From Couch To Computer, A Psychotherapist’s Tale

By Dr Anjali Singhania

For those unaware, the COVID-19 pandemic had an unprecedented impact on people’s mental health globally. The lockdowns, social distancing, and isolation measures put in place to control the spread of the virus led to significant changes in the way psychotherapists such as myself delivered services, and forced us to adopt new ways of working to ensure clients continued to receive the support they need while trying to safe during a time of great uncertainty.

In amongst the difficulties of our own, those in the helping professions had to help clients navigate the emotional impact of the pandemic, whether it be grief, anxiety, depression, or simply the uncertainty and fear of contracting a potentially deadly virus. Some of us lost clients to COVID-19. We provided emotional support to clients who have lost loved ones to the virus, even when facing losses of our own, and to help those facing the loss of jobs or businesses due to the lockdown, while potentially facing similar issues ourselves. Like many in my profession, my first day of working online with clients was the first day I was forced to.

By far the most common issue we faced was a question of how to cope with the uncertainty and ambiguity surrounding the pandemic. Some – clients and therapists alike – struggled to deal with the stress of constantly changing lockdown regulations, the financial insecurity, and the fear of contracting the virus. We were required to think on our

feet and develop new techniques to help clients manage their anxiety and deliver them virtually, and when we finally emerged from the heighted state of the pandemic, our practices and methods were likely changed permanently.

The sudden switch to working online and its effects should not be underestimated. Many clients simply didn’t want to work online or struggled for privacy. Some were reluctant to allow therapists an insight into their homes through the webcams hastily purchased online and set up in spare rooms and on kitchen tables. Clients lost a crucial element to the work, although this likely didn’t reveal itself until later – the journey. No longer was there a time between home and their therapist’s offices; instead, it was a click and a quick return to emails or their next meeting.

This shift to online therapy was a significant change for therapists who had not previously offered their services virtually such as myself. However, as lockdown measures continued (and in some parts of the world, lifted and subsequently returned) we began to discover some previously unconsidered benefits. I certainly met with people I suspect may not have begun therapy without the comforting barrier of a laptop screen. The convenience of online therapy also made it easier for people to schedule appointments and attend sessions, especially those who had busy schedules or lived in remote areas. It came with its challenges too, including technical issues, privacy concerns, the loss of body language and use of silence, and the difficulty of building a rapport with clients without physical interaction. I began more sessions than I would have liked by saying “can you hear me?”

I think its broadly true to say that most therapists, even now, aren’t trained in online work despite its unique challenges, and I was certainly in that boat. It’s a different skillset to establish a rapport with a client through online sessions, and I found

a great loss in only seeing those I did meet from the shoulders up. I met one client who shook his knee almost uncontrollably when he felt anxious. I only discovered this during our 16th session when we met in-person for the first time.

Psychotherapists had to find creative ways to overcome these challenges and ensure that the quality of therapy was not compromised, adapting our approaches to suit the virtual setting, such as using more visual aids and providing written resources to support clients outside of sessions. When a recent study was conducted to investigate the main difficulties therapists encountered when switching from in-person to online therapy, the findings spoke loud and clear to the issues we faced: patients’ privacy, our own boundaries, and an ability to make an emotional with new clients.

What we now know is that the pandemic and lockdown measures had a huge impact on the mental health of people globally, leading to an increase in stress, anxiety, and depression. As the timeline of COVID-19 continued, it also became clear to me just how significant the mental health challenges faced by frontline workers were, from the stress of being higher risk of contracting the virus, to their own losses, to the enormity of the physical and emotional energy required to do their jobs. I began to see an uptick in enquiries from people in these professions looking for help, and that continues to this day. Several sociodemographic factors, including gender, age, occupation, site of employment, and department of employment, as well as psychological factors, including a lack of social support and self-efficacy, were linked to greater stress, anxiety, depressive symptoms, and insomnia in healthcare workers. Many therapists began offering support groups and workshops specifically designed for these individuals, providing a safe space to discuss their experiences and receive the support they needed.

So please forgive us, folks. Us therapists had to adapt quickly to the new realities of the pandemic and find ways to continue offering effective support to their clients. The shift to online therapy allowed therapists to reach more people and offer more accessible services, but also came with its challenges, and we’re only human after all. We wouldn’t have passed through them all perfectly. But perhaps it’s been a forced change for the better. I now work remotely with a number of clients, and continue my in-person practice, and in the glacial paced world of psychotherapy, where slow change is a prerequisite, an involuntary nudge into modernisation might be just what we’ve needed.