Mar 18

Mar 18 The Benefits and Burdens of Doing Teletherapy from Home

As I write this many therapists across the country are scrambling to set up teletherapy options for their clients in the wake of the coronavirus pandemic. For some, this is an easy and welcome switch. A few therapists I know already have completely online practices so it’s just business as usual. However, for most, this change feels stressful and overwhelming as we try to figure out:

what consent forms to have in place
what training we need to be eligible to offer teletherapy
which video platforms are HIPAA-compliant
how to get clients on board for the sudden change
where in our home is quiet and private enough to conduct sessions

For many Sensitive Therapists, who are wired to prepare in advance for big changes, this is a very difficult time with a lot of uncertainty. Whenever anything happens out of our control, it can feel scary and activating for our sensitive nervous systems. Just yesterday, I rushed to my office to gather supplies as I bunker down for at least three weeks due to the “shelter in place” restrictions currently being enforced in the San Francisco Bay Area. It was sad and ominous not to know when I would be back, to not be able to offer therapy to my clients in this safe space I have created and more frivolously, sad that my plants would probably not survive my absence.

Each one of us will have a different experience during this time, but I wanted to share some of the burdens and benefits I’m hearing from Sensitive Therapists making the transition to offering teletherapy at home. At the very least, I want you to know that you’re not alone and that there could be some bright spots amidst the chaos.

Burdens of Teletherapy from Home

Perhaps the most difficult part of this whole situation is being thrown into overstimulation overdrive! Everything is coming at us at once and we may be forced to work in conditions or with technology that isn’t conducive to feeling our best.

Being on Screen

Being on-screen is very challenging for a lot of Sensitive Therapists. It’s distracting and sometimes uncomfortable to see ourselves on the screen throughout the session. This can make it even more difficult than it already is to stay focused and connected to the client. As someone with allergy-prone skin, I’m always self-conscious about how pink or blotchy my skin looks! Many therapists find it helpful to put a post-it over their image on the computer screen.

Preserving the Therapeutic Container

What I find the most difficult about doing teletherapy at home is trying to preserve a quiet and confidential container. This is especially difficult when everyone is home all at once and you find yourself limited in private space, especially if you have kids, a spouse working from home, other relatives or roommates in your house. It takes a lot of extra energy to make sure no one can hear your client and your client can’t hear anyone in the house. Being on video at home can also feel vulnerable if your client is seeing your bedroom or getting a glimpse into your personal life they wouldn’t have otherwise.

During these times when we’re all in it together, I personally think there’s permission to show our human side a bit more with our clients. Below are a few suggestions that I’ve used to preserve the container as much as possible:

Put my dohm white noise machine outside my bedroom door.
Use headphones or a headset so no one can hear my client and to reduce background noise.
Conduct phone and even video sessions in my car. I recently discovered that me and clients can join video sessions with the “Telehealth by Simple Practice” app.
Brought home my door hanger that says “in session” so everyone in the house knows when I’m with clients.

No Transition Time or Work-Life Separation

Although it may seem beneficial to skip the commute, the lack of transition time between work and home can be jarring. For me, I like to take some time to myself after my last session to decompress, finish up my notes, and then enjoy the train ride home to process and decompress. It’s difficult to immediately be at home when the session ends, especially if you have children to care for or people in your house that want to engage with you.

I encourage you to create a buffer for yourself as much as possible. Give yourself an extra 15 minutes to yourself after the session ends - hop in the shower, go for a walk, close your eyes for a few minutes, whatever would help you take off your therapist hat. Perhaps everyone in the family engages in “quiet time” by reading or playing independently.

Troubleshooting Tech Issues

I’m sure we have all had a session where the video was pixelated or the sound was lagging. This is probably my worst nightmare as I often don’t know how to troubleshoot and it takes more energy to manage the session when the technology is glitchy. I also worry that my clients are not getting the supportive session they are used to in the office.

If you’re new to telehealth or using a platform for the first time, do a test run with a therapist friend or your spouse ahead of time. I personally have a “Test Client” saved in Simple Practice that I scheduled a video session for using another email address (you could use your personal email address). This helped me see the whole process - what the text reminder looked like, the email with the video link, what the client needs to click when joining the video, and test the video quality from home.

Also, make sure to have a backup option that you review with the client at the beginning of the session. For instance, you could agree to switch to the phone or have another platform available. I’m hearing that some folks will leave the video going, but put it on mute and then use the phone call for sound. This helps if you don’t want to manage another platform but need a video for HIPAA-compliant reasons.

Benefits of Teletherapy from Home

Wow, there’s A LOT of possible difficulties when doing teletherapy at home when you first look at it, but we can also use our creative HSP brains to find solutions that work for us and our clients. Let’s look at some of the possible benefits of doing teletherapy from home which applies to us and our clients.

No Travel Time

Not needing to drive or commute into the office could be a huge benefit. I personally save two hours per day if I don’t go into the office. This allows me to sleep in later, have more transition time in the morning, and avoid crowded commuter trains which are very overstimulating.

Less Draining

Although not the case for every clinician or client, I find working with clients over the phone and video far less draining. We’re not taking on the energy of the client in the room and can focus more on the content of what they’re saying rather than managing ourselves in the room.

Comfy Clothes

Need I say more!? There’s nothing better than being able to wear comfy clothes, cozy socks and/or slippers at work.

Pets Are Invited

Having your pet by your side during sessions can be emotionally comforting and physically regulating for our nervous systems. Bonus - your client may enjoy seeing a glimpse of your cat’s tail or your pup’s sweet face. Pets can really bring a sense of warmth to the teletherapy experience for both you and your clients.

Homemade Meals

I personally love being able to cook my lunch when working from home and not needing to worry about bringing enough food with me into the office.

Familiar Space

Although some of us find our offices to be our second homes, there can be a great sense of comfort in being home. Especially during stressful times, being close to home can feel safe and nourishing.

The transition to a new system is often the hardest part, especially when we don’t have time to prepare and process along the way. Everything is moving so fast and we don’t know if we can do it right. You probably feel overwhelmed and worried about the changes and how long they’ll last. You’re not alone. I encourage you to be gentle with yourself, give yourself permission to be imperfect, take breaks, and reach out for help from other therapists.

Despite the challenges of moving to teletherapy, I’m holding gratitude for the fact that we have an option to continue care for our clients during an extremely scary time, generate some income when many are not able and have somewhat of a sense of normalcy/meaning in being able to do our work.