Doing Therapy Online – Advantages and Challenges

Illustration of a flu virus

Taking my private practice online

The world is experiencing a pandemic of Coronavirus, or Covid-19 flu. Due to the way it’s transmitted, people are being advised to severely limit in-person contact with others, and to take great care around hygiene. As everywhere, the situation in London is very much ongoing – and changing rapidly.

This post is to announce that, due to the current situation with Coronavirus, I am now seeing my clients entirely online. This will remain in place until things change again. This means I will be working either by video/audio link using Zoom (or another similar service as backup), or by phone. My colleagues are doing the same, or working towards it. 

The benefits of online therapy

I would like to say more about this as not everyone feels comfortable with the idea of working with a counsellor or psychotherapist remotely. I have been working online and by phone for a number of years, and I would like to reassure anyone who is looking for therapy at the moment but has never done it online before. 

There are significant advantages to working online:

  • We do not need to be in the same location to work together. Online access has created a revolution in therapeutic communication and relationships.
  • We have greater choice of working times, as I am not tied to the in-person hours I have at my office.
  • It provides access if you are unable to leave your home for any reason, or if you find in-person work very difficult.
  • Very importantly, we can continue to work during unusual periods like this when meeting in person is not possible.

There are also challenges:

  • Finding a private space to have therapy. This is important to reflect on, if your home or workplace are not right for this.
  • Feeling comfortable using a medium that you may not have used before, or which you have previously mainly used for social or sexual contact.
  • The reliability and safety of the technology.

If you’ve never had counselling online before, I have tried to answer some of the queries you may have:

Doesn’t it feel weird doing therapy while looking at each other on a screen?
I think we all felt weird the first time we did any kind of video call, even with someone we know well in real life. The first time you have a session on video as a client, it’s okay to take some time to feel into it, make sure you are sitting in a comfortable position and, if you need to, feed back to your therapist about what’s going on for you. 

I’m worried it might feel distancing.
It may do at first, and it’s important to honour whatever you’re feeling at the time. However, humans are highly adaptive, and it’s likely that, it will gradually start to normalise.

Don’t you lose something by not being in the same room?
You lose some body language for sure. But your senses recalibrate.

Isn’t it strange to do therapy by phone?
My experience is that you can do very effective therapy by phone. With only hearing to guide us, our senses recalibrate further and our focus increases.

Do I have to install anything on my computer/phone?
You may well need to download an app and/or sign into a website. I am happy to guide you through this.

What if something goes wrong and the tech doesn’t work on the day?
This happens occasionally. Wi-fi can go down. Services may be busier as more people take their lives online. However, I have several apps on my laptop as backup, andwe can use our phones. Depending on the access issues, we can look at each other on video while speaking on the phone, or even typing on messenger. (For the latter, a discussion on confidentiality is necessary.) If everything goes down completely, we can reschedule.

What about confidentiality?
In terms of what we say to each other, my approach to confidentiality is the same as when we are working in a room together. As for protection when working online, as soon as electronic media are being used for communication, there is a slightly greater risk. This is unavoidable. It’s about balancing the possible risks with your needs at the time. Some VOIP apps are seen to be more secure than others, and it is my responsibility as the therapist to check up on this. 

When reflecting on whether I and a new client are a good fit, I take a number of things into account – and working online is not going to be the right thing for everyone. I’m also aware that for some people, the act of leaving your home, travelling to your therapist’s consulting room, and coming back again, is part of the process, and it feels odd not to have this.

While these tools – computers, phones, and the internet – are not perfect (because humans made them) they are enormously useful, especially at times like this when there are very few other options.

While we all try to adapt to this rapidly changing situation, therapy may not be uppermost on your mind. However, if you would like to start therapy and are interested in working with me online, on video or by phone, please get in touch.


Bipolar disorder, race and mental health services, ableism and sex, and more…

Blue keyboard‘That orgasm problem’, zoophilia, sex positivity, the meaning of public relationship announcements…

Interesting things online, because they’re recent or because I think they deserve another outing.

PLEASE NOTE: As always, me linking to something doesn’t mean I endorse every word of it, or everything in the publication it came from. There may be obvious content warnings and some may be a bit unsafe for work.

MENTAL HEALTH

I’m a therapist and keep this poster in my waiting room, apparently it’s saved a few lives (9gag)
I’ve put this one up before elsewhere, but it’s so powerful I’m going to link to it again.

”A cry for help’ makes it sound like I’m supposed to take pity on you. But you don’t need my pity. This isn’t pathetic. This is the will to survive.’

Black and dangerous? Patient experiences of mental health services in London (Lacuna)

Long and very thorough investigation of the inequalities in mental health care in the UK, focusing on the black community, with a number of personal stories.

‘There are few mentions of race in the current government’s mental health strategy documents. Instead it has been submerged under the general heading ‘equalities’. Within the black community, there are wide variations of experience and concern including high rates of self-harm among Asian women and high occurrences of African Caribbean men sectioned by the police. Lumping all such variances together under the general heading ‘equalities’ increases the risk of mental health providers ignoring them. It is much cheaper to focus on meeting a general equalities duty, than commission work to investigate and improve services for specific groups. People are marginalised in different ways and each group, whether gender, class or race, needs tailored support.’

10 things you should never say to someone with bipolar disorder (Guardian)
Important list of unwelcome queries. I think every mental illness needs a list like this, and many of the questions could apply to other conditions. Actually, and physical illnesses too. And disabilities. And addictions. And being pregnant. And – it’s worth reflecting on why people feel a need to ask such personal questions of someone they have just met, about aspects of them that they have little or no control over.

‘Oh yeah, I’m a bit like that
I’ve had plenty of people say this to me after finding out that I have bipolar disorder. It’s meant kindly, as a means of finding common ground. Except often it comes across like Russia battering a flag into a bit of the Arctic she doesn’t own.’

RELATIONSHIPS / GENDER AND SEXUAL DIVERSITIES

Women and that ‘orgasm’ problem (Cyndi Darnell)

Great post by Cyndi Darnell that I put on my Facebook page, but I’ll link to it here because it makes such an important point. One day, we will find ways to have a less goal-driven approach to sex.

‘One thing I do know for sure is that when I ask women who don’t have orgasms why they want to, they very, very rarely if ever say it’s because they want pleasure. This may come as a surprise to many of you. Remember, I am in the very privileged position of hearing people’s deepest, most intimate erotic secrets day in and day out. For many women, genuine pleasure is rarely even on their radar. More than anything, their reasons are because they want to feel normal or because they feel they are missing out, or because everyone else is having them (apparently), or their partner expects it of them – all of which are answers motivated by fear and shame rather than pleasure.’

And here we are again, back at my post from the other day, about wanting to be normal.

Don’t be a sex-positive jerk (this ain’t livin)

Expecting everyone to be sexual and all in the same way can be very excluding and unhelpful. Coercive positivity is a theme I will be returning to more than once in this blog.

‘The brand of sex-positivity that continues to insist that sex is a unilateral good (except, of course, for rape), is not viewing the nuance and complexity of human sexuality, something rather surprising considering it comes from a movement that claims to be concerned with the rich array of, well, human sexuality.’ 

Getting laid isn’t the answer to ableism (Everyday Feminism)

Long first-person piece unpacking the infantilisation and presumed asexuality of disabled people.

‘Even sympathetic friends have repeatedly made it clear that how far I go in any relationship depends on the compassion and open-mindedness of the other person, as if my sexuality is grotesque to the point where only bleeding heart saints would dare tolerate it – and I would be forever indebted to them for doing so.’

What it’s like to date a horse (nymag)

Challenging and thought-provoking interview with a self-confessed zoophile about his life-long sexual relationships with horses. Many issues come up here, about consent, and about ownership. Many people actually think about human/human relationships the same way.

Did you date at all?
I did ask a girl to the prom. Now that I look back, I feel so sorry for her. We sat at the table and didn’t dance. I don’t even think we hugged. As much as I later experimented with people, I was always sure I wanted horses. It was never a case of “I’m just giving this a try to see if I would prefer humans.” ‘

Can You Tell That I’m in a Relationship? Attachment and Relationship Visibility on Facebook (Sage Journals)
Academic study looking at the way we portray our relationships online. One outcome is that the more insecure a person feels about their relationship, depending on their attachment style, the more likely they are to advertise the relationship publicly. Anecdotally, I can’t help noticing how quickly some people announce new relationships online, only to have them founder within weeks. In the old days, it used to be called ‘The Curse of Hello.‘ (Scroll down for the explanation, about the apparent jinx on celebrity couples appearing in Hello magazine. (Irish Independent))


CBT ‘a scam’, the joy of polyamory, parental estrangement, terrible sex ed…

keyboard close-up‘Are you a pervert?’, invisible disability, trans* history and politics, sex work and the modern slavery bill…

A regular roundup of links to things I’ve found interesting, either because they’re very recent, or because I think they deserve another outing.

Please note: me linking to something doesn’t mean I endorse every word in the the article or anything else carried on that particular website. Some of these articles carry an obvious content warning, and some, depending on their subject matter, may be very slightly unsafe for work.

 

MENTAL HEALTH

The Debt – When terrible, abusive parents come crawling back, what do their grown children owe them? (Slate)
Long, excellent article about people debating whether to resume contact with the parents who harmed them.

‘Loved ones and friends—sometimes even therapists—who urge reconnecting with a parent often speak as if forgiveness will be a psychic aloe vera, a balm that will heal the wounds of the past. They warn of the guilt that will dog the victim if the perpetrator dies estranged. What these people fail to take into account is the potential psychological cost of reconnecting, of dredging up painful memories and reviving destructive patterns.’

Lauren Laverne – It’s Time to Make Emotional Abuse a Crime (Guardian)
I think it’s important to keep saying this, whether individuals or charities. But I’m curious about the way language is used when applied to children. Children are ‘bullied’ at school, but this word is often not used when this occurs in families at home. Similarly, the word ‘abuse’ is rarely used in a school context. Sometimes is not quite joining up for me here.

‘What I remember most about emotional abuse is that it’s like being put in a box. […] So you try to make yourself fit. You curl up, become smaller, quieter, remove the excessive, offensive parts of your personality – you begin to notice lots of these. You eliminate people and interests, change your behaviour. But still the box gets smaller. You think it’s your fault. The terrible, unforgivable too-muchness of you is to blame. You don’t realise that the box is shrinking, or who is making it smaller. You don’t yet understand that you will never, ever be tiny enough to fit…’

Am I obligated to disclose my invisible disability? (xojane)
Invisible illness/disability comes up a lot in conversation, particularly around mental health as well as physical.

‘Frequently, when people who know about my accident ask me if it hurts still, I deflect or spew platitudes and just say, “Oh, you know.” I don’t say that physical discomfort has been a near constant companion.’

Oliver James declared Cognitive Behavioural Therapy to be a ‘scam and a waste of money.’ (Daily Mail)
This started a long discussion online, with most having the view that CBT is very useful for specific things, but less effective where there are deeper problems that need longer work and a fuller therapeutic relationship. There’s a general sense of too much money being funnelled for far too long into this very specific way of working. One size doesn’t fit all. I’m curious that this story has not been carried anywhere else. I’ve put it here as a discussion point, and I’m interested as to whether there will be more on this.

 

RELATIONSHIPS / GENDER AND SEXUAL DIVERSITY

The Joy of Polyamory (Archer)
Long and fulsome article by Anne Hunter. One of the big contrasts I notice between monogamy and polyamory is the issue of terminology. It feels to me as if many people in monogamous situations that are not working for them are caught in structures that they would change if only there were a name for what they are looking for.

‘Many of my relationships don’t have a simple label available to them. For example, I have some beloved intimates with whom I will jump into bed, naked, and talk about absolutely anything. The relationship is way past what most people think of as a friend – there’s no sex, so it’s not a lover; we don’t make life decisions together, so it’s not a partner. There is no term that accurately describes our connection.’ 

‘Are you a pervert?’  (Vice)
This is actually a serious and quite important piece by Martin Robbins outlining the double standards around what are still, in some quarters, known as ‘paraphilias.’

‘The thing is, pretty much every type of sexual desire can cause distress or harm to others, regardless of the kinkiness involved. Why fixate on kink? How can you even determine what is normal or paraphilic in the first place? […] Are the people who are trying to express their sexuality really mentally ill, or is the real sickness in the repressed culture that’s so terrified of them?’

The ‘dispute’ between radical feminism and trans people (New Statesman)
Long and important piece by Juliet Jacques in the New Statesman. It’s also an excellent history, both public and personal.

‘In a world where left-wing politics have often derided LGBT identities as ‘bourgeois’ and then accused us of splitting the movement, it infuriates me that I’ve had to take a break from writing a piece on the Tories’ ‘liberation’ of the NHS to write 8,500 words to debunk a sexological concept that was shown to be untenable before the start of the First World War.’

Yesterday (Nov 20) was also International Transgender Day of Remembrance.

Listen to sex workers – we can explain what decriminalisation would mean (Guardian)
After intense campaigning, an amendment to the modern slavery bill was dropped, which would have brought in the Swedish model of criminalising clients.

‘Mactaggart’s justification for attacking “demand” (clients) is that “prostitution is an extreme form of exploitation”. But exploitation is rife in many industries, including the agricultural, domestic and service industries, particularly at a time of increasing poverty, decreasing wages and insecure employment, and no one suggests that domestic work or fruit-picking should be banned.’ 

Sex education in schools: it’s just bananas (Guardian)
Eye popping Guardian piece about the state of Sex Ed in schools. I’m putting this here because this lamentable situation affects us all, whoever we are. The way we are introduced to sex can reverberate throughout our whole lives.


Welcome to London Central Counselling

Welcome to my new counselling and psychotherapy blog.

If you’ve suddenly found yourself on this page and are wondering what it’s all about, I’m Tania Glyde, author turned counsellor/psychotherapist in private practice in Central London.

There are so many interesting things going on in the world and it all moves so fast. I’m going to share articles I’ve written, thoughts on therapy, and other material that might be useful or interesting. I’ll also be putting up links relating to mental health and gender/sexual diversity. I’ll be focusing partly on articles that have come out in the last week, and partly on older stuff that I think deserves another outing because I found it so helpful. (Needless to say, me linking to something doesn’t mean I endorse or agree with every word of it, but I and my colleagues might have found it a fruitful talking point.)

If you’re brand new to therapy, here’s my guide to having counselling and what to expect. If you’d like to read more, Sense About Sex has a detailed section about getting help. I’ll also be addressing some issues that come up a lot, and making suggestions about how to make the festive season go as well as it can, whether you’re participating or trying to avoid it.

Thanks for reading.