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a relationship, and b) your situation may have changed by the time I have a place, so the information I gathered is out of date anyway.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.

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

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.

Tips for coping with ‘pandemic fatigue’

Lucy Hyde on 16 September 2020

Lucy Hyde online counsellor pandemic fatigue

I had a week off recently. It was a bit ‘meh’. My previous week off had been a couple of months into lockdown and I relished being prevented from doing anything very much, in glorious weather. I expected to feel the same this time, and I didn’t.

Instead my mood yo-yoed and I found it difficult to settle. I enjoyed seeing some friends in real life – it felt like an ‘event’ – and I was also aware that in some ways seeing people in real life now feels a bit weird. Some days I kept bursting into tears and couldn’t motivate myself to do anything. One day the weather was terrible and I was relieved because it meant my options were reduced!

online therapy rainy day feeling (image noah silliman unsplash) — Image: Noah Silliman on unsplash

Exactly halfway through the week I crashed and had to go back to bed after breakfast. Initially I was railing against myself; unable to get up, to move, yet unable to allow myself to lie there – but by the afternoon I was able to surrender to not being able to do anything other than lie in bed and read Joan Aiken books. And that ‘surrender’ felt like an improvement – rather than being consumed by frustration that I wasn’t ‘making better use’ of my holiday.

The day after I felt, quite simply, better. We went to a wildlife reserve that we hadn’t been to for a few years……..and I realised how much I had needed to get away from home. I recognise how lucky I have been during lockdown to be able to get out for walks locally but something in me had really needed more country and to be out of earshot of traffic. For a while we just sat and listened to grasshoppers, birds and wind.

https://www.facebook.com/lucyhydetherapy/videos/1497869573717828

I caught up with a couple of people by phone/Zoom and discovered that I wasn’t alone in struggling, and that what I was dealing with was partly ‘Covid weirdness’. We spoke about places we’d been together, and I was taken a little out of myself and my horizons pushed further away.

It occurred to me that I’d shifted into another state from the initial fire-fighting in the weeks immediately before and after lockdown, through the girding-my-loins for the long-haul, and into something that felt a little like ‘pandemic fatigue’.

online counselling pandemic fatigue (image annie spratt unsplash) — Image: Annie Spratt on unsplash

As I got ready to return to work, I noted down some of the things I’d learned that week. Here they are, in no particular order.

1. It helps to reach out

………even in a small way. Let others know that you’re finding it tough. Sometimes opening up to someone new can really help – not necessarily a counsellor, but someone you don’t normally have such conversations with. It can help you feel you’re not moaning all the time to the same people about the same old stuff.

Be compassionate to your own context — Image by Annie Spratt on Unsplash

2. Sometimes you need a few plans in place

Having a completely empty week that I could do what I liked in didn’t help me on this occasion – I just felt additional pressure to Use It Well. A couple of appointments, days out or even planned tasks, would have given me a bit of structure……….

3. …………and routine

Even on a holiday routine can sometimes be helpful; not necessarily the SAME routine, but something to create a scaffolding to hang your day on, such as getting outdoors at the start or end of the day.

online therapy set routines for wellbeing

4. Finding ANYTHING weird at the moment is normal

Even things you think are ‘just the same’. So much has changed in how we do things, that it’s affecting relationships, work, leisure. We’re more likely to notice BIG changes and consciously attend to them, but the subtle ones can be slightly out of our awareness and hence more destabilising.

5. Getting moving helps

Going for a walk is always useful for me; I had a looooong walk one day. Although it didn’t ‘make me feel happy’ something about the movement and being in a different space stirred me up and enabled me to clarify and voice some of the stuff that had been going round in my head and bugging me. Walking brought some kind of shift, and that’s what I needed. Swimming outside helped too, for different reasons. When I’m swimming in the sea, most of my focus is on not drowning or doing anything (too) risky and that makes it hard to ruminate – in fact, I’m too busy ‘being’ to notice how I’m feeling.

Lucy Hyde online therapy wellbeing sea swimming

6. A change of scene is good

It doesn’t have to be a trip abroad. Taking a train, a drive, a cycle to somewhere else gets you away from your usual space. In my case this meant getting away from the reminders of all the things I wasn’t getting done at home, freeing up a little bit of space in my head. The risk of catching Covid from the car club car was outweighed, for me, by the emotional benefits.

7. Small tasks or activities help your mental health

Even things like cleaning or tidying. Finding a way to bring it back to one thing and focusing on that rather than being overwhelmed by the enormity of everything that I wasn’t getting done enabled me to do something and to feel a small sense of achievement from that, even where it was just cleaning the bathroom. It helps if it’s something you can do mindfully, bringing your attention to what you’re doing as you’re doing it (I did a bit of berry-picking) rather than, for example, clearing a pile of paperwork where each piece can potentially lead to another ‘to-do’!

8. Sometimes I just need to surrender to misery!

…….and to hide in bed. Fighting it can mean it takes longer to get through. For the morning of the day I spent in bed, I had a voice in my head telling me I was being lazy / needed to pull myself together / was wasting my week off, but once I’d made the decision to just stay there until I sensed that I wanted to get up, the relief of giving myself permission to collapse was – well, a relief. It was a turning point that seemed to free up more of my energy for the next day.

I’m not saying just letting go and being miserable is always the solution, but my hunch is that it’s more often helpful than you think – because there’s something about giving yourself permission that sends a really significant message to the part of you that might feel it’s not good enough.

Part of me continues to say “but you’ve had it easy during 2020 compared to many people”. I get that. I am grateful that my income hasn’t been affected, that I haven’t had to worry about home-schooling, that I have other privileges that many people don’t (not just my colour, but economics, class and where I live, too), that have meant that I haven’t been hit as hard as many people by this.

I can be grateful for all of that and I can also listen to that part of me that’s frightened and fed up and doesn’t know what’s going to happen…… and to let it know that I hear it. Expending energy on giving yourself a hard time for being a snowflake doesn’t help anyone else (or yourself).

If you can find the things that support you in difficult times you’ll have more energy available to support others.

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.

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

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

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.