Here in Leeds, my spouse and I have three sources of income; Jane rents out rooms in our therapy centre, I have a busy, mostly face-to-face, private practice and then we are co-directors along with our core team running the TA Training Organisation, a vibrant RTE. Jane and I are totally self-employed, and, as our face-to-face therapists walked out of the centre our income vanished and my financial terror grew.

I have worked online for many years - some specially insured clients I work with in China and UAE Dubai and with several supervisees from across the UK – but in percentage terms this must be less than 3% of my practice. How was I to move all my clients to an online modality and quickly?

A good collaborative approach seemed to work well for me and my clients. I suggested that every client “give it a go” and experiment with working online – and then we could decide if it was right for them or not. This collaborative, experimental, adult-to-adult, pluralistic approaches worked well and most, to date, have remained working with me.

My questions and experiences so far

I want to remind myself of - and share - some discoveries that I have found as a therapist; that we have found as a training team or I have been supportively told by members of the community:

  1. Wonderings about early, introjective transferences – mirroring, twinning and idealisation. There is something about working with online video where one is positioned apparently “much closer” to the client than in a physical, face-to-face session.

  2. There is something about boundary, barrier and merging. It is as if the walls of the therapy room have dissolved, meanwhile the client’s home has become accessible. If they are sitting in front of French windows I get a sense of distance beyond them and possibility. If they are wedged against the lounge wall I can feel enclosed and that we both cannot penetrate into a space “beyond”.

  3. Disinhibition. “All the online training courses go on about disinhibition” think I! I’ve not seen any evidence; surely this is a feature that is left over from the early days of telephone or email counselling? – and then suddenly my client is off! – He reversed his webcam and is taking me on a grand tour of his house.

  4. Fatigue – we have noticed in the training setting that tiredness can set in. Rather like the treatment of chronic fatigue good “pacing” is needed and taking of breaks regularly, even if not tired. With the online training we are taking breaks every 50 minutes for a good 10 minutes. I’m wondering how that might expand to one-to-one therapy? Should there be an interval?

  5. One of my colleagues discussed with me the shared sense of vulnerability considering the therapeutic frame. It is as if we have a wall missing in our houses. In these vulnerable times, does working online inherently result in greater exposure?

You can read a longer version of Andy's article on LinkedIn