Teletherapy in the time of COVID-19: The secrets to success

An image of a women using a laptop to video conference with another woman

The York University community has within it extraordinary creativity, solidarity and dedication to serving the public good while caring for all people, including the most vulnerable. With clients in mind, when COVID-19 began, Psychologist Shari Geller realized that conducting therapy sessions – increasingly essential, given the pandemic – would have to change… and fast. The York alumna, on teaching faculty in the Faculty of Health, wasn’t sure what that would look like or how it could be successful without the seemingly vital face-to-face interaction.

So, she integrated her research on how the therapeutic relationship could be fostered and maintained with ‘therapeutic presence’ (that is, a way of being with the client that maximizes the effectiveness of the therapy), with her current clinical experience with online therapy. Therapeutic presence means creating a safe space, maintaining eye contact, communicating empathy and more.

The findings of her work were published in Counselling Psychology Quarterly (2020).

Shari Geller
Shari Geller

Geller emphasizes the urgency: “In a matter of days, psychotherapists across the globe had to shut down their in-person psychotherapy practice as the coronavirus pandemic escalated in early 2020. Psychotherapy quickly transformed into being together yet at a physical distance, with two computer screens between therapists and clients.”

She notes that it’s not only clients suffering. “Many therapists have also had to cope with their own personal anxiety, grief and trauma related to the pandemic while supporting their clients to do the same.”

This is Geller’s forte. She is a clinical psychologist, author and mindful self-compassion teacher. She has been researching, writing and training therapists in cultivating therapeutic presence for decades. Her expertise includes a unique blend of effective modalities, including emotion-focused therapy, mindfulness, experiential approaches and rhythm-based therapy.

Need grows greater every day during pandemic

Geller suggests therapists need to express presence and empathy more readily in an online environment
Geller suggests therapists need to express presence and empathy more readily in an online environment

Geller’s timing could not be better. Mental health has risen to the fore as a key issue during the pandemic. As she notes, therapists, unable to maintain a face-to-face relationship due to physical distancing measures, have needed to shift their practice online.

“This created an immediate need around how to build and maintain strong therapeutic relationships while navigating this new online environment. We all wondered how the therapeutic relationship will be maintained and fostered over the internet,” she explains.

Research unpacks challenges, find way forward

Geller’s article does many things: (1) Explores the challenges of cultivating therapeutic presence in online therapy; (2) offers tips to encourage and support the therapist and the client, to help them remain present while engaging in telepsychotherapy; and (3) considers implications for future research and clinical training for cultivating presence in telepsychotherapy as well as integrating what has been learned during the pandemic back into face-to-face sessions.

Tips for success pre- and during therapy session

Geller offers suggestions for clients, which include optimizing their presence by minimizing distractions, finding a private spot to talk, speaking with family or roommates about ensuring privacy, and keeping the camera on so that the therapist can read any facial clues or body language. Having blankets and Kleenex on hand are also recommended.

For therapists, she has the following tips:

  • Create safety and guarantee confidentiality. This also encompasses psychological safety. Therapist should find a consistent site in their home office from which to host the sessions, for example. Geller underscores the importance of therapists looking directly at the client. “Maintain your eye view at the level of the camera so clients experience you looking at them. If you’re looking down at the camera, clients may experience you looming over them,” she suggests. “You can look at your client, you don’t need to stare at your camera light, just maintaining eye level is helpful to encourage visual connection.” Even lighting and professional attire contribute to creating a therapeutic presence.
  • Undertake prep work. Take time prior to the session and clear the mind. Increasing self-care is important here, so therapists don’t burn out.
  • Communicate presence, empathy and resonance. This is achieved through tone of voice, eye contact and non-verbal cues. “Ensure these are visible to clients so they can feel you with them in session. You may need to do more of this with online therapy, as the face is the main connection point between you and your clients,” she adds.
  • Mirror the client – meaning mirror their expressions, gaze, tone and pace, even breathing pattern. “Allow yourself to co-regulate with clients. This can invite a felt sense of what their experience is and can allow clients to feel you present with them,” she explains.
Image of a woman leaning forward with clenched hands at her face, looking worried
Geller notes that therapists need to cope with their own anxiety around COVID-19 as well

Lessons for the future  

Geller anticipates that these tips can help therapists carry forward their learning to push through difficult times and grow themselves professionally. “This will hopefully leave therapists more skilled in developing presence and therapeutic relationships, and to continue their work with increased self-care,” she says.

These tips will also prove helpful after the pandemic. Indeed, Geller foresees that many clients may prefer to continue online even when face-to-face sessions are possible once again.

In this case, she believes training will hold the key to success in online work. Research suggests that training and comfort with the technology would increase the likelihood that therapists would use telehealth. There are many advantages to institutionalizing telepsychotherapy: It would allow access to therapy to a much broader community, such as those who live in rural communities, or have physical, cognitive or emotional limitations making it difficult to come to a therapist’s office.

“The pandemic has taught us a great deal,” Geller sums up. “The difficulty of cultivating and sustaining presence online and working through those challenges can hopefully benefit therapists. The experience of struggling and overcoming the obstacles can illuminate the resilience of therapists and their abilities to retune and refine their ability to be present and increase safety and intimacy in the therapeutic relationship.”

To read the article, “Cultivating online therapeutic presence: strengthening therapeutic relationships in teletherapy sessions – during time of COVID” in Counselling Psychology Quarterly (2020), visit the website.

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By Megan Mueller, senior manager, Research Communications, Office of the Vice-President Research & Innovation, York University,