Pros and Cons of Online Zoom Therapy Sessions

[Read Transcript]

Hi there, it’s Doctor Courtney Raspin.

I was speaking to my colleague Alex the other day and we were talking about Zoom therapy and how some people really, really like it, and other people don’t.

It got us talking in depth about some of the pros and cons of doing therapy in this way and we thought it would be a really great idea to have a chat online, have a bit of an interview to talk about it a little bit more because we thought it would be of interest to you as potential clients and maybe some therapists out there too might find it interesting.

[AP] So we were talking quite a bit about the way people might feel about coming online for a therapy session as opposed to being in person with a therapist, and the pros of that, but then also the cons of it as well.

So why people might be nervous of doing an online session rather than seeing someone face to face in an office. Have you found that a lot of your clients are happy to move to online therapy?

[CR] You know I’ve actually been surprised at how easy it’s been for many people to do it and I think it’s especially the people that you already have a relationship with because once you’ve formed that relationship you kind of know where you stand, you know how you feel in the room, but even in the therapy space, so it’s been an easier transition.

There have been some glitches with regards to the technology but I think we’ve ironed that all out and we can talk about that a little bit later.

I’d say that for some people it has been hard and I think some of the hardness has been around newer clients who perhaps wanted to start therapy but now are saying they don’t want to. They want to wait, although people on our team have had success with that as well, existing clients even being seen on a screen has brought up a lot for people.

[AP] So why do you think that is? Why would it be any different being on a video call with somebody than to be in a face to face room with somebody?

[CR] I think the one thing is with Zoom – and that’s what we use – you can see yourself, and that’s a bit disconcerting, especially because I work a lot with body image difficulties, eating disorders, you know anxiety and what not, and social anxiety, and so much about social anxiety is how you perceive yourself to be seen by other people and you’re always looking for cues from other people to decide how it is that you’re being perceived.

So, you’ve got yourself coming back at you and people start thinking, you know “well why does my face look like that?”, or “I wonder what they’re thinking about that”, and all of these things.

Now as a therapist I think it’s fantastic because it’s grist for the mill, you know we can talk about so what is it like, when you see yourself, or when you made that facial expression, what did you think that I was thinking?

So, it provides a new opportunity for us to talk about difficulties in a different way.

For some people it’s just too overwhelming to see themselves. So, what we do is we have them turn their self-view off.

[AP] Yeah, I was going to say you could have different views can’t you on the Zoom as well, so you could just have you featuring and not me, so to speak.

[CR] Absolutely and actually that’s a much more natural therapeutic office experience, right, you know when you go in to see your therapist, you’re not looking at yourself in the mirror, yeah. And so you can turn your self-view off by those three little dots in the right corner and I think you right click and it says hide self-view, so then you just get a big old face of me, which is probably what you would get in the office.

I mean what’s interesting for me is that I find it really disconcerting to see my own face as well so I turn my self-view off! But I didn’t know how to do that early on so it was just distracting because I’m very emotive you know, I’m very animated and I found that when I could see myself I was going “Oh God, you look weird, stop doing that!” Yeah distracted and not my most authentic self, yeah.

[AP] Yeah, you’re not relaxing into the conversation, you’re looking at yourself in the camera.

[CR] Absolutely and I think you know I’m not the best therapist for everyone but I think part of what makes me effective for the clients I do have is that I am very warm and I am very animated and emotive and so if I start kind of pulling it back it’s not natural so I’ve turned off my self-view.

What else? I think the other thing that can make it hard is things like privacy.

[AP] Yeah, well you can see my office for example which is, like my sewing table over here and my husband’s desk over here. You know sometimes even when I’m on calls I worry about what people can see, so maybe if you’re at home you worry should you tidy up or where should you sit and that could become a whole anxiety thing as well maybe?

[CR] Absolutely. Again, how are you perceived and how much do you want to let somebody else in? I mean this is for the therapist and the client, as well. It’s been really interesting to see people in their own spaces. That’s something new and an opportunity that you don’t usually get as a therapist I mean I’ve seen people’s bedrooms, people’s offices, people’s dogs you know.

[AP] Yeah, children.

[CR] It’s been amazing – children, parents sometimes, finding that private space to talk and feeling like you’re not being overheard.

[AP] Yeah so when I’ve had, and I’ve actually had some counselling online before and I used to take myself to a local nature reserve which is only 10 minutes away.

[CR] Oh wow.

[AP] But it’s so that I’ve found that was a lovely place to sit and look out and I could do the call on my phone and I was private nobody could hear me; I was separated from anybody at home. So, I suppose, obviously we’re all in lockdown at the moment, but yeah, I suppose if you didn’t want to be on camera you could always go for a walk and have like a call type experience maybe.

[CR] Yeah absolutely it’s a wonderful idea. I mean, in fact I just got a text this morning from a gentlemen that I see who wants to start again he stopped when lockdown happened because you know, he’s got three children and his wife is there all the time and he just felt like, he says your room is such a safe haven for me, you know?

[AP] Yeah for being honest.

[CR] Yeah.

[AP] You don’t necessarily want people to overhear what you’re saying because you, sometimes, you’re just very honest about how you’re feeling.

[CR] Absolutely and also I think in the therapy room you create a sense of safety there, you might be doing experiential exercises you know, teaching people how to down regulate how to manage their feelings, and you know the colour of the walls, the plant I have, some spray that I spray. All of those more sensual aspects of the safe space you can’t access those as well at all really, all you’ve got really is me which hopefully we can try and recreate that together, but it’s harder, but I think you’re right, going somewhere.

He said that he takes a walk on one of our local parks, he’s available next week perhaps we can have a phone call. Yeah, I’ve got another client that she really is at risk to herself and feels like she has to see me, she HAS to see me or she might hurt herself, yeah, and so we do a socially distanced walk once a week.

[AP] Yeah so there’s other ways of doing it you know you can meet people’s needs depending on what their circumstances are. Can’t you?

[CR] Yeah, I mean the other thing though is, my privacy, you know you’re out here you’re looking behind me. People say oh who plays the piano, you know? And that opens all of that up. I’ve got a 14-year-old upstairs who’s you know, gaming and banging on the table, and then the doorbell rings and the dog!

[AP] Yeah, barking!

[CR] And so I think you’re forced to, in some ways, reveal a little bit more about yourself as a therapist than perhaps you might otherwise, and that’s not a big jump for me because I tend to share a lot compared to some therapists but it still is, it’s not always on your terms because things happen and you have to manage them as they come up.

[AP] Okay that’s very interesting. So, I’m just having a look.

What sort of feelings do some of your clients – are they enjoying doing the online sessions more than being in the office? Have you had any feedback to that?

[CR] You know what it depends. Some really like it and I find that for some of my clients especially those who maybe do find intimacy and that intense level of intimacy very difficult, still maybe they’re more earlier on in their journey, they find that that little bit of distance allows them to relax and open up a bit more. It’s really been interesting to see.

So, I’ve actually been able to get at things differently, and a bit better than perhaps others.

For other clients they find it almost impossible, they want that kind of feeling of a hug of the room and I think this is especially my clients who have early childhood trauma, kind of traumatic attachment who you know, maybe we’ve been doing a lot of work like I said around emotional regulation coming back into what we call a window of tolerance, a lot of breathing exercises and imagery.

We have found ways of doing that online but that can be a little bit more challenging.

One of the things I have found that helps is, I do this exercise where we breathe back and forth so as I breathe in and you breathe out and you breathe in and I breathe out. We can kind of envision that connection.

Or putting a safe bubble around me and my screen and them and their screen and we’re in there together. Trying to recreate that sense of connection in the body so that they can feel safer, but some of them find is so, so hard and just want to be with me in the room and I understand that.

[AP] So, you were telling me about how you’ve been using the chat function as well on the calls.

[CR] Oh yeah, so yeah, sometimes when I’m in the room with somebody and they find it too difficult to say something or maybe there aren’t words, yeah maybe it’s a feeling that is kind of preverbal we use things like art to express that. Or if they feel that they’re unable to say something because of critical voices in the room preventing them from saying it they can write it down or they can draw it. And the way we’ve been able to recreate that with Zoom is that there’s the chat function. So, if something feels too difficult, yeah, then they can type it out and we can type back and forth for a little bit. Or we can share the whiteboard and they can draw it out. So yeah, that’s been really cool, yeah!

[AP] Utilizing the things on there.

[CR] Absolutely, I mean the whiteboard has been fantastic, because I can draw little mini formulations of what’s happening and then I can save those and send them to my client, and we can share the whiteboard, so they can draw, and I can draw, and that’s also been a way of feeling more connected. So that’s been lovely, yeah.

[AP] Brilliant. So, I’ve heard a little bit about Zoom fatigue as well with other people who have days of meetings online. Do you get that, or do you find clients get particularly drained by the online, I don’t know just watching, it’s almost like watching television isn’t it but maybe it’s harder than being person to person?

[CR] I don’t know if it’s so much a problem for our clients because it’s one hour with us, but I think for therapists at the end of a day of doing Zoom I do find myself exhausted. More so.

I mean obviously there are days in the office where you feel the same way because what we do is, we really do give all of ourselves in our work and you have to feel deeply and you’re moved deeply by things and you’re thinking all of the time and being. But with Zoom and I don’t know if this will pass over time as I get more used to doing it, but you almost feel like all you have to communicate is the screen, so you’re focusing, I think so much, on putting everything into the screen you don’t really have as much of the body language, so I think it’s a new way of attending that takes a lot of new energy, and new way of looking at things.

[AP] Yeah, it’s maybe more sensory, cause you’re really focusing on the listening and the watching maybe a lot more that’s more tiring.

[CR] So yeah, so there’s definitely I call ‘Zoom fatigue’ and I think I’m trying to space things out in the day a little bit more so that my clients can get the best of me.

[AP] Yeah, breaks in between the calls?

[CR] Yeah, absolutely.

[AP] and get up move around.

[CR] Yeah which you would do in session as well but I think especially sitting in a computer chair you know stretching the hips out moving around, you know all of that is going to be really important.

[AP] So you mentioned before about the security of Zoom. I know there’s been a lot in the media about how it was insecure and they’ve had hackers coming in? And, I mean, I personally have used Zoom for years and I’ve never experienced anything like that ever, so what would you say to somebody who’s thinking about online therapy but are worried someone else might hack into it?

[CR] Well listen, people have been using Skype for years, yeah, people have been using other forms of face time and what not and Zoom in my view is still the most secure.

They did not anticipate growing as quickly as they did yeah they really didn’t and I’ve been using it for a long time, never had any problems but when we went in lockdown everybody started using it and you know if you build it the hackers will come and they came. And to Zoom’s credit they responded very, very quickly and they’ve tidied it up, they’ve tightened it up in response to the demand and to the hackers.

And so now what you’ve got is a waiting room that’s automatically enabled so you can only come into the call if the person who is hosting it allows you in. You can then lock the room yeah so nobody can even come into the waiting room I don’t think after everybody who’s in the call is supposed to be in the call and there’s a password to get in. And so I tell my clients now you know you can be assured that we are in a safe space that isn’t being overheard and it’s so important to have that it really is so important to have that because you’re talking about, you know your vulnerability you’re deepest darkest thoughts and secrets sometimes so I think knowing that nobody else is listening in is really key.

[AP] Yeah definitely. So, I think we should just end by mentioning your brilliant headphones that you have on because I haven’t heard you talk about that.

[CR] Yeah, you know what I just find that I can be easily distracted, which is why the therapy room, I love my therapy room because it’s just quiet and I can focus on my client. Here I’m looking at you, but I’ve got that over there, and then I’ve got the bird building her nest outside and then I’ve got noise and this, and without the headphones and without really good headphones it’s more difficult for me to be fully immersed in the work that I do. And I tried a few different ones and these are gamer headphones and I love them and I look ridiculous but actually I had one of my clients say that it looked like I could land a plane!

[AP] Yeah Princess Leia.

[CR] Yeah okay I got it! They felt contained and safe because I looked like the captain and that I could land a plane.

[AP] And you’re in control.

[CR] And I’m in control! So I’ve tried to just take on that persona and yeah they look a little bit funny but I think that I’m my best when I’m insulated in your voice and then you can just hear what I’m saying and also you can’t hear the dog or the kids way out there so I like them.

[AP] It’s very good.

[CR] Thank you!

[AP] So I suppose we should probably finish with talking about how you do offer a free 20-minute online consultation which we’ve been doing for a while.

[CR] We have been yeah.

[AP] There is that opportunity to give it a go and no commitment and see how you feel about it before necessarily signing up to a course of therapy.

[CR] Absolutely. I think it’s always good to give things a go especially when this new technology is about you know and so we do offer a 20 minute free online consultation just like this like you and I are talking now with a member of our team where you can talk briefly or in depth if you want about your difficulties and what it is you’re looking for from therapy and have a think with our consultants whether or not therapy or online therapy is right for you.

And you can access that I think from our website, from our Instagram, from our Facebook page so it’s just at Altum Health and have a look and hopefully there’ll be something there that will interest you.

[AP] Excellent. Okay well thank you Courtney.

[CR] Absolutely thanks for taking the time to chat with me Alex.

[AP] Okay talk to you soon.

[CR] All right take care

[AP] Bye.

[CR] Bye.

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