At a glance
The hard part of an online session is rarely the technology. It is finding an hour in your own home where you are not half listening for someone else. This article helps you make that hour before you open the call.
Clinical insights from 22 years in psychotherapy
I’m Mark Colclough, MA, psychotherapist in Copenhagen. Qualified at the Psychosynthesis Education Trust and the University of East London. 22 years of full-time, face-to-face clinical practice.
- The session held at the kitchen table. Clients who take the call from a shared room often speak more carefully than they mean to, and tell me so weeks later.
- The last 2 minutes. Clients at home step straight from something difficult into the rest of the evening, with nothing in between.
- What the camera leaves out. I can see a face and little else, so I ask about the breath and the hands instead of reading them.
Clinical notes: My observations are anonymised and compounded from my session notes since 2004.
Where in my home can I actually be private?
Privacy is the whole question, and in a Copenhagen flat it is usually a practical problem before it is an emotional one.
Plenty of people book online sessions precisely because the room they live in is the only room available, and then find they cannot say the thing they booked to say. A partner is working in the next room. A flatmate comes home at six. The walls are thin and you already know how much carries. So you lower your voice, you choose the softer word, and an hour you paid for quietly becomes a performance for whoever might be listening.
It is worth solving before the first session rather than discovering it halfway through the second. A bedroom with the door shut and something playing in the hallway is often enough. A car parked somewhere unremarkable works better than most people expect. If nothing in your home works, that is useful information rather than a failure, and it usually points towards the room instead.
What is worth setting up before I open the call?
Set up for your own comfort rather than for how you look, which is the opposite of what most people do.
- Light in front of you. A window behind you turns you into a silhouette, and I lose your face for the whole hour.
- The device on something solid. Held in your hand, the picture moves with your breathing and you spend the session managing it.
- Headphones. They keep your end private, and they make my voice feel closer than a speaker across the room does.
- Everything else closed. Messages arriving in the corner of the screen pull you out, and you rarely notice that they did.
- Water, and somewhere to put your feet. Small things, and they are what let you stay in a difficult conversation for a full hour.
I would add one thing that is not a setting. Sit so you can see me without also watching yourself. Most people spend the first sessions half monitoring their own face, which is a reasonable thing to do when you feel exposed, and it keeps you one step outside the conversation. Most programs let you hide your own image. It is worth doing.
What does the screen take away?
It takes the body, and that is the part worth preparing for.
In a survey of 479 therapists across 25 countries, the one area where almost nobody found an advantage was the bodily one: 216 responses named something lost in nonverbal and physical contact, and none named a gain.1 Those answers came from therapists rather than clients, and they were given during the first months of 2020, when the change was forced on everyone at once, so they describe a particular moment as much as the medium itself. On the relationship, the same therapists were split roughly down the middle.
In my own experience the loss is real and it is workable, provided you fill it in out loud. I cannot see your shoulders drop or your hands stop. You can tell me. Saying that your chest has gone tight, or that you have just gone somewhere else for a moment, takes three seconds and gives the session back the information the camera removed. In the room I would notice it. Online you and I do that part together.
What if the connection drops in the middle of something?
Agree what happens before it happens, because the moment it goes is a bad time to be improvising.
The usual arrangement is simple: if the call fails, rejoin once, and if that does not work the session continues by telephone. What matters more than the arrangement is knowing there is one. A dropped call in the middle of something painful can feel like being cut off by me rather than by a connection, and if you have no agreement to fall back on, that feeling has nowhere to go.
The same holds for interruptions at your end. If someone knocks, say so and deal with it rather than freezing and hoping I did not notice. What you do with an interruption is often more interesting than the interruption.
How do I come back to myself afterwards, and when is online the wrong setting?
At home there is no walk back from the room, so build one.
- Keep 15 minutes after. Not for anything in particular. The gap is the point.
- Change the room. Open a window, move the chair back, make tea. Something that marks the end of the hour for your body as well as your diary.
- Go outside if you can. Even a short walk does what the stairs down from a consulting room would have done.
- Write nothing down straight away. What stays with you by the evening is usually the part worth returning to next time.
Online is not the right setting for everything. Where there is nowhere in your home you can speak freely, the work will keep bending around that, and the room is the better answer. Where what you want to work on lives mostly in the body, in what happens to your breathing and your posture when a subject comes up, a screen makes that slower and sometimes impossible. And if you are in a relationship where another person could overhear, and part of what you need to say is about them, online is not private in the way it looks. A free 30-minute call is enough to work out which setting suits what you are bringing.
Questions people ask
What do I need at my end?
A device with a camera, headphones, a reliable connection and a door you can shut. Nothing else is required, and nothing else makes much difference.
Can I take the session from my car or my office?
A car is often the most private room people have, and an office usually is not. The test is whether you could say the difficult sentence out loud where you are sitting.
Can couples sessions work online if we are in different places?
They can, and being in two locations changes the work enough that it is worth naming at the start. Each of you then has somewhere private to be afterwards, which cuts both ways.
What if someone walks in?
Say what has happened, deal with it, and come back. Pretending it did not happen costs more of the session than the interruption does.
Can I switch between online and the room?
Yes, and many people do, depending on the week and the subject. It is worth saying why you are choosing one on a particular day, because the choice often carries something.
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Sources
How this article was written: I choose the subject and the angle. An AI assistant researches and drafts. I read the draft, correct and improve it and stand behind every clinical statement. The professional and clinical judgement is mine.
