Now that therapists and counselors are mostly seeing their clients on video platforms, is counseling a less satisfying, less productive experience?

These sure are strange times, aren’t they? It seems nothing that we do is the same. I used to love stopping in the local market and looking at all the fresh foods, see what moves me, and pick something up to make for dinner. Invariably, I’d run into someone I know and chat and catch up. I might even end up in a conversation with someone buying an interesting vegetable I’ve never used and talked about how it’s prepared. A fun, no-pressure social experience. Now it’s, make a list, in and out as quickly as possible, wear a mask and gloves, and wash everything when you get home before it gets put away, and shop so you don’t have to go too often. Weird right? And it’s a less pleasant experience.

Now, what about counseling? Now that counselors and counseling agencies are using mostly video platforms rather than seeing clients in the office, is counseling a less pleasant compromised experience too? That’s a good question and it’s definitely a mixed bag. For many years now, in addition to seeing folks in my office, I’ve been seeing people all over the US, Canada, Europe, and beyond.

People will ask, gee Neil, you’re such a strong proponent of family therapy, “Can you see families using video?” And then I’ll explain how that can work, and I’d like to share some of the challenges and advantages of using video platforms for family therapy here today.

Addressing The Family's Way Of Thinking

First of all, family therapy isn’t about who is in the room; family therapy is a way of thinking. Children, teens, and adults are all in or from families or both. They weren’t hatched from an egg in the wild, they were or are being raised in a family and every family has its own unique characteristics, it’s own dynamics, and everyone in the family is influenced by everyone else in the family, and that influence lasts a lifetime.

When someone is experiencing problems and change is needed, changing the behavior of anyone in the family will have an effect on everyone else in the family and from a family therapy perspective, we want to support healthy family change. Once you have that essential concept in mind, then that informs how a therapist works to help parents help a child or teenager get what they want or need in life or in their family, or even how we can help an individual adult.

Advantages Of Video Platforms For Counseling

Here is one huge advantage for counseling using video, there is no travel time for the family. It can be a huge challenge for parents to negotiate getting off work, picking up kids, or spouse, traffic, parking, and then getting back home afterward. With video, you make the time of the appointment and as long as you have private space, a workable device, and the counseling time set aside, there you go. Much, much simpler. Now, since the time and hassle to drive isn’t involved, the counselor can meet with the parents and the teenager or young adult in the same week, or even the same day without someone hanging around waiting for the other to drive back home.

Here’s another advantage, there can be a main counseling appointment with either the parents or kid or both, and then there can be check-ins for shorter periods of time during the week. That way, the therapist and the clients aren’t shackled to the once a week 50-minute model. Now, what are we going to check in about?

It seems to be that video counseling even more than in the office counseling, lends itself to actually accomplishing something tangible.

In the office and in-person, we have a natural tendency to act socially, be understanding, and supportive. Good stuff right? We need that, but it’s not entirely productive. However, when we’re on the video screen, it just seems that we have the expectation that we aren’t there to be social as much as to share information, get something specific done, and that can be fabulously productive.

Then when the counselor and the client or clients have talked and figured some things out, then they can make a plan about what to do and how to do it. They can even do some role-playing to learn or practice a new skill.

After that, check-ins on any timeline that best fits the situation can support the larger plan. Check-ins can be even daily or every few days or if the therapist is flexible, “as needed.”

Challenges Associated With Teletherapy

Now, should the therapist ever meet with the whole family, just as they might in the office? Absolutely, they just don’t need to do that every time and they can be more specifically helpful when meeting with different parts of the family separately. When everyone is together, then they can talk about what’s going on at a higher level and they can talk to each other. With everyone together, the therapist can help them come together with a common goal, and in later sessions, come together to discuss progress towards that goal.

And what’s the goal? Starve the Beast, of course. The question is "What is each person doing that feeds the beast, and what does each person need to do to starve the beast." It can be awkward when parents and kids are next to each other with some heated energy and the therapist is trying to guide things from a screen, but sometimes it works reasonably well. An alternative that does work well is when parents and their teenager(s) are on different devices. That way, there is a greater opportunity for them to actually hear each other since two people can’t talk at the same time on a video platform. For many couples, being on the same device seems to work just fine, even when I want to help them try a new way of talking together. For the most part, it works quite well. Separate devices for couples work perfectly well too.

One challenge on video is that the therapist can’t know what the client is feeling as easily. They can’t read the cues of body language or slight facial muscle changes. To address that, the counselor may need to simply ask the client more specifically about what they are feeling, and the client can take a minute and reflect if they don’t already know and then share what they’re feeling. That’s good for the client to own and express their feelings and for the therapist to know without making assumptions.

I’d like to make this one last point, and here I’m talking mostly to my colleagues. For the most part, we’re taught to not be too expressive in our professional role as therapists. After all, the counseling is about the client and their personality, not ours. But if we are terribly reserved on a video platform, we’ll come across as flat, uninspiring, and disengaged. That’s certainly not what our clients need.

When we are using video platforms, we need to be more actively validating, supportive, empathetic, even more actively challenging. We need to change our tone, volume, and even how close or distant we are from the screen. Notice what happens if you talk more softly, slow your speech way down, and move your face slightly closer to the camera for instance. These are ways that the therapist can bring their full selves to their clients and have video counseling, be a rich, satisfying, and most importantly, productive experience for clients.

Folks, during these profoundly trying times, therapy can be more important than ever. To stay safe and to limit the spread of the virus, video platform therapy is a safe way to go. It will take some getting used to on the part of both clients and therapists, but let’s stay with it, and guess what, we can make it work.

During this very challenging time for our respective countries, and in our communities and families, many folks will experience feelings and situations that are overwhelming. If you’d like a consultation with me, give me a call or email and we can set up a meeting in a Zoom meeting room.

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If you are a therapist who works in a behavioral health treatment program and would like to talk with me about improving outcomes in your program, come on over to my website neildbrown.com and shoot me an email or give me a call. I’ll be happy to talk with you.

Please, take care of yourselves; you need it, you deserve it, you’re worth it. Bye for now.