There are many things to consider when bringing a client into a shared physical space; how does this cross over to the virtual space?
COVID forced health care to go virtual rapidly and I am sure that many practitioners have learnt from their own and colleagues experiences on how to best support clients in this mode. Clients may choose telehealth for a range of reasons. Telehealth may provide a safer way for them to connect that feels less distressing; it may be convenient or face to face may not be accessible for them.
For virtual sessions we can not signal our consideration of clients possible experiences in the same way that we can in a face to face session. Room colors, fidgets and flags are not going to be helpful. We can ensure that we are signaling our consideration of their unique experience with the client on our website and other public domains, in communication pre and post sessions.
In the virtual space we can not rely as much on the non verbal cues and signs between us and the client and need to be more direct in setting up safety for ourselves and the client in the room.
Ensure that the platform you are using to connect online is secure to ensure client privacy and confidentiality. Ensure this is communicated in writing or verbally to the client.
Check the location of the client each session. With the variety of presentations of clients we see we can not know all risks for the client. It is important to know where the client is connecting to the session from; home, work, in their car at the local supermarket. Hopefully you will not need to know this information; but in the case of an emergency this information is imperative. This can always be asked in a less formal way if it feel more comfortable:
“ You are in a room I haven’t seen before; where are you joining me from today?”
Ask if there is anyone else in the room or the location with the client.Ask the client if they feel they are in a space where their confidentiality is protected and they can speak freely.
“ Is there anyone else there with you today ? Do you feel comfortable to speak freely and not be overheard?”
Let the client know any measure that you have taken to protect their privacy. This may be using headphones,being alone in the room, and having the door closed.
“You may notice the door is open behind me today and I don’t have my headphones; I wanted to reassure you that I am home alone today and no one will be coming home during our session time. “
Requesting the address that client is at for a virtual session could also be built into your practice policy and communicated to clients on the website, in confirmation and reminder email and in new client form.
“ As you know our practice policy is that I need to have the address of where you are each session, could you please add it to the chat or let me know so I can add it to the notes. Thanks.”
Starting the session
It can be easy to miss the small talk and checking in that is often present at the start of the session and can be easy to dive into the session. When meeting someone face to face we often greet them in a waiting area, make small talk as we walk to the room together and get settled in the room. This process may seem insignificant but it can create a powerful transition time for you and the client to ‘arrive’ mentally and emotionally ready for the session.
When connecting online we may need to make a deliberate effort to engage in this same transition process to move into the session. This may include orientation to both your locations as described above, checking in on confidentiality, some small talk about weather or a small antidote.
Over time you will develop your own style and range of tools for this. An option may be acknowledging that there is a need to arrive for the session.
“ It sounds like you have had a busy morning at work and I can see you in one of the meeting rooms at work. I have gone from session to session this morning. Would you like to take a moment with me to take 3-4 deep breaths together so we can both feel more grounded and ready to start the session?”
This can be a lovely role modeling opportunity to educate clients about helpful grounding tools and the power of transitions between different parts of our days.
During the session
The connection with a client in a virtual room can be just as powerful as face to face; Especially with clients we know well. While we are developing rapport with clients there may be times that we assume a reaction from them implies something. We need to be sure to check in with the client if what we are thinking is correct or not (this is also valid for face to face sessions).
“I noticed that as we started talking about this you have sat back in your chair and are looking down. I am wondering how you are feeling if this discussion is difficult or bringing something up for you?”
As always it is important to check in with the client how they are feeling in a session and the impact that information we have offered has landed. This may need to be a more direct question during virtual sessions where we are unable to see their whole selves and have access to nonverbal cues in the same way as a face to face session.
“We have been talking for a while now and I just wanted to pause and check in on you? How are you feeling? Are there any feelings coming up in your body or thoughts?”
Some people find it harder to concentrate in virtual sessions; let me know if you would like to take a pause or if there is anything that might help you?”
Be aware of your own concentration and attunement in the session. For some online sessions feel easy and for others they won’t.
Are you taking notes on the computer during the session? Have you asked consent from the client to do this? Are you able to fully be connected and listen to the client or is it distracting you and the client?
Through trial, error and discussion with colleagues you will find what works best for you.
It may be a weighted lap pad, or a fidget. It may be sitting at a desk or a comfy chair. Experiment to find the way you can be more regulated and attended while holding virtual space for a client.
We’re Jo and Christie—Accredited Practising Dietitians and Credentialed Eating Disorder Clinicians with a shared passion for disordered eating, eating disorders and body image work.
Our resources are developed alongside people with lived experience and designed for health professionals who want to deliver high-quality, client-centred care.