How to get the most out of online therapy, according to therapists

10'000 Hours/DigitalVision/Getty Images
Originally Published: 

As the coronavirus pandemic presses on and forces many in the US to stay home for who knows how long, you probably feel overwhelmed and anxious, among other emotions — which you might prefer to navigate with a professional. Thankfully, video conferencing allows face time with a therapist from a safe distance. But maybe you’re skeptical. Maybe opening up over video seems a little weird, and you worry the experience might be a watered down version of in-person therapy, and not worth the cost. But if you have no choice, how do you make online therapy feel like the real thing?

Although online therapy might be convenient, it can pose barriers to connecting with your therapist. Ariel Hirsch, a licensed marriage and family therapist in Los Angeles, points out that webcam setups might not allow for direct eye contact, unless you gaze into the camera lens, in which case, you’re not seeing the other person’s face — which might feel awkward, as might seeing your own face onscreen.

It’s also easy to get distracted by Slack notifications and other apps, Tess Brigham, a San Francisco-based marriage and family therapist, tells Mic. It might be harder, though not impossible, for your therapist to read your body cues over video. And if you live with other people, you might struggle to find the privacy and quiet you’d get in a therapist’s office.

When a well-matched client and therapist share the same physical space, “there’s something really special that happens” — an ineffable chemistry that you don’t fully experience online, Annie Wright, a licensed marriage and family therapist in Berkeley, California. That’s why, “at the end of the day, it will never replace seeing a therapist in person, but right now it’s a good option.”

When a well-matched client and therapist share the same physical space, there’s something really special that happens — an ineffable chemistry that you don’t fully experience online.

That said, online therapy allows you to continue making progress on your mental health goals from home, which is especially important now, Wright says. And since it doesn’t require you to travel, it can make scheduling sessions easier, too. “It allows people to be able to do this truly on their lunch break,” Brigham says. Plus, you might have access to fur babies, blankets, and other sources of comfort at home that you might not get in a therapist’s office, Hirsch says.

Westend61/Westend61/Getty Images

Research also suggests online therapy is as effective as in-person therapy for certain disorders. “It is effective, and it does work,” Brigham says. And most importantly, you can take steps to ensure it meets your needs.

"The first thing I would say is, if you’re feeling resistant or don’t think it’s going to feel as good, my advice is to just try it once," Wright tells Mic. "Don’t let that feeling of it not being ideal stop you from getting support right now." Remember, you can always transition to in-person therapy later.

If you’re new to therapy, consider your level of support and need, Hirsch says. Platforms like Talkspace or BetterHelp, which match you with therapists and allow you to switch if you don’t end up clicking, might be ideal if you have an urgent need for therapy. “You might need support first before you can start to have some preferences,” Hirsch explains.

Otherwise, Wright suggests focusing less on finding the right platform than finding a therapist you’re comfortable with, and who makes you feel seen and understood, as you would when seeking in-person therapy. Do your homework. Make sure the therapists you’re interested in have competency in the areas where you need support. Peruse their websites or Psychology Today listings, Brigham recommends.

“Get a sense of who they are and what’s their approach,” she says. “If it feels like, oh my God, this person is speaking to me, this person seems to understand me, then that’s a good indication.” Call your top picks to check whether they offer online sessions, Wright says. If so, ask if they’d be willing to hop on a 20-minute consult call to further gauge whether you can want to work with them.

She also advises finding a therapist in your area, in case you want to switch to in-person therapy post-pandemic or at some other point. This is especially important if you struggle with severe depression or suicidal thoughts, since they may need to call a hospital on your behalf, Hirsch says.

Once you’ve settled on a therapist, “set yourself up for success,” Wright says. Schedule sessions at times when you’ll have privacy. If you and your partner both work from home, talk to your therapist while your partner is on a call, or ask your partner to wear noise-cancelling headphones. Optimize your space. Close the door and wedge a rolled-up towel beneath it to muffle sound, and tell your partner to stay away for an hour. If home isn’t a good option, go to a park or retreat to your car. “Try hard to limit the distractions,” Brigham says. You wouldn’t scroll through Instagram in an in-person session, would you? Close your apps, and turn off your notifications.

Optimize your space. Close the door and wedge a rolled-up towel beneath it to muffle sound, and tell your partner to stay away for an hour.

Traveling to a therapist’s office would offer you the time and space to reflect on what you want out of your upcoming session, while the trip back allows you to process how it went, Brigham says. Since you don’t have that in-between time with online therapy, she suggests blocking it out yourself, even just 10 to 15 minutes before and after your session. Before your session, consider what you want to work on, what you’re struggling with in your life. Afterward, reflect on what you want to work on and think about later. Take notes if you want.

Making the mental transition into Me Time can be hard without that physical transition into a therapist’s office, Hirsch says. Padding in enough time before an online session can help you to enter that quiet, introspective headspace. Take advantage of the flexibility provided by online therapy and avoid cramming your schedule, Brigham says. In other words, you don’t want to find yourself rushing from a Zoom work meeting into your therapy appointment.

And as with in-person therapy, honesty is crucial. Online therapy can feel weird at first—and if it does, say so. “Just say, ‘It feels really awkward. I’ve never done before over video. I’m not quite sure how to be,’” Brigham says. “This is a place for you to be completely honest about how you’re feeling. There’s going to be no judgment that you’re feeling this way.”

Speak up if the internet connection sucks, or if it’s hard for you to feel connected to your therapist without their eye contact, Hirsch says. “There’s only so much we can get unless the client says it specifically.” Wright agrees. Specify what does or doesn’t feel comfortable. For instance, if you want your therapist to notice body cues, like foot tapping or handwringing, adjust your camera. The important thing is to feel safe; when you feel safe enough to open up to your therapist, you can engage in the same deep conversations you would if you’d met in person.

Last but definitely not least, be kind to yourself as you adjust to online therapy. “I do think it takes some getting used to,” especially if you’ve had a long-term relationship with a therapist you normally saw in person, Hirsch says. It may very well feel weird at first, and that’s ok. A little preparation and honest communication can make the initial awkwardness worth it.