The arrival of the Coronavirus has changed our world and the Resource Therapy community. With social distancing and lockdowns Telehealth options are essential for good mental health support.
At the Resource Therapy Institute we gratifyingly know Resource Therapy can work extremely well online (we have been doing this for several years now).
Resource Therapy online is effective and powerful. All Resource Therapy Actions can be done online, even with new clients, if you consider the guidance below.
We will now be offering Resource Therapy training Programs online, join us for the fun, learning and lots of practice for your skills development.
Details here https://resourcetherapy.com.au/resource-therapy-foundation-training-online-philipa-thornton-sydney/
We have another world first with Resource Therapy’s maiden Webinar, Practising RT online with Clients which we hope to share with you shortly. It’s on soon email me here to join or for a replay Philipa Thornton at philipathornton@gmail.com
We’ll be in touch and posting more as the weeks unfold. To help you get started on your Telehealth Online Resource Therapy journey here is a guide and some useful information. Please share widely to assist others.
For Therapists
- Make life easy for yourself, set up yourself on one online platform. If you use a variety of platforms, you have to remember who uses what, and perhaps switch devices. Skype is not secure and should not be used except as a back up to troubleshoot.
- Zoom is recommended by many, it’s free for one-to-one work, and you can schedule your whole day in advance. Clients do not need an account to use it. We recommend you use the paid plan for the most secure option to protect ours and our client’s privacy.
- Relax, it really doesn’t matter who starts the meeting. You have both agreed and consent to meet. Just as with in-person sessions, people can and do DNA online.
- It’s up to you if you send guidelines in advance. The essentials are to ask them to find a quiet uninterrupted space with a good internet connection, and to make sure someone else is looking after any young children. Make it easy. Too many guidelines may give clients the impression that this will be complicated and they might get it wrong. You know your client group best, adapt what you send out to them to fit their need.
- Anxiety. Just as clients are nervous about coming to your rooms for their initial sessions they can be anxious about meeting online. Be your calm therapist self and have the confidence that this can be a good option for them and that it will be both easy and useful. You are the Good Enough online therapist!
- Always have a back-up way to contact people. Phone numbers are best because they aren’t reliant on the internet. If there’s a problem with logging on, ring them quickly, as a long wait could be anxiety-provoking for clients. You may need to talk to them through the details of going online.
- Screen share. Help show your clients around the technology if necessary. You can request your clients to share their Zoom sessions to assist them in having an easier and safer online experience.
Setting Up at Your End
RT Online session Set up Guidelines
- Make sure your laptop/video camera is at a horizontal height, just above eye level. No one likes a nostril shot and ceilings are boring.
- Ideally sit at a distance from the camera where clients can clearly see your face and some of your torso. Talking heads aren’t cool here. Ensure the background is still and calm. I love a lamp, books, and a plant. You can use a virtual background with Zoom. I like the idea of the Golden Gate bridge behind me but wouldn’t use it with my clients usually.
- Good lighting. You want either a good desk lamp, like my Ikea beauty that shines on you – from in front.
Your First Session
Online therapy is beneficial but it’s different. You are a visitor in your client’s space. it’s akin to a home visit.
As it’s your ‘first date’, you will use your assessment and clinical judgment as to how much work you do in the first session.
It’s better to go slowly if necessary, engaging and building rapport are your best goal.
Some clients are totally in the Action stage and you can literally do an amazing trauma processing and restorative session. Work within your knowledge.
I will sometimes allow up to 90 minutes for a session.
I just had a client contact me to rebook after a one session wonder four years ago. I usually assume the best and she said things had improved. It was a big session, let me tell you.
You will need to evaluate each client’s capacity and their environment.
Be a good and kind visitor.
Technical set up
It is good to check in with and let clients know the backup plans and procedures should technology fail at any time. Be mindful of their and your own batteries running out. It happens. Failsafe by having all equipment you use powered up and plugged into a power source. In my home office, I flick one switch and the lights and everything turns on.
Privacy
Do a check you will be able to run your session uninterrupted. I have had clients who have had children who are home sick from school or pets that run riot. Definitely distracting. See what can be done to minimize any potential disruptions. This might be a challenge in Coronavirus times when many people are at home.
Safety
Creating a safe space is paramount for any trauma processing work. This means complete privacy, with no possibility of being overheard. Please check that they are not in a place where there people who are abusive to them. They have adequate child care. If they can’t find someone to look after young children please don’t do trauma processing.
Apply your wise self and make a judgment accordingly.
I keep sessions relaxed and open. I want to establish myself as a person, who respects people and who wants to help them in their life goals and getting past any blocks.
This helps clients open up and share with you, building a better relationship. Clients often report “I knew I could trust you when I first met you.” Another lady said to me one of her parts said ” I think she is the one who can help.”
Let you and your client ease into things, it’s a negotiated respectful relationship.
You may have to adapt your grounding techniques. I sometimes teach the butterfly hug or ventral vagus tapping. You can always have stand up and stretch.
Butterfly tapping is with hands slightly higher up so more visible. The therapist models the tapping and the client imitates.Tapping Together. The therapist taps on the computer or table, and the client imitates them.
RT Tip With Vaded in Confusion protocol standing up is necessary. I get people to stand up ( make sure their eyes are open) turn around and sit back down again in the chair.
Enlist a ‘co-therapist’
If you are concerned someone will dissociate and that you will not be able to bring them back, you might still be able to do the work if there is a supportive person in the house who you can talk to about grounding techniques in advance.
For young people this could be a parent. You need to have their contact details and they should be in the house but not in the sessions when you are processing. If your client dissociates, call or text the other person, get them to come in and talk them through physical grounding techniques. Again this is not necessary for more straightforward clients or those who can bring themselves back if they dissociate.
If you want to record the sessions for learning and supervision, it’s very easy using Zoom.
Obviously, clients will need to consent and they will know that you are recording because Zoom tells them so. Here is a video consent form you are welcome to adapt. Please click the link here: consent2018docx
Do your usual risk assessment, and make a plan if necessary. This is no different from in-person work. Know who else is in the house and who you might be able to call on if necessary. If they are living alone, who else might they be able to ring after a session with you?
It’s no easier for clients
- Do your usual risk assessment, and make a plan if necessary. This is no different from in-person work. Know who else is in the house and who you might be able to call on if necessary. If they are living alone, who else might they be able to ring after a session with you?
Therapeutic Issues
- In Mark’s experience, often working with clients he’s never met in person, it’s fine to initiate EMDR with a new client in exactly the same way as one would in-person. As ever, it depends on the individual, but the online environment is in itself no barrier.
- If you’re changing from in-person to online, there’s every chance that the transition will work very well, but it does take effort, on both sides. You’re in a new space together, so use the first session to talk about how that feels and to work out how it works.
- If you’re already into trauma processing, you might find to back out and go back to the preparation phase for a while. People may also feel angry or scared about the reasons why you’re moving online. Make space for that discussion.
- The unexpected will happen. Working online is different to being in a clinic room. You are in the client’s home, and you see snippets of their real life. If you take this into your stride, the client will do so too.
- Things will go wrong. The sound will cut out, the picture will freeze, there will be people who can’t log on, the WiFi will drop out. These are all teething issues and not a big deal unless you make them so. Apologize (by phone if necessary) and move on. Online work is very intense. You may find that clients can only tolerate shorter sessions.
- Pets will walk into shot.
- Sometimes urgent deliveries arrive. If you don’t let them go and answer then they are worrying about whether they have missed their parcel. It interferes less if you let them go and then just pick up again. Same, by the way, applies to you as therapist, especially in these Corona days, where it’s not OK to miss a delivery.
- Children may interrupt. (click that link for a hilarious real-life example of how that can happen…) Ask your client to try to make sure this isn’t likely to occur, but if it does, take it into your stride. Pause, give your client time to take the child out and settle them, and then pick up where you left off. Letting them deal with it causes fewer problems than if you and they try to ignore it.
- You can always say no. Your clinical judgement is important. Don’t feel you have to offer EMDR online to anyone who asks. Do your usual full assessment and if you feel uncomfortable or unsure, don’t do it. Start slowly with the preparation phase, and use that as a way to test out how they respond. Start with using CIPOS, the Flash Technique or ‘tip of the finger’ processing before full EMDR. This way, you get an idea of how they will manage thinking about the trauma.
- Only progress to trauma processing when you and they are confident. If it feels unsafe, back out and do more preparation.
- Make a buffer zone between therapy and home life. When clients come to see us, they have to travel, creating a space between their life and the session. When they meet us online, there’s no space. You can encourage your client to take ten minutes after the end of a session before opening the door, particularly if they are caring for children. They can use the ten minutes to write down their reflections, do a breathing exercise or listen to a visualization.
Working online can remove barriers to participation
- It enables us to offer therapy to those who could not otherwise access it. People who live far from a therapist, people who are agoraphobic, or people who find meeting people in-person so anxiety-provoking that they can’t get to a clinic. It’s often easier for children and young people to access therapy online.
- It enables us to be very flexible. It’s easy to vary session length when working online. You can offer very short sessions for children.
- It can take the pressure off. Not being in a clinical room means that people can be present in the session with less pressure. Children can be in the room whilst their parents talk, but they don’t have to be sitting next to them listening. Parents can be around whilst their children have therapy, but again, without sitting right next to them.
Remember: If it’s a choice between no RT and RT online, then RT online is the better option.
Credit where credit is due: This page has been adapted by me and used with permission from the wonderful work of Naomi Fisher, Alexandra Dent and Mark Brayne.