Lessons Learned in Providing Technology-Assisted Services During COVID-19

By Richard P. Long, PhD, LMFT, Chair of the Telehealth and Technology Network.

Many MFTs would agree with Gayle King, co-anchor of CBS This Morning, during a recent interview recap, when she paraphrased Sara Bareilles, American singer-song writer saying, “a screen is a flimsy surrogate for human connection.” Yet as Harriet Brown says in a July 6, 2020, article in Vice, after trying remote therapy, some may never go back to in-person sessions. Aaron Norton, in a presentation entitled, “Telehealth for Counselors: Zooming into a New Era”, relates a total of 51% of those surveyed practiced telehealth exclusively as of 5/29/2020. The number for MFTs may be similar.

What follows is an attempt to point out five lessons learned from what for many MFTs was a conversion experience. Each lesson is meant to invite MFTs to reflect on their own online practice, asking—"what is working and what is not working?  What am I getting right? What am I getting wrong?”

1. MFTs should observe and comment on what they see on their screen. In-person sessions do not tell us about a client’s connections to a client’s pets. Are there pets in the room? Are they in the lap of the client or quietly sitting to the side? What about a beverage? Is there a cup of coffee near the lap top or a bottle of scotch?  What about the art work in the room, if any?  Does it tell us something about a client’s connection to nature, heritage, gender, etc.  What room is the client in and what is our reaction to the choice of rooms. A client choosing to the put the laptop in a bedroom is giving us different information than a client who set up the laptop in the kitchen.  Of course, there is the potential a tit for tat discussion of the setting, so MFTs need to be ready to talk about their own recording environment.
2. MFTs should give their clients instructions about how to complete an intake packet. Granted there is a lot to cover, but clients will become more comfortable faster when they understand how therapy will work online. What information does the MFT require? How does the MFT secure releases of information? What is the back-up plan for those times when there are technical glitches—poor video, poor audio? What is the MFT’s plan for handling an emergency session? Even though most of these instructions are provided on a website, not all clients learn best by reading.
3. MFTs should project more energy online than they project in-person. The premise here is that media streaming applications are the MFT’s competitors. A client’s attention may drift when participating in a talking-head-only 50-minute session. This means that the MFT needs to be positioned close to the webcam and must maintain eye contact that is direct and demonstrates an interest in the thoughts, feelings, and behavior of the client. MFTs need to use their voice effectively, aware that variations in vocal pitch can help project attunement to the client’s concerns or issues. Above all, MFTs need to recognize that more energy is required to provide effective online therapy as compared to in-person therapy.
4. MFTs should use more experientially-based approaches than psycho-educational, classical approaches when using technology-assisted services. This is not to discredit the latter models, rather the issue is one of adjusting to the requirements of the medium. Gestalt-oriented individual therapy, emotionally-focused therapy for individuals and couples, functional family therapy and structural family therapy all invite greater levels of engagement than listening to a presentation on the differences between I-messages and you-messages, for example.
5. MFTs should slow down when it comes to processing the emotional content of an online session. Any MFT who has watched a recording of Carl Rogers doing a consultation is struck by the way he uses stillness during the consultation. It is when he is listening, leaning forward, and giving direct eye contact that change happens for the client. Recall the days when as MFTs-in-training we were told by our supervisors to silently count backwards from 100 before jumping in with an unexpected question or insight.

While this list of lessons learned is not exhaustive, it does raise the question of how online therapy differs from in-person therapy. Of the five lessons learned, which one(s) do you agree or disagree with? What would you add to list based on your experience providing therapy during COVID-19?

Richard P. Long, Ph.d., LMFT, is the chair of the Telehealth and Technology Topical Interest Network. He can be reached at [email protected].