Key Takeaways

  • Make sure your workspace is set up for teletherapy. Consider lighting, video quality, your background, and what you’ll do if technology fails. 
  • Being fully present is key. Clear away any distractions from your screen and your space before sessions.
  • When you can’t feel the energy in the room, it’s important to encourage clients to verbalize what they’re experiencing.
Teletherapy opens up a world of opportunity for clients, especially those in areas with limited access to mental healthcare. But, because it’s a different dynamic than in-person support, it requires a different approach for building therapeutic relationships. What are the key distinctions to keep in mind? How can you address the challenges that may emerge in the teletherapy environment? And how can you take advantage of the unique benefits? The following seven recommendations can help you compassionately and effectively navigate teletherapy with both existing and new clients in your practice.

1. Structure your sessions in service of telehealth.

When providing teletherapy, you’ll need to be sure your environment is set up well for the session — and that it communicates what you want to your client. All of these factors are important:
  • Lighting
  • Video quality
  • Audio
  • Background
  • Where your eyes are looking on the screen
  • Making sure you’re not too close or far away from the camera
  • Backup plans for when tech fails
If it feels appropriate for your practice, you can also use whiteboards, shared screens, articles, images, music, and videos as part of your work together. Knowing how to troubleshoot any tech challenges when they arise can support the therapeutic relationship by demonstrating you’re there to help. Make sure you’re familiar with how to troubleshoot common issues with the telehealth platform you’re using. 

2. Be fully present and attuned to cues.

Building the therapist-client alliance in telehealth allows you to enter the client’s environment — including what they’re seeing and hearing during a session. As a therapist, you can tap into these details and use this context to better understand your client.  Therapists have to be in tune with verbal cues, nonverbal cues, and everything that’s happening in the session. This means it’s important to avoid distraction. Aim to be as fully present in a teletherapy session as you would be in an in-person one. Close all other browser windows and turn off notifications on your computer during sessions to help prevent distractions. 

3. Enhance communication.

In a teletherapy setting, doing what you can to enhance communication will help you build rapport with your clients. One way to support connection is by leaning toward the screen and intentionally using your facial expressions, voice tone, body posture, and body gestures to send the right message. 

4. Work with your client to make their environment feel safe.

Being able to engage with a client when they’re in their home or other intimate space is a gift — and it’s very rare to get this close to a family system (when applicable) in action. But not all clients feel comfortable with really opening up their environments. Don’t push a client into sharing their space with you until you’ve built trust and understanding. Figure out what their comfort level is and help them maintain their version of safety.

5. Be transparent and flexible.

If your client is used to in-person therapy, name and validate how different teletherapy may be for them. Different could mean good, bad, or just unfamiliar. All of it is worth exploring. Check in with your client: Are you too close to the screen? Can they hear your audio okay? Is the setup working for them? Make sure you’re having these conversations with your client so there are no elephants in the room and you can adjust things if needed. If something strange or distracting happens, don’t ignore it — bring it into the experience.

6. Reflect on biases, always.

Even if you’re not meeting with clients in person, cultural humility and awareness remain critical. We always need to reflect on ways that the therapist/client relationship impacts power imbalances and inequities. Therapists also need to understand how to create a judgment-free atmosphere through the screen.  Just as important as self-reflection is seeking to understand and validate the social and cultural contexts your client is bringing in. They could be carrying a certain interpretation of what it means to be in therapy with a new clinician or for the first time ever.  Some questions to pursue answers to in therapy include:
  • What are their expectations? 
  • How do they feel about you being present in their home?  
  • What are they willing to share or not share? 
  • Are they able to find the privacy they need to talk openly? 
Focus on curiosity, reflective listening, compassion, and transparency to create a validating space for all contexts and experiences.

7. Ask direct questions.

Therapists also have to be able to ask direct questions about what a client is experiencing. When you can’t feel the energy in the room, it’s important to encourage clients to verbalize what they’re experiencing.  Verbalizing what you’re experiencing is also a powerful tool for therapists. There are some cases where it might be helpful to tell a client directly, “This is what I’m feeling: What you just said makes me a little bit uncomfortable. And this is why.”  Asking direct questions and sharing about our own experience can really help strengthen the way that we’re relating and connecting with our clients.

How Rula helps you build the therapeutic relationship

At Rula, we believe that the therapeutic relationship starts with matching the right clients to the right therapists. Rula ensures that therapists are seeing the kinds of clients they want to work with, and clients are able to find the type of support they’re seeking. And if a relationship isn’t working out, rematching through Rula is easy.  Rula also uses measurement-based care to collect data on a regular basis to give therapists feedback on how things are going with clients. And, therapists who work with Rula have access to case consultations with other providers, so you can get feedback from other therapists about building strong therapeutic alliances with your clients.  For more tips on building the therapeutic alliance when seeing clients virtually, watch our webinar: The Importance of Therapist Client Fit in Teletherapy.

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