Adjusting to Online Consulting

We've all had to make adjustments to our life and working patterns for the duration of the lock-down period. As a result, I’ve moved my “premises” from my Parkhurst consulting rooms (in a separate area at the side of my house) to my dining room table.

I’ve also started using a pair of wireless headphones which I was given as a Christmas present some years ago. I’ve suddenly found a new lease of life use for them – it means that I can hear my clients more clearly and privately in the confines of my home.

It would be rather difficult, to say the least, to balance my laptop on a bended knee or were I to sit on the sofa where my clients usually are, it would be too relaxed leaning over the sofa and not having any direct support in order to look directly at my clients and listen to what they’re bringing to the session.

As someone who has used Skype or FaceTime for the past 10 years while living and working in the UK, returning to South Africa a little over a year ago has made me sit up and take notice how many newly-found colleagues here are not au fait with the process and perhaps have been reticent to embrace this form of therapy in the past.

Supervisors I’ve had over the years were reluctant to use Skype and insisted on face-to-face meetings, even during London transport strikes which meant sometimes a two-hour journey there and back. But in recent years, things have changed and they too have mellowed as they have decided to embrace new technologies and methods.

When I arrived back in Johannesburg last year, I tried out a number of supervisors: one was a 45-minute car journey from Parkhurst, the other in Cape Town who offered his services via Skype. No guessing which one I opted for.

In recent weeks, few talk about Skype – it’s all Zoom or Microsoft Teams. But the chap who advises me on technology matters, recommended a relative newcomer to the market, Vectera. I paid a one-off fee and the system works smoothly and efficiently for my couples therapy, wherever in the globe they might be. I even have one half of the couple in Lagos, the other in London; the connection and sound is always as clear as can be.

I imagine other therapists who have suddenly switched to working exclusively via video conferencing since the March 26 initial lockdown might be finding it difficult or strange. “You don’t get up from your chair to open the gate or the door,” complained one. “And you can’t look around – even at your toes, if you wanted to,” said another.

For clients, several have opted not to have their weekly sessions via the web, and instead have said they would rather wait till the lockdown is over and then return to regular face-to-face sessions. What option do we as therapists have to argue against this? None I believe. It’s all new and unchartered territory for us.

Could it possibly be that these clients are reluctant to come to therapy and use the crisis as an excuse to avoid it? Or on some unconscious level are they communicating, “we’re fine – we don’t really need therapy for the next month or so.”

What does that do to the process of weekly regular counselling? Does one normally allow a five-week hiatus to our work, and without payment?

As I discussed with my supervisor already, perhaps this is a blessing and will allow clinicians to have a cull of some of the clients we no longer wish to work with.

I realise how tiring it can seem to have on-line work rather than face-to-face, but most of us will already have met our clients personally so we will already know what they look like other than just seeing their faces.

It also means that we are able to observe their facial expressions in more detail and because of the size of the screen, it means couples are often more cosy or cuddled up during video sessions. Obviously crucial body-to-body communication is not possible under the terms of what Winnicott would have seen as providing a holding environment that promotes “in dwelling of the psyche”.

And what if the connection doesn’t work properly – or the Wi-Fi is down? What about the anxiety this creates for both therapist and client.

These are indeed unchartered waters, and being able to be flexible and creative at the same time might make us all stronger and more successful in the work we love doing.

Michael Kallenbach is a couples therapist with consulting rooms in Parkhurst, Johannesburg. He trained at the Tavistock Institute in London.

Image by Gerd Altmann from Pixabay