Commentary: As therapy sessions move online, more may finally seek needed help
Seeking help online is helping to create psychological safety, forge more powerful connections and tackle stigma, says IMH’s Dr Grace Soo.
SINGAPORE: The circuit breaker was a challenging period for those in the psychology profession.
In the last few weeks, psychotherapy had to be carried out over phone or video calls.
There were many keenly felt concerns. Is it safe to conduct our therapy sessions virtually?
What about the human connection between psychologist and client, which makes therapy work?
Will it become cold and business-like? Will therapy via phone or video-conferencing meet the needs of clients?
Despite harbouring these concerns, I came away learning much from the experiences of my clients, and have been humbled greatly as a clinician.
CHANGES IN THE DYNAMICS BETWEEN CLINICIAN AND PATIENT
Going online or calling in for therapy has equalised the relationship between psychologist and client.
Some of my clients never thought to simply leave the therapy room when they wished to avoid speaking about something.
But now, they can simply “walk out” of a psychotherapy session, with the click of a button. Although my clients laugh when I point this out, this ability makes clients feel less obligated to their therapist.
Such a dynamic has been empowering to children, adolescents, and adults I work with, leading them to take greater ownership over their progress.
Some told me remote therapy has allowed them to open up more easily. They fear less about being judged when they aren’t in the same room as me.
For one young person, I offered to cover my camera so she couldn’t see me. She was surprised at how it was easier than she had thought to voice difficult feelings.
OVERCOMING FEAR AND STIGMA
Over the years, many clients shared they could not commit to therapy because of work, school and other priorities – not to mention fears of how they could be perceived by others if they said: “I need time for therapy.”
Some were afraid to be recognised even when they decided to attend.
Others were so afraid, they shuttered their windows and pretended they weren’t home when I came over, back when I worked in a community mental health team.
According to a 2016 study by the Institute of Mental Health, more than three-quarters of respondents with a mental health condition did not seek any professional help.
Be it from stigma or a learned fear, this unwillingness to get counselling can be changed with remote psychotherapy.
A young client of mine found it so distressing to come into the clinic, she never made it to therapy for a year.
With video-conferencing, she was able to cope by using the virtual background to “hide” herself through the distorted onscreen image. She could also type instead of speaking aloud.
This medium allowed her to access care she couldn’t get face-to-face and gave her enough distance to feel safe.
She even said that she may try therapy again.
EMPOWERMENT: ONE VIDEO CALL A TIME
During sessions, the therapy room is a protected, welcoming space for both therapist and client.
A place where all can speak in confidence is needed to conduct psychotherapy safely.
Yet during the circuit breaker, things got tricky. Video-conferencing may have allowed us to press on with sessions but not everyone has a large home where they can speak without being overheard.
Some of my clients shared that they speak leaning out the kitchen window because they share a 1-room flat with the entire family.
Some just had no safe space at home, as their family members could eavesdrop on the session, and use what they overhear against them in quarrels and fights.
READ: Commentary: Isolated with your abuser? Why family violence seems to be on the rise during COVID-19 outbreak
I encouraged such clients to text us via the hospital’s secure messaging platform. They could also attend therapy via video-conferencing and type their responses in the chat box.
But if it’s unsafe for clients to do that, we can revert to face-to-face sessions.
Even those lucky enough to have privacy for an hour have hurdles to clear. They need to secure a safe space for therapy (commonly the office or bedroom), get an earpiece, and ensure their device is fully charged and updated.
Ironically, while these might present a higher barrier to remote therapy, they also prod clients to take charge and invest in their sessions to their benefit.
After I asked clients to brainstorm on how they could maximise their sessions, whether face-to-face or remote, they tell me these brainstorming exercises gave them a sense of emotional validation and greater autonomy.
Remote psychotherapy has helped clients engage with sessions, improving their chances of progress. As opposed to being passive guests in a curated clinic room, clients are less inclined to see themselves as helpless, passive pawns in their treatment.
KEEPING IT REALISTIC AND ORGANIC
As much as therapists do their best to understand our clients’ backgrounds and living circumstances, we can only imagine how they live from description, unless we made home visits.
However, thanks to video-conferencing, we now have a glimpse of our clients’ homes and can tailor our advice accordingly.
One of my clients had difficulty identifying situations that distress him, giving us little to work with in sessions.
During our video call, he immediately expressed embarrassment about the stacks of papers and books strewn across his room. This clutter had been distressing him for days.
Just like that, we immediately had a situation that was raw and relevant to him. I prompted him to apply his learnt skills to this situation, rather than have him search for another less visceral scenario.
If not for the use of video-conferencing and phone, I would not have gained these insights into their lives. Home visits are typically expensive – but technology circumvents the high cost.
Regardless of what medium we use to communicate, the most essential part of therapy is still the human connection and ability to share freely.
One of my client has a protective dog. As she’s usually distressed and tense, he’s constantly on guard to support her.
But, as the session progressed, he might have realised she became calmer and more relaxed, because he settled comfortably on the floor to rest his head on her lap and promptly fell asleep. It made me feel like I passed his test in that instance.
If therapists hold on to the core of our work and remain open-minded to leveraging technology for therapy, these online sessions can make a significant difference in helping our clients achieve emotional breakthrough and complement face-to-face meetings, no matter which stage of combating this pandemic Singapore is in, or even after.
Dr Grace Soo is Senior Clinical Psychologist at the Institute of Mental Health.