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The need for social distancing has necessitated a turnaround in terms of willingness of clients and therapists to work together remotely. ‘Digital competency’ is now a buzzword. Many clients and therapists alike have surprised themselves by how well they have adapted to this new way of working. It has been a lifeline for those who would otherwise not have been able to access much needed help during this global crisis. Many also value not losing time in their day to travel to and from appointments, and report being able to do counselling in the safety of their own home, while a therapist’s office can feel intimidating.
Nevertheless, in this sea change, it feels those who do not want to work in this way have been somewhat left behind. Many organisations are not currently offering therapy to those unwilling to do e-counselling or work on the phone, and saying you are not prepared to do so will result in you remaining on a waiting list, or being flat out discharged. Much of the response to those unwilling to do counselling remotely has been along the lines of ‘well this is the new normal, and it’s better than nothing – you’ll just have to try it and get used to it’.
Still, there are some very legitimate reasons a person may choose not to Zoom, that are steamrolled by such a line of argument. The risks created by simply turning away clients who are unwilling to work remotely must be factored into decisions about what format counselling can work in at the moment. I say that as someone who themselves is very on board with the importance of social distancing at this time. That said, COVID-19 is not the only health risk factor we should consider in determining where counselling takes place. Here, people who were offered therapy via Zoom or the phone share their reasons for declining or stopping mid-way through therapy.
Concerns around privacy, or feeling unsafe in one’s home
Online therapy may work well for those with an extra room and thick walls, or who share a household with those who will respect their space, but not everyone has this set up. Factor in fears like being overheard (even by those you trust), or interrupted by your children, and e-counselling can create significant stress.
“I’ve been offered therapy online but the idea makes me so uncomfortable. I live in a university house with nine others, the idea of any of them hearing me would stop me from getting the most out of the session.” G Powell, 20
"I have two kids in the home and there's no way they'd give me enough privacy to speak to a therapist at home. I was offered therapy on Zoom but just thought 'my kids would be bursting into the room every two minutes!' For me it would be more stressful than helpful." Anonymous
“I was offered CBT over the phone but I didn’t go for it. I live with my parents and would have been terrified that they’d hear what I was saying.” Naomi, 25
“I don't get much out of Zoom appointments, due to my home environment. I have no safe place to talk in privacy and I end up dissociating more. Perhaps because it doesn't feel as safe, but also because the conversation doesn't feel as real. I think it's a real problem only offering telephone or zoom appointments due to people being in abusive situations and them be unable to say anything as others can hear.” Anonymous
Disconnect from Therapist
Therapy is an incredibly intimate and often daunting experience. While for lots of people this won’t be a problem, others may find doing therapy without the physical anchor of their therapist in the room a chaotic and stressful experience. It can be especially hard for those who already struggle to feel closeness when communicating using technology, as well as those for whom body language is more important.
“I feel that topics in therapy are highly personal, and it’s difficult to build a connection with a therapist over the phone or Zoom that allows you to feel comfortable enough to share intimate details. Virtual therapy feels very detached to me and therefore means I share less about my thoughts and feelings.” Anonymous
“Therapy from a client perspective feels awkward even in real life, and it can feel amplified via Zoom because it’s weird for us as humans to be talking to a stranger about stuff in our lives anyway, so doing it online is literally telling a screen all your deepest thoughts which feels very odd! Being online also takes away from the human connection we can only make in real life which makes this even harder - you’ve literally never met the person you’re supposed to be completely open with and trust - how is that possible?!” Lara Maher, 17
“I express how I feel a lot through my body language, and this is very difficult to do over a computer screen. On occasions, I felt that my psychologist wasn’t being as empathic as I would have liked her to be, or as she was when we were doing it face to face.” Anonymous
Disorder-related considerations
There may be specific disorder related considerations that need to be taken into account, and these will be particularly important to think about. For instance, those with eating disorders or body dysmorphic disorders may find the pressure of seeing themselves on a screen, or knowing that they are being seen on camera by their therapist, to be so distressing that they can’t work productively in this way. A person experiencing paranoia or anxiety around being recorded or filmed could also find Zoom unworkable. Several experiences of this are listed below, though this is far from an exhaustive list:
“A lot of my OCD surrounds social media/being recorded/saying the wrong thing/being inappropriate etc. I’m terrified that I’ll use my phone in my sleep and stuff like that - as you can imagine it’s incredibly distressing having any sort of online presence, including Zooms, and even my university lectures!” Ria Gregory, 21
“I was recently diagnosed with Tourette’s, in a Zoom session with a consultant. I wasn’t sure if he could really see me properly or how I was supposed to behave. My real issue with all the zoom sessions I have to do, is that I can see myself as well and this just makes me so uncomfortable and self-conscious. It’s easier to suppress your tics when you can’t see yourself, but impossible when every conversation happens into a big mirror.” Nigel Ashworth
“I’ve been really wanting to do therapy but the whole Zoom situation freaks me out because they say that they have a ‘HIPAA safe browser’ but I’m secretly afraid that they may be able to record me and show someone else.” Sarah R, 21
“I have existential OCD, so not being in a physical room with someone can trigger intrusive thoughts that they're not really there and I'm just talking to myself!” Bex Parker Smith
If you are someone who finds being on Zoom or speaking on the phone difficult, rest assured you are not alone. These ways of communicating may have been a lifeline for many in terms of staying connected and being able to work during the pandemic, but that does not mean that everyone can or should be expected to use them to speak to a therapist.
