Is the Future of Therapy Online?
Therapists have found Zoom sessions easier than they had expected, for them and their clients
Some are considering cancelling consulting room contracts to work from home online
In person and online therapists can be found on welldoing.org – start your search here
Online therapy is with us to stay, even when the Covid pandemic is over. Where once there was genuine scepticism about its efficacy, the past four months of Zooming has convinced the majority of therapists that it is a workable alternative to in-person sessions.
But, at the same time, a minority crave a return to their consulting rooms, as do many clients. How that will work, when coronavirus infection still involves such high risks, is now evolving, according to a survey of therapists by welldoing.org., distributed through our therapist newsletter and Facebook group.
What therapists have discovered since lockdown: therapy results
95% of those who responded to the survey had worked through the lockdown period, with 92% of them offering video sessions. More than half of the therapists surveyed had never done online sessions before.
However, only 4% of them actually found it difficult; 45% said that online therapy was “better than they had expected”, and another 38% found it “acceptable”.
Therapists believed their clients were slightly less enthusiastic – estimating that 17% found online sessions more difficult – though most had accepted it as comparable to in-person.
24% of those surveyed are currently seeing clients in person; 35% are seriously considering returning to in-person work. The remainder want to stay online, at least until they assess the risk of infection has lowered significantly, though a large number of that group intend to stick with online.
Looking to the future, the changes to therapy that were identified by therapists are:
- more therapists offering online work
- more online clients coming from outside their neighbourhood
- more clients seeking private therapy
- fewer therapists continuing to pay for consulting rooms
Many clients like seeing their therapists from home
London therapist David Weale, a member of the BACP and UKCP, was already quite positive about online, before the lockdown. Last year he had taken part in a trial programme for the gay charity London Friend and seeing six clients whom he never met in person over that period had shown him that many clients were disinhibited by being in their own homes. “I was quite sceptical before I started, but it really worked, as it has in these past months.
“Clients appear to like the idea of being at home when they meet you, and it speeds up where they are prepared to go in the session, especially about quite intimate things. I think being together might take longer to achieve that intimacy. I wouldn’t have predicted that.”
Technology gives flexibility
When the lockdown first came psychodynamic psychotherapist Simone Gold was worried that “my practice would disintegrate before my eyes. But in reality, you can do it all online, and everyone has stayed who was already with me. But what they want has changed. Some want fortnightly, or every now and then. With the freedom of technology I am able to be much more flexible. I can take on new people knowing I will find space for them; I’m not so limited by my slots. And I can see people who are not in the vicinity.” A North London therapist, she has now taken on a client in Oxford, for example.
There have been occasional technical problems, but says Gold, it was far easier than she had imagined. Having viewed her old counselling room – now set up with wall-mounted hand sanitiser, marking tape on the floor, and even optional plastic sheeting dividing the consulting room – she is unsure if she will return. “It is not how I want to greet my clients. It’s prompted me to think about working at home and doing a lot more online. Something I had never dreamed of until now.”
EMDR works well remotely
Some therapists have known for many years that Zoom sessions worked well for them. Mark Brayne lives in North Norfolk and is an EMDR specialist whose clients live all over the world. As a former BBC correspondent, he was well up to speed on the technology, and he’s been thrilled to see others rise to the challenge so quickly. A webinar he pulled together with an American colleague in the early days of lockdown attracted 500 live Zoom watchers and has been seen by thousands on Youtube.
“I discovered early on that EMDR works very well for remote learning. I’ve been banging on about it for years. The differences between in-person and online are insignificant, the eye contact and the brain recalibrate.”
He also believes there is “an intimacy and safety — clients drop into their material more readily. I think EMDR lends itself particularly well to online. It’s not a better way, it’s at least as good; I think it’s certainly the future of therapy. Top quality therapy from anywhere. Ethically, it’s much less compromised.”
Brayne has now shut down his three-day a week London practice as he can do sessions without ever leaving North Norfolk, and every one of his clients whom he had been seeing in person has made the transition. Many other therapists find the idea of not paying rent, and not commuting to an office, very attractive.
Some want to see their therapist in-person, but many don’t
Among the respondents who have started seeing clients in person is Gestalt psychotherapist Claire Asherson Bartram who has a practice in Highgate, North London. Three weeks into her return to in-person work, she is cautiously optimistic. “For me, it’s nice to see people properly. I’m seeing those who would prefer to see me in person. But only those who are happy about it. The others are still on Zoom.”
The Zoom months were much better than she had anticipated, tech fails notwithstanding. “And in some cases they were even better. It’s really good for working with couples. By seeing them together, from another place altogether, I found I could see their relationship very easily.”
More enthusiastic about the return to in-person was another London therapist who doesn’t want to be identified, as she believes that wanting to see clients in person is rather frowned upon in therapy circles. “I’ve given it a lot of thought and discussed with my supervisor and clients and for those that want to, it feels right. I have written an additional contract for clients, checked with my insurance company and the BACP - who were rather on the fence, and a little unhelpful in my opinion. I think it is right to go back where we can and if we as practitioners want to.”
Unrealistic to expect all therapists to adjust
This therapist pointed out that practitioners like her had lost clients, some who didn’t like online, others who could no longer afford it. Her flat is unsuited to Zoom: “It caused me stress thinking clients might hear banging and screaming children, so part of my decision is for my mental health, and to look more professional.
“Also I have found a new room in my community and I get to see humans! I live alone so this is also part of my decision-making. And I believe I had the virus in March; I am still being careful, but I don’t want to Iive in fear.”
While most of the therapists surveyed felt their associations had supported and advised their members well this therapist felt that BACP was less than optimal. “They seemed to assume if online doesn’t work for clients we can all afford to just sit back and not see clients and therefore not earn any money. This is a very privileged viewpoint and unrealistic for most of us.”
Walking therapy was not stopped by lockdown
Jan Merrills never stopped seeing some of her clients in person by doing walking and talking therapy in the countryside where she lives. “There is the advantage of being in nature, but also in the moment. They don’t feel exposed; nobody knows what you are talking about, and if we come to something difficult and people are around, then we wait until we are in a quieter place. We stay socially distanced, of course, but it’s so nice to be not stuck in a room.”
An integrative therapist and BACP member, Merrills has been doing online therapy for the past 18 years (she started when she was living in Bali, treating ex-pats) and is in no doubt how valuable it can be. “I do have some face-to-face clients, because that’s what they want. But I’ve been mostly online for years.”
The results from from our therapists’ survey clearly showed that Zoom is here to stay, but there is still a market for in-person therapy, certainly as far as many clients are concerned. While the demand for therapists slowed on the welldoing.org site during the early months of the pandemic, it is now returning to previous levels and above. And many of those looking for help are specifically asking “Are you seeing clients in person yet?”