As the COVID 19 crisis continues to alter every aspect of our lives, mental health providers are getting up to speed on telehealth formats for service provision. There have been some amazing resources popping up that address various aspects of the transition such as technical platforms, HIPPA, and billing codes as well as specific ways of practicing within one’s specialty.
Tips for enhancing virtual connection are not just for therapists; this essay includes both concrete and conceptual information that also apply to workplace and social connections. The ideas here are virtual connection 101 basics for those of us new and/ or resistant to doing our relating online. It is designed to stimulate creative thinking about possibilities.
2 weeks ago, I had my first Zoom playdate with my 5-year-old niece, thinking it would be brief and disappointing for us both. We like to snuggle and run around, how would we manage sitting in front of a screen? 2 hours later I had to end our time together, even though we had not nearly drained our enthusiasm. It was chaotic delight. A bit dizzying to watch the ceiling fan when she laid me down or carried me through the house. I have no idea what the puzzle looked like that she put together – that camera angle never worked out.
This experience confirmed (yet again) that it is the relationship that matters most, being present to one another in whatever format possible.
Showing up for one another is the foundation for healing, having a session might be the only touchstone in long spans of unstructured time in which the nervous system takes us on a wild ride, spinning and crashing. Expectations and goals for therapy need to be adapted for the current reality. Simplified to providing continuity and calm in a time of chaos and fear as best we can.
A brief check in for a few minutes might be all that is necessary, or possible. Even emails that have been sent to say, “I’m here for you” and offering online options have been significant toward creating a sense of connection, whether we have a session or not, people like knowing that there are options for access.
In the last week, I’ve had a few Zoom therapy sessions, multiple Zoom meetings, and availed myself of the generous wisdom being shared in professional communities. Even participated in a meeting with 200 people in which we seamlessly went into breakout sessions. Learning so much! Trial and error, lots of humility and grace.
To cultivate a richer understanding of presence in online therapy, I highly recommend the free webinar and chapter from The Sensorimotor Psychotherapy Institute.
An additional resource for Zoom in the workplace or other meetings comes from the Boston Globe article -The 12 most annoying things co-workers face on zoom.
Here are a few practical things to consider when facilitating therapy through a video format; you are not only a therapist, you are now a director/cinematographer responsible for creating therapeutic presence that transcends the cyber distance.
Preparing for video therapy requires planning ahead and tending to new types of details. Sensory experiences are different, and perhaps more vital to the quality of connection. Both for yourself and for your client. What are the elements that allow you to be your best therapist self, your most fully present self?
First and foremost: Experiment so you have a sense of yourself from the client’s view. It takes practice to find your visual center, eye contact perspective, and camera position. Invite someone to practice with you, someone that will give you constructive feedback on how you come across virtually.
Background: What is the scene you are showing, what is the backdrop? How much can you move around and still provide a view you would want to share? Your clients are now in your home, and you in theirs. This might be an important issue to discuss directly. It’s a very different level of access.
Lighting: Be aware of the lighting and how it shifts throughout the day, through the session. Lights behind you can blind your clients, and also render you a silhouette. Light can give you a halo, bounce off your glasses so your eyes are not available, or cast strange shadows & beams.
Angle, Proximity, Eye contact: Try to ensure that you are upright and looking straight towards your camera/ client. You don’t want to have your face fully taking up the lens, nor do you want to be so far away as to further create a sense of distance. Looking up into the camera or from above create an odd relational disconnection. I’ve been in several video meetings where I might only be seeing the eyes and forehead or the mouth and neck of someone. Other times when it felt like the other person was looming over me.
When making eye contact, if you are looking at your client’s eyes in the screen, they have the sense that you are not looking at them as your view to them comes from the camera. A wider mid-range scope that puts the gaze toward the space centered between client and camera tends to work.
Be aware that gesturing moves your hands directly toward the camera and can feel really invasive from the other end. Everything is maximized.
Discuss these elements with your client, ask them about their experience with the quality of these environmental aspects, and let them know what might be impacting your ability to connect as well. Share ideas for adjustments you might both need to make in order to enhance connection.
Sound: Background noises and computer feedback are distracting, and at times excruciating. Headphones help. They also provide extra layers of privacy. Not being a tech person, its difficult to identify some of the sound concern sources. I pose the concern without adequate solutions.
Props, Movement, Mirroring: We all have our own styles and tools for our work, we need not abandon them, we need to be resourceful in thinking about adaptations. Helping clients identify items in their environments that can be used is actually a great way to bridge session work into daily life.
While the computer poses some limitations, movement is possible. Altering the visual frame as you move, or disappearing from it altogether in order to get something or practice a body- based suggestion, is fine.
Pillows, teddy bears, and blankets or scarves can provide comforting sensations of being held. As we guide our clients through various self-soothing, we get the added benefit of soothing ourselves as we lead and mirror them. Wrapping a scarf around ourselves, breathing deeply, putting our hands on our hearts.
Our steady empathic presence, mirroring or modeling in our own bodies, and gentle vocalizations that indicate, “I’m right here” provide the same co-regulating functions as they do in person.
Setting/ Boundaries: Doing this particular kind of work from inside our own homes is quite an adjustment. The boundaries we’ve created need to be re-created within an ever-shifting reality. Preparing yourself, moving away from distractions, and creating a safe place in which you can settle into your work is ideal, and difficult with children and/ or pets who do not understand, or small living spaces where privacy is almost impossible to achieve. These are obstacles for our clients and ourselves.
Rituals: Setting an intention, mindfully attending to the senses, creating a small ritual can have significant impact on the quality of the interactions that occur. An opening and closing ritual, simple perhaps as taking a pause and a cleansing breath, helps anchor ourselves, our clients and our work. In this uncertain time, we need as many anchors as possible. Moments of stillness and connection.
Working this way has definitely takes more preparation, and demands more energy to stay fully present. With practice its getting easier, and sometimes even exciting.
Calmly containing, creatively sustaining, and actively searching for the treasures to emerge in this darkness.
We’ll get through, together.