Reflections on Remote Work with Clients

New Lessons on the Space Between Us

Maggie Mulqueen

As a therapist, I never wanted a home office. My commute is annoying at times, but it creates a clear demarcation between being on and off. Besides, my office is private and comfortable. There's a leather chair with an ottoman for me and a couch with ample cushions for clients. Ironically, without ever having thought about it, we probably sit approximately six feet apart. Although many therapists choose to work from home, I like that aspect of my personal life to remain private. I don’t even tell clients the name of the town where I live.

Then the world was turned upside down by a pandemic, and I made the decision to work remotely. I repurposed a guest bedroom into a makeshift office, setting a table for my laptop and dragging in my favorite chair from the living room. The walls are nearly the same green as the ones in my office, which is comforting.

Like most therapists, I’ve always kept a physical distance from my clients—other than the occasional handshake upon meeting, or hand on the shoulder upon leaving after an especially intense session. But being in the same room, hearing each other breathe or sigh, watching the tears flow or the sound of someone shifting in their seat, creates an intimate closeness nonetheless.

I had no idea how that would translate to remote work with clients. Even if we could see each other through a webcam and hear each other’s voice, what would it mean emotionally to not be in the same room? I was surprised at what I found. Instead of feeling distant from my clients, it seemed as though I’d entered a new realm of closeness with them, which put our relationship in uncharted territory.

I was in their homes and they were in mine. I came to know them in new ways. One client introduced me to her husband on screen, another sat in bed without makeup (a view of her I’d never seen before), and another exclaimed, “I have those same glasses!” when I took a drink of water. Still another client commented, “I love all the windows you have.” As I saw the artwork on their walls, their choices in furniture, and many of them wearing more casual attire than ever before, the physical distance between us seemed to shrink.

But there were challenging adjustments to make, too. I changed my hours to help people meet during times conducive to their privacy. I was now talking to my 4 o’clock Thursday client at 7 a.m. on Tuesday. And staying in my professional mindset while throwing a load of laundry into the washer between sessions was new to me.

Quickly, I also realized the pacing of a session is different on a video platform. Some clients who are chronically late to sessions, without the stress of driving or finding parking, were now in the “waiting room” early. The initial minutes of a session that often consist of someone taking off a coat, settling into a seat, and exchanging pleasantries, and that have always allowed me to assess their overall state of mind, were gone. Now we sat face to face from the outset.

I also found it harder to end sessions smoothly. In person, there are ways of signaling that the time is drawing to a close, motioning to get up or diverting my eyes to the clock. I always try to give a warning, so clients have time to finish their thoughts and collect themselves before reentering the world. I also caution clients not to jump onto their phones right after a session, to try to build in transition time for themselves. But now, transitions for most of them were shortened by family members hanging out in the next room.

For me, the most jarring part of using the video platform was seeing myself during the session. Not since my training days have I actually observed myself in my role as a therapist. It was distracting to watch myself listening. Getting rid of that feature was imperative to improving my ability to pay attention to my clients, and I asked them to do the same, if possible. After all, reducing self-consciousness is at the heart of a good therapy relationship.

Some of my clients chose just to talk over the phone. But the majority chose video, which allowed me to better assess their overall well-being. It felt a bit like an old-fashioned house call. A common way I evaluate my clients who suffer from depression is to ask them, “Is your house doorbell ready?” In other words, would you be embarrassed to let someone into your home without notice? In the past, I’ve always relied on their self-report. Their answers provide a concrete way for me to understand how much their self-care has slipped. These days, with no one going in and out of each other’s homes, it’s easy to imagine dishes piling up, beds unmade, and dust bunnies galore.

Video enhances my ability to assess how well my clients are functioning. I’m hopeful that by inviting me into their home each week, they’ll be motivated to shower and tidy up, all of which contribute to better mental health.

Pleased by how quickly I adapted to the ins and outs of using video, my appreciation grew for how connected we could stay no matter how long I had to work remotely. I’m also recommending my clients use video to stay connected with others in their lives. I suggest everyone, especially those who either live alone or those who feel alone in their living situation, have frequent video chats with another person besides me. This interaction will bolster their well-being between sessions.

It bothers me not to be able to tell my clients when we can resume sessions in my office again, with its comfortable furniture and cozy privacy. No matter how accustomed I become to working remotely, I know I’ll gladly get back in my car and return to my office when this is over. What’s more of a question is, will my clients feel the same?

***

Maggie Mulqueen, PhD, is in private practice in Brookline, MA. She’s the author of On Our Own Terms: Redefining Competence and Femininity.

Photo © iStock/MamikaStock

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Topic: Cultural, Social & Racial Issues | Professional Development

Tags: 2020 | boundaries | boundary issues | ethical boundaries | Ethics | healthy boundaries | home | Illness | Illnesses | Office buildings | online | online therapist | online therapy | Personal & Professional Development | personal boundaries | professional boundaries | Professional Development | therapist's office

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6 Comments

Thursday, April 2, 2020 4:30:47 AM | posted by Mirna Awad
Dear Dr.Maggie, Hope this message finds you well. I read your article about remote work with clients. I was wondering if you came across clients who smoke cigarettes during the online session, and if yes, how do you deal with it? Waiting for your reply, Mirna Awad

Monday, March 30, 2020 10:27:36 AM | posted by Loraine
Thanks for the article! Like others, we just started doing Child Intensive Outpatient Therapy in peer and Multi-Family groups this last week, and it was a steep learning curve. I have had to go over rules for talking in group, and I have also used the fact that they are in their space to have them share things from their space 1 time for the 2 times weekly that we are meeting to increase engagement. The first group night was terrible, but the second was pretty good as we were problem-solving right away, and establishing new group rules, and the families were again looking to me to set the tone for their time together. Because of the stress for me and the families, I have added a 15 minute break in the middle of our 3 hour block together, to allow for bathroom breaks, snacks, and physical movement or stretching, and I get up and walk 2 times around our office building as I move about less in the virtual space, and allows the kiddos to transition from peer time to adult time as well. I'm giving the families blocks of activity for a 15 minute time period I'm calling "family huddles" to give structure to our time, and this helps them keep on task. If a family is done early, I suggest fun activities they can engage in together like "silly ways to say good-bye" (see you later alligator, what's new cashew) or "using your full name, how many words can you cerate" to do something fun together in the time that also builds their skills that are transferrable to other activities. Last week, I had each child share a family pet, and tell us what they love about their pet, and the kids loved it! This week, they'll share a part of their room with us, and next week I'm thinking of having a pajama party. While it is a stressful time, we are in the unique position of providing a space and a time for them to learn and grow in a caring environment, and this also grows us as well. Exhausting but worth it! Thank you Maggie!

Sunday, March 29, 2020 12:44:30 PM | posted by David Schiesher
Hello from Switzerland! Thanks for the validating article Maggie, voicing what I have been experiencing as well with online therapy. I have been working online now for years, but only with a handful of clients who started in person and then moved away and chose to continue working with me. I miss the handshake and the sharing of aura energies and observing body language, but I agree that there can be sometimes "deeper realms of closeness" in videoconferencing therapy and the effectiveness of the work seems to be very close to the same as face to face therapy.

Saturday, March 28, 2020 3:35:24 PM | posted by Mary
Hello from Ireland! And many thanks for that lovely article, Maggie! You echo so much of what I've experienced this last week as I've adjusted to online therapy with clients and supervision with therapists. It's great to know that others are having similar anxieties but also those lovely moments you mentioned too. Here's to even better moments up ahead!

Saturday, March 28, 2020 3:04:59 PM | posted by Kirsten Lind Seal
Hi Maggie, I originally hail from Cambridge, MA and so have fond feelings for Brookline where you are. I can imagine friends of mine who are current Brookline residents and can imagine you there working telementally! I am doing the same from Minneapolis and have experienced everything you so clearly explain in your piece. And having a high risk husband I am wondering whether I am EVER going to feel comfortable seeing people so closely in a limited space again...so I am pondering moving to online completely going forward, though we have no idea what the future will bring. No matter what happens, I want to send you gratitude and thanks for this helpful and validating article! Best, Kirsten Lind Seal, PhD, LMFT

Friday, March 27, 2020 1:35:37 PM | posted by eileen savage-creedon
thank you I really enjoyed this article. You articulated much of what I have been experiencing over the last week. Its a huge shift but I feel fortunate we can shift and still hold on Be well. Eileen