Therapist Sam Hope sings the praises of video counselling
Content note: Article mentions ableism, transphobic violence
I spent my week off, in which I should have been holidaying in Devon, doing a virtual writing retreat with a few friends. As a disabled person, I have missed writing groups for a long time because I simply did not have the spoons. This lockdown may have removed one possibility but it opened up another: I fully intend to keep my little virtual writing group going into the future.
The writing activities we did reminded me of something important. When you place restrictions on yourself as a writer, it can enhance the creative process. We did one activity in which we had to describe a scene without using the sense of sight: it pushed us to explore other senses more, and deepened the readers’ connection to the scene by inviting their other senses into it.
When we read a book, how do we connect to the protagonist when we are not in the room with them? When they might not even exist in reality? How is it that we feel what they feel? It turns out questions like this are useful to ponder when we move on to my next question: is online counselling “real” enough? In case there was any doubt, I’m going to argue yes.
I saw two different posts on counselling forums in the same day, both claiming that counselling via video call is “lesser” than “face-to-face”. One posted this article, in which the writer imagines that the exhaustion and grief many of us are feeling is because we’re using online communication, rather than because Britain has the second highest death rate per million in the world. It goes on to dismiss evidence that video counselling is as effective as in-person (let’s stop calling it face-to face – we are face to face on a video call), citing little more than hunches and vague notions that it just doesn’t feel the same.
I would like to counter this belief with some considerations for my fellow therapists and encourage them to see the potential of creativity in the ways in which we work that video calls offer.
I will start by saying that as someone who works online for the majority of my practice and has done for years, I acknowledge video calls do not work for everybody, just like therapy itself does not work for everybody. I have clients who need to feel the physical presence of another body in the room with them in order to open up. I also have clients who cannot manage the particular sensory input of video calls and prefer to work by phone.
But I would like to encourage therapists and others to see the benefits of this way of working.
In my own therapy, I have had a mixture of phone sessions and in-person, as my counsellor has yet to be persuaded of the magic of video calls. On days when my fibromyalgia is particularly bad and my workload is high, driving for forty minutes to see her on my day off has been too much. My therapist and I noticed early on that our phone sessions, rather than being a poor substitute for in-person, were actually some of the real breakthrough sessions. As a highly sensitive, neurodivergent person, leaving the home and driving a car somewhere, especially if it’s a bright day, can be a huge sensory overload for me. This means that I can arrive at my counselling sessions in a somewhat dissociated state, meaning that although I am in theory more “present” with my therapist, in reality I am less so.
Now, I like to visit my therapist when I can and I’m not saying that in-person has no benefit for me at all, but I invite the reader to consider that for this client in-person is not necessarily better therapy. That for a neurodivergent and physically disabled client, there may be accessibility issues that mean being in their own home is better.
My client group is largely made up of people from a community that is very interconnected. They say that we are all connected by six degrees of separation. In the case of the LGBT+ community, I tend to think it is more like two degrees. To find a queer-friendly therapist who is knowledgeable and sex positive, sex worker positive, kink positive, polyamory positive, trans affirmative, ace affirmative, LGB affirmative, etc. is hard enough. Finding such a therapist who is not in your circle of friends is even harder. Putting another limit – that the therapist must be commutable to is often asking too much.
The fact that clients from these groups are able to access a therapist who may be hundreds of miles away from them and their social group, or even in another country is a huge asset. I see clients around the world, and the geographical distance somewhat mitigates the fact that there are inevitable overlaps in our social worlds.
Another asset is the benefit for trans clients to be able to see their therapist in relative safety. For far too many of my trans clients, leaving the house is dangerous, or at least highly anxiety provoking due to the growing levels of transphobic hate crime in the UK.
It may be hard for straight neurotypical people to understand, but many trans people have found safe harbour in their lives by living mostly online, particularly trans people who are autistic. By living online, we can choose to be in communities where we are safe, and avoid the bullying, hate crime, gaslighting and harassment we might receive when we walk out of our doors. It is highly stigmatising to call these clients’ lives “unreal” and suggest that the toxic interactions they experience in the in-person world are not something they are permitted to opt out of. Who made those rules?
No more stigmatising
We may have all kinds of rationalisations as to why “in-person is better” but there is no real evidence base that this is so. However, stigmatising online interactions and experiences does have the potential to undermine people’s experiences in the same way that stigmatisation of LGBT+ and neurodivergent identities undermines us – it can do real harm to tell someone that the meaningful life they are having isn’t legitimate.
The stigma of virtual communication versus face-to-face communication is an unnecessary one, and ultimately marginalises already marginalised people. There are people who have sexual and romantic relationships across continents; there are people who have a rich and rewarding online life. Meanwhile, it is possible to be in the same room as someone and not connect to them at all. This, of course, is particularly true if you are LGBT+, disabled, or neurodivergent, and getting to that room has been so exhausting, stressful or overwhelming for you that you have dissociated or dissolved into a big puddle of anxiety or are simply too tired and in pain to think or feel much of anything.
I sincerely hope that virtual communication will be valued much more highly in our lives going forward. That counsellors will see the benefits to clients of offering video and phone counselling as options, if they are able to work this way. Not all counsellors will feel able to do this. I appreciate there are some people who find the sensory information gained by somebody’s physical presence to be an essential ingredient for them. But I promise you, there are ways of connecting into what is happening in the clients’ body via empathic communication. That communication between two bodies in contact via video call is still embodied because our bodies are where we are.
It is, of course, important the counsellor stays in contact with their own body, and perhaps the false belief that they have become disembodied while on a video call could be a potential source of exhaustion and disconnection.
Let us not stigmatise the fact that our sensory experiences widely diverge from one another’s. If counsellors who do not like working online could own that it is merely their experience, not a universal one, we might get away from this “online is lesser” narrative and begin to understand that online and phone counselling are exactly the right approaches for some clients and some counsellors and every bit as real and connected for people who are used to seeking connection in this way.