Stressful and busy agendas, great distances, and heavy traffic all seem to make it perfectly natural to have a therapy session online in the safety and comfort of one’s own home. And sometimes online therapy is the perfect solution for those who truly have a difficult time connecting in person with their therapist.

However, online therapy has some unique challenges that need to be understood and addressed in order for it to be safe, effective, and satisfying for the client.

1: Confidentiality and Privacy Issues

Online work is inherently unsafe. Computers can be hacked and conversations that are conducted via satellite connections can be interrupted. In order to provide my clients with the highest possible privacy and confidentiality assurance, I do not conduct online sessions via Skype or any other online platform.

I offer online sessions through a secure web host. NousTalk provides medical professionals in North America with a platform for online consultations that comply with the stringent privacy requirements formulated by governments. SecureVideo is PHIPA and PIPEDA compliant.

In order to use this platform, clients are required to download SecureVideo’s software on their computer. This is a one-time activity that is relatively easy and very well described when the first online session is booked. Reminders are sent to the client via email before the session. A computer with a camera and a good sound system (or headphones) is required for online therapy to work.

2: Private Space and Focus

Some of the very advantages of doing therapy from your home can also become stumbling stones for successful therapy. Yet it is easy to create the environment at home that will support your emotional, psychological and/or spiritual work during your online therapy session.

• Create an interruption-free zone. Close the doors to the room where you are sitting. Let family members know that you can not be interrupted. Arrange for a babysitter for the kids. Turn off the house phone, radio, TV, etc. in your “therapy room”. And disable alerts and notifications for emails etc. on your computer.
• Get comfortable — but not too comfortable. Find a comfortable place where you can sit at the computer without getting stiff or twisting your body. However, treat your session like you would treat a session with your therapist in the room.
• Keep the sound down. If sound carries in your home, consider using headphones so that you can be sure that your family members aren’t overhearing parts of your session.
• Stay hydrated. Set up a cup of tea or a glass of water before the session starts so that you don’t get unfocused when / if you get thirsty.

3: Emotional Support

Deep emotional work can be difficult in online therapy. Without the support of another human being in the room, some people feel too vulnerable or are worried that they won’t be able to keep themselves ‘safe’ when they let go emotionally. On the other hand, some people allow for more emotional “letting go” if they aren’t facing their therapist. Either way, there are some ways to provide emotional support during and after an online session that may be worth considering.

• Keep the Kleenex close. Make sure that you have tissue paper close at hand during your session.
• Book extra time. Allow for an extra 10 minutes after the session to decompress and collect yourself. If you were visiting your therapist’s office, this would be the time you’d spent getting home.
• Have your journal at hand. Like after an in-person session, journalling can help sort through and normalize some emotions that have come up during a session.
• Get help if needed. Again, like after an in-person session sometimes it may be best to call a friend or to go for a long walk in order to let the emotions settle slowly.

4: Technical Set-up

The thing getting most often in the way during online therapy sessions is technology: the headphones don’t work, the computer freezes up, the camera dies, etc. If something breaks or stops working during a session there isn’t much we can do. I develop an alternate plan for such situations with each client before we start working in online therapy. Alternatives may include finishing the session by phone or rescheduling for a later date.

In order to avoid unnecessary complications, please ensure that your technical equipment works as best possible. Try out the headphones and the camera, charge up the batteries of the laptop. And please download the software from SecureVideo well in advance of the first session to avoid last-minute complications.

Under certain circumstances, such as bad internet connection, prohibitively long travel time, or lack of privacy at home, sessions may be conducted via the phone. 

Telephone therapy has several advantages, much like online therapy (please read the text for Online Sessions for details about preparing for your session). 

One of the biggest disadvantages of telephone therapy is the lack of visual cues. However, with a little extra effort, telephone sessions can provide a valuable and effective way of conduct therapy.

Some things are better talked about when we move. Movement can help us release our frustration, give us direction in our confusion, or settle our anxiety. Especially walking in nature can help loosen our thoughts and relieve our fears, offer reflective moments, and make quiet consideration and contemplation easier. More than that, walking can help us reconnect to nature and beauty in the world and it adds some exercise to our daily routine.

Therapeutically speaking a walk in a natural or semi-natural environment can help with some symptoms of depression and anxiety, reduce stress, and increase overall well-being.

With these thoughts in mind, I am offering walk-and-talk sessions. Dogs can be brought to walk-and-talk sessions but have to be kept on leash during the walk. Dog owners need to understand that the intensity of the focus on their work may suffer when they bring their dogs.

Session duration is the same as for regular sessions, and sessions are charged the same fees. Sessions begin and end at the office. This allows for last-minute changes to plans, e.g. with inclement weather conditions presenting last minute. The main difference between regular sessions and a walk-and-talk session is that during the latter we will walk for about 45 minutes at a pace that is set by the client.

There are some issues that are not appropriate for walk-and-talk sessions:

• deeply emotional issues
• acute crisis
• deeply personal issues
• shame issues
• other issues that may be determined individually

Should any of those issues be the theme of a client’s session plan, walk-and-talk sessions would not be encouraged. Should any of those issues arise during a walk-and-talk session, client and therapist together will decide on the best continuation of the session.

Requirements for walk-and-talk sessions:

• indication that a walk-and-talksession would be preferred upon booking
• wearing appropriate footwear
• personal understanding of physical fitness level to accommodate a medium-speed walk
• carrying appropriate weather gear (sun, cold, rain, wind protection)
• carrying water or snacks as desired
• willingness to be flexible in arrangements if weather or circumstances require it
• if dogs are brought to a walk-and-talk session:
  • keeping the dog on leash throughout the walk
  • “poop and scoop” compliance
  • consideration of alternative options in case of a change of plans
  • understanding of the dog’s suitability for such a walk experience