Guidelines for Remote Therapy

It can be challenging to switch from in-person to remote therapy sessions, both for the therapist and the patient. Many therapists are having to switch very quickly to offering remote therapy sessions, which can lead to some confusing conversations with patients and a ‘hit-and-miss, learn as you go’ approach to remote therapy sessions.

It’s important to pay attention to changes to the therapeutic frame when remote sessions become a wise choice, or even a necessity. Gillian Isaacs Russell has shared the guidelines she sends to her patients as they figure out whether (and how) to meet remotely.

They include tips and advice to help both therapist and patient get the most from their sessions.

Feel free to use and adapt these as you feel fit, and as best suits your practice. 

They are adapted from Russell, G. I. & Essig, T. (2019). “Bodies and screen relations: moving treatment from wishful thinking to informed decision-making.” In Govrin, A., & Mills, J. (eds.) Innovations in Psychoanalysis: Originality, Development, Progress. Routledge, London. 

Remote Session Guidelines for Periods of Restricted Travel 

If we are being advised to limit travel unless absolutely necessary it might make sense for us to have our session via phone or screen. But a remote session is not the same things as what happens when we meet in person. Also, it is not the same as a typical phone conversation or SKYPE or FaceTime call. 

Listed below are some guidelines for how to get the most benefit as possible from these remote sessions when it makes sense not to travel to the office. 

  1. The most important thing is to have privacy. I do my best to provide that when we meet in my office. But now it’s up to you. Please do everything possible to make sure you are in a private space where it is unlikely you will be heard or interrupted. You may need to ask others in your space to respect your privacy by doing things like turning on entertainment in another room or listening to something on headphones. 
  2. Try to make yourself comfortable, but not too comfortable. If you can, settle into a nice, comfortable chair. A workspace, if you have it, is best. Avoid laying in bed or on your TV-watching couch, as well as sitting on the floor or walking around. Try to arrange yourself in as session-like a position as you can.
  3. Put a box of tissues next to where you will be. If you want, pour yourself a glass of water. But avoid having a snack or meal even though you may be reasonably close to your kitchen. Leave that for either before or after the session.
  4. Please be sure to dress as you would if we were meeting in the office. Even though I may not be able to see you if the session is audio-only, or all of what you are wearing if meeting via video, a reality is that you will know what you are wearing.
  5. Turn off or put to sleep all devices other than the one you are using to make the call, including watches, laptops, and other phones. If using a smartphone or computer, do your best to quit from all programs other than the one we are using and turn off all notifications if you can. It is best to leave your hands free by using headphones. If we are using audio-only be sure to put your phone screen-side down. If using a computer for audio-only, please either turn off your monitor or completely darken your screen.
  6. Try to leave yourself an additional 15-minutes both before and after the session for a walk, either by going outside and doing something like going around the block (if you are comfortable doing so) or, if staying inside, wandering around your place. If there is no way to take a walk it makes sense to do some simple stretching. It is not a good idea to leave another remote meeting or call or activity requiring focussed attention (either work or play) and then immediately calling in to start the session. You will need some time to get ready for the work we are about to do. Similarly, after the session is over take 15 minutes to do the same thing before diving into the next activity. This will give time for the session to resonate before jumping back into whatever you have next. 
  7. Location is important. Please do your best to always meet from the same place during this period of time, although that is not always possible. Also, when we meet in- person we share the same location. But now we do not. If you find yourself curious about where I am, please feel free to ask. I will do the same so I can imagine where you are. 

I recognize that these guidelines make the remote sessions a little less convenient. But the additional benefit will be more than worth the effort. And remember, we will get through this together.

For more information and advice, you can view Gillian’s book on google books here:
Screen Relations: The Limits of Computer-Mediated Psychoanalysis and Psychotherapy” (2018) Routledge.