For many people, social distancing doesn’t just mean cancelling plans with friends; it also means figuring out how to take care of their mental health during a time of widespread anxiety, isolation, and despair. As the coronavirus pandemic reshapes modern life, some therapists are switching from in-person sessions to phone or Zoom appointments. This is uncharted territory for both therapists and their clients, and it can be a difficult transition—even for young people who are fairly fluent in digital communication. Meanwhile, people who are suddenly unemployed or struggling with quarantine-related loneliness might be wondering what their options for therapy are right now.
If you’re trying to make therapy work in these less-than-ideal circumstances, here are some things that might help.
Approach virtual therapy with realistic expectations.
Rebecca Cowan, a Virginia-based therapist and board certified telemental health provider, said it’s important to go in your first virtual appointment knowing it will likely be very different than an in-person session. Both she and Molly Carmel, a therapist and founder of The Beacon Program in New York City, strongly recommend using video conferencing rather than phone calls because therapists miss nonverbal cues on the phone. “Video conferencing creates an environment that aligns most with what we create in face-to-face therapy,” Cowan said.
There’s no getting around the fact that it’s not the same as in-person therapy, and Cowan and Carmel emphasized being honest with your therapist about this. For example, if you’re being treated for PTSD and your therapist’s calming physical presence feels completely absent in virtual sessions, tell them so they can think of alternatives. Cowan has her patients create “comfort boxes”—which are filled with items like photos, essential oils, and a stress ball—that they can reach for if they feel triggered during the appointment. If you have a suggestion or idea for a way your therapist can make the session more productive, communicate it to them so you can give it a try together.
“It’s important to share in therapy how weird it feels so we can talk it through together,” Carmel said. “People sometimes idealize therapists, but we’re not mind readers.”
Find a private space for your appointments.
It’s hard to relax and be fully honest during therapy if you’re worried someone might be able to hear your conversation. For those of us living in close quarters with partners or roommates, privacy may require some creativity. Carmel recommended asking your housemate to put on noise cancelling headphones, listen to a podcast or music, take a shower, or leave the apartment to complete their essential errands during your session. She also said that white noise apps can offer an additional layer of privacy.
Speak up if your sessions aren’t feeling helpful.
If you’re struggling to adjust to the remote sessions or feel like your therapist’s advice just isn’t useful during this time, you should be as clear and honest as possible with them. “If something isn’t working, tell your therapist so they can try something different,” she said. “If the therapist doesn’t know that and isn’t aware, they can’t meet [your needs].”
Cowan added that some patients need more support than others, and communication is crucial to ensure your needs are being met. For example, some clients find it helpful to use worksheets between sessions; if that’s something you’re interested in, your therapist might be able to email some to you, or direct you to online resources. Rosara Torrisi, a certified sex therapist based in New York, previously told VICE that The Mindful Self-Compassion Workbook and Self-Therapy Workbook are good options for individuals (and both are available on Kindle).
If you’re really missing the in-person connection, Carmel recommended starting each session by doing some sort of grounding technique together. “[Virtual sessions] can be disorienting,” she said. “Starting off by sitting ‘together’ and doing a breathing exercise can help you feel more connected with your therapist.” (This just means you’ll both sit down in a similar position and do the same breathing exercise in sync before you begin talking.)
Know that it’s totally reasonable if coronavirus talk dominates your session right now.
Coronavirus doesn’t need to be the elephant in the (virtual) room—after all, it’s the reason in-person therapy isn’t currently available. Carmel emphasized that there’s no “right” or “wrong” way to talk about coronavirus in therapy, but it’s important to address it. “We can feel really crazy about it and people are trying to cover that up. But that’s what therapy is for,” she said. “Share how you feel about [COVID-19] and how disorienting and scary it is.” She noted that many people initially say things like, “it’s crazy, but it’s fine”… but it’s important to delve into what you’re truly feeling. “This is unprecedented,” Carmel said. “People may be ashamed at how scared they are, but your therapist is here to help with this.”
Cowan said it’s wise to use therapy to address the fact that the pandemic has caused a major disruption to everyone’s schedules. She recommended talking with your therapist about how to create a new structure and routine. “When you have mental health issues, keeping a routine in place is really important,” she said.
If you’re a “high risk” patient, work with your therapist to put additional support in place.
For people who are dealing with suicidal ideation, eating disorders, and substance abuse disorders, switching to virtual therapy can be especially challenging. Carmel said it’s important to work with your therapist to create an “action plan” for when you experience suicidal thoughts. This means having detailed plans of specific coping skills you’ll use and a list of people you can reach out to. Should you start having thoughts like “I have no friends” or “life isn’t worth living and no one would miss me,” turn to your action plan.
“Having really thorough action plans is a game changer because doing something is the opposite action to severe depression,” she explained.
Both Cowan and Carmel also recommended finding additional support through virtual group therapy. Psychology Today is a good place to search for groups, or you can ask your therapist for suggestions. Cowan said she’s in frequent contact with her colleagues and can ask them from group resources when needed. “Therapists have access to information that clients don’t,” she said. If you’re struggling with eating disorder symptoms, ask your therapist to connect you with an online support group.
Groups like Alcoholics Anonymous and Narcotics Anonymous are also putting virtual meetings in place. Cowan said to contact these organizations directly in order to get information about online group sessions.
If virtual therapy just isn’t working, that can be a legitimate reason to consider breaking it off or putting it on pause.
Despite your and your therapist’s best efforts, the bottom line is that phone or video sessions aren’t going to be effective for everyone. Or you may simply feel like you’re not getting anything out of therapy right now because you don’t have as much to talk about, and discussing COVID-19 at length has begun to feel like a waste of time and money.
If you decide to “break up” with your therapist, Cowan recommended reaching out to them directly and telling them what isn’t working. “That constructive feedback is always helpful to me because it helps me better serve future and current clients,” she said.
If your reason for ending therapy is solely financial, make sure to communicate that to your therapist because there may be a way to make it work. “A lot of therapists offer sliding scales and conduct group sessions,” Carmel said. If your therapist doesn’t offer reduced payment, they might be able to refer you to a colleague who does.
Know that it’s not too late to start therapy.
If you’d been considering therapy before the pandemic but hadn’t found a provider yet, it can be even more anxiety-inducing to suddenly find yourself alone in your apartment, concerned about the health of yourself and your loved ones, and coping with economic uncertainty. The good news is that both Cowan and Carmel said therapists are taking new patients. In fact, Carmel just began taking new clients again due to the increased need.
If you have friends who are also in therapy, Carmel suggested asking them if their providers can give recommendations. “Friends shouldn’t share therapists, but good therapists tend to know good therapists,” she said. “So I think it’s a great thing for a friend to ask their therapist if they have a colleague who’s taking new patients.”
Both Cowan and Carmel said Psychology Today is an excellent resource that allows you to search for providers in your area who accept your insurance. Carmel describes it as the “Match.com” of therapy because you can use filters to specify what you’re looking for in a therapist. For example, the site’s search tool allows you to narrow your results to just see therapists who specialize in issues specific to people of color and the LGBTQ+ community.
If you don’t have insurance or can’t find a provider who is taking new patients, there are other resources that can serve as an effective stopgap. “Talkspace and BetterHelp are really good,” Cowan said. “I trust both of them. Their therapists go through a credentials process.” The downside is that they can get fairly pricey (and insurance typically doesn’t cover them), but Cowan recommended looking out for specials they may be running and reaching out directly about financial concerns. “They’re willing to work with clients on a case-by-case basis at times,” she said.
This is a difficult, uncertain time for both patients and therapists, but Cowan said it’s important to remember that it is temporary. And although it’s easy to focus on the negative aspects, try to put things in perspective. “We’re still able to connect,” Cowan said. “Ten or 15 years ago we might have been away from each other for a really long time, so at least we have a way to continue therapy.”
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