Couples counseling is stressful during normal times – two people struggling to keep their relationship alive, and pinning a lot of hope on their therapist. Even “good sessions” – with both partners working hard on the relationship – are often filled with a double-dose of painful emotions.
When COVID-19 hit, couples therapy became even more complicated. Many therapists switched to telehealth to reduce the risk of spreading the disease. Now, partners are in their own home (together), and the therapist is miles away peering at them through a tiny camera.
Sue Johnson, the developer of Emotionally Focused Couple Therapy (EFT), wrote that her first response to the idea of online couples therapy was “total disbelief.” In an article published in the November/December 2020 issue of Psychotherapy Networker Magazine, Johnson said that until about 18 months ago, she “simply refused to consider it.”
Johnson describes adjusting to using telehealth and she is very grateful she started using online counseling with couples before COVID-19 hit. She plans to continue using telehealth after the pandemic subsides.
”We must find as many ways to reach and support people as we can, and I realize now that online interventions have to be part of the therapist’s toolbox,” she said.
If you’re still adjusting to working with couples online, here are some special considerations for conducting couples counseling via telehealth:
Telehealth for couples certainly has some advantages. Like individual therapy sessions, there’s no travel time, and it’s safer for all involved with a pandemic raging. The convenience also may mean fewer cancellations.
For couples with children, it may also mean saving on babysitting costs. (Be sure the children are out of earshot during sessions).
Technology like screen sharing and powerpoints can be used to display handouts and to share information you might have written on a whiteboard in your office. Therapists also may add pages to their websites to host assessments and resources.
Couples may be more relaxed talking to you from their own home.
Your state licensing laws may allow you to work with clients statewide, not just those in close proximity to your home.
It may be harder to pick up on body language and subtle mood shifts in clients over a webcam.
Screening for domestic violence also may be more complicated. Make sure no one in the home can listen in on the individual assessment sessions.
Volatile couples present special safety concerns. Make sure you know where your couple is located. Know the phone number for the police department near the clients’ home. Have the phone number of an emergency contact.
Children and pets in the home may interrupt the session. Have a plan for managing the interruptions.
- Add a “telehealth” page to your professional website. Use this page to explain how telehealth works, explain your telehealth platform and include any additional information your clients will need for their sessions. Remember, many clients may be viewing the pages on their phones. Make sure the pages are mobile web-friendly and check them on your device.
- Update your assessments, intake forms, and confidentiality forms and move them online. This will save a lot of time, and you won’t have to worry about clients struggling to find or open possibly non-secure email attachments. Again, make sure the forms are mobile-friendly.
- Consider conducting a brief domestic violence assessment over the phone with each partner before the first session.
- Think about how you will collect your payment, insurance co-pays, or other fees. Explain this to your clients before the session.
- A few days before the first session, provide your clients with onboarding instructions.
Consider using digital tools from couples counseling (Gottmans, Therapist Aid, etc.) or create your own powerpoints or short videos to enhance your sessions. Does your video conferencing platform allow you to share links through a “chat” feature? Does it have a “whiteboard” or screen share option? These features can help make the session more dynamic.
- Expect technical issues and plan for them. You will experience a screen-freeze at some point. Discuss this with the clients during intake, explain that it likely will happen and you will just pick up where you left off when the signal resumes. Have the phone as your backup. Ask the couple to put you on the speaker.
- Be mindful of your on-camera presence. Is your client on a phone or a laptop? For example, when you gesture clients watching on a phone might not see anything except your face. Keep their perspective in mind.
As with individual counseling, couples therapists should make sure they get training on the legal, ethical, clinical, and technological aspects of telemental health. Also, consider getting additional training and networking with other couples therapists for tips.
By Amanda Barnett, LPC, NCC EDS