How Therapists Can Connect Better with Online Clients

Key Points:

• Online therapy, seen by many as a temporary stop-gap at the beginning of the pandemic, is looking increasingly here to stay.
• Therapists who continue to see patients online must take steps to establish a strong therapeutic alliance, the most robust predictor of therapeutic success.
• Making small changes to one's environment can help put the therapist in the best light for a video call, helping the client to feel more at ease.
• Communicating openly and checking in with the client regularly can help ensure she feels understood and is getting the most from online therapy.

Living through the COVID 19 pandemic has had multiple impacts on peoples’ lives, including the demand for ongoing change in the way we do everyday things. For many counselors, this has meant shifting to do more of our work on-line or remotely, whether through video platforms, over the phone, or through other use of technology. Since March 2020, my own counseling practice shifted almost completely to be online, through video counseling.

Connecting with people using video platforms had already been a small part of my counseling role; however, this last year, it has become the main way I do my job. This has led me to realize that this is no longer feeling like a stop-gap to get through the time of this pandemic; rather, this is likely going to continue to shape a large part of how I think about counseling going forward.

There is abundant evidence that one of the central ingredients to any successful counseling experience is the quality of the counseling relationship and connection between counselor and client. This is one of the most robustly studied aspects of counseling, and it is also illustrated as similarly central in any internet-based counseling.

At first, I worried a lot that the shift to online counseling would mean that my connection with clients would suffer. I worried that it would be too hard to do well, and that ultimately, the usefulness of counseling for people would lessen. It has been a pleasant surprise to find it works better than I feared, many people enjoy it, and some report preferring connecting online rather than coming into an office.

There has also been a lot of grace, an acknowledgment that we are all adapting and doing the best we can during this time of so many changes, and a lingering sense this is temporary. Many people say that it’s better than the alternative of not meeting at all.

But what if this continues to be a way some people choose to engage with counseling in the future? How can we ensure we’re building the strongest counseling relationships possible while working remotely?

Connecting for counseling online

Source: Image by chenspec/ Pixabay

3 Ways to Strengthen the Online Therapy Relationship

With the abundance of research on this important aspect across all types of counseling, we can use some of the key findings to guide what we can pay attention to to enhance our online counseling relationships.

1. Set the tone and boundaries.

The environment you create through the meeting space can greatly support a feeling of ease, consistency, and safety. This provides a foundation to create a supportive connection.

Consider the lighting and environment you are in. Have lighting that allows your face to show up well, and without too many shadows. Have pleasant colours and images in your background.

Privacy is of course paramount for ethical counseling work. It also can ensure you are free from distraction and keep the focus on the interaction at hand.

Turn off any other devices. Have the sound off, and the displays out of your sightline. Keeping a pure boundary for your own focus and attention will support the message and experience for your client of being truly listened to, and allow you to guide difficult conversations well.

Manage the pacing of the interaction. Allow space between asking your next question or waiting for the client to respond. Some cues will be harder to read for when a person is about to speak, or that the person needs time to reflect or think. Going a little slower helps avoid speaking over each other, or missing an opportunity for the client to respond.

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2. Create conditions for trust.

At the centre of a positive and successful counseling connection is the building of trust between client and counselor. A key way we contribute to creating the conditions for this to grow is through the quality of our presence and attention. Some key aspects for enhancing and conveying your presence for your clients:

Consider how you sit. Consider how they will see you. Pay attention to how much of you is visible in the frame. Seeing all of your face and some of your shoulders allows there to be facial and body language conveyed through movement, gestures, and expression. Also, ensure you are comfortable so that you can be grounded and steady in your presence.

Think about distance. Pay attention to how close or far you are from the camera. Too far, and you’ll seem detached and unreachable. Too close, and you’ll seem more intense and in their face.

Consider the use of eye contact. Although it is uncomfortable and sometimes threatening to have too direct eye contact, without some sense of being able to really see and be seen, there can be less of a connection. You may need to toggle looking at the image of your client on your screen, and more directly or in the area of your camera, so they have the experience of more direct visual acknowledgment.

Consider earbuds or headphones. With earbuds or headphones, you are less likely to need to strain to hear, and the sound will feel more immediate and intimate.

3. Practice collaborative communication.

Counseling relationships that have the most benefit include a sense of collaboration between client and counselor. This includes ensuring there is a consistent opportunity for the person you are supporting to use their voice, have a choice in the course of setting goals, feel like you are negotiating together what is focused on, and build on client strengths.

Take time to check with your client about all of the above areas mentioned. Discuss together the lighting, your distance from the camera, how well you can hear each other, and elements on privacy in each person’s environment. These extra steps strengthen a sense of creating a joint space for your counseling work together.

It can be helpful to verbalize or narrate more often what you are thinking or wondering about, or how you are sensing your client might be feeling as you interact. Following this up with curious and open questions to check your observations not only helps you learn to read and listen to your client in this different medium, it also helps the other person become more aware of these things as well. It is making the unspoken more spoken and explicit.

Check in regularly with your client about what the experience of online counseling is like for them. What are they noticing about it? Check in how they feel before and after sessions as well. These transitions may be very different if they are connecting from their home, their office, or their car. Creating plans together for helpful ways to get ready for an online session as well as how to shift gears afterward, can support the overall feeling of a well contained, and supporting counseling relationship.

Using online or remote methods for counseling is becoming more common and is likely here to stay. Applying practical knowledge from tried and true methods of creating the kind of environment, tone, and collaboration that promotes a strong counseling relationship, can help all of us adapt better to use this modality well.

Regardless of how we are interacting with those we support as counselors, positive outcomes rest on the development and experience of a solid and positive connection.