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The Benefits of Virtual Therapy

When it comes to Virtual Counselling, there are different formats for virtual counselling. Counselling can be done in person, through various video platforms, by telephone, or through text or chat programs. In both in-person and video counselling, the therapist and client can still see each other and observe non-verbal forms of communication. While with telephone counselling, you can still have communication through vocal tones and words. With Text and chat-based counselling, the counselling is based on words and is more prone to misunderstandings. I generally find that it is more difficult to create a therapeutic alliance with my clients the more forms of communication that are removed. I find in-person and video counselling to be similar in effectiveness and which is more effective for a person depends on personal aspects and preferences. I have described some of the benefits, considerations, and challenges of Virtual Counselling below. Please note that most of these are based on video counselling rather than telephone and chat-based counselling.

More Convenient & Accessible

A person can access Virtual counselling from their own home. This helps people who have trouble getting out of the home or have busy lives and have a hard time finding the time to travel to and from appointments. You are generally able to find a comfortable place to sit at home to attend your counselling sessions.

Virtual therapy can often be squeezed into an hour during your day, such as your lunch hour. Occasionally, you can also have shorter appointments, if that is all you have time for.

Often can have comfort items with you

Often you can have a counselling session in a room in your home that is comfortable for you and you can have pets or things with you that can be calming for you and enable you to be more present in the counselling session.

Finding a provider that fits your needs

Effective counselling often means a good fit between client and counsellor. You want a counsellor that has the skills and techniques to work with the issues and challenges that you are bringing to therapy. The counsellors in your area may not have the skills to effectively work with your issues, but when you have virtual counselling, you can have a greater selection of counsellors to choose from.

Establishing a Therapeutic Relationship

A lot of people have found that they have been able to secure a good therapeutic relationship through virtual therapy. Therapists have found different ways to deepen a therapeutic relationship when not in the same room as the client.

Attunement and Body Language

With virtual/video therapy options, a therapist can still read a lot of the information that they would if it were in person. This is not the case for telephone or text-based therapies where the therapist cannot observe the face and shoulders.

More flexible, customizable

If you have trouble finding privacy at home, you might want to talk to your therapist while on your smartphone while walking or in a park. If you have chronic pain, you may be able to sit in positions that are more comfortable than if you attended counselling sessions in person. Often there is a lot of flexibility and adaptations that can come with a therapeutic experience that is virtual.

Reduced stigma & Increased Confidentiality

There is reduced stigma because people do not see you walking into a therapist’s office or see you in a waiting room. There is also increased confidentiality because you are not seen attending therapy. This means that you are in control of who finds out that you are attending therapy.

The rules around privacy and confidential client information for virtual therapy are strong and part of the ethical framework of therapeutic associations. Therapists are expected to use encrypted programs for therapy sessions, so what you say in therapeutic sessions should be as private as you are able to make it on your end (secure network, private space where others cannot overhear, etc.).

Making Virtual Therapy Better

Creating more privacy

There are ways to increase the privacy of your end of therapeutic sessions. If you are afraid of being overheard, you can use a white noise machine between you and the door. You can find a quiet, private space for doing your sessions in, such as a car, a large closet (clothes and fabrics also help to dampen the sound), a large pantry, or a bathroom, if necessary.

Reduce Distractions

Work with those around you to create boundaries around your therapy sessions, so that there are fewer interruptions and distractions.

What are some of the challenges with Virtual Therapy?

Certain Mental Health Conditions

People with intellectual disabilities, schizophrenia and at a high risk of suicide among those who would be more appropriate to be seen in person.

Personal Preference

Some people prefer meeting a therapist in person and have trouble connecting over video, if that is the case for you, you might want to pursue in-person counselling.

Technical Difficulties

With using technology to access counselling, there are chances that the technology could fail (Internet/power outages, device malfunctions, etc.). Usually, the therapist has a plan for technology issues.

The Benefits of Trauma Counselling

Trauma Therapy can help you understand why you are reacting in the way you are.

Through trauma therapy, you often learn that certain thoughts, emotions and behaviours occur because of the trauma you have been through. When you understand the living legacy of your own experiences and that they are normal reactions to abnormal circumstances and environments.

Often through trauma therapy, you may understand that you didn’t learn some of the techniques and skills of emotion regulation, coping, interpersonal relationships, and distress tolerance that people who grew up in emotionally and physically secure environments did.

Trauma Therapy can help you gain more control over your life.

Once you understand why you are reacting in a certain way due to past trauma, you can work with your therapist to use techniques to minimize the effect that your trauma has on your life. This can include reducing the chances of being triggered because you are putting things in place to be able to deal with some of your frustrations in better ways.

Trauma therapy can help you understand your triggers and help you become less reactive to your triggers and know what to do when you become triggered.

Trauma therapy can help you figure out how to create safety (physical and/or emotional) within your own life and how to create healthy boundaries to protect and care for yourself.

Trauma Therapy can help you find yourself.

Often people who experienced developmental trauma spent so much time trying to survive and fulfil their basic and emotional needs, that they don’t know who they are.

For example, a person who longs for acceptance that they didn’t get from their parents may become a people pleaser or someone who is focused on achievements. They don’t have the instilled acceptance within themselves from their parents and feel like they must do things for other people or achieve things to be accepted. Eventually, when they may realize that they don’t know who they are inside because they have always been about acceptance due to external factors.

Through a process of figuring out what are the effects of trauma, what are things you’ve done because that is how you survived, and what is the essence of who you are, you can discover a true sense of who you are.

Trauma Therapy can help you build better relationships.

Often people who did not learn good interpersonal skills growing up have difficulty in their adult relationships. Trauma therapy can help you learn to make good boundaries, learn how to ask for what you want without threatening the relationship, and learn how to assert your views in a way that respects both yourself and the other person.

Trauma therapy can help you gain awareness of how your previous relationships are affecting your current relationships and help you separate the past from the present.

Trauma Therapy can help you build a better life.

Trauma therapy can help you build on what you have. You can use the strengths you have built through your resilience in dealing with your trauma and learn new information and skills to help you grow the life you have into something better than it was before. A trauma therapist can help you reduce the trauma-related symptoms while helping you learn the tools to improve your life and how to cope with your trauma.

How Much Trust Do I Need to Find Success in Therapy?

Please realize you do not need to completely trust your therapist to find healing.


Often people have had a lot of damage in the past due to trauma or past betrayal and you have learned that people cannot be trusted. Do not feel that you cannot do therapy. The amount of trust you need is the amount that it takes to do the work. It is absolutely fine to hold parts of yourself back until the relationship you have with your therapist develops. If at the beginning all you feel comfortable with is the intake, discussion of goals and learning skills, that is fine. The trust can be built as the therapist shows his/her care for you and the relationship develops.


For some people the idea of an expectation of trust in the therapist is insane. If authority figures in your life have proven over and over again that they can’t be trusted, it is normal to not trust the therapist initially. Why on earth would you trust a person you never met, when the people that you should have been able to trust either betrayed you, proved unreliable or neglected you? In those situations, I recommend being honest with your therapist that you have trouble trusting and mentioning the direction that you feel okay going in (for example: focusing on skills, psychoeducation, focusing on a current situation at work, etc.).


At the end of the day, a client needs to be able to work with the therapist. Adjustments can be made for the wounds of the past. That is part of respecting the client and accepting where the client is. It is always okay, in fact, it is important, to tell your therapist that you don’t want to go to a certain place, do something, or deal with a certain part of your past.
Even for trauma processing, you do not need to reveal details about past trauma. With EMDR, these are the things we need to do processing (beyond some of the prep work to make sure you have the resources to deal with trauma flare-ups):

  • Current symptom, frustration, or limitation and the longing/missing need associated with that
  • Recent times when that longing/missing need wasn’t fulfilled
  • What the worst part of it is?
  • Be able to rate it on a scale of 0-10
  • A negative cognition (“I am”) statement
  • Past memories of something similar (only mention event “like a book title” and age)
  • Worst part of the memory
  • A positive cognition of what you would prefer to believe (“I am” statement)
  • What emotion you are feeling?
  • Identification of the location of a body sensation

Trust can be an important part of a relationship but when it comes to a relationship between a client and their therapist. There only needs to be enough trust to do the work. That trust may be in the techniques the person uses or that their experience and expertise may enable them to help you. A therapist can work with trust issues if you still can feel like you can do the work.

Window of Tolerance

The Window of Tolerance was first coined by Dan Seigel to describe the “optimal zone of arousal for a person to function in everyday life.” This window is the state where a person can effectively manage and cope with their emotions, and readily receive, process, and integrate information. When in this window, a person can adapt and respond in a way that fits the situation.

When you leave the Window of Tolerance, the reactions take over. They are instincts built within your body from evolution (they are instincts that helped out ancestors to survive and were passed down to us) and past experiences. They are about what was helpful then, but they may not be helpful now. For trauma survivors, these reactions are the story of their survival. They are reactions that were not integrated into the system, so when something similar happens in the present they come back feeling like they are in the present moment, but they are tied to the past.

When you are outside your “Window of Tolerance,” you are not able to think properly and that is because your prefrontal cortex (the thinking/reasoning part of the brain) in the brain has shut down to allow the survival part of the brain to take over. Before you can think about the situation, you need to get back to your “Window of Tolerance.” There are various techniques to achieve that, including grounding skills.

Hyperarousal is a heightened state of activation/energy and is often referred to as the “Fight, flight, or freeze response.” The person’s nervous system is on high alert and primed to respond to danger. This may appear as:

  • Angry outbursts
  • Panic
  • Hypervigilance
  • Fear
  • Tight muscles
  • Anxiety
  • “Deer in the headlight” freeze

When you experience chronic hyperarousal, you may experience:

  • Emotional overwhelm
  • Impulsivity
  • Hypervigilance
  • Reactive
  • Racing thoughts
  • Angry
  • Feeling unsafe
  • Defensiveness
  • Panic

Hyperarousal can be helped through deep breathing, orientation grounding techniques, and self-soothing techniques.

Hypoarousal is a “shutdown” or “collapse” response. It can either come directly from leaving the Window of Tolerance or come after going through a Hyperarousal state after leaving the Window of Tolerance. It comes from too little arousal and an overloaded parasympathetic nervous system. Hypoarousal can appear as:

  • Depression
  • Blank stare
  • Inability to speak
  • Numbness
  • Dissociation
  • Emptiness
  • Flaccid body/paralysis without obvious cause (trauma)

When you experience Chronic Hypoarousal, you may experience:

  • Numb
  • No feelings
  • Ashamed
  • “Dead”
  • No energy
  • Disconnected
  • Not present
  • Passive
  • Unable to think
  • Shut down
  • Unable to say “no”

Hypoarousal can be helped through movement, reminders of the present moment and location, focus on one of the 5 senses, and re-regulating the breath.

While stress and trauma can shrink your window of tolerance there are strategies that you can use to expand your Window of Tolerance. Grounding and mindfulness skills can be used to return to the window of tolerance. Processing trauma through specific modalities such as EMDR, Internal Family Systems, Somatic Experiencing, and Sensorimotor Psychotherapy can help to widen a person’s window of tolerance.

The National Institute for the clinical application of Behavioural Medicine has a useful infographic on their website as well as good information about the Window of Tolerance. https://www.nicabm.com/trauma-how-to-help-your-clients-understand-their-window-of-tolerance/

A book that describes well how the Window of Tolerance works with people who have been traumatized is Janina Fisher’s book “Transforming the Living Legacy of Trauma.”

What are Grounding Techniques?

Grounding Techniques are strategies that can bring an overactive nervous system down. They are different ways of calming a nervous system.

There are different types of grounding techniques. Not all of these work for everyone. You may need to try a number to figure out what works or combine a few of them to help to calm your nervous system down. There are some techniques that fit into more than one of these categories.

You may need to pick out some that work for different situations. When you are dealing with trauma from childhood experiences it may be more effective to match the grounding technique to the age you were when the trauma first happened or the needs that were neglected during the trauma (such as love, safety, stability, comfort, validation, and acceptance). For example, if you have a trauma trigger that is connected to your 7 year old self, a grounding technique that would be comforting to a 7 year old may be more effective than something that an adult is more likely to do (wrapping yourself in a blanket may be better than exercising indoors).

Grounding techniques can be used to bring someone from a hyperarousal state back into their window of tolerance. Some may work for people in a hypoarousal state. They are an essential resource for trauma recovery. It can be good to have a card with the grounding techniques that work best for you in different situations, so you can reference it when you are not able to think straight and enable yourself to get back on track.

I have a separate blog post with examples of the different types of grounding techniques.

Observation Techniques are grounding techniques that help to calm the nervous system by focusing on identifying and describing objects in the environment. For example, you may pick an object in the room or outside the window and start to describe it in different ways until your system starts to calm down.

Somatic Techniques are grounding techniques that help to calm the nervous system by focusing on sensations and/or movements in the body. For example, you may focus on the feeling of your feet pressing onto the floor.

Breathing Techniques are grounding techniques that help to calm the nervous system by focusing on the breath, control of the breath, and/or sensation of breathing. For example, you may focus on prolonging (slowing) the exhale as you are breathing.

Distraction Techniques are grounding techniques that help to calm the nervous system by distracting yourself from what is causing the nervous system to be overactivated. For example, you may watch funny Youtube videos.

5 Senses Techniques are grounding techniques that help to calm the nervous system by using your senses to calm the nervous system. For example, you may focus on the taste of a candy or the scent of a particular scent.

Self-Soothe Techniques are grounding techniques that help to calm the nervous system by soothing the nervous system through activities that are comforting to your system. For example, you wrap yourself in a soft blanket and focus on how soft the blanket feels around you.

Present Moment Techniques are grounding techniques that help to calm the nervous system by alerting it to the present moment during trauma triggers. When you are triggered by trauma the past comes back and feels like the present, so reminding yourself what the present moment is can calm the nervous system. For example, you may name today’s date and location.

5 Senses Grounding Techniques

Using your senses to regain control of your body can help you when you are hyperaroused or hypoaroused. They can be good to help to ground you in the present moment.

Scent – the olfactory bulb (scent organ) has direct access (other senses have indirect access) to the parts of the brain where emotions, mood, memory, and creativity are processed, so you can have faster effects for calming the nervous system.

Put on a scented perfume/aftershave/cologne/lotion and focus on the scent and how it makes you feel.

Inhale a scent (essential oil through a diffuser, burning incense, or scent from a scented candle). Focus on the scent and how it makes you feel.

Go for a walk in a wooded area and breathe in the smells of nature.

Sniff a strong mint. Focus on the scent and how you are feeling and any changes within your body after inhaling the scent.

Make some baked goods and focus on the scent of them baking.

Smell some flowers.

Taste

Make a favourite meal. Focus on the taste. Focus on the emotions and memories associated with that meal.

Treat yourself to a dessert or baked good.

Have a piece of candy and focus on the taste, texture, and sensations coming from the candy.

Take a raisin, nut, or some seeds. Focus on how it looks, feels, and smells. Put it in your mouth notice how it feels before chewing it slowly, and notice how it feels to swallow it.

Mindfully taste the food you eat.

Sound

Listen to a favourite song. Focus on the melody and how it makes you feel.

Stop and listen. Notice and name the sounds you can hear nearby. Starting with the closest and loudest sounds. Gradually have your awareness move outward, so you are focusing on sounds further and further away.

Put on a piece of instrumental music. Give it all of your attention. Maybe follow a single melody line, notice how the music makes you feel, or notice the changes in rhythm.

Sit in nature and notice the sounds around you.

Play a sound on an instrument you play (piano, guitar, etc.) or sing a song.

Hum a soothing tune.

Listen to loud music.

Make a playlist of music to get you through tough times. Listen to it.

Touch

Put on a favourite item of clothing, wrap yourself in a blanket, or hug a pillow. Notice the texture, colour, and the way it smells.

Splash some water on your face. Notice how it feels. Now how the towel feels as you dry. Use words in your mind to describe the sensations.

Hold a cool beverage glass, can, or bottle in your hands. Feel the coldness and wetness on the outside. Drink slowly taking the time to notice the taste and texture of the drink.

Hold your breath and put your face in a bowl of cold water (above 50 degrees) or hold a cold pack on your eyes and cheeks. Hold for 30 seconds (This is especially for reducing extreme emotion).

Wrap yourself in a blanket. Give yourself a bear hug.

Pay attention to the clothes on your body, what is covered, and the sensation of your clothes as you move in them. Notice how your feet feel.

Wear an elastic band on your wrist and flick it gently, so that you feel it spring back on your wrist.

Feel something that has an interesting texture. Describe it in your mind in detail as if you were trying to describe it to someone who has never felt it.

Cuddle or pet a cat or dog.

Hold an ice cube and let it melt in your hand. Noticing the temperature and how it feels. Notice the wetness on your hand as it melts.

Take a long bath or shower.

Have a massage. Soak your feet. Focus on the body sensations.

Put a cold press on your head.

Sight

Look at a picture of a loved one, a place with a good/neutral memory, or an object that reminds you of a loved one. Notice how it makes you feel. If any memories come up, notice how you feel when you revisit those memories.

Look and take an inventory of what is around you. Name and notice the qualities of large objects before moving to smaller objects.

Pick an object in your vision and trace the outline with your eyes like you were drawing it.

Do some kind of puzzle (crossword, sudoku, word search, etc.).

Read a book, magazine, or article.

Walk in a beautiful place noticing the sights around you.

Look at the stars at night.

Look at beautiful pictures.

Light a candle and watch the flame.

Go people-watching or window shopping.

Watch a beautiful sunrise or sunset.

A number of these techniques are from:

Linehan, Marsha M. (2015). DBT Skills Training Manual, Second Edition. Guildford Press.

Observation Grounding Techniques

Observation grounding techniques use what is in your environment to help ground you. They are beneficial grounding techniques because you can use them pretty much anywhere and there is nothing that you need to have with you to be able to do them.

5-4-3-2-1

What are 5 things you can see?

What are 4 things you can feel?

What are 3 things you can hear?

What are 2 things you can smell?

What is 1 thing you can taste?

Pick an object and describe it in as much detail as possible. Make sure you describe it in different ways: colour, texture, shape, etc.

Describe the room you are in.

If you are in a place with other people, take notice of their appearance and describe as many details as possible.

If you can, step outside and notice the temperature of the air and how it is different from where you came from. You can also notice if there is any scents in the air.

Somatic Grounding Techniques

Somatic Grounding Techniques use your body to help ground you in the present moment. They can be useful for both hyperarousal and hypoarousal.

Press your feet onto the floor and notice the sensation. Focus on the connection that your feet have to the floor.

Body scan. https://www.healthline.com/health/body-scan-meditation#beginner-tips

Wiggle your toes or fingers and notice the sensation as you move each one.

Rhythm. Tap your feet or fingers in a particular rhythm and repeat it. Stay focused on the beginning and end of each sound.

Do an activity that involves using your hands: gardening, knitting, playing with sand/silly putty, folding laundry, washing dishes, etc. Pay attention to the sensation or body movements.

Clench your hands into fists, then release the tension. Repeat this 10 times.

Press your palms together briskly. Notice the sound and the feeling of warmth.

Reach your hands over your head like you’re trying to reach the sky. Stretch like this for 5 seconds. Bring your arms down and let them relax at your sides.

Stretch and focus on your breath and the physical sensations.

Go for a walk and notice your surroundings, the sensations of walking.

Notice the pressure points on your body on the floor, chair, or whatever you are laying on if lying down.

Do a quick bout of intense exercise in which you use out the body’s stored physical energy (running, jumping, lifting weights, etc.)

Squeeze a rubber ball very hard and notice the sensations in your body as you are squeezing and releasing the tension.

Hold ice in your hands and notice the temperature and the wetness as the ice melts.

Breathing Grounding Techniques

Deep breathing quiets the sympathetic (fight or slight; stress response) part of the autonomic nervous system, which triggers the relaxation response of the parasympathetic nervous system. Deep breathing needs practice and you want to practice deep breathing when you don’t have high anxiety (if you always do deep breathing when stressed or in pain, your body may associate deep breathing with those states and it won’t be as effective).

The extension of the duration of exhalation can calm a person because the exhalation connects with the vagus nerve that calms us. So if you are not able to focus on an entire breathing pattern, just focusing on extending your exhale can help to calm the nervous system.

https://hbr.org/2020/09/research-why-breathing-is-so-effective-at-reducing-stress

Belly or Diaphragmatic Breathing. Place one hand on your stomach, and the other on your chest. Breathe slowly and deeply into your belly. Try to keep your chest still.

4-7-8. Breathe in (inhale) slowly for 4 seconds. Then, hold your breath for 7 seconds. Finally, breathe out (exhale) slowly and softly, for 8 seconds. Repeat as many times as feels comfortable.

Paced Breathing. Slowly and deeply breathe into your belly. Try to average 5 or 6 breaths per minute. Exhale slower than you breathe in.

Paired Muscle Relaxation. This is a muscle relaxation technique that is paired with breathing. While doing belly breathing, tense your body muscle. Notice the tension in your body. Say the word “relax” as you exhale and release the tension. Notice the difference in your body.

Heart Breathing. While breathing slowly and deeply, imagine that you could breathe through the centre of your chest. Imagine breathing in around the heart space and breathing out through the heart space.

Boxed Breathing. Inhale for 4 seconds, hold your breath for 4 seconds, and exhale for 4 seconds. (You can increase the length of time for the sections as long as you stay at an equal length to each other, such as 5-5-5, 6-6-6, etc.)

Pairing Stretching with Breathing. Stretch while you are slowly and deeply inhaling and exhaling.

Pair the Breath with Body Movements. This can be done by doing one body movement on the inhale and another on the exhale. For example, you can start with your arms at the sides with the inhale raise your arms over your head and lower your arms to the starting position on the exhale.

Pair the Breath with Intention. Pair a word or phrase that you want to bring in with the inhale and let your body relax on the exhale. Some examples of words/phrases are strength, calm, peace, I am loved, etc.

Self-Soothe Grounding Techniques

Self-Soothe grounding techniques are about taking care of yourself. With self-soothe grounding techniques, you are grounding yourself in things that are comforting to you. One important thing with self-soothe techniques is to listen to your body and do what is comforting to you and not what is effective for others. Each of us is unique and has unique experiences that influence what is comforting to us, and it is important to respect that. When you do activities or imagine things that are comforting to you, it signals to the brain that you are in a good place and that calms the system down.

Take a shower or bath. Notice the sensation of the water hitting your skin

Make a cup of tea or coffee. Focus on the taste. Notice the warmth of the mug.

Wrap yourself in a soft blanket. Focus on the softness of the blanket and how it makes you feel.

Sip a cool drink of water, iced tea, or juice. Notice the difference in temperature and how it makes you feel.

Imagine very relaxing scenes.

Engage in spiritual practices, such as prayer to God/higher power or something else.

Imagine hurtful emotions draining out of you like water out of a tap or sand slipping through your fingers.

Remember a happy time and imagine yourself in it again.

Find purpose or meaning in a painful situation. If you have trouble finding meaning in your current circumstance, try to remember a time you found meaning in a painful situation.

Imagine everything turning out okay.

Focus on the positive aspects of a difficult situation.

Do some self-massage.

Practice yoga or some other stretching.

Get into bed and pull the covers over your head.

Remind yourself of another time when you felt similarly, and things turned out okay.

Encourage yourself:

  • “I will make it out of this.”
  • “This will soon pass.”
  • “I’m doing the best I can.”
  • “I will be okay.”

Imagine yourself leaving the painful feelings behind. This can be walking, swimming, or running away from the feelings. Writing the feelings on a piece of paper and burning it.

Visualize your favourite place. Think about the sounds and scents there as well.

List and visualize 4 or 5 things that bring you joy.

Some of these techniques are from Marsha Linehan’s DBT Skills Training Manual, 2nd Edition.