Category: Therapeutic Modality

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.

What is Sensorimotor Psychotherapy?

Sensorimotor Psychotherapy was developed by Pat Odgen and is a body-centred approach that focuses on the somatic symptoms of trauma. It holds that unresolved traumatic experiences end up trapped within the body. It is a combination of somatic therapies, attachment theory, neuroscience, cognitive techniques, and other techniques.

The focus of Sensorimotor Psychotherapy is to use a person’s physical, mental, and emotional states to manage and relieve the physical sensation that are connected to the trauma. Details of the trauma do not necessarily need to be recalled for the treatment to be effective.

Sensorimotor Psychotherapy can be beneficial for:

  • PTSD
  • Substance dependency
  • Abuse
  • Anger
  • Relationship issues
  • Depression
  • Anxiety
  • Development issues
  • Issues with emotion regulation
  • Chronic pain

Further Reading

Sensorimotor Psychotherapy https://sensorimotorpsychotherapy.org

This is the official website for Sensorimotor Psychotherapy. It is more for therapists desiring trainings, but it does have some information on Sensorimotor Psychotherapy and it has a Therapist Directory in which you can look up officially trained therapists.

What is Somatic Experiencing (SE)?

Somatic Experiencing (SE) was developed by Peter Levine and focuses on addressing the effects of trauma. It focuses on releasing people from where they may have been stuck in a traumatic event. For example, someone may develop chronic pain in a body part that was hit in a motor vehicle accident. The reason for that pain may not be physical but may be due to not going through certain processes that release the traumatic energy and therefore the energy stays in the body and creates tensions and pain.

The purpose of Somatic Experiencing is to help the body release the traumatic energy and to enable it to self-regulate.

The focus of Somatic Experiencing is to help the client find places of safety so that the client can experience sensations relating to traumatic events in a safe way and be able to process the trauma.

Somatic Experiencing can be very helpful for trauma and other conditions that involve a dysfunctioning nervous system from trauma.

Further Reading

Trauma Healing https://traumahealing.org

This is the official website for Somatic Experiencing. It has resources, information on trainings, and a place to look up therapists who have passed their official trainings.

Official Youtube Channel https://traumahealing.org/c/SomaticExperiencingInternational

Recommended Books

Healing Trauma – Peter Levine

This book is a simple little book that is a 12 phase Healing Trauma program. It provides the necessary information that is important to trauma healing but not all the science behind it (if you want the scientific background read Waking the Tiger or In an Unspoken Voice for that information). It includes a CD with 12 guided Somatic Experiencing exercises. There are a variety of exercises or modifications that you can use for each of the 12 phases.

In an Unspoken Voice – Peter Levine

This book summarizes Peter Levine’s work in trauma. It explains the science behind the strategies of Somatic Experiencing, why some people develop PTSD and others don’t, what you can do to lessen the chances of developing PTSD after a traumatic event, and what you can do to release the trauma that has become trapped in the body after a traumatic event.

What is Internal Family Systems (IFS)?

Internal Family Systems (IFS) Therapy was developed by Richard Schwartz in the 1990s after he began hearing clients speak about inner parts within themselves. He looks at these parts as an internal family in the mind, where some parts have certain goals while other parts have other goals. Each part has its own likes, dislikes, burdens, and history and is thought to play a role in achieving self-preservation. Parts have healthy, productive or extreme roles and those with extreme roles may benefit from therapy.

There is a Self that is the seat of consciousness at the core of each person. The Self is often hidden by the different parts, especially the extreme or wounded parts which are trying to protect it. The goal is to unburden those parts and create a trusted, healthy, harmonious internal system that is coordinated by the Self.

Internal Family Systems is an evidence-based practice and has been found to be effective for the improvement of general and mental well-being. It can be used to treat:

  • Trauma
  • Physical, emotional, or sexual abuse
  • Compulsive behaviours
  • Depression
  • Bipolar
  • Body Image issues
  • Anxiety
  • Phobias
  • Substance dependency
  • Chronic pain

Internal Family Systems can be used to understand why certain behaviours keep happening and for more extreme behaviours (substance dependency, self-harm) figure out if those behaviours are still needed and what could be done instead. Some of the parts may be living in the past when the circumstances were different and Internal Family Systems can be used to bring those parts into the present where those extreme behaviours are not needed anymore. Internal Family Systems can be a powerful tool to work with trauma, especially developmental trauma.

Further Reading

IFS Institute https://ifs-institute.com

This website is the official website for the practice of Internal Family Systems. It has resources, ways to find a formally trained IFS therapist, training and learning options, information about the theory, and research about IFS.

No Bad Parts – Richard Schwartz

This is a book written by the founder of Internal Family Systems, Richard Schwartz, for the general public. It explains the IFS theory and why it works for trauma and other struggles. It also includes techniques and exercises.

What is Cognitive-Behaviour Therapy (CBT)?

Cognitive-Behavioural Therapy (CBT) is a short-term form of behavioural therapy. It focuses on the relationship between beliefs, thoughts, feelings and behaviours. The assumption behind CBT is that by changing one corner of the triangle, you can change the other corners of the CBT triangle (see image below). For example, by changing the thought you have in a situation you also can change the emotion and behaviour you have in that situation. In cognitive behaviour therapy, there is awareness brought to the pattern of thoughts or emotions and then there is an effort to change that pattern. This is done with short manageable goals.

CBT can be used to better manage and cope with chronic conditions such as Chronic Pain, Chronic Fatigue Syndrome, Diabetes, and Irritable Bowel Syndrome.

CBT has been found to be effective for:

  • Depression
  • Anxiety
  • Mood Issues
  • Post-traumatic stress
  • Obsessions and compulsions
  • Chronic fatigue syndrome (CFS)
  • Irritable bowel syndrome (IBS)
  • Chronic Pain
  • Sleep Issues
  • Phobias
  • Disordered eating
  • Substance dependency
  • Sexual issues
  • Anger management

It can be very effective to lessen the suffering of people who have negative thought patterns or are prone to anxiety. It complements other modalities as well.

Further Reading

Beck Institute https://beckinstitute.org

This is the website of the institute of one of the biggest influencers of Cognitive Behaviour Therapy. This website has a lot of information about CBT, possible trainings, and other resources.

Mind Over Mood – Christine A. Padesky & Dennis Greenberger

This is a great book on how to use CBT to improve the quality of your life by changing your thoughts and emotions. It has worksheets included with the book and has step-by-step plans that you can use.

What is EMDR?

Eye Movement Desensitization and Reprocessing (EMDR) therapy was developed by Francine Shapiro and is a body-mind integrated therapy that has been proven to be highly effective for people who have experienced trauma. It was founded on the basis that trauma interferes with the brain’s processing and that during trauma, our brain processes and stores memories incorrectly. This incorrect storage makes it so that past events seem to be in the present. These memories can be triggered by emotions, negative cognitions, and physical sensations.

EMDR uses bilateral stimulation (eye movements, tones, or taps) to access memory networks in order to move them from a place of emotional activation to a more rational, logical place.

EMDR is an effective, evidence-based form of treatment for Post-Traumatic Stress Disorder (PTSD) and is recognized for its effectiveness by the American Psychiatric Association, the Department of Defense and Department of Veterans Affairs (US), and the World Health Organization. With EMDR, it is not necessary to discuss the details of a traumatic experience.

EMDR can be used for more than just PTSD, it can be used for:

  • Anxiety
  • Panic attacks and phobias
  • Depression
  • Chronic Pain
  • Substance Dependency
  • Various kinds of trauma (intergenerational, developmental, etc.)
  • Abuse and Assault (Physical, Emotional, and Sexual)
  • Grief and loss
  • Eating Disorders

Further Reading

EMDRIA https://www.emdria.org

EMDRIA is the international association for EMDR. It has guidelines for official trainings, reports on EMDR research, explanations of EMDR, as well as a place to look up EMDR trained therapists.

Getting Past Your Past – Francine Shapiro

This is a great book for people who aren’t mental health professionals. It has good explanations about trauma, EMDR, and techniques to use for trauma.

What is Dialectical Behaviour Therapy (DBT)?

Dialectical Behaviour Therapy (DBT) was developed by Marsha Linehan at the University of Washington while trying to find an effective treatment for suicidal and borderline personality disorder patients. She started with Cognitive Behaviour Therapy but found that it was lacking in certain areas, so she added aspects to the treatment and made changes to improve treatment results. This resulted in what is now known as DBT. Some of the changes she made were a balancing act between acceptance and change, adding validation, mindfulness, and interpersonal skills.

The focus of DBT is to “build a life worth living” and it is a collaborative type of therapy where the therapist and the client work together to enable the client to build a better life through collaboratively decided goals, therapy techniques, and skill-building.

Behind the DBT is biosocial theory, which believes that invalidating environments are at the root of emotional dysregulation. Emotion dysregulation involves being emotionally sensitive and emotionally reactive and having a slower return to baseline. There are several reasons for emotion dysregulation, such as biological disposition, attachment problems, loss, trauma, and invalidation. When people have frequent prolonged intense emotional reactions, they tend to create neural pathways that are sensitized to these types of reactions. These reactions can become more automatic as time goes on. The emotional reactions can become more and more intolerable as time goes on it can become more difficult to cope with them and choose effective behaviours to deal with them. DBT can help point clients in the right direction of choosing better behaviours to deal with intense emotions and learn how to tolerate them.

DBT works by moving back and forth between acceptance and change. It validates your past experiences yet encourages you to move forward. It offers skills that you can learn to deal better with the world around you and better manage your emotions. These are often skills that people who grew up in supportive environments learned, but people who grew up in less supportive environments did not learn or have deficiencies in their skills.

The skill-building in DBT can really help people to be able to better cope with their emotions, tolerate distress, improve their relationships, and better understand how they can improve how they feel about life. I find this modality really works well with people who have had emotional neglect or developmental trauma because it focuses on the skills that were neglected in their childhood. There are other modalities that work well with the actual inner wounds from childhood, so this form of therapy works well complementing those.