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Online psychotherapy in a time of crisis

Online psychotherapy has become trendy over the past few months. The majority of states declared a lock-down. Bulgaria made no exception. Most psychologists in the country switched to online counseling in order to assist in the fight against the corona-virus spread. Online psychotherapy has previously been applied mainly to clients from remote locations or expats, but recent developments have turned it into a standard treatment option for all. Of course, this situation provoked both positive and negative reactions. And since a lot has been written on the subject in cyberspace, I want to share some first-hand practical conclusions.

Online psychotherapy – benefits

As a proponent of face-to-face counseling, it will be biased to neglect the advantages of online psychotherapy, especially for clients who already have some experience with standard psychotherapy. Here are some of the benefits we discovered.

Online psychotherapy saves time. 

When we use Skype video call service, the session starts almost immediately after receiving the call. Settling in, exchanging niceties, preparing a notebook and a pen – all those become unnecessary. The client has already prepared for the talk. The same goes for the end of the session.

The home environment strengthens the relationship between the client and the therapist.

Working from home means showing at least some degree of individuality. Although therapists are very careful about what we reveal about ourselves, we do not always remain a “blank sheet”. There is no problem in you learning that my living room is painted in a warm shade, that I grow aloe, or that you sometimes hear my cat meowing. Such details, caught by my computer’s camera and microphone, complement a simple human image. The same goes for you – I can learn things about you that you have not shared with me in the office.

Remaining in your comfort zone can stimulate revelation.

Talking about yourself from the comfort of your own home turned out to be of a great relief. Physical distance is especially beneficial for those, who are more defensive. They managed to reach new depths of self-knowledge from the safety of their homes. In most cases, it is exactly the change of the environment that provokes a change of perspective. However, it will not be fair to ignore the successes of those for whom self-disclosure was a huge challenge.

Many people feel ready to start psychotherapy when they know the experience is virtual.

Those unwilling to book an appointment because of all sorts of doubts, are more likely to sign up for online therapy. In this way, the lock-down has even helped those who would not otherwise go to offices to get the help they need.

The disadvantages of online psychotherapy

Nothing is ever black or white. Despite its benefits, online psychotherapy also has numerous shortcomings.

Video sessions limit the possibilities for behavioral experiments.

As a cognitive-behavioral therapist, I can say the biggest disadvantage of online psychotherapy for my clients is that they cannot fully benefit from the here-and-now experiences. A number of diagnoses require us to leave the office to test and modify reactions to various stimuli. For instance, I would not allow myself to induce a panic attack in a client with panic disorder when all I see is their face on the screen. What if the connection fails at the peak of anxiety?

Virtual therapy allows for less creativity.

Not every spontaneous idea that comes up during the conversation is applicable to video communication. Limiting the senses to hearing and vision (and to a limited extent on top of that) deprives us of full experiences. Not to mention that a number of standard techniques, such as progressive muscle relaxation, are difficult to implement virtually.

Digitization of therapeutic practice is not widespread.

Many of our forms, tests, and visual aids are physical objects – sheets of paper, maps, drawings, diagrams, etc. We typically use them jointly face-to-face. Younger clients who are accustomed to using technology find the transition to the digital world easier, but let’s face it – not everyone has this opportunity.

Lack of complete control over the physical space.

When we are at home and we are not alone, providing an hour of personal space can be a challenge. I had sessions where a family member came into my client’s room and we had to interrupt the conversation for a while. On another occasion, her dog barked so loudly that she had to get up to lock him in the other room. Such interruptions have a negative effect on the effectiveness of the session.

The state of emergency made us adapt to the needs of society. We continue to eliminate the inconveniences created in the course of our work in our strife to be as efficient as possible.

If you face difficulties in your routine and limited activities, know that you can talk to a specialist from home. Anxiety and depressive disorders are expected to be on the rise in the following few months, so you are not alone in your struggle. Stay healthy and patient!


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