How I learnt to love online therapy

If you are considering therapy or training as a therapist and have asked yourself which is better; in-person or online therapy? My own journey with this issue may help clarify this.

I have been involved in the therapy world for over 15 years - both as a client and as a therapist. I always had my therapy in person. Being in the room with my therapist seemed the absolute ideal way to have the therapeutic experience.

Throughout my training to become a qualified therapist, this belief in in-person therapy was sustained, especially when I began my placement and started working with clients. Training in the field of Gestalt therapy also meant I was aware of the importance based on the therapeutic relationship and the role that I, as a therapist, had in this. Gestalt therapy emphasises dialogic relating. This can be best described as a person to person encounter where the therapist meets the client as a whole person rather than an object to be analysed. Influenced by the work of philosopher Martin Buber, dialogic relating focuses on mutual presence, transparent communication and what happens in the 'between' of the client and therapist.

Joyce and Sills (2010) say dialogic relating will 'include four elements; presence, confirmation, inclusion and a willingness for open communication'.

With this in mind, my commitment to working with my clients in-person was set in stone. As I established my private practice in 2019, I noticed an unease in me about offering online therapy. Therefore all my clients, in my early days of working as a qualified therapist were in-person, based on a belief that I could only truly have an authentic therapeutic relationship if I met them in-person.

Looking back on this fixed mindset now helps me appreciate the journey I have been on in this area.

In Spring 2020, everything changed. The Covid pandemic meant I could not see any of my clients in person at all. I found myself driven to work online and one of the most valuable pieces of learning I have had about working with people in therapy took place. I learned that the therapeutic relationship and dialogic relating were just as powerful when working with a client online as when working with clients in-person. It may seem obvious, but for me - a staunch sceptic of how Gestalt therapy could be effective when working online - I learned a powerful lesson in the power of the therapeutic relationship.

There are also other benefits for working online:

• Clients can work in their own space where they may feel safer and more secure.

• It can save the client valuable time in terms of travelling to and from the therapy space provided by the therapist.

• Geographical location is less of a restraint here too - allowing clients to find a client based more on preference than locality.

As you can tell from what I mentioned earlier, one of the key aspects for me as a Gestalt based therapist is the way that I work with clients. Working holistically and often using observation of the client in the here and now is a key aspect of the Gestalt approach and there was a concern on my part (and also other Gestalt colleagues I have discussed this with over the years) that subtle visual cues could be missed - such as the tapping of a toe or a not fully noticing body posture. My experience as I have worked with online clients since 2020 is that it is more the here and now of the therapeutic relationship that matters. Inviting clients to share what they notice about their body allows them the opportunity to tune into themselves. And, I still notice things that I can share with my clients that allow for greater focussing and awareness.

What I have come to truly appreciate is the importance of meeting my clients where they are. To not impose any kind of hierarchical way of thinking on them. whether it is working in-person or online, it is as much my willingness to meet with my client as they are that contributes to effective therapy.

There is something powerful about the therapeutic relationship experienced in Gestalt therapy. 'From the very beginning, both participants engage in a relationship of mutuality where not only the client is changed by the counsellor but the counsellor is also affected and changed by the client.' (Clarkson/Cavicchia 2014). I have learned that working with a client in online therapy is just as effective as working with a client in-person.

I recently finished working with client online who I never met in -person and the progress they had made was incredibly evident The therapeutic relationship between us was a huge part of that change for them. It was a powerful moment when we said our farewells - a genuine connection where the screen and online medium that allowed us to work together seemed to melt away to allow us to meet in a truly authentic way. This is the power of therapy and I will undoubtedly write more about what it is that contributes to effective therapy, but for this blog, it emphasises the effectiveness of working online.

Returning to the four key principles of dialogic relating - presence, inclusion, confirmation and a willingness for open communication are just as accessible online as they are in -person. I now work with more online clients than in-person ones and I enjoy and have just as much satisfaction in my work online as with my in-person clients. A valuable lesson learned.

So, if you are considering therapy and wondering if online therapy actually works as well as working with a therapist in-person. Take it from me - the biggest sceptic of online therapy a few years ago - yes it does.