Increasingly, online psychotherapy is emerging as the preferred option for many clients and patients who welcome the advantages of this form of psychological intervention.

Not surprisingly, the freedom it provides and the ease with which the psychologist’s office can be accessed via the Internet are factors from which many benefit. The limitations of time and space do not have to burden us when accessing psychotherapy services.

However, the idea of attending therapy over the Internet is often somewhat confusing to those who are considering this option and are not very familiar with the options provided by the remote format supported by new networking technologies. Let us see, then, what the first online therapy session looks like .

This is how the first online psychotherapy session begins

At first, what distinguishes online from face-to-face psychotherapy is minimal. The contact between the therapist and the patient is fundamentally the same in both cases, given that currently most of the first steps in establishing communication occur on the Internet, either through the psychologist’s website or through a directory of psychologists. It is, in short, an email or a phone call.

From there, the practitioner can consider the possibility of carrying out therapy online or in person , or it can also be the case that the potential patient expresses the intention to use only the online format.

In any case, it is not always necessary to take into account that even if you are going to receive care online, the service will be provided by a mental health professional clearly identified by name, surname and member number, not by a computer program or a virtual interface alien to any human component.

Miguel Ángel Rizaldos, an expert in online therapy with more than 25 years of experience and one of the pioneers in the use of this modality in Spain, points out that this therapy modality is subject to the same quality standards as the face-to-face attention in physical consultations, and the same psychologists who can attend via Internet are trained to practice face-to-face : the type of service is the same, and only the medium in which it is provided changes.

At the same time that the date and time of the first online psychological therapy session is set, the patient receives simple instructions on how to start the session, which will take place via video conference.

Exploring the problem

Once the connection has been initiated, both the professional and the patient have on their computer screens a live image of what is captured by the other person’s webcam , which points to the face: both the image and the sound.

Videoconferencing is the basis of online therapy, as it provides a context in which both parties can share elements of verbal and non-verbal communication, and there is also the possibility of sharing audiovisual content in real time (which can be useful in various phases of therapy).

In the first few minutes of the start of what can technically be considered the first online psychotherapy session, formal presentations are made. This phase is aimed at creating a communicative flow in which patients feel comfortable. Then, the patient, invited by the professional, explains what he is looking for or what his problem is.

This explanation need not be very well prepared, and may be relatively spontaneous and improvised, as patient and therapist will later negotiate the setting of much more concrete goals.

In any case, it is important to note that these explanations are not given “on camera”, since the session is spent not looking at the camera (which would be uncomfortable for many people), but looking at the therapist. The online format itself is designed to be a very similar interaction to the one that would occur when both are in the same room .

On the other hand, even though in this phase of therapy the patient has a lot of information about the case and the therapist does not yet have it, the latter often intervenes to help the patient structure his explanations. If necessary, the patient can share videos or photos to provide more information about their case, as long as these documents do not violate the privacy of others.

A remote but not impersonal session

Most of this first session by video conference, which usually lasts less than an hour, is dedicated to the patient explaining and communicating their concerns and aspirations related to the problem or need to be treated.

The professional acts as a guide to make those explanations go towards one or another area of life, but does not give orders or abruptly interrupt the other person without giving them the opportunity to continue explaining themselves. Miguel Ángel Rizaldos points out that the fact that there is a screen in the middle is in no way an excuse to offer a more distant and impersonal treatment to the patient, but rather a resource to be used to allow a type of communication that fits better with the availability of both parties.

Of course, psychologists take a professional role and don’t try to pass themselves off as friends of the patient, but that doesn’t mean that they don’t show empathy and closeness, or that they make relevant decisions in a totally unilateral way. The creation of consensual therapeutic commitments is always sought , which allow the therapy to advance. Thus, the first online therapy session ends by pointing out the objectives of the following session, in which a summary of what has been put in common in the first one will be made and proposals will be made to start walking towards the established objectives.

Bibliographic references:

  • Zack, Jason; Stricker, George (2004). Online counselling: a handbook for mental health professionals. Amsterdam: Academic.
  • Zelvin, E. (2004). Online Counseling Skills Part I: Treatment Strategies and Skills for Conducting Counseling Online. Academic Press.