What happens in therapy? – PART 2

Lucy Hyde on 30 May 2022

How does counselling promote change?

Earlier in the year I published ‘How does therapy work? – Part 1’, which talked about the practicalities of what to expect when you start counselling for the first time.

But that question – ‘How does therapy work?’ – can be answered in another way.

What is it that makes talking therapy an effective resource for helping you feel better?

What processes are at work there?

“Can I fix this problem in me?”

Many clients come to counselling, believing that if they could just understand WHY they feel so depressed, or anxious, or stressed, or angry, they would be able to do something about it. It seems like a no-brainer, right? It seems such a logical process:

5 self reflection Lucy Hyde online counsellor (image Ben White on unsplash) — Image by Ben White on Unsplash

Something’s broken
It needs fixing
If I figure out what it is I can fix it
Then it won’t be broken anymore

We can expend a lot of energy in the trying-to-fix, and often exhaust ourselves with thinking round and round a problem before we even get to point of finding a counsellor, eventually deciding we need an expert who’ll be better at fixing or figuring-out, to help us with the WHY.

But that’s NOT how therapy helps.

More understanding about ‘root causes’ CAN be helpful – but only if it encourages you to take a more compassionate attitude to yourself. In terms of ‘fixing the problem’……….

It might be that the reason for the depression, anxiety or stress is something that happened to you – and you can’t go back and change that
It might be that we’ll never know exactly why you have symptoms of anxiety or feel so angry – because you can’t remember everything that’s ever happened to you in life

repair tools in container with hammer and screwdriver — Photo by Anete Lusina on Pexels.com

If therapy isn’t about fixing problems – what IS it?

The way I see it – it’s all about the relationship.

The relationship you have with others.
The relationship you have with yourself.

The truth appears to be that many human struggles, from phobias to obesity, are consequences of evolution and not deficiencies of character. Identifying problems that we hold in common and developing methods to circumvent or correct them is a solid foundation upon which to build a therapeutic alliance.
Cozolino, 2002

What is the therapeutic relationship?

Asay and Lambert (1999) researched the factors that influenced the effectiveness of therapy. They found that the biggest contributor towards how well someone responded to therapy is ‘client variables and extratherapeutic events’ – i.e. what other shit is going on in your life, what supports you have around you, and how motivated you are to do the necessary work in order to make changes in your life.

The second biggest contribution – 30% – is the therapeutic relationship: the relationship that the client and the therapist form as they work together. This is why it’s important to find someone you feel comfortable – or comfortable enough – to talk to. You need to be able to trust your therapist. You need to feel safe in order to be able to explore those feelings.

Lucy Hyde counsellor talking helps — Image by Mabel Amber on Pixabay

I think of therapeutic work as being about GROWTH (I want more of myself) and RECOVERY (I want to feel less wounded by what happened to me).

Both growth and recovery need to be nourished in an environment that feels safe enough, as the client will at times be feeling very vulnerable and exposed as they reveal their innermost hopes and hurts. The therapist won’t laugh at, or criticise, these tender, vulnerable parts – and for some clients, that experience of compassionate, loving attention may never have occurred before. Seen in this light, the therapeutic relationship really is healing.

Making changes

Another important aspect is CHANGE – which is presumably what you, as a client, are looking for. If you’re content with things staying just as they are, you’re probably not going to look for a counsellor. So, there’s something you want to change, whether it’s changing an aspect of your life situation, or changing the way in which you feel about something or somebody (including yourself). Both involve you needing to do something different in terms of your behaviour – from changing the way that you talk to yourself, to taking steps to change how you live your life.

Lots of research has demonstrated that changes take place within the brain during the therapy process. Although the most significant change and learning takes place during the first seven years of life, the brain continues to change and adapt throughout our lives, as we do new and different things. This is what’s meant by neuroplasticity.

When we encounter new situations or experiences (for example, the experience of believing that another person – the therapist – really wholeheartedly accepts us just as we are), we develop new neural networks. These networks get stronger each time we repeat the same experience – it’s a bit like walking over the same route repeatedly. A path gets clearer as we use it more, and the old path, as it gets less used, gets overgrown.

Lucy Hyde counselling outdoors East Lothian

The most recent research has demonstrated that brains have evolved socially – i.e. that the brains have evolved to connect with other brains, which explains why we can be influenced by the feelings of others. When people feel something we feel it too, by the brain creating an internal model of the other. So the therapist can influence the brain of the client by modelling and attunement; I’ll say more about this later.

There’s a great clip by Louis Cozolino talking about this here:

Within the relationship between therapist and client, a number of different experiences may take place, that support you, as the client, in making changes. These include:

having a neutral space with someone who has no connection to your life situation
hearing yourself say things out loud for the first time (and having them offered back to you)
being in a relationship with someone who accepts the whole of you just as you are
making sense of your thoughts, feelings and behaviours and where they may have come from
learning and practising ways to change your relationship with yourself
finding resources to improve your wellbeing
bringing your attention to how you and the counsellor relate to each other (helping you choose a different way of responding in relationships with others)
being able to experience strong emotions and still be OK
subconscious-level experiences, such as getting your emotional needs met

Let’s look at each of these in more detail.

Opening up to someone neutral

“This is the first place I’ve had where it felt OK to say how I really feel.” That’s what Mandy*, who’d got in touch because of overwhelming social anxiety, said to me at the end of her first session. And many, many clients say a similar thing when I ask them how it’s been – that first occasion of speaking to someone, where you don’t worry about the impact of what you say on them, is so DIFFERENT.

Sometimes, you might not even realise how much you self-check or monitor when you’re talking to family and friends (no matter how much you trust them). You worry that if you really tell them how much it hurts, or how lost you feel, they’ll be frightened, or worry about you, or feel that they have to do something to make it better. The relationship between counsellor-me and client-you is different from ALL of those, and that means that you actually get to air those thoughts and feelings that generally just keep buzzing around inside your head, and……..

Listening to your inner child — Image by Paolo Stefanelli

Saying things out loud for the first time – and hearing them

The experience of hearing your words reflected back when you share your thoughts and feelings can be very powerful. Speaking out lets that part of you that feels stressed, or angry, or ashamed, know that it’s OK to share that; and to have that received with empathy and understanding reinforces that sense.

Even if it’s not the first time you’ve spoken to someone about what’s going on for you, often people’s responses are something along the lines of ‘oh, yes, that happens to me too, isn’t it awful’ or focused on figuring out how to fix your problem, both of which don’t really make space for your feelings. When I offer your words back to you, you know that you really have my full attention, and that it’s important to me that I really hear and understand just how it is for you.

Being accepted just as you are

You’ve probably come to therapy because you want to change something about your life or about yourself; you might think there’s something ‘wrong’ with you. But although I’ll talk about what you want to be different in your life, my starting point is that you are an OK human being just as you are, right now.

That doesn’t mean that I won’t be able to see that some behaviours or thoughts you have may be unhelpful, or hindering you, but I believe your core, your fundamental being, is right.

Making sense of thoughts, feelings and behaviours

Probably, as we talk, we’ll discover that those behaviours and thoughts and feelings mentioned above, are actually a pretty logical and normal response to your experiences in your family, in your life, and in a society, culture and world, that is frequently dysfunctional and restrictive of natural human growth. You might be reading this and thinking “but nothing bad happened in my childhood”, because a frequent narrative is that unless you’ve experienced ‘capital-T-trauma’ you should be a fully-functioning confident adult.

However, there are many aspects of 21^st century life that discourage us from following natural healthy tendencies. These include:

excessive exposure to other people’s lives via social media, encouraging us to make unhealthy comparisons;
product marketing that is designed to play on our insecurities, promoting a sense of not being ‘enough’;
political and social attitudes that put increased emphasis on the individual rather than recognising collective, community responsibilities for each other; and
disconnect between a philosophy that economic growth is appropriate or desirable, versus the real existential threat to life – via the climate crisis and unequal access to resources – that such a philosophy promotes.

Emotional distress is a natural response to living in today’s world, no matter what your individual history is.

big waves under cloudy sky — Photo by GEORGE DESIPRIS on Pexels.com

Getting a better understanding of the links between how you feel and the context of your life, while it doesn’t ‘fix the problem’ in itself, can help you be more accepting of your emotional experience. It can also help you recognise those areas that are outwith your control, and those areas that you can do something about, so that you can choose where to focus your energy to make changes.

Developing a better relationship with yourself

The experience of me accepting you just as you are, right now, combined with greater understanding of why you have the emotional experiences that you do, are really powerful in supporting you to shift from a self-critical to a self-accepting attitude.

In addition, I’ll often point out the language that you use in talking about your thoughts, feelings or behaviours. Language can reveal a punitive attitude to yourself that you may not have realised you had; a common example is using the word ‘should’ – “I should be doing such-and-such” which implies that you are failing if you’re not doing this.

Noticing this, and making small changes subtly shifts your attitude towards yourself – in this example, replacing ‘should’ with ‘could’ is softer, more permission-giving, less judgmental. The language that we use in relationships is powerful, and that applies in your relationship with yourself too.

I’m interested in ALL the thoughts and feelings that you have, even – in fact, especially – ones that seem contradictory, inappropriate or unattractive, and I’ll encourage these different aspects of you to get an equal say, possibly in contrast with your previous tendency to squash them down or ignore them. As I do this, I’ll support you to make space for these parts yourself – which usually leads to you realising that they’re not as scary or unpleasant as you thought they were, and you’ll discover that you can develop a compassionate attitude towards them.

Finding resources to help your wellbeing

There are two aspects to this, as one place you’ll find resources is within yourself. There’s a good chance that, when you’re finding things difficult, there are tools that you already know help you. In fact, one of the solutions to helping you feel better, can be to do more of what you’re already doing, or to remind yourself of things that have helped in the past that you’ve stopped.

You might say to me “but I’ve been doing my yoga / getting out for walks / going to bed early so I should feel OK” – yet sometimes our need for what resources us is greater than at others, and recognising that can be helpful.

The other aspect is looking for new resources. I’ll encourage you to come up with your own ideas, sometimes by us exploring together what already helps or hinders you in feeling well, and developing further ideas from this. I might also make suggestions based on my experience of what other people have found helpful.

I’ll ask you to focus on the smallest possible next step you can take, because building things up gradually is more manageable. The experience of successfully making a small change is more motivational and encouraging of hope, than trying and failing to make a big one!

How can I change my habits? - phone counselling

Understanding your patterns of relating

You and I can learn a lot about the way you are in relationships, by noticing what happens in our relationship – we’ve got really valuable information playing out in real time in sessions. For example, when I first started working with Mahmood* he would sometimes take a long time to answer questions that I put to him, and I could see that he was thinking hard before he replied. After a few sessions, we reviewed the work together and I discovered that at these times he was working hard to try and guess the ‘right answer’ to my question – his focus was on giving me what he imagined I wanted. This was relevant for his process in relationships generally, where he found it difficult to pay attention to his own needs as he was so concentrated on keeping the other person happy.

Discovering this meant that when I saw this happening, I could bring his attention to it and we could notice what his internal experience was in those moments, paying attention to the part of him that felt it had to keep the other person happy, and checking out what it needed. Mahmood was also able to experiment with not giving me the right answer, or with telling me when my questions didn’t make sense or feel relevant, noticing what feelings this triggered and how he could learn to tolerate them. The therapy session can be a safe enough space to try a different response, before taking that different behaviour into the outside world.

Developing resilience and recovery

Often clients say to me at the start of our work together that they want to get rid of a feeling – of anxiety, or anger, for example. I’m clear that I won’t help someone to ‘get rid’ of any aspect of themselves – it doesn’t fit with my philosophy of the whole of that person being OK. As mentioned earlier, feelings are a response to a situation, a response that has been a natural, logical step for some aspect of that person at some time in the past, even if with their grown adult perspective it may not seem helpful now.

Your way of dealing with an uncomfortable or overwhelming feeling might have been to try and ‘not feel’ it, to suppress it, ignore it, or distract yourself from it in some way – through over-eating, perhaps, or through getting very very busy doing things. In therapy we do something different – I welcome the feeling, and hold a safe space for you to gently turn towards it.

I’m there to pace you, to encourage you to pause when it feels like it’s too much, to help you get some distance between you and the feeling so that you’re able to experience it as part of you rather than feeling consumed by it. Almost always, you’ll find that you’re more able to tolerate these strong feelings than you realised.

walk and talk therapy (georg-arthur-pflueger-unsplash) — Image by Georg Arthur Pflueger on Unsplash

And crucially, by giving the parts of you, that are anxious or angry or stressed, some time and attention, they will usually settle down and be less demanding. I use the analogy of a small child screaming with distress – you could shut her in a cupboard, but she’s going to carry on crying, whereas if you sit her on your knee and ask what’s going on she’ll begin to calm down.

Getting your emotional needs met

Sometimes the most profound and important work that happens in our relationship together is the hardest to see and articulate, that we may not talk about explicitly in sessions. This takes the form of interpersonal (between you and I) and intrapsychic (within your mind) growth and development.

As we work together, I influence your brain through modelling, where I demonstrate a way of being that may be different from other significant caregivers in your life. Modelling is much more powerful than verbal instruction – ‘Do as I do’ is hugely more influential than ‘Do as I say’!

I’ll also be influencing your brain through attunement, which is where I allow myself to resonate with your emotional experience, genuinely listening and caring about what is going on in your inner world. Attunement is fundamental for children to develop their ability to securely attach to others, but sometimes we don’t get enough of this when we’re little. The therapy relationship is ‘reparative’ – repairing the deficit. As we work together we create the optimum conditions for your inner growth and development, supporting you to be more able to meet your emotional needs – both in your responses to yourself, and in your ability to voice your needs to other people.

This is one of the seemingly ‘magical’ effects of therapy, that you can start to feel better, to learn to like yourself, by the experience of being in a relationship with someone that is reparative and healing of your previous wounds.

Talking it out Lucy Hyde online counsellor (taylor hernandez on unsplash) — Image Taylor Hernandez on Unsplash

All of the above experiences happen over and over again during the counselling relationship. There may be some moments where it feels like a lightbulb goes off in your head, and something big changes, but more often, in my experience, the process of therapy is one of re-learning or adjusting your way of being.

It’s not a straightforward linear process where you steadily feel more and more like the person you want to be. Shit will still happen and you’ll sometimes be triggered by it and react exactly like you did before you started counselling. The difference is you’ll be more familiar with, and understanding of, those reactions and can use your new learning to recover more quickly from those experiences.

Effective psychotherapy or counselling is a transformation that therapist and client facilitate together by allowing ourselves to really connect to each other in relationship. It’s mutual work – not something ‘done’ to the client by the therapist, but something that is built together. Like any work, it can sometimes be hard, or a trudge, but it’s sometimes fun and enjoyable! Importantly, to be able to work together to create something, client and therapist need to be able to establish a good-enough, safe, trusting relationship where both can be vulnerable to being impacted by the other.

Psychotherapy is not a modern intervention, but a relationship-based learning environment grounded in the history of our social brains.
Cozolino, 2016

If reading this has been helpful, you might also want to check out ‘What happens in therapy – Part 1’ where I talk about the practicalities of what’s involved from that very initial contact.

And if you think I’m someone who you’d like to try and build that therapeutic, growthful relationship with, please g et in touch.

* not clients’ real names

References and further information

The empirical case for the common factors in therapy by Asay & Lambert

The Neuroscience of Psychotherapy by Louis Cozolino

Why Therapy Works by Louis Cozolino

There are various interesting articles and short videos by Dr Cozolino at drloucozolino

Counselling and neuroscience

Strengthening neural connections through meditation

What happens in therapy

What is attunement?

What happens in therapy? – PART 1

Lucy Hyde on 16 March 2022

The practicalities of counselling

I decided to write this blog for anyone who’s wanting to get an idea of what to expect if they start counselling.

The questions ‘What happens in counselling?’ or ‘How does therapy work?’ can be answered in different ways so I’ve split this blog into 2 parts.

Part 1 looks at the practicalities of starting therapy, and what happens at a conscious level, including the sorts of questions I might ask, setting goals, boundaries, and the control you, as client, have over the direction we go in.
Part 2 speaks more of what it is that makes talking therapy a useful contribution to helping people to ‘feel better’, touching on the neurology behind psychological healing – the unconscious stuff that’s going on while – and after – therapist and client talk.

I’m writing from my own perspective – i.e. about what’s likely to happen if you and I work together. While much of what I say will hold true for many other psychotherapists and counsellors, there will be variations in the way we work.

lucy hyde online therapy (image eileen-pan-unsplash) — *Image: Eileen Pan on Unsplash*

What happens in therapy – Part 1: The Practicalities

So………you’re thinking you might find it helpful to see a counsellor. Or someone’s suggested to you that it might help. Or perhaps they’ve told you that ‘being in therapy’ has helped them. What happens when you take the next step, and get in touch?

Initial contact with the therapist

When you contact me, sometimes I won’t have space to start working with you straight away. If so, I’ll ask if you want to go on my waiting list, and I’ll usually suggest some colleagues who may have availability.

Sometimes by the time I get in touch to offer someone on my waiting list a space, they’ve found someone else, which is absolutely fine and to be expected. At this stage, I don’t usually ask you for information other than contact details, until I know we’re going to start working together.

That’s not because I’m not interested in you – it’s because a) I don’t want to hold unnecessary personal information about you unless we actually start a relationship, and b) your situation may have changed by the time I have a place, so the information I gathered is out of date anyway.

Even a brief email exchange agreeing the above should give you a bit of a feel for what I’m like, and at least a hunch as to whether you want to work with me. Forming a working relationship is really important in therapy (more on that in Part 2). If, for some reason, I get on your nerves, it doesn’t have to mean we can’t work together – but no matter how good the counsellor is, sometimes there’ll be personality clashes.

Trust your instincts UNLESS you reach the point where you simply think you will never find the ‘right’ therapist – it may be that something in you doesn’t want to! In which case, try someone – or a few people – who feel ‘good enough’, to get started.

We’ve agreed to start working together – what now?

The dreaded paperwork! I ask people to complete a brief assessment form to check I’ve the experience and skills required, and – if we’re going to be working online – that I believe online therapy is appropriate.

Lucy Hyde online counselling (image shayna-douglas-unsplash) — *Image: Shayna Douglas on Unsplash*

I usually offer a chat over the phone at this stage – sometimes that’s the easiest way for us to compare diaries and find a time that works for both of us, and I can take some assessment notes at the same time, which some people prefer to the form-filling.

We’ll also talk about HOW we’re going to work together. At the time of writing this blog (early 2022), I’m offering:

online counselling via Zoom video call, instant messaging and email;
tele-therapy / phone counselling;
walk-and-talk therapy – counselling while walking outside.

If you’ve decided you want to work in-person with somebody in a room (the ‘traditional’ way of counselling) I can signpost you to other people who may be able to offer you this.

Again, this is an opportunity for you to get a sense of what it might be like to have sessions with me. If we decide to go ahead and book a first session, I’ll send you an agreement or contract to read over, complete and sign. The agreement goes over practicalities like fees, privacy and where/how to complain if you’re not happy. There’s no requirement to commit to a certain number of sessions.

What happens in our first counselling session?

There are a few areas I usually cover at the start of the first therapy session (e.g. confidentiality, cancellation policy), which are also in the written agreement – I go over them again because I think they’re important. At the end of the session I’ll check with you how the experience has been, and whether you want to continue; we’ll confirm further details, usually agreeing a review point after the first 5 or 6 sessions.

In between the beginning and the end, though, the first session varies greatly depending on you. You might have a very clear idea of what you need to ‘get off your chest’ and the relief of having a space where you can do that means that you don’t need any help to get started. This can be especially true if you don’t have much opportunity to talk to other people about how you feel, or if you’re anxious about burdening people by telling them.

At the opposite extreme, you might not know where to start. If that’s the case, then I may ask you some questions…………..

Things the therapist is likely to ask about:

More information about why you’re seeking counselling

-and why now? Has something changed or brought things to a head?

Your previous experience of therapy

If you’ve had therapy before, I want to know what you found helpful or unhelpful, partly because I don’t want to do more of the unhelpful stuff, but also so I can look out for similar dynamics repeating in our relationship so that I can flag them up and we can talk about them; they might be a feature in relationships in your life generally, so we could learn something from them.

What do you want to GET from counselling?

If this is where you are now, where do you want to be? You might not know at this point, in which case we’ll come back to it at some point down the line.

Your current circumstances

Your living situation, significant relationships, occupation – this helps me understand things like support networks that you have available to you and factors that might contribute to your overall wellbeing.

Your family of origin

Information about what it was like for you growing up can be really useful as it’s likely to influence your behaviour and relationships as an adult, and getting more understanding of ‘no wonder I do this when I had that experience as a child’ can help you be more forgiving and compassionate to yourself.

Lifestyle and self-care patterns

Mental and emotional health is completely interwoven with physical health; there may be changes you want to make at a practical level that will help you mentally.

Anything that feels important to you about your identity or sense of self

You may have a very strong sense of who you are – or you may not know at all.

All these areas may have a bearing on why you’ve decided you want to have therapy, and talking about them can help you better understand yourself. We might not get to any of them in the first session, but I’m likely to ask you more about them at some point.

Reviewing how it’s going

It’ll take us at least a few sessions to settle into a rhythm and get used to each other. I normally suggest that we review how it’s going at session 6 (assuming that you’ve decided you want to carry on that long).

therapy helps you find your way (robert-ruggiero-unsplash) — *Image: Robert Ruggiero on Unsplash*

I’ll ask you how you’re finding the experience and I’ll share things that I’ve noticed – patterns that we get into, things I’ve not asked you – to see if they feel significant. I’ll want to know what has felt helpful, but I’ll also ask what has felt challenging or unhelpful, and what you think I or we might do differently – for example – do you find it difficult to stay on topic, and want me to flag up when you’re going off on a tangent? Do you feel as if you’re trying to guess the ‘right’ answer when I ask you questions?

Contracts and goals for counselling

I see my role as being to help you change. That might be:

making changes in your life
changing the way you respond to situations, circumstances or people

So, when we review how it’s going, I might ask what you want to change. Sometimes people find this a difficult question to answer – either because they don’t know, or because voicing what they want to be different, out loud, feels risky. But that’s useful information for both of us, too, as there isn’t a right or wrong answer to this question.

You’re the expert on you, and it’s your right to direct the course of the therapy. It might be that I’m not prepared to agree to work towards the change you want, in which case I’ll say so (gently!) and why. Usually this will be because I don’t think the particular change is within your – our – power.

For example

You might say you want to change the way other people treat you.
I’d point out that we can’t make that change as you don’t have control over other people’s behaviour, and suggest that we could focus on changing how you respond if other people treat you badly.
This might involve, building your confidence in speaking out; choosing not to engage with such people; or developing your self-compassion when you feel bruised by the behaviour of others.

And if my suggestion doesn’t feel right for you, we can carry on negotiating, or we can agree to park it and come back to it. From time to time I might check with you whether the goals we’ve agreed are still relevant or whether they need tweaking.

Is it just the client talking and therapist asking questions?

To an observer, a counselling session might look like two people having a chat. It’s known as talking therapy, after all. Often at the start of our relationship, a large chunk of sessions might be you telling me your story – what’s caused you to get in touch. Early in therapy, I’ll probably ask you more questions about your life now, and your history, as I try to get more of a sense of who you are and the influences that have shaped you.

I don’t tend to give advice and certainly don’t tell you what you should do. But equally, I don’t hold back on information which might be useful to you, and so will sometimes share models to help you understand your thinking or behaviour patterns, or introduce some basic neuroscience – this can be helpful in reassuring you that what you see as ‘something wrong with me’ is often a normal biological response to past experiences.

I might also share exercises for you to try inside and outside sessions. Sometimes we’ll agree homework tasks that we can discuss from session to session.

Sometimes I teach a practice called ‘Focusing’ (read about it here) during a session. This is somewhat similar to mindfulness. It can be really helpful as a way of learning to respond to very strong emotions in a way that doesn’t involve avoiding them or being driven by them; instead, you can learn to acknowledge that they’re there and ‘sit next to them’ which can help lessen the intensity of overwhelming feelings.

Doing this in session means that I can help you pace how you do this, a little at a time, especially if you find the thought of engaging with strong feelings, such as anxiety, shame, or fear, is really scary, and worry that they’ll take over – using the session as a space to practice in can be helpful.

Focusing can also be helpful when you’re not sure how you feel, or when you feel numb – it can help you tune in to the feelings that really will be there, below the surface.

Talking about boundaries

The counselling relationship is a very specific one, like no other. We’re often sharing things that are really intimate, revealing the most vulnerable parts of ourselves. And yet this is happening within one 50-minute session, once a week (or whatever frequency we agree).

I’m firm about the boundaries of the relationship, both for the client and for myself. When we sign our agreement to work together we’re also agreeing the parameters within which that takes place. I don’t engage in conversations outside sessions, other than administrative ones where something unforeseen happens and one of us needs to rearrange the session.

This doesn’t mean that I’ll ignore you if you contact me, and it doesn’t mean that we can’t agree extra sessions sometimes if you’re in distress, but – as I don’t offer a crisis service – in general, we’ll keep to the principle that therapy takes place within the session time boundaries.

Lucy Hyde online therapy setting boundaries (image jan-canty-unsplash) — *Image: Jan Canty on Unsplash*

This is partly because I take my responsibility as a practitioner seriously, and that means taking my own self-care seriously; I’m not good at multi-tasking and need to keep my work and leisure time separate.

But it’s also because many clients I’ve worked with, struggle to maintain good boundaries, which can lead to various difficulties, such as burning out because you can’t say no when someone asks you to do something. My maintenance of boundaries models to you as a client that taking care of oneself is important; this is much more effective therapeutically than simply telling you that boundaries are important without practising what I preach.

In P art 2 of this blog I’ll talk more about how ‘modelling’ by the therapist is a key part of the effect of talking therapy, as well other aspects of how the therapist and client relate, and I’ll delve a bit further into the internal changes that take place during the therapeutic experience.

Everyone’s experience of therapy is unique because every relationship between two people is unique. If you want to know more about what it might be like for you to work with me, please get in touch and we can have a chat.

How should I behave coming out of lockdown?

Lucy Hyde on 27 July 2020

In this blog I look at

WHY it’s normal to find coming out of lockdown difficult
WHAT might help you cope with the unexpected anxieties brought up by coming out of lockdown
HOW to disagree with people on the ‘best’ way to behave around COVID-19

How do I come out of lockdown (United Nations covid 19 response on Unsplash) — Image: UN Covid19 response on Unsplash

Coming out of lockdown – why it’s tricky!

Is it just me, or is coming out of lockdown harder than going in?

From this distance, looking back to mid-March, it seemed like we flicked a switch. One moment we were tootling along as normal, the next we were hiding behind closed doors. Of course it didn’t really happen like that – especially for those of us keeping an eye on what was going in the rest of the world and waiting for the tidal wave to hit – but there was some sense of the world changing overnight.

Alone or lonely Lucy Hyde online therapy (Anthony Tran on Unsplash) — Image: Anthony Tran on Unsplash

During lockdown I heard people saying “I can’t wait for things to get back to normal” and felt surprise that they thought that life was going to return to operating in the same way. And I heard at least as many people saying “I’m enjoying not having to see people/commute/be driven by fear-of-missing-out/etc”.

Perhaps THIS is a more difficult transition to negotiate. Somehow life was simpler when you were told the safest thing to do was stay indoors except for once-a-day ‘government-mandated exercise’. Suddenly there are variables. There’s choice. There’s using your own judgement – and therefore the fear of getting it wrong.

And there’s disagreeing with other people about what ‘right’ or ‘wrong’ is.

Personally, I don’t like conflict (some people do, honest). While I’m OK with challenging injustice, or speaking up in defence of causes I’m passionate about, I struggle where things are less clear-cut. In particular I’m uncomfortable when I feel differently, or have a different opinion, from someone who’s important to me. I get nervous, anxious, wobbly, and it’s only in recent years that I’ve realised that something in me believes that it’s OK to disagree with ‘them’ but not with ‘us’ – that this part of me feels scared and unsafe in such situations (probably terrified of being abandoned / rejected – yeah, that wee inner child again). So I’m constantly having to remind that part of me that it’s OK to disagree.

It’s OK to disagree. And still be loved, and loveable, and safe.

Coronavirus etiquette – who’s right and who’s wrong?

In terms of the current situation, there are many not-clear-cut areas. You think there are lots of ‘shoulds’ and ‘shouldnts’ but they’re all mythical really, a kind of collective hallucination about what is and isn’t ‘allowed’. For example…..some people are exempt from wearing masks and (as there’s no requirement to wear a label stating what your exemption is!) we have no way of knowing who they are.

When I did an internet search for ‘coronavirus legislation’ I found a lot of temporary changes to very old laws but nothing that told me about what was ‘right’ or ‘wrong’ in terms of my behaviour as an individual. A mid-July article on the BBC website showed that while the law in England stated that you can have a gathering of up to 30 people at home or anywhere outside, the government’s official guidance said you should only be socialising in groups of two households or six people. 🙄😤🤬 FFS!

Social distancing Lucy Hyde online counselling (evgeni tcherkasski on unsplash) — Image: Evgeni Tcherkasski on Unsplash

So very little has changed in terms of law – but, for many people a lot feels as if it has changed – and social ‘norms’, which we often allow to restrict us, are part of that.

There are very few absolutes on what is ‘right’ or ‘wrong’. Really, the only thing we can do is to take note of guidance and then make our own risk assessment – remembering that any decisions made in terms of guidance are made accounting for a number of variables, and they may not be given the same weight as you would give them. (An example is ‘getting the economy going’. My personal opinion is that the myth that ‘economic growth’ is the only thing that can sustain civilization, is partly what has led us to destroying more and more wilderness areas where viruses previously unknown to humans reside. My personal opinions influence my decisions.)

How do I stay safe around other people?

We risk assess all the time; it’s part of how we navigate our way through life. Risk assessing is how we adjust our behaviour when crossing the road, now that traffic is returning to non-lockdown levels, so we don’t get run over. But we don’t operate in a world where ‘not catching coronavirus’ is the only consideration and the only indicator of health. For some people, particularly people with significant physical health conditions, it may be a very important consideration, in which case staying away from other people completely might feel more important. But we need human connection, and for some of us the likely risk of dying of coronavirus needs to be weighed in the scales against risking losing important human connections.

Risk assessments with regard to coronavirus need to take account of the risk to the other, of course. “I think there’s a low risk to me if I catch the virus, so I won’t bother with social distancing” doesn’t account for the risk to the person you’re not social distancing from. And so, into the mix comes the reality that you can’t control what others do, you can only operate in the world, and finding peace with the reality that others don’t have the same attitude as you is as important in navigating the coronavirus pandemic as it is in so many other aspects of your life.

Learn to disagree Lucy Hyde online counsellor (liwordson on nappy) — Image: liwordson on nappy

So it’s OK to disagree. And in some ways it’s easier to disagree with ‘the other’ – to tut at those people who don’t wear a mask on the bus, who don’t give you your 2 metre gap when you want to get past them. They’re ‘not like you’.

But it becomes more difficult to navigate when you disagree with people who are close to you – friends, family, loved ones.

For me there are two main aspects to this whole coming out of lockdown situation…………..

😷 managing your own anxiety, discomfort or incomprehensible feelings

😷 managing disagreement with your loved ones

Managing your own anxiety, discomfort or indefinable ‘weird’ feelings

A reminder: these are normal. It was normal as we went into lockdown to find it fucking difficult, and it’s normal as we come out.

Take a moment to pause and reflect on where you in your ‘pandemic journey’. There are so many unknowns. “What is the world going to look like in six months’ time? In 2021? For the rest of my life? Will we ever get back to where we were before I’d heard of coronavirus? Do I want to?” You’re likely to have your own particular stories around the pandemic – the cancelled opportunities. Death or serious illness of loved. Financial stressors. Loss of work. Relationship break ups. Loneliness.

Self reflection Lucy Hyde online counsellor (Ben White on unsplash) — Image: Ben White on Unsplash

Even positive experiences – like realising that you were more relaxed or happy during lockdown than you had been, like, forever – are likely to make you question your sense of who you are and who you want to be going forward. Questions and uncertainty are all around us. You may be experiencing fear, anxiety, depression, resentment, frustration, burn out…….

So what do you do with all that? Well….learn to live with it. No, I don’t mean ‘suck it up and get on with it’. I mean, literally, that there are things you can do to help you tolerate feelings that are difficult. You’re probably doing some of them already, or have some that you know work.

Think about what you know helps you in terms of self-care, such as

getting exercise 🏃🏽‍♀️
getting outside in nature 🌳
eating properly 🥗
good sleep hygiene 🛏
scheduling worry time (setting aside a time each day when you write out everything that’s bothering you) 😟
mindfulness, meditation or focusing exercises 🧘🏻‍♂️
talking to people 😀😀
relaxation exercises 😌
mindful activities – anything that occupies your brain in a soothing way, such as cooking, gardening, crafts, colouring 👨🏽‍🌾

If there’s something that you want to feel less anxious about getting back to, see if you can break it down into smaller steps that feel more manageable. No step is too small.

I wrote a blog previously about managing difficult feelings which might help you with this. My stress management blog will also help you with ideas for self-care.

Managing disagreements with your loved ones

Think about a particular relationship that feels like work at the moment. Then take a moment just to think about where that person might be in their ‘pandemic journey’, in a similar way to when I suggested you reflect on yours. Is it possible they might be in a different place from you?

Even if you can’t easily see they might feel differently from you, you need to find a way of accepting that they do. We can assume that our way is the ‘right’ way but – as mentioned earlier – there are few ‘absolutes’ and little to be gained by trying to persuade someone else into our point of view. It’s OK to love someone and have different views from them.

OK to disagree Lucy Hyde online therapist (tolu bamwo on nappy) — Image: Tolu Bamwo on Nappy

But sometimes acceptance isn’t enough – especially if there’s two of you, both thinking you are ‘right’, both unable to convince the other to agree.

If you disagree with someone else you need to find a way to compromise rather than expending energy on worrying. THERE IS NO RIGHT OR WRONG ON THIS. You need to account for the feelings of the other person. You are going to have to learn to disagree so finding a way of doing this is the only way that you are going to be able to maintain relationships with people.

Much of this is about communication. Even when we think we talk a lot, we’re not necessarily communicating what is important or healthful to our relationships. Here’s some guidelines for effective communication:

1. Make space for the conversation

Tell that person that you’re finding things difficult and that you’d like to talk about it. Be explicit about what you want to talk about and try to avoid doing it in the heat of the moment. If you can’t get their buy-in then you may not be able to change things alone. If necessary share these guidelines with them.

2. FOCUS ON THE PARTICULAR ISSUE

Don’t get caught up in the all the myriad ways that you wind each other up. You want to find a solution to the current problem and reach a point of understanding. DON’T try and decide who is right/wrong or try and find ‘the truth’.

3. speak for yourself

Offer your thoughts, feelings and concerns and don’t give your perception or interpretation of the other person’s motives.

4. own your feelings

Say how you feel from your point of view (not how they ‘make’ you feel or even how Covid ‘makes’ you feel). “When this happens, I feel anxious” not “You make me anxious” – can you hear the difference? These are your feelings.

5. listen to the other’s thoughts, feelings & concerns

Hear their point of view without trying to change it. There needs to be room in this for you both to hear each other. Share the floor.

6. SLOOOW IT DOWN

Pause before you react to criticism. Slow down, listen to the pain in the other person and try and respond with empathy rather than becoming defensive. Notice when your reactions are coming from a place of fear. It’s not easy, but it can really help.

7. ASK FOR WHAT YOU WOULD LIKE AND ALLOW THE OTHER TO ASK FOR WHAT THEY WOULD LIKE

There may not be a perfect solution, but perhaps you can find a position of compromise.

8. oFFER EACH OTHER YOUR UNDERSTANDING OF WHAT’S BEEN AGREED

You both need to be clear that you know what you’ve agreed. Don’t agree to something that you won’t do, or that you will feel resentful about doing. Be assertive and make decisions on what you can control.

Finally – compassion, compassion, compassion. For yourself and for the other person. No one is finding this easy and if they say they are they’re probably talking bollocks or at the very least kidding themselves.

We are living through a challenging period and allowing yourself to feel that it’s fucking hard is not only OK, but necessary.

If you’re finding things hard to manage on your own, you might find it useful to speak to a counsellor to get some help. Sometimes just a few sessions can help you recognise that what you feel is normal and to reframe how you look at things. There are lots of counsellors working online who can support you to get back out in the world. Get in touch with me if you’d like to talk about having some therapy online, or would like to try walk and talk therapy outdoors, or visit one of the online directories like ACTO , Counselling Directory or Psychology Today

References:

Facemask exemptions

Managing conflict in relationships

COVID-19 explainer

How to ease coronavirus-related anxiety

Lucy Hyde on 24 April 2020

I’d like to introduce a simple practice that I believe can really help with managing uncomfortable feelings. It’s relevant in any situation, but perhaps particularly so at a time when more of us are dealing with unaccustomed feelings because of the unusual situation we’re in, with changes to routine, uncertainty, fears for ourselves or loved ones and other challenges. ‘Covid-19 anxiety’ is becoming a catch-all term for all sorts of ways in which our emotional and mental wellbeing may be thrown off balance.

Focusing, or ‘inner relationship focusing’, is a way of easing difficult feelings. Notice I don’t say ‘getting rid’ of feelings. I’m used to hearing from people that they want to get rid of feelings of anxiety or overwhelm or stress or despair. If that’s you, then you might not like it when I say that, in my experience – and I’m talking about my personal experience as well as professional – what really makes a difference is when you stop pushing those feelings away.

What is ‘Focusing’?

Inner relationship focusing is a term coined by Ann Weiser Cornell who worked with Eugene Gendlin , the originator of ‘Focusing’. Gene Gendlin studied under Carl Rogers, who founded person-centred therapy. Gendlin did extensive research in the 1950s and 60s, in an attempt to ascertain what made psychotherapy successful for some clients but less so for others. He found that clients who made positive lasting change had an innate ability to pause and check ‘inside themselves’, to access a body feel of their issues, an intuitive ‘felt sense’ which they could learn from for their personal development and growth.

Lucy Hyde therapy asking for what you want

Gendlin went on to develop a step-by-step process, by which clients who didn’t have this ability naturally, could be taught it – not only to get more from therapy, but to work on issues or challenges themselves. Ann Weiser Cornell , a student of Gendlin’s, went on to develop her inner relationship focusing from this.

How can Focusing help me?

Three years ago I uprooted myself from my home and moved with my partner to Italy for two years. Various circumstances led to this being possible, and for it to be the right time (post Brexit referendum but pre-Brexit!) to do it. What I thought in my conscious mind was: “It’s going to be a bit tricky in some ways but it’s a great opportunity and I’m lucky to be able to do it.”

Underneath all this – and mostly ignored and suppressed by me – was terror at the unknown and the fear that I wouldn’t be able to cope in a country where I didn’t speak the language and didn’t know how things worked.

You know what? It was bloody hard. I wasn’t working for the first time in my adult life. I didn’t speak the language. I didn’t have any friends or family close by, other than my partner. Everything was complicated by not knowing how things worked. BUT what made it harder was that, at the start, I didn’t allow myself to really feel how difficult and frightening all this stuff was, because I was living in the most beautiful city in the world and so I was ‘lucky’. I was aware there was a lot of discomfort, and that I wasn’t feeling happy and skippy – but also there were lots of times when I was excited and happy at the newness and beauty of it all – the ‘acceptable’ feelings.

managing conflicting feelings with online counselling

My feelings about the experience were unique to me – my own history and personal baggage lent their own twist – but even as I began to acknowledge that there were feelings of fear and loneliness and shame (at not having a wonderful time) I was ruminating about how to get rid of them, figuring out what I could busy myself with to get through them or away from them quickly.

I’d been trying Focusing on and off over the previous 3 or 4 years, while also in personal therapy – and it had become something I used to try and make sense of intense feelings (a kind of emotional first aid when things became extreme). Because I knew it could be helpful when I was feeling things were getting on top of me, when I was anxious or stressed or emotionally overwhelmed, I began doing it more.

What I discovered was interesting. Focusing didn’t make those feelings of anxiety or stress or shame or overwhelm go away. As I look back on my experience of living in Italy, I remember vividly that it was both terrible and wonderful, and that, even after two years, I was still at times experiencing anxiety, fear and shame.

But what I learned was that I could tolerate these feelings by sitting alongside them. I learned that I could hold both the despair and the delight – sometimes at the same time – without being consumed. I also discovered that sometimes these parts of me, that were trying to get my attention, had some wisdom to impart, which I could learn from. My friend and colleague’s phrase “This is an AFLOG” (another fucking learning opportunity for growth), was never so apt as then.

A part that often came up during this time was my inner critic. So I might find myself sitting with something that was telling me I just needed to get on with things. Often as I stayed with this, I realized that this part was really scared and young, and ‘getting busy’ was its way of pretending it was grown up. The critic or the busy bee was trying to protect me in the only way it knew how. I see people writing about ways to ‘shut the inner critic up’ and I feel sad for that treatment of what is essentially someone’s inner child, who just needs to be listened to, but is manifesting itself in a way that feels ‘too much’.

My experience of feeling out of place, not belonging and not knowing how to belong, has been invaluable to me in my work since then with clients. Developing my practice to offer online therapy (so that I could continue to work with English-speaking clients) was unexpectedly invaluable in the current setting where suddenly online counselling is all there is.

the growth you hold within - online therapy — AutoRinascita by Carlotta Baradel

But more valuable than both of these has been learning the ability to sit with the not-knowing, to feel anxious, or afraid, or not-good-enough – to be able to say to those parts of me “Oh hey there! I know you’re there. I know you’re feeling [whatever]” and to be able to carry on. Don’t get me wrong – that inner critic is still there (this time saying “you shouldn’t be feeling that your emotional wellbeing is affected by coronavirus lockdown because you’re an experienced online counselor”)…….but I’m able to recognise it pretty quickly and to give it space while still allowing the feelings of sadness and missing family and friends and routine.

How is Focusing different from meditation or mindfulness?

You might already be familiar with exercises or practices that can help you soothe yourself, like mindfulness or meditation. In which case you might not be interested in learning about another one! Focusing is much like mindfulness…..AND it’s more. Because with Focusing there’s the opportunity, not only to notice when something comes into your awareness but, rather than letting it pass through, to form a relationship with it, listen to it – and learn from it. It can be soothing, it can be calming – and more too.

“If I let my anxiety in, won’t I become overwhelmed?”

Here’s a metaphor for you. Imagine that the anxiety (or feeling, or self-critical thought) is a little child wanting to get your attention. You ignore it. It shouts louder. You shut it in a cupboard. It really needs to scream now to be heard. And it’s going to carry on screaming even if you try and pretend it’s not there. What would happen if instead you let it out of the cupboard, take it in your arms and soothe it?

That’s how I think about uncomfortable feelings. Whether it’s anxiety, feeling that you’re out of control, thinking that you’re not good enough – there’s a part of you that’s trying to get your attention, and the more you ignore it the harder it tries. The practice of inner relationship focusing is a way of giving those feelings some space without becoming overwhelmed by them, because it encourages you to sit alongside them – like you might sit with a friend – rather than be in them. I see these ‘parts’ as being rooted in myself at different times in my life – part of my ‘inner child’, if you will – and by spending time with them I’m doing some gentle parenting.

The easiest way of understanding what inner relationship focusing is, is to try it! I’ve included a video at the end of this blog that talks you through a very brief version of a focusing exercise so you can try it for yourself. If you want to skip the preamble, you can fast forward to about 2 minutes 20 seconds in, to the start of the exercise.

My own experience of Focusing encouraged me to learn more, initially with a Focusing Skills certificate, and I’m currently studying to become a Focusing Practitioner. I use a Focusing way of being in my work with clients, and I also teach them Focusing, if they’re interested, as a way of becoming more comfortable at ‘checking-in’ with themselves.

If you want to learn more about Focusing, including how to develop your own practice, check out the resources below.

Benefits of Focusing

Ann Weiser Cornell’s inner relationship focusing

Gene Gendlin’s six step guide to focusing

British Focusing Association

COVID-19: Transferring your therapy practice online temporarily

Lucy Hyde on 18 March 2020

First up: Don’t Panic. You can do this.

Or, actually – take a moment.

Bring your attention to the part of you that is panicking. This isn’t the whole of you; you are still functioning. Let that part of you that is feeling anxious know that you hear it. Say to it “No wonder”. Anxiety is normal, and it’s OK. And you can hold the anxiety and carry on with other stuff.

DISCLAIMER: I should mention that I’m just a therapist who happens to do a lot of online work. I’m not qualified to train other people to work online, and I don’t recommend switching your practice online on a permanent basis without specific training. This is an extreme situation and I simply want to offer reassurance and practical tips at a time when there is a lot of uncertainty and anxiety.

So here, in no particular order, are some things to think about if you’re planning to transfer your practice online, or even if you’re wondering if you can. I’ll add / update things as I think of them.

Insurance

Check that your insurance company will cover you for online work. They don’t all do this as standard, but even if not, they will probably offer it as an optional add-on – in the current situation even if they didn’t before.

Check registration body guidance

Most of the registration bodies provide at least some guidance around online working. It may also be helpful to check out the competencies published by the Association for Counselling and Therapy Online here .

Supervision

When in doubt – talk to your supervisor! You can discuss your caseload and your sense of yourself working online and explore doubts and fears. Consider whether you have at-risk clients that online working wouldn’t be suitable for. You might want to discuss whether your Clinical Will is up-to-date, at a time when many people are going to get ill. Your supervisor should be able to help you decide on how competent you feel to work in this way from an Adult position.

You could also consider extra supervision from a supervisor who has expertise in working online (if your existing one doesn’t). Check out ACTO-approved online supervisors here . Who do you know that works with clients online who could offer some peer support?

ICO & GDPR

Most therapists are registered as Data Controllers with Information Commissioner’s Office (ICO ). If you’re not already then you need to consider whether you should do so at this point as you are likely to have at least some personal information stored / processed electronically.

Added 25.03.2020: You may also need to consider note-taking, particularly if you work for an agency where notes are stored on the premises. Do you have lockable secure storage for your notes in your house? What might you need to consider in terms of secure electronic storage? I use a cloud-based secure client note system called bac-pac , but there are other types of secure client-note software too – ask around to see what other people use.

Platforms / software

It is generally understood in the online counselling world that Zoom is the best choice for working with clients. There are various reasons for this which centre around security of calls and data security, which you can read more about if you want to here . VSee is another option which is more secure than Skype, but, like Skype, you have a contact list which means client data is at risk if you get hacked. (Note: there has been talk about VSee restricting new free accounts but they still seem to be available as at 19.03.20.)You don’t have this with Zoom. (And if you have clients who ‘don’t like online’ but are happy with phone counselling, you can use Zoom for audio calls too.)

However, I have heard that Zoom has been struggling because of the additional load as everyone moves online. So, we are talking least worst here at least in the short term, and it’s good to have a back-up. My personal preference is to use Zoom and then to let the client know that we will use WhatsApp as a back-up, checking that I have the right number for them; this means I have their number to hand – belt-and-braces if we need to go to phone counselling.

If you work with groups or offer group supervision you will need to pay for at least a Zoom Pro account – the free account only offers group calls up to 40 minutes.

Security

Added 25.03.2020: It goes without saying that you shouldn’t be using the same password for your Zoom account as any other account and if you’re working more online than normal, cyber-security is an important principle to consider. Use different passwords or pass-phrases for every different log-in that you need and don’t write them down. Consider investing in a pass-phrase storage system like Keeper or something similar to ensure that client data isn’t vulnerable.

Added 01.04.2020: There have been stories about people trolling Zoom rooms or ‘Zoom-bombing’ where someone keys a random string of 9 digits into Zoom in the hope that it will just happen to be the ID of a meeting. The chances of finding their way into a meeting that’s actually running at that time are pretty slim, but there are a few things you can do to protect yourself and your clients.

One is, obviously, only send the meeting link to people you want to be there! Another is to enable the ‘waiting room’. This means that your client will have to wait for you to let them join the meeting but crucially, means that you would see anyone else who tried to get into the meeting. You can also set a password which means that someone with the meeting ID – but without the password – wouldn’t be able to access the room. The password is encrypted into the link you send your client, so you don’t need to communicate it separately. And finally, if you set screen-sharing options to host-only, then even if someone was to access the room, they wouldn’t be able to share unwanted images.

Planning and physical set-up

Many of us are used to spending at least some time online or at a device of some sort. Don’t assume that you need to be set up with a PC and camera. You can use Zoom from a mobile device too – phone or tablet. You can make a phone stand out of cardboard like the one below.

It’s important that you consider lighting and background. Your face needs to be visible to the client and you probably don’t want a view of your socks drying on the radiator behind you.

My preference is to use headphones or earbuds because they cut out any noise interference from my end, and ensure no one elsewhere in my house can hear the client. I encourage clients to do so as well – sometimes there’ll be feedback of my voice from the speakers at their end which can be distracting.

The main thing, of course, is that you have a private and confidential space with a good enough internet connection. The easiest thing may be to find a colleague in the same boat, set up your Zoom accounts and call each other, then you can feed back on each other’s ‘space’.

Added 23.03.2020: Remember to account for any ‘smart’ devices you have in your house. Law firms are highlighting concerns with client confidentiality where Alexa or similar devices may be listening in to conversations. Don’t forget to turn devices like this off or make sure they’re out of earshot of wherever you’re working. Think about other potential interruptions like deliveries, house phone ringing etc. Olivia Djouadi has written a helpful article about practicalities here .

Prepare yourself

When I first started working online, I had a check-list that I used to make sure I had everything to hand when I sat down. This included things like ‘shut doors, earphones, pen, phone, diary, water’. This is particularly helpful if where you normally sit at your computer doesn’t feel ‘appropriate’ as a client space, for example you might want to sit on the sofa with your laptop on the coffee table instead, so a checklist can help you have things to hand.

It’s also helpful to plan what you’ll do if there’s a problem with the technology, to have a back-up plan.

Emma Cameron has created an online therapist daily checklist .

Help the client to prepare

Remember this is new for the client too, to relate to you in this way. They may be used to FaceTimeing friends and family and it’s going to be helpful for them to be reminded that this is something different. Reassure them while acknowledging that you are not an expert – you are modelling being Good Enough!

I send an info sheet to all my online clients before we start working together (and have done so with in-person clients who are moving to online work) to help them prepare their ‘room’. It’s important that they, too, have a private and confidential space. Reminding them of the importance of taking time to ‘get into the space’ before and afterwards can be helpful as they won’t have their usual travel to you.

Re-contract with clients

You should make your client aware that nothing online is 100% secure, even though you are taking precautions. I include a paragraph in my online working contract around the limitations to security and advising clients not to use shared computer equipment or communicate in environments where there is a lack of privacy.

I’m also explicit about online counselling not being suitable for working with certain issues, such as suicidal thoughts or acute mental illness, and that I will support clients to other sources of help if these arise during our online work and we can’t meet. This is a slightly different scenario to when you already have an in-person relationship but it’s still important to talk about what you/they might do if emergency support is required.

Be clear with clients about the difference between face to face and in-person work – that some of the usual sensory cues are absent so that there is a greater opportunity for misunderstanding each other.

And – agree what you’ll do if there’s a technology fail.

Payment

If you normally do cash or cheque, you’ll need to think about how the client pays you. I offer payment by bank transfer or PayPal. PayPal charge commission but some clients are more comfortable with this way of payment so for me it’s worth it to offer the option. Make sure that you communicate to the client that payments by PayPal are subject to PayPal’s privacy policy. There are other options for electronic payment out there so ask around.

Client presentation & online disinhibition

Clients may present differently when you are working with them online and you will both need time to adjust to this. If you’ve ever found yourself marvelling at the ‘flame wars’ that arise on social media, you’ve experienced the online disinhibition effect. The particular relevance in online work is that clients can ‘expose’ themselves more due to the perceived distance from the therapist, that they reveal more of themselves, which can be beneficial.

However, it can also have a negative impact on the client because they can say more than they later feel they wanted to and feel shame or want to retreat. Here we are talking about someone you are already used to working with and you can help them pace themselves. You can read about the online disinhibition effect here .

Remember self-care!

Be aware of your limitations. Make your workspace as comfortable as you can – it may only be temporary, but if you’re sitting at it for hours a day, it’s going to have an impact on you physically. Take regular breaks from the screen and from your seat.

Remember you’re likely not to be moved around as much, if you’re used to travelling to and from your place of work so be mindful of this when you’re scheduling clients in and make time to move around, go out for a walk or do some crazy dancing on the spot if you’re in self-isolation.

It will be OK

It’s OK to acknowledge that you’re not tech-savvy – your client didn’t contact you because they thought you were a technical wizard. You are not expected to be an expert, don’t be afraid to not know. It’s OK to ask. These are extreme circumstances and you are looking to balance the risk against the benefit. Refer back to your guiding ethical principles to remind yourself what is in the best interests of your client and yourself. Don’t let Perfect be the enemy of Good!

You are going into the not-knowing together with the client in this as with the rest of your work. Allow it to be a bit weird. Bring yourself back to core principles that you work to and to your self-awareness. These will serve you in this uncertainty as they always do.

And finally – invest in training!

A reminder that there is lots of great training out there for working online with clients. Don’t be tempted to think after a few weeks of working with clients online “Oh, I know what I’m doing know.” Committing to a proper training course is essential if you decide to do this on a more permanent basis. Look here for information about training courses.