Mark Online Therapy Consent Made Easy

Mark online therapy consent

hello I'm Victor yalom and I'm here today with Anastasia yeah Tokina you're a she's a psychotherapist practicing in France working both with clients in person and has been working online for many years and we're going to learn something today from her about working online which is becoming necessary and critical during this covin 19 crisis so welcome thank you - thank you for having me you've been a contributing writer to psychotherapy down net for several years and I know you've done research on working it online doing online therapy so I thought it was a perfect opportunity to kind of grab some of your expertise and share it with colleagues around the world so obviously with this pandemic a lot of therapists are quickly scrambling to learn how to work online through video conferencing you know broadly under the category of telehealth but generally through through some video platform and some people have experience doing this others don't so let's first talk about transitioning say you're a typical therapist working in person what are some things to know in making the transition to to working remotely because the transition and I've been there few years ago when I had to try and make personalization and I know that this is if you like where you'll relax because we have to do this it's not really a choice but because of the current circumstance doesn't have to venture into this new space you know there's a lot of anxiety so transition does mean anxiety and how to and actually the client might feel some anxiety about peeing on line especially if it's the first time for them if they used to senior in person to be in this so to speak change and I think it's what I guess always piss off it's to start with talking about it we can always invite the client to share what he feels about being online about this different set up subtly being in front of his computer in his own home and see me on his cream sometimes it can be very small scream because some clients will use their phones and that can surprise suddenly to imagine that you're very tiny on this cream so all these things can be talked about totally in that very first LAN session right so that's something fortunately that's something we're good at is talking with the client about you know what's called to hear now about the relationship we know that that's important we know we know that it's important the the relationship is important some therapists may have more experience really talking about how is it going together how's our work going and this is a perfect opportunity to use that from what I hear you're saying talking to the client how does it feel to you working working online with me how does that feel different than before and another thing I which I wanted to pick up on is you're saying anxiety about making the transition but that's superimposed on the mass of anxiety we're all feeling about this crisis yeah absolutely I think you know also things I do you about technology yeah we didn't feel very anxious about being cut off to lose the client it may be a very important moment of the conversation so that adds layer and you know the technology is a very versatile thing it's actually very adaptable and you know even if we lose the cloud because the connection is bad it's overloaded it'll change you know and it's important to actually experience at some point to be able to we can again you know and see that it's okay we can cope with that and that coming together is really an important part of therapy where it's a together endeavor so technology sometimes Oprah's really interesting unexpected you know openness to talk about things that we usually all right like the relationship there's so much of what you're saying one I hear is we want to check them to the client about how they're doing and how they're feeling about the transition but we also need to pay attention to how we are feeling because we may be feeling anxious and if it's if we're making that transition for the first time to working online inevitably we will be feeling some anxiety about that transition to pay attention to that and maybe if appropriate to share that with the client maybe government of course I would be good modeling to say hey this is new for me and there will there are glitches in fact you and I just had a couple glitches finding on today so and there may be you know if everyone is jumping on the internet now there may be some bandwidth problems sometimes the the the receptive the you know the internet is is not as good one thing you can do is you can always switch to audio only if you're not getting a video connection that's something something I have to do sometimes absolutely and it's really good to I think it's really to practice I'm very reassuring for the client to discuss that you want to really train to not wait until something happens with the connection but you know agree that you know if something happens we can always switch to even brought up why not you know we have to be very creative you know it's at that time when you know we have to use anything that works any technology that it can do the job okay so one other thing I'm thinking about is it seems that you have clients that you've been seeing in person for you know weeks months years whatever and you are wanting to encourage them to continue working with you if appropriate online I think it's probably important how you communicate that to them so that you encourage them to do it at least give it a try because a you know you want to we need to continue working and you know if we suggest that in a way that shows our discomfort they that may discourage the client to continue working absolutely it's really I think it's important to kind of sheerly cozening to look this new meaning it's also important to be honest you know and we don't know how to work for something in my experience it usually does work pretty well I think it's very reassuring for everybody to hear but for some clients it's maybe will not work you so we have to keep open mind you know and try it out but yeah I think but I think if you have experience working online and I've done that with a few clients and I I was skeptical as I think a lot of therapists are I mean we're kind of set in our ways like most people I was skeptical whether you you could have that feeling of immediacy and vitality that you feel in the room with someone and I was pleasantly surprised that actually in some ways it's extremely intimate the claim is very close to you a you know closer in some sense than when they're sitting 10 feet across in the room and I've had very good experience with it so I think if you can convey that if you have that experience or if you haven't you say look I've heard from my colleagues that this works actually quite well how about we give it a try and see how it goes you know to set the stage to encourage them to give it a try no absolutely in here I think you mean your mentee needs myself at the beginning you know we're surprised by this face to face immediate quality you see it's very close to each other yeah right probably much closer I'm closer to my screen that I am using to my client right I mean each where you ultimately meter away from me right now so you come to feel like she might didn't right okay so we're making now we're actually making the transition from transitioning to working online to I know again you've done a lot of research on this and you're in midst of writing a book about this what are some once you you know make that transition what are some things you've discovered that you think are important for clinicians to know what are some key points about working online what are some pros what are some cons there's no you know climbing room there's no access to a lot of information but we also gain something and I think if we pay attention to what is behind our clients back where is he connecting from you know this is very informative this is really some amazing leader such as for example you know Clarence the oldest think about where they would sit for the session rate uh-huh anyways their way to communicate something to the therapist it's never neutral you know so enquiring into what does this special when is the first time I know you've written with some blogs for us about that about clients in bed or can you think of any examples just off the top of your head or what I've been some information you've gleaned from the city from the situation where they they've been for example if I have a client who connects from it please the clues videos strange like for example a garage was connecting from a kind of compass really covered yeah I think tells a lot about the environment right that maybe their lack of space from in space fancy oh maybe it says something about their relationship with people they're living with can give live meat can be children parents it's always interesting also what kind of what happens in that space during the session come or what do you mean by that and pull home sometimes kids I'm truly into that space and now with the coronavirus in Europe at least we're gonna find so right now I'm curious and they cannot get out running and great no Ivy situation so kids around and they intrude be storming you know they knock at the door sometimes they don't all right so it gives you a lot of information that you wouldn't get otherwise if you're doing it do not bring their kids is there sometimes I'm sure we fantasize about our clients and what their relationships are like what their home is like we get to see that they are they very disorderly is it messy noisy they want to show right client can connect every time from a different room from a different place be literally or do you want to walk you through their space and sometimes if we become and very often that leads to some real tool I have clients showing me would this out of their window mm-hmm it can be really important actually it means something to them information they would never share in a word with you and can you think of any examples of how you've been able to use that to enhancer and rich or deep in the therapy yes and what he saw it's a wonderful beautiful blooming Park with the viewing the whole scheme and actually it's meant a lot to him to share that it really meant a lot for his relationship with his country because he's here so you know it had a real sense to do to a whole new topic for us yeah well I think it what you're saying we want to know about our clients and it gives us a new window to them just like maybe techni other technology you know having a smartphone and photos clients are much more likely now to show us photos of their life than they would have 10 years ago they were they wouldn't maybe make the effort to bring in paper photos but now it's so easy to do you know like if your clients an artist or a musician if you they show you some part of their their life that can be very meaningful and helping you understand the the fullness of their being and you're saying seeing their space seeing their view it also shoots completed the power dynamics network in a way writing the ratio should be choose whose you know issues before they're there in your space and you can things and a latarian absolutely equal and the tools to give so some power they also have to be more self realized in a way because they have to for their own issues right in the water and then can feel a stretch for therapists who soon use to you know be a provider with those things yeah control so sometimes there is a way of mitigating this you know those initial sessions online we can create rituals we trade rules in this new way for example sharing a cup of tea you know with a club and becomes often coffee and we know you know depending on the time of the day ritual that places we used to have well these are some wonderful ideas in terms of how to transition and how to make use of the film the new online space and I would hope that well of course we all hope that this pandemic you know comes to an end as soon as possible but I'm imagining that just like people that are forced to now telecommute to work remotely they may think them they may be less likely to go back to work at least five days a week in the office because companies are saying that this can work and I imagine some therapists after this is over are going to continue to see some clients online and even if they much prefer to see clients in person that this will give them some flexibility when their clients are traveling or if they're traveling or a client is sick that they may now have a new tool in their toolbox so to speak to offer online services in addition to the traditional in the room therapy so I want to thank you so much for sharing your thoughts and expertise to us and you know this technology technology is allowed you and I you and Paris me in Northern California to have such a nice conversation so and I know you work with clients all over the world in case people are wondering about your accent I know you're originally from Russia and working in Paris and work in several languages as well what what languages do you working I'm working French onion impression wow that's impressive okay alright we'll be sharing this with our our our viewers and therapists around the world hopefully today or tomorrow thank you