Tips for Online Couples Counseling During Covid-19

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:

Pros

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.

Cons

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. 

Other Tips

  • 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

Resources

The Telemental Health Training Certificate Program

The Gottman Institute: Clinicians Digital Tools

Therapist Aid

American Association for Marriage and Family Therapy

Key Source

Going Virtual with Couples: From Skeptic to Believer by Sue Johnson

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Very informative. I learned things that I wasn't aware of about state laws!
Tamara Coleman
Counselor / Tamara Coleman Counseling LLC
Very well done. Encourages active engagement in telemental health process while guiding effectively.
Chris Brotherton
Marriage and Family Therapist / Addiction Counselor / Brotherton Counseling LLC
Educational and informative content that was easy to follow and comprehend.
Scott Lipp, Ph.D., LMHC, LAC, NCC
Licensed Mental Health Counselor; Adjunct Professor / Greater Things, LLC; Florida Atlantic University
This course is more comprehensive than all the other HIPAA courses I've taken combined.
Michelle R. Gould, LMHC
Mental Health Counselor
This course was extremely helpful understanding the legal requirements for interstate telehealth counseling.
Donald Kirk Henderson
Licensed Professional Counselor / Milestone Family Resources
Brillant concept and a great way to support counselors as they transition into on-line therapy/services.
Bianca Abrams
License Professional Counselor / The Wellness Institute of Atlanta
The course was so informative and I was glued to my screen for the entire duration. I received so much knowledge concerning ethics in telehealth and I am greatly encouraged to read about all the standards and policies that pertain to my practice. Thank you!
Bridgette Nalumu
Public health consultant / Green and Purple Consultancy Network
This course was very interesting and allowing me to understand the way telementalhealth services need to work correctly.
Patricia A Hill
Mental Health Counselor II and LCDC, MAC / Central County Services
Vey helpful and user friendly. Most importantly informative. Very good information to enhance an individual's practice.
La Keicia Boyd
Licensed Professional Counselor / Private Practice
Amazing and relevant information conveyed over excellent format. This is a professional organization worth joining.
Summer Allan Wilson LCSW-S; Nationally Certified TFCBT
Pediatric Psychotherapist / East Texas Family Guidance Center
This course is providing me with valuable information that will be helpful in providing competent and effective services for clients.
Nancy Sweet-Holp, LMSW
Therapist / Liberty House of Albany
Thank you for an informational, relevant course to help me obtain my TMH certificate. Excellent presentation.
Tomica Horton
counselor/therapist / Jodi Province Counseling Services
I learned a lot in this course and will put what I learned into practice when I move my home office space.
Raymond Corbo
Clinical Supervisor and Counselor / Redeemer Counseling Services
Courses were very informative! Extremely helpful!
Carron D. Alexander
LPC / Premier Counseling Services
It was one of the best courses I’ve attended; clear, well-structured, creative, transparent and professional! Bravo.
Elizabeth Tramonte, PsyD
Private Practitioner / Elizabeth Tramonte PC
The training was well structured and presented by a knowledge individual. Information shared in the training was useful, clear, and concise and can easily be incorporated into future practice techniques.
Dora Falls
LPC, MAC Private Practice - / Private Practice

The course was very detailed and informative. It covered everything that is necessary to work with Tele mental health.

Cynthia Allison
Mental health Counselor / Friendly Therapy LLC
Very informative training, instruction was clear and easy to follow
Jill Bogan-El
Therapist
Very informative! Well organized! Takeaway- protect yourself- know your ethical code and standards/ be insured.
Brenda Staerker
Private practice / Thaxton Holistic Wellness
Easily one of the best online or in-person workshops I have ever attended. The information was unbelievably relevant to current practice with our students doing e-learning and having to provide online therapy and support. Thank you so much for this workshop and the information.
Vincent Amador
School Psychologist / Thornridge High School
I took the Board Certified-TeleMental Health Provider Training Certification Course in 2018, I feel so lucky to have found the TeleHealth Certification Institute. It's a top notch training center which has continued to provide me with tools and the knowledge to grow my private teletherapy practice. I recently participated in the TeleMental Health Preparedness Summit 2020 and was definitely not disappointed. The excitement and enthusiasm from the participants and TeleHealth Certification Institute staff is contagious. I've been inspired, since, to look into taking more courses, and joined their FaceBook group. I will likely join their consultation group in the near future. I don't believe there is another training institute out there that is as good as this one for everything telebehavioral health. Thank you Ray! You are a visionary!
Larissa Golloub, LCSW-R
Psychotherapist, solo practitioner / Larissa Golloub, LCSW
Wonderful free training. Helpful discussion on how to aid clients in breaking out of the negative thought trap.
Jaime Wright
Great, course. Really helped me during this challenging time to connect with students.
Priscilla Robinson
School Counselor / Baltimore County Public Schools
This course was very informative and very relevant to today's telehealth practices!
Keith Ayson
Housing Case Manager / Bridgeways
I really gained a deeper understanding of Telehealth. I think this course helps pave the way for success in our field. This was very convenient. I am so blessed to take a course like this during the crisis we are facing as a nation. This course really helps me perform at a high level for my job. THANKS!!!!!!!
Jackie Tanna
Therapist / Region One Mental Health
This was quite beneficial. You explained well at a comfortable pace and you provided sufficient details for me to develop an Emergency Management Plan. Thank you!
Dr. STEPHEN KIURI GITONGA
Necessary technological guidance!
Frances D Murdock
The training was very informative, there was more in-depth information to the details of privacy and HIPAA on an electronic level that I was not aware of. The more technological part of it was new information to me.
Nellie Decker
Therapist II / Yakama Nation Behavioral Health
This course was eye opening and highlighted some definite areas for improvement to better address emergency management planning.
Nikkita Scott
Director of Counselling & Student Activities / Bbermuda College