Moving to 100% online therapy at The Grove

Our clinic first started with online counselling when one of our clients moved away from Melbourne, and we began providing online counselling to maintain continuity of care. In time, this offering grew as more inquiries arrived for therapy that met specific client needs. Some patients lived in rural and remote locations, while some were unable to leave their homes due to illness. Others were simply trying to avoid the cross-town commute.

We were happy with the offering. Clients who felt comfortable in the online forum had the option to engage in this way, and therapists who wanted to offer their services online were supported to grow this part of their practice. It felt like a good balance.

However, with the arrival of COVID-19, that ‘good balance’ was dramatically upended. In under two weeks, we went from offering approximately 20% of our services online to 100%.

This post is an outline of how we managed such a monumental endeavour. I’ll walk you through each step we took and the tasks involved. I hope it can be of service to you as we all grapple with what it means to be an allied health care provider in such a challenging time.

In the beginning

A counterbalance to uncertainty is certainty. Recognising the enormous amount of community fear generated by the COVID-19 pandemic, we moved decisively to quickly make the following adjustments and become a 100% online counselling service.

We accepted that our offering would not be perfect, but concluded it was more important to quickly meet the changing needs of our community, rather than get the offering absolutely right.

We agreed that dynamic communication would be necessary to support this shift, and we ensured our communication was (and still is) timely, professional, and concise, as well as personalised, caring, and consistent.

By taking this path, we knew we’d have to be prepared to adapt and change. Our initial attempt to move online evolved into a stepped process in order to accommodate client needs. Today, our offering is further evolving as we work to incorporate the new Cliniko telehealth feature.

We had to stay mentally and emotionally healthy. In recognition that we as practitioners are also dealing with a lot of change and subsequent exhaustion, we all agreed to be kind to ourselves—and each other—as we navigated this tumultuous time.

Before the session

Clients must feel at ease—we are a therapy practice, after all. Our clients needed to feel safe in knowing we were abreast of the unfolding situation, and that their care was utmost in our minds.

Address client concerns

After reaching out to our clients and outlining the process and expectations, we found that roughly 30% of those with upcoming appointments were concerned about participating in online sessions. Therapists responded to their clients individually, and—once all concerns were addressed—the majority of our clients converted.

Support struggling converters

For those who needed additional support to make the switch, we adhered to the following process for every individual:

• We gently asked about their barrier to getting counselling online. ‘Can you share with me some of your concerns about doing the session online?’
• We met their concerns with understanding. This was a critical step to reduce the enormity of the barrier for the client. ‘I hear you are worried about…’
• We were clear on our position regarding in-person vs online sessions. ‘I really hear that you would prefer to see me in person. However, in order to keep you safe, and to keep me safe, we need to move forward in a different way.’
• We workshopped ideas to overcome the barrier whilst keeping the agency with the client. ‘Would you consider giving X a go at your next session, to see if that helps overcome your worries about Y?’
• We made the conversion in a collaborative and clear manner. ‘Great, let’s give X a go at the time of your next appointment, and we can see how it goes from there.’
• We considered a stepped solution for those who really did not want to convert. We met the client in-person for one last session to discuss their reservations, but to also let them know that after this, all sessions will be online.
• For those who were still unwilling to participate in online sessions, we let them know that we’d do our best to ensure their therapist would continue to be available for them after the COVID-19 precautionary period passes.

Common barriers and solutions

Here are some of the most common barriers that were named by our clients regarding their reluctance to convert to online counselling. And, based on our clinic’s experience, I’ve also included potential responses to these concerns.

"I am not sure I can find a place that I feel is sufficiently private."

Meet their concern: ‘I can hear you are worried about not being able to find a private space.’

Workshop potential solutions:

• Schedule the session when your housemates are likely to be out.
• Drive your car to a favourite location, and do the session from the privacy of your vehicle.
• Use headphones so no one can hear the therapist’s voice.
• Let others know not to enter your room because you are on a call.

"I will miss coming to the clinic. It is a space I really like."

Meet their distress: ‘It is a lovely space and change is hard.’

Workshop potential solutions:

• Ensure you give yourself transition time before and after the session, as you would if you were travelling to and from the clinic.
• Make yourself a cup of tea at home, like you would when you come to therapy.
• Light a candle like you would see in the waiting room before your session.
• Play relaxing music like you would listen to in the waiting prior to meeting with your therapist.

What we can do:

• Work hard to create therapist environments that are reflective of themselves and the practice.

"Are you sure the therapy will really work if we do it online?"

Meet their concern: ‘I can hear you are worried about the efficacy of the therapy.’

Workshop ideas:

• How about a free 30-minute online session to test the experience? If you like it, we can continue booking them.
• Let’s give it a go, and if you don’t like it, we can find a different way to engage moving forward.

What we can do:

• Cite studies that indicate telehealth is a viable form of therapy.

"I am scared of technology."

Meet their fear: ‘I can hear you are concerned about your ability to work the technology. I will be right here to support you through that.’

Workshop potential solutions:

• Use the easiest and most reliable technology you can find.
• Have your mobile handy, so you can use it as a hotspot if the Internet is unreliable.

What we can do:

• Use your appointment confirmation and reminder messages to provide clear, consistent instructions on how to join the online session.
• Ensure sufficient time between sessions, so you’re able to coach the client through the process over the phone, if necessary.
• Suggest a back-up plan. If all else fails, we will call you on your mobile.

Advice for the session

When a client is new to online therapy, it’s important that you take the time to help them feel comfortable with the platform. Acknowledge that it may feel odd at first, and thank them for being willing to give it a go.

You also might double-check that they have everything they need with them (e.g. water, tea, tissues, cell phone) and whether they are free from disturbances and have power access nearby. They’d likely appreciate a reminder to shut the door as well.

If you’re unable to see or hear them well due to poor lighting or background noises, encourage them to make appropriate adjustments to their situation, and let them know the back-up plan if the connection fails for some reason.

It’s helpful to establish expectations of how the session will be structured and how you will address payment and scheduling of follow-up appointments.

If you have clients who really seem to struggle with the idea of online therapy, you can try offering a free trial session, shorter sessions, or making the first session all about adjusting to the new platform—or at least as much of it as they need.

Closing the Online Session

Take time to check how the client found using the online platform and whether they have any feedback or suggestions on how it could improve for future appointments. In our experience, clients generally find it much better than they ever imagined.

Helping the client to feel empowered is especially important during a time where we feel so constrained. Give them the power of choice by asking if they’d like to re-book another online appointment.