Virtual/Video/Telehealth Sessions

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I know there are lots and lots of therapists switching to virtual sessions during the pandemic. I expect after this is over, virtual sessions will be popular, especially in under-served areas. But I also know that the idea of virtual sessions really scared me and doing the sessions has been a big challenge.

1. Have you made the transition? Is the idea of virtual sessions too frightening to switch?
2. What makes the sessions hard?
3. What has worked for you if you have made the switch?

Here are my thoughts.
1. Yes, I started with talking on the telephone, staying as Big Wendell. We talked about my fears and how to address them. Then we did just 10 minutes of video. We practiced turning off the video feed. Then we progressed to longer sessions.

2. I really need to read people to feel safe, and that means having them in front of me in person. I start to have untrue thoughts pop into my head. Seeing my therapist just over the screen, it somehow seemed that she had had sex with my teenage part, even though I know that's not true. I'm afraid I'll do something wrong and get in trouble. I feel lonely when there's not somebody really in front of me.

3. (Some of these ideas are from discussions in my Trauma Diary.) My therapist has my favorite objects on view in her office, and we begin by having her take the camera around the room to see those things. She sits fairly far away from the computer camera, so she looks the way she does in a normal session. I had to find a safe place to do the sessions, where I could be away from my family. I drive to a park and use my phone. The trees and nature in front of the car help me ground. We agree that if I say, "That's enough," it means we'll turn off the video. I make sure to bring grounding, physical items into the car, such as my journal book, water, favorite stuffed animal. I think I'll bring more little things. Interestingly, I've been paying her by mailing a check, and I wrap up the check in a piece of paper with one of my photos and a little note on it. Anything that helps connect the physical with the virtual.

I recently learned that my former therapist is growing her already huge practice and is expanding into virtual sessions. I would like to write up my experiences as a client with both PTSD and a dissociative disorder so that her therapists will have some idea of how to approach those of us for whom video is a big challenge. If you give permission, I would include your perspectives as well in my note to her (with no user names attached, but with attribution that these are not my ideas).


I don't do video for the same reasons I don't do photography, that I'm not going into here.

But yes, we call.
Tbh I don't care about that change as something major or disruptive or whatever. We already had an interesting time syncing up schedules, the mode of communication doesn't matter to me one bit.

That and I still find a lot of service she does for me soo goddamn luxurious. So still extras, improving my quality of life. Not something to seriously bitch about.

Her former colleague / my former T would have been another story, and yeah, tried vid sessions with him back a while when we both were in different states bit away. But that had nothing to do with the means of communication as boundaries & him just not being a good fit for me, personality wise, and actively worsening my dissociation with his not grasping what I'm dealing with and lacking in active listening skills like she has.


Have you made the transition? Is the idea of virtual sessions too frightening to switch?

^Yes I've transitioned but I already had for my psydoc bc he's too far away. My T is just getting up to speed on it, getting things sorted at her end. So that's an additional session via link up.

It's not frightening at all. Actually if I want to I can switch off, it's one click away. But I know these people well so that's not going to happen. They are the same people & the video is clear & in real time. When I've had to do sessions over the phone - living in a no internet area - that was difficult but still effective. Kept me going believe me.

Actually I think it's harder on the psydoc & T. Idk why I think that. I suppose they cannot read body language etc. ??

What makes the sessions hard?

^Nothing much. Making sure we link up at the right time is sometimes difficult. Both parties must be running on time & prepared for a little bit of lapse with the initial contact.

The internet can be a little bit of hit & miss at times, as can the phone. Generally we try to link up when the internet is not under heavy use but now that may not be possible to predict.

Make sure you have the video camera facing you & you are sitting in front of a window or a wall. Have the light source facing you, not coming from behind because that washes out the video. Make sure there's nothing the camera can pick up that you don't want to disclose. Like a pile of ironing, dirty dishes or a tray of paperwork that you've still not got done. :rolleyes:

Make sure you are not going to be disturbed no matter what! Put your phone on silent. Close all other running applications on the device you are using. Lock the door if possible & ensure you have made it clear you are not to be disturbed. All of those things are in your control more or less depending on where & whom you reside with. Ensure your own privacy, because that's important.

Make a cup of tea/coffee or have water, tissues handy before you start. (That's one of the good sides to video link/phone consults).

Make sure you are not still in your pj's :banghead: Have washed your face, brushed your hair or at least made an effort. lol.

Be mindful of the time - which is easy to see because most devices will tell you. Time seems to fly over video more than in real life??

Give yourself 15 mins before & after the consult session in case there are difficulties with the link up or you are late finishing. And have time to settle down again.

All the usual things apply after a session. Make sure you don't overload your schedule afterwards. Self care x 100. Just because its a video link or a phone call doesn't mean it is any less effective or perhaps upsetting.

Remember you don't have to fill the gaps when communicating via video/phone. Silences are still completely acceptable and maybe necessary.

What has worked for you if you have made the switch?

The Covid19 problem that has caused T's to transition to link ups will be around for perhaps a long while. If you need T - don't put it off bc you're waiting for a vacine to eradicate the necessity. Your T still needs to continue. Please don't underestimate how important it is even now., perhaps more important.

Ease into it gently. Don't be put off by the strangeness of it all. Let the psydoc or T lead the session if you are put off. Give it time. After a while it should seem normal or at least better than the initial sessions.

If the app has a capacity to record the session - decide what you want to do before you get into it. Record or not record. Normal privacy laws still apply. Or, ask if it does if you don't know.


I think my biggest worry is that I feel safer being in the same room as my therapist. We’ve started trying to get me to let my feelings out, cry, be vulnerable, and things like that. Being genuine with me feelings is terrifying for me, but it’s getting a little easier when we’re in the room together. With tele-health though, really I’m alone. I don’t know how not to be scared of that


With tele-health though, really I’m alone. I don’t know how not to be scared of that

^Well, yeah I get what you are saying. There is definitely a physical comfort thing in being in close proximity to another human being who is sharing your grief.


Remember though you are actually always alone with yourself, even when you are in company of your T or anyone else. The T can only sit with you & share your time and space when in physical consults and that's still possible over the video link up. There's still that sharing of time & space. I guess having confidence that the T won't click 'end call' might be part of it?


1. Have you made the transition? Is the idea of virtual sessions too frightening to switch?

Interesting, very timely post. Thanks for exploring it.

I was actively suicidal last week and the week before. I had chosen a date. I saw my T in the office and he asked me to postpone until we could meet again.

Before that 2nd meeting, the state went on lockdown. Well...not really. It was going to go on lockdown that night at midnight. In this state, therapy is considered an essential business. Not important here, I guess. Just a source of annoyance.

He contacted me (wanted to call but lost my number? Again, not important here, but another source of annoyance) and said he wanted to move to video sessions until the state had opened up again. I absolutely understood, but this was a critical session for me and now I would have to do it online. He acknowledged how hard it was, but for me then, it was just talk. I hate anything to do with having my picture taken and I will NOT let anyone video me. That's always been a thing with me and it's only gotten worse the older I've gotten. I was super upset and canceled.

I have an appt on Monday and haven't decided if I'm going to do it yet. I've never done this before - not even on social apps - and it terrifies me. Part of it is worry that I'll screw it up, do it wrong. That will lead to embarrassment and shame. Part is that I just *need* to be in the same room with him when I talk, because that feels safer. And then, there is this feeling...not even sure how to describe it...that meeting online is dismissive in a way. That not as much care goes into it. I know it's not true and he teaches and does all sorts of stuff online, so I know it is important to him. I have a hard time feeling valued, though, and not being able to meet in-person reinforces that.


I was supposed to have one more in person session with her, but the morning of, I received an email saying that due to her elderly parents (that she cares for) her family decided that she needed to switch to tele therapy. If I didn’t want that I could have a free 10 minute phone call each week. She also left me a card at the front desk (a transition item thing we do during separation). I picked up the card and did the online. Didn’t really like it. It felt detached. I was distracted by her home interior. She didn’t know how to look at me yet. Talked a lot about tools and self care. I had to switch to a tele format with my clients one on one as well so I emailed her my discoveries throughout the week.

We found a “rhythm” on the second visit. I have an obsession with making my bed and cleaning my bedroom even though she can’t see it the way I have us set up. I have a back up location in my closet. It’s hard with two teenagers, a dog, cat and husband in the house. First session I laid in my bed. Now I’m sitting in a chair holding a pillow just like in her office. I put classical music on to drown out home noises. We are doing emdr and it is working quite well. I have a post on here about that.

I’m mostly distracted by noises in my house. I miss our end of session hug. I’m a bit scared that this is confirming my fears related to the outside world being dangerous. I miss the safety of her office, but I’m not that connected to her new office location that we’ve been adjusting to since January. I miss her, but I’d rather her stay alive and her parents stay safe.


I need to make the switch to tele-health but I am hesitant as I hate talking on the phone or thru video. I feel that I am about 6 years old when I try to carry on conversations like that. I am not sure why I feel so young and lost, but I do and I am in danger of missing an important appointment.

I suppose that I will need to give it a try. It will probably work out better than I am expecting as I tend to go to the worst-case scenario first. Somehow it feels unsafe to me. I get the same kind of discomfort that I get when I am anticipating a conflict. Oh well, it is not like I have never been uncomfortable before. :)


Fantastic thread. I was given four choices. Go to the office because he is still allowed, phone session, video, miss the session. The phone video and missing sessions all terrified me. Video more so than phone. I’m already distraught so trying to navigate video and phone would increase the distraught behaviours and then what we would be doing is spending time trying to navigate unchartered, unhealed territories. the phone is a trigger and my abusers have used it as has video been used in abnormal ways, so trying to normalize it’s use in an equally abnormal time is a lot of work. for me it’s not a matter of hating video and phone, it’s the terror of those two things. When the pandemic first started my phone rang a lot with doctors and others phoning to cancel appointments and it seriously increased panic attacks and crying. I can email him more, and my in office is cut to every four weeks instead of every two weeks. On his website I can listen to him because he has recorded himself leading a relaxation exercise. So if other therapists can think that way and add prerecorded tools to their websites and access to email it is tremendously helpful to those who cannot surpass the hurdles of video or phone. My connection comes from knowing he will do the safest option for us. There is a real need to guide these processes, not just for those who have tech challenges, but for those who have abuses where tech, video, phones were tied in. Also yesterday when I saw him I took two wood blocks from the box we use when I’m having trouble talking. The blocks have phrases on them so if I’m stuck in shut down and can’t talk I show him a block. This time though the blocks took on a whole new way of being used because I asked if I could take home the blocks that said, I’m safe and I can get help. Two powerful messages that are sitting right in in my space where I can see them.
Thanks for this thread, @Wendell_R.

I've had three teletherapy sessions. It's a problem for me as I live in a very small house with very thin walls with three other people (one other adult), and I have very poor hearing which has led to a very loud voice.

So for the first session, I went out to my car with my phone. I hated it. It felt unsafe and terrible. We still had a pretty good session but I felt awkward and uncomfortable the whole time.

Since then I've been using my laptop in my bedroom with white noise machines in front of the door. It's a lot more physically comfortable, but I noticed I was still unable to discuss certain topics because I was afraid people would overhear.

So I talked about it with my T. I realized that her office is a real safe space for me, and we both expressed our sadness that we couldn't be there together. And since I didn't feel safe, she gave me the option of not doing trauma work for now but doing work on day-to-day things instead. I quickly realized that was unacceptable to me. And I also quickly realized that if I wanted to continue trauma work, I was going to have to push through the feelings of not being safe. Because even in my tiny house, I'm still actually safe. If anyone overhears, they'll just overhear and I'll deal with it.


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Have nt had dyad session yet but had my group on zoom. My feeling is if trauma is deeply rooted to before language and one has issues with or needs communication in non verbal levels, eye contact, gazing, textual etc, they need three dimension communication and relating unless they have come conscious of this and can manage the time being.
However, if one had trauma occur later after self formation and language and some cognitive foundation, or long therapy experience, then the 2 dimension communication and relation is not as painful.

Edit---I really should not say not as painful... All depends on the person.

No research based. Personal experience. I fell in love in Skype relationship and I am in intense therapy so this is my personal opinion. Would be interesting to know if others have differentiated their experience similar or not.
Ps. I have both trauma BTW. More I do not have the high cognition but more body based communication but I hold myself reasonably.


I just switched to video this week both with my therapist and with my clients. As a client, I miss being in the room with my T, but going without therapy is not an option. So, I will get through it. I have various items there to ground during the session, and since I am at home, my cats are participating too! For my clients, they are all feeling the anxiety associated with the uncertainty of this virus. If they are not comfortable with video, they can cover the camera with tape if they want. While I prefer to be able to see them, I can do therapy with just audio if necessary. As the therapist, audio and video therapy is more exhausting. I am having to do more to take care of myself so I can continue to provide good, healthy support to my clients.
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