Jeremy Tomlinson  M.Ed., R.M.F.T., R.S.W., EMDRIA Certified

Individual, Couple and Family Therapy, Sex Therapy, EMDR

So You have Questions about Online Counselling?

©Jeremy Tomlinson, M.Ed., R.M.F.T., R.S.W., EMDRIA Certified

Very suddenly so much shifted for us culturally. Most of us have encountered uncertainty, discomfort, strong emotion. There are different day-to-day challenges and tensions: both if all household members are sharing a space 24/7, or for people who live alone, the isolation of so much time alone. For essential workers, there are concerns about exposure to the virus and access to protective equipment, as well as concerns for their own family members when returning home and how to manage that. Many of us feel uncertainty about the future related to work, school or employment.

In these times, responding quickly to change to maintain both our physical and mental health is important. Until a few weeks ago, the vast majority of psychotherapists chose to meet only face-to-face with clients. But with social distancing we rapidly shifted our practices to accommodate telephone and videoconferences.

Here are some things to consider as you reflect about whether Online Therapy is right for you.

Concern about a Lack of Connection

Client J.: "When I meet in person with my psychotherapist, I feel his presence. There is almost an energy in the room that helps me to have the difficult conversation."

Client M: "My therapist seems to notice nuance when I am in her office. She'll comment about my facial expression or notice a shift in my body. I can't see how that would work by videoconference."

These were also some of my own biggest concerns as a therapist when I switched to videoconference sessions. It's okay to feel skeptical in fact that's how I felt too when I first launched into this approach. But I realized right away that there can be a very strong therapeutic connection and that we can do very similar therapeutic work including noticing subtle shifts in a client's response.

Ideally your therapist is doing a variety of things during your therapy session:

  1. Listening to your story/situation/problem and providing support, compassion and empathy.
  2. Assessing throughout the meeting how they can be helpful to you.
  3. Providing grounding and safety to be able to confront difficult issues. Often that feels like a particular energetic presence.
  4. Looking for what's behind the words what emotion, what body sensation, what history of trauma or history of success can help, or is getting in the way, of you moving forward.
  5. What one of my non-therapist friends calls my capacity to read other people. We therapists tend to notice subtle changes in facial expression, tone of voice, body language and we're curious about whether those may be clues to what's getting in the way, or what can facilitate moving forward.

Does that feel different by videoconference? Likely, yes.

Can it still happen by videoconference? Absolutely. It's up to the therapist to adapt and find new ways to engage with the client.

Can I still feel that sense of energy through a computer screen? It has surprised me as I shifted my practice how strong that energetic connection can be virtually.

How do I know if a particular therapist is right for me?

How you will assess this for yourself for videoconference to phone counselling, will be similar to how you assess if the person is the right therapist to meet in person. For more about this see How do I know I'm seeing the right psychotherapist.

By videoconference you should assess whether:
  • you can sense the therapist's presence and attention
  • the therapist is noticing you enough your emotion, your discomfort and your success
  • you feel supported

One other factor to consider is the location of the therapist. Each jurisdiction may have different legal or ethical guidelines around the provision of psychotherapy. If the online therapist does not live in your province or region, you may want to check if/how they are professionally regulated to ensure ethical care.

How Do I Know the Technology Used by my Psychotherapist is Safe/Secure?

Each jurisdiction will have guidelines on which videoconference platforms are acceptable for psychotherapy and that may differ from province to province in Canada, and may differ again in other countries outside Canada. The information seems to change day to day about these platforms. Some of these platforms have been designed specifically for use by psychotherapists or medical professionals with issues of privacy in mind.

  • Ask if the videoconference platform meets those standards of security and safety.
  • Ask whether your confidentiality will be maintained by the platform so you ensure the privacy of your healthcare.
  • Ask whether the platform keeps any of your personal information after the meeting.

The platforms you use to chat with your friends and family will not have the same security measures as these do. Your therapist should not be using one that you regularly use to chat with your loved ones.

On the other hand, don't be concerned you will not be able to join a meeting. The psychotherapist will provide access to a meeting in an accessible format.

The platforms used for these purposes tend to be quite user-friendly. Even if you don't have much experience (or confidence with) new technology, the platform will likely be easy to use. Ask the psychotherapist about this.

If you are uncertain, the psychotherapist can phone you at the start of the meeting to help you as you set up the first time.

Virtual EMDR Therapy

Many of my clients meet with me for EMDR Therapy . It's an approach that is helpful to manage traumatic experiences or other upsetting experiences that are lingering in the body, or when anxiety is troubling. The therapist helps the client to process the difficult memories using eye movements or ear tones. As well, we use EMDR Therapy to increase strength and resilience. All of that can happen, and happen well, through videoconference.

When looking for an EMDR therapist to do virtual work, make sure
  • you feel safe and comfortable doing difficult therapeutic work with them. Trust your intuitive responses, ask them questions to reassure yourself if you have doubts.
  • that they do a thorough process of preparation and history-taking before beginning any processing. This should take 3 to 5 sessions (or maybe more).
  • that during those initial few sessions the therapist has helped you develop strategies for self-care, and also resources to use should you feel upset between sessions

EMDRIA, the EMDR International Association, recently released guidelines for virtual therapy . They hastened the release of the document to address our shift to virtual work during the outbreak. The upshot is that the organization feels that while in general it is preferable to do EMDR therapy in person, that under certain circumstances it is acceptable to provide the therapy virtually. They emphasize the importance of the EMDR therapist being especially mindful of creating a safe infrastructure to do the work and to monitor grounding and self-care even more robustly when working virtually.

As well, EMDR therapists will make decisions on a case-by-case basis how to use the approach, especially with new clients we have not before met in person. Our intention in the work is likely to be different: to help our new clients to manage their current response (including triggers) and how that it is being influenced by their histories. In many cases, we won't use the full protocols because we want to manage what is upsetting in the here-and-now. But we will be flexible, and use our assessment skills to figure out what we think is the best way to help. Your role will be to just be as open and honest as you can be under the strange circumstances.

Phone Versus Video

There are a few reasons you may prefer phone counselling rather than videocounselling:
  • Being watched on a screen may feel intrusive.
  • Seeing your own image on screen may feel difficult.
  • You may have a difficult issue to discuss and you are concerned about feeling judged or ashamed, and working just by voice may make that issue easier to speak about.
  • You may be a person who gets distracted when too much is going on, so working just by voice may reduce the amount of stimulation.

While working by phone, the therapist will not have all the same cues to assess your situation, he/she will tune in differently to your voice tone, breathing, pace of speech and so on. In the absence of visual cues, the therapist will ask questions differently to understand how you are feeling.

For you to decide

For now therapists can't provide face to face support.
  • Would you benefit from support and therapeutic listening during the crisis?
  • Have feelings or memories been activated over the past weeks due to how you have been feeling during the crisis? (This is common. Some of our usual ways of keeping those things tucked away tend to be harder to access in times of crisis.)
  • Are you noticing difficulties in your family and relationships more acutely while you are living in close quarters as we socially distance?
  • Are you living alone, feeling uncomfortable with a lack of social contact?
  • Do you have time and space to work on historical issues?

Virtual therapy may be what helps.

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Jeremy Tomlinson, M.Ed., RSW is a therapist in Toronto. He specializes in EMDR therapy, couple therapy and sex therapy. Many of his clients are survivors of childhood sexual abuse or have experienced attachment issues in childhood, are survivors of adult sexual assault, or are living with symptoms of depression or anxiety. He currently has a virtual practice in a home office while social distancing.

To read more about professional guidelines for virtual EMDR Therapy:

The Canadian Association for Marriage and Family Therapy
EMDR International Association - EMDRIA
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