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  • Writer's picturehanna basel

How does online therapy work?

Updated: Feb 23, 2023

Many aspects of our professional and personal lives have moved to online platforms during recent months. So too has mental health support. For some of us, meeting a therapist online will feel like a seamless transition and for others, this new experience can be a big adjustment.

Maybe you are asking yourself . . .

Will it feel like just another online meeting? Will I be able to open up? Do I need to deal with downloading even more applications? How do I know if this technology will work? I don’t have a laptop; will it work on my phone? I don’t like looking at myself on the screen; will I be able to adjust the view?

Different variations of these questions and worries can really take up a lot of your attention, which is understandable. Here are a few tips on what you might expect and how you can prepare for your first online therapy session:

Get connected and comfortable

Online therapy means you don’t have to travel or sit in a waiting room before your session. You can literally have your online session anywhere as long as there is an internet connection and privacy. 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. You will need to have a cellphone, tablet or computer and access to the internet. I also recommend finding a quiet, private place that allows you to speak freely without distractions. Lastly, it’s a good idea to have a notebook ready to jot down any notes from your session. Now, get comfortable on your favorite chair with a coffee, tea, or beverage of choice, you are ready to go.

Getting logistics out of the way

During the first session, your therapist will address all those practical topics like consent forms, privacy and confidentiality, scheduling and fees and payment. If you and your therapist haven’t set a regularly scheduled time yet, you likely will in your first session. Many therapists suggest having a regularly scheduled weekly appointment so that the same day and time every week you know you have an hour reserved just for yourself and your growth.

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.

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 or a local park can work. Rest assured that your therapist will problem-solve with you if you are having trouble finding a confidential space. 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.

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.

Getting to know each other

You’ll most likely spend the first part of your therapy session just getting to know one another. Your relationship with your therapist is just like any other—it helps if you’re able to connect with one another on a personal level. You don’t have to leap into your deepest darkest secrets immediately—feel free to talk casually at first to get a sense of how the two of you will communicate with one another. Keep in mind that honesty is paramount to successful therapy. In order for your therapist to help, they need to know what you’re experiencing. Therapists aren’t there to judge you. They chose their profession so they can help people improve mental health and wellbeing—not to make things worse.

Question time

Your therapist doesn’t know much about you yet; therefore, they will likely ask you many questions as they start to understand you and what you’re experiencing. Your therapist will need to know why you’re seeking therapy. They may ask what kinds of needs or issues you’d like to address in your treatment together as well as what you’ve done to manage past relationship struggles. They’ll want to talk through what worked and what didn’t to get an understanding of how best to help you. Depending on the therapist and their approach to therapy, you might be asked questions about your c

hildhood, education, job, relationships, thoughts, feelings, or actions. All your responses help your therapist understand you and know how best to help you.

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. 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.

Managing your expectations

Your initial session is often more helpful to your therapist than it is to you. For this and other reasons, your first session can be somewhat disappointing or frustrating if you don’t know what to expect. It’s important to have realistic expectations for the therapeutic process in general and the first session specifically. Therapy isn’t a quick-fix. Quite likely, you won’t discover solutions at your first session because relationships are complex. Just as it takes time for problems to develop and begin interfering in your life, it takes time to work through and unravel those challenges.

It is unlikely that you emerge from session one feeling transformed. It is, however, realistic to expect that after your first meeting you will feel a sense of hope that, in time and with work, therapy will help you create the change you are looking for. The first session is just the beginning of what can be a rewarding journey. With preparation and realistic expectations, you and your therapist can start to develop rapport, trust, and an important sense of hope for healing.

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