in occasionally but is rarely the focus of the sessions. People are dealing with a huge amount of loss in various ways and change over which it feels they have little control. We find ourselves in the rare situation where clients and therapists are sharing a wide range of collective experiences. Every client is a person, every person is different and each individual’s experience and the relationship between client and therapist will always be the focus of the work whether we meet in person or online.