Online isn’t going away for therapists…the good and the bad

The COVID-19 crisis forced the majority of the mental healthcare profession online—from graduate school training to supervision to delivery of services to clients. After the initial transition many experienced therapists reported success in their transition to online care, especially those working from CBT models, with therapists practicing from a psychodynamic model suggesting some limitations that generally are more easily perceived during in-person sessions (Békés & Aafjes-van Doorn, 2020; Shuster et al, 2020). There is further indication that the therapists’ previous experience with both telehealth and the therapeutic models that they are working through are good predictors of the therapists’ ideas of success, which is a challenge for novice therapists and their supervisors to address in an ongoing matter.

The more difficult area to dissect is the impact that COVID-19 will have on therapists currently in school. With many in-person schools being forced into online teaching programs, both educators and students had to make quick adjustments to new ways of learning and teaching. Student isolation is higher in online schools, especially in asynchronous classes.  Isolation is a predictor in attendance, attrition, and retention rates (Esgi, 2013; Cao et al., 2009), but also impacts the abilities of students to engage with 1) the course content, 2) the instructors, and 3) other students. These areas are important in a field that is based on human relationships as a mechanism of change, but unfortunately online coursework relies most on the course content at the expense of the interactions with instructors and other students.

The limitation of interactions with instructors and other students in real time has particular effects in certain classes more than others. For example, in cultural competence classes where there is already problems of students refraining from engaging in difficult topics around privilege, racial identity, acculturation issues (Thrower, Helms, & Price, 2020), students have the opportunity to further opt out of uncomfortable conversations due to limited peer interactions, limited interactions with the entire group, and a very nuanced conversation that can even take into account the racial identity of the instructor. Further complicating this dynamic is when students are addressing their own racial identity for the first time and are less likely to engage in the peer-to-peer learning process.

This is not just a problem with online learning. These dynamics play out in sessions with clients as well. Uncomfortable topics can be bypassed by both the therapist and the client in online sessions. The asynchronous factor is removed during online sessions, but dynamics that are not discussed fall much more on the therapist’s responsibility to point them out and bring them up. As the distance between therapist and client increases, so does the therapist’s responsibility in attenuating to these circumstances and ensuring that they are discussed. Supervisors need to be aware of this dynamic, too. Not only does the distance exist between client and therapist, but the distance exists between therapist and supervisor, which makes the opportunities to avoid information even larger.

Answers to these problems are to engage more directly with students, supervisees, and clients about uncomfortable topics in a more direct approach. Especially as we consider the very realistic possibility of extended periods of online therapy, training, and education.

 

References

Cao, Q., Griffin, T.E., Bai, X. (2009). The importance of synchronous interaction for student satisfaction with course websites. Journal of Information Systems Education, 20(3), 331- 339.

Esgi, N. (2013). Comparison of effects of e-learning types designed according to the expository teaching method on student achievement. Education and Science, 38 (170).

Shuster, R., Topooco, N., Keller, A., Radvogin, E., & Anton-Rupert Laireiter. (2020). Advantages and disadvantages of online and blended therapy: Replication and extension of findings on psychotherapists’ appraisals. Internet Interventions, 21. https://doi.org/10.1016/j.invent.2020.100326

Thrower, S. J., Helms, J. E., & Price, M. (2020). Racial Dynamics in Counselor Training: The Racial Identity Social Interaction Model. The Journal of Counselor Preparation and Supervision, 13(1). http://dx.doi.org/ 10.7729/131.1313

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