Your First Online Therapy Session: Anticipating 5 Key Aspects of Your Experience

By Dr. Nia

In the time of coronavirus, we are all adjusting to many stressors: concern about our health and that of our loved ones, school or workplace closures,and financial worries, among others. Many people are experiencing understandable increases in anxiety, depression, and social isolation. Fortunately, online sessions (also known as teletherapy) are an option for staying connected while observing the guidelines around social distancing. Video or phone sessions can allow you to maintain the connection you have with your therapist or develop a new relationship if you are seeking therapy for the first time.  

1. Consent: Similar rules apply in online sessions as in the actual therapy room. The first is that you provide informed consent. This means you agree to treatment and participate willingly, you are aware of the risks/benefits, and you can withdraw from treatment at any time. Your therapist will obtain your consent and make sure to answer any questions you have. Also, your therapist will ask where you are located, since we can only practice in states where we are licensed. 

2. Confidentiality: Another rule is confidentiality, which means your therapist will keep what you share between you, with a few exceptions (child or elder abuse, danger to self/others, and court orders). On your end, it’s helpful to have a private area where you can speak freely. Using earbuds/headphones can improve privacy and sound quality. For added security during your sessions, turn off smart devices, like Alexa, that may be “listening” even when not in use. It can be helpful to let family and other folks know you have an appointment that requires your attention. Children and pets often require our attention so it’s okay if you need to step away. A private space is not always possible but perhaps an option like the family car can work. Rest assured that your therapist will problem-solve with you if you are having trouble finding a confidential space. In my previous work in community mental health, I had sessions with clients in nontraditional locations. This included places like parks, Starbucks, and in one last-minute bind with a hungry kiddo, a Burger King! Although not ideal, we are all having to be more flexible in these times, so try to offer yourself compassion and be creative, while upholding your own confidentiality. 

3. Space: The physical space in a therapy office often creates a feeling immediately when you walk in. Your therapist has likely put a lot of thought into things like furniture, lighting, and even artwork, in order to create a space that feels comfortable and inviting. The benefit of online sessions is you have control over creating this space for yourself. When considering what can help you to feel most at ease during an online therapy session, think about your 5 senses. Would you like a soft throw pillow on your lap or to have a warm drink? Maybe you’d like to light a candle with your favorite scent? Notice how your body feels in the space during the session and make adjustments based on what brings you a sense of calm. 

4. #Awkward: It’s okay to feel a bit apprehensive when doing online therapy for the first time. Normally, interacting in a video format is reserved for friends and family or for work. Online therapy can feel too personal or not personal enough at the same time. There may be times when there are long pauses or eye contact feels too intense. It’s normal to feel self-conscious about seeing yourself on-screen (this comes up a lot with teens). It can help to place a sticky note over your picture and focus on your therapist’s friendly face. You can experiment with different things to help you feel more comfortable, such as angles, distance, and lighting. You and your therapist will work together and gradually develop a rhythm for your online sessions. 

5. Technical difficulties: Despite all our best efforts, these will happen! And when they happen in therapy, they can be ill-timed and cause frustration. Remember to take deep breaths. These challenges are expected and no one is to blame. Closing down other programs on your laptop or phone can help improve your internet connection. As a last resort, you and your therapist may decide to have a phone session. Together, you and your therapist can navigate these difficulties and have an ongoing conversation about how they impact your therapeutic relationship. 

Therapy reflections: 

1. If this is your first time in therapy, how do you think an online session might be different from in person? What worries or concerns do you have? 

2. If you previously met with your therapist in person, what did you like about the physical space? Is there anything you’d change? 

3. What challenges do you foresee in your online therapy process and how can you plan ahead to work through them?

4. What tools can you use in your own space to create a sense of safety and comfort? 

I hope these tips help you feel more prepared for your video or phone sessions.