A hybrid practice sounds great in theory but can quickly turn into a scheduling nightmare! I have had the opportunity to talk with many therapists to brainstorm schedules that work to balance in-person sessions with remote teletherapy. Following are some thoughts and reflections on this creative process. I welcome your feedback and invite you to join me in this new endeavor, as we start to think outside the screen!
The pandemic shifted our priorities and created new possibilities for the future. It provided us with an opportunity to work from home, limit our commute, and focus on what matters. Our practices changed, and so did our perception of teletherapy. For some therapists, the transition was seamless; clients adapted easily, and the quality of therapy improved, with more time to focus on self and family.
For other therapists, the transition remains rocky; tele-therapy doesn’t cut it, their clients are struggle and they yearn to return to a safe space. There are therapists who have no desire of returning to the office, and others who miss the intimacy created in a safe therapy room.
First, take an honest assessment of who you are, and what is needed for yourself and your practice. Before designing a hybrid practice, it's important to critically reflect on your needs and capacities. Following are a few reflections to guide the process:
Pause. Breath. Ponder. Choose. Once you have decided what feels right for you and your clients, then its time to get creative! In the following section I’ve suggested simple scheduling solutions that have the least impact on your clients schedule. In some scenarios I've also suggested “super organized” solution for those who can handle it. Let’s dive right in!
Quarterly Office Sessions (every 2-3 months)
The simple elegant solution is to schedule a “Week at the Office” every few months. In this scenario you don't need to move any of your clients around. Simply book a Visitor Pass and then let your clients know which week you will be providing in-person sessions and allow your clients to choose whether they will join you remotely or in-person. The benefits are that everyone gets a fair chance to see you in-person.
If you're unable to provide a whole week at the office, then you need get super organized. Start by choosing your "office days". You can choose these based on personal preferences, or you can invite your clients feedback and preferences via an online scheduler like Doodle.
Once you have chosen your office days, the following steps will help get you organized:
Monthly Office Sessions (1 or 2 days/month):
The simple scheduling solution is to offer "Weekend Office Visits". While this may sound unusual at first, it has a number of benefits: (i) since the weekend is typically a more relaxed time to catch up with friends and family, it provides clients with a more intimate connection (ii) some clients are more flexible during the weekend, (iii) your week load will be lighter on the weeks that you offer Weekend Office Visits since some of your clients will cancel their zoom sessions in exchange for meeting you in person. With more breaks during the week, you can also re-frame it as your monthly “catch up week". Catch up with paperwork during the week, and catch up with clients in-person on the weekend. Simply book a Day Pass in advance and open the possibility to your clients.
Not keen to meet with clients in the weekend? Another simple scheduling solution is to rotate your in-office days each month. For example, say you've decided that you'll go to the office on the first week of each month -- but only for one (or two) days. So on the first month, you offer your Monday clients the opportunity to meet with you on the first Monday of the month. On the On the next month, you book a Day Pass for the first Tuesday of the month. The coming month, book a room for the first Wednesday of the month and give your Wednesday clients a chance to see you. And so forth. This new rhythm provides equal opportunity for your clients to see you in-person.
Weekly Office Visits:
Simple scheduling approach 1 is to assign specific weekday(s) for in-office sessions, for example, "every Tuesday and Thursday". In this case, you may want to consider a standard Daily Sublease. The benefits of this approach is that you can create a hybrid practice with more routine and structure for yourself and family. If you have some wiggle room with your schedule and not sure which days to offer, you may consider asking your clients for feedback. You can also use an online scheduling tool, such as Doodle, to determine what days work best.
(My personal favorite) Simple scheduling approach 2 is remarkably elegant if you have access to flexible therapy rooms. Simply keep your clients on their normal schedule and create a rotating in-office schedule, i.e. rotate between each day of the week. For example, on the first week of the month, you offer in-person sessions to your Monday clients. On the second week of the month, you offer in-person sessions to your Tuesday clients. On the third week, you welcome your Wednesday clients, and so forth. This is the simplest way to offer equal opportunity for in-person sessions without disrupting your current schedule.
Regular/Daily Office Visits
For many therapists, teletherapy just doesn't cut it. It feels inadequate, disconnected and/or a disruptive to the daily work/life balance. Understandably, it will be some time before all of your clients return to the office, and even then, some may prefer to stay online. When looking for a dedicated space, you'll want to consider how the space is managed, what overhead costs you will have, as well Wi-Fi reliability.
For therapists with a full-time practice, now is the time to get ahead and secure a dedicated room (we only have a few left) or a daily sublease. The future of therapy rooms is a little unpredictable as many previous therapy suites have terminated their leases. One of the perks of renting a dedicated room at Sima Space is that all your subtenants get a free Flex Plan. This will help you secure subtenants with ease.
For therapists with a small, or part-time practice, keep in mind that our model was built for you. The Flex Plan is our most popular plan and allows you to return to in-office sessions with minimal commitment and maximum flexibility. Book our rooms on an hourly ($25/hr) or daily ($90/hr) basis depending on your needs.
Still undecided? Too many options can leave us confused. I'm happy to chat and brainstorm.
Schedule a tour with us and I'd be happy to explore your options together.
Covid-19 compelled most people to shut their offices down and make necessary adaptations to their businesses. Similarly, mental health professionals have also been forced to offer telehealth services to their clients as an alternative to in-person therapy. Being a therapist, I found this adaptation challenging yet rewarding. Opting for teletherapy is an ethical decision to address the needs of communities and to alleviate the psychological impact of restrictive interventions. Developing teletherapy skills ensured not only the continuity of care but also improved the quality of my overall therapeutic services. It made me a better therapist.
The three most essential teletherapy skills that heightened my productivity as a therapist include awareness of limitations, flexibility, and creativity. Let’s discuss how.
Awareness of limitations
Offering teletherapy made me realize that the awareness of limitations is the key to success. Once we become aware of the limitations, we begin attempting to propose and test the solutions. I faced communication barriers in teletherapy despite having the privilege to use interactive videos. It was common to miss auditory and visual subtleties and nuances in video chat sessions. I needed to depend on clients’ willingness to show or hide their behaviors. But I learned to adjust my approach according to the needs and facilities. Once I had to provide teletherapy to a client suffering from depression. His voice pauses, pitch, or any other cues were almost undetectable due to low levels of loudness. I decided to use headphones so I could catch as many cues as possible. Additionally, I realized that teletherapy is not a suitable modality for severe clients, including suicidal ones. Awareness of limitations is assisting me to manage ethical issues in teletherapy more professionally.
Providing teletherapy requires continued advancement. In my venture of continued advancement, I have learned to be more flexible. Previously, uncertainties used to scare me a lot. Teletherapy made me question my abilities and expertise many times until I opted for maximizing knowledge through research and reading. I read new ethical guidelines and temporary relaxations in HIPPA requirements and made necessary adaptations to my practice accordingly. I tried to replicate the experience as much as possible for clients who had attended in-person therapy previously. Thera-platform software made it possible for me to replicate in-person therapy.
I learned to modify and customize the traditional in-person forms of therapy to make them suitable for teletherapy. The dedication and consistency in gaining knowledge helped me meet the clients’ needs in changing circumstances. I have learned to live by and overcome the novel challenges.
Creativity is the key to solving problems, especially of an ambiguous nature. Therapists deal with a great variety of people having a wide variety of problems. Variety brings ambiguity and uncertainty, while innovative thinking alleviates the pressure ambiguity brings along. Creativity is the most important teletherapy skill considering the ever-changing circumstances of the world. Rethinking therapy sessions, interventions, and goals for every client was possible only through innovative forms of thinking. I successfully employed online alternatives for all procedures involved in therapeutic practice. Enhanced creativity is still helping me tackle innovative challenges.
Without any doubt, teletherapy has changed the usual norms of practice, but it has also helped me become a better therapist. I feel more prepared to deal with uncertainty, and it no longer scares me. I have improved confidence in my ability to modify according to changing circumstances.
Hina Babar, Psychology Intern
Amid these unprecedented times, one of the new-normals we have to figure out is how to resume seeing clients face to face. Whether you already have experience of building a practice outside of your home, or currently considering the idea, it is important to consider elements such as health and safety, location, and type of venue.
More so than most other professional relationships, the therapist-client relationship ideally requires person-to-person connection. The therapeutic bond is healing in itself, and especially if at crisis point, the holding presence of a therapist in a safe environment could be essential for a client’s emotional state.
Of course, a safe environment now means dealing with Covid. More therapists are considering holding sessions outside of the home in order to minimize risk. Office spaces such as Sima Space have ensured that full sanitization and protocols are in place - a reassuring option for both therapist and client to consider (see Sima Space’s response to Covid protocols here).
In-office sessions provide the following benefits:
~ Working as a healing practitioner can be an isolating experience, so access to a supportive therapeutic community makes the journey more enjoyable.
~ Healing rooms are often used for other related activities such as supervision, family support sessions, or simply a quiet space to rest and work in.
~ Networking opportunities provide referral opportunities - the benefit of being in a shared practice environment enhances the chance to build your client base or (for those with a full practice) build a more robust referral system for new clients that you simply can not take on.
~ Working away from home enables you to better compartmentalize work time versus home time. You may feel more professional and held when working in an office environment, or it may be refreshing to simply get out of the house!
Check out Sima Space here to see how flexible and easy it is to manage working away from home. Providing bespoke rental packages (i.e. if you are unsure of how many in-person sessions you will be doing, you can opt for a co-working space), you also have five locations and thirty therapeutically-designed rooms from which to choose from.
Stay informed, stay safe, and stay working!
Ellen Evans, Transpersonal Psychotherapist
Have you ever experienced restricted judgment during a therapeutic encounter? If so, you are not alone. More often than not, such a situation arises from countertransference. From an early psychoanalytic perspective, countertransference can be defined as the influence of a client's problems on the therapist's unconscious feelings and emotions. It may serve as an obstruction in the therapeutic alliance and overall therapeutic outcome. It is essential to manage countertransference as it interferes with the therapist's rational decision making and objectivity.
Moreover, 'beneficence and nonmaleficence' is one of the general principles of the APA code of ethics, but countertransference brings the opposite energy to the therapy room. It may cause harm to the client. If you are going through the same problem, then worry no more. We have got you covered. Let's dive into the 5-step model (Cartwright and Read, 2011) and see how to deal with countertransference.
1- Identifying triggers and countertransference responsesThe first step is to acknowledge your countertransference responses that can either be physiological or emotional. If the client's abusive marital life makes you cringe, that might be because of your own unresolved traumas. You have been there, right? Every therapist has to go through a tiring journey of self-actualization before they can finally unravel their triggers, leading to positive or negative countertransference. Maintaining a self-reflection journal may deem beneficial in this regard.
2- Understanding countertransferential thoughts within the context of therapyBoth therapist and client bring their idiosyncratic vulnerabilities to the relationship, and clients may provoke emotional responses in the therapist. Therapy is a two-way confidential transaction in which the client and therapist work mutually. Therefore, it is important to reflect on your and your client's individual contributions in evoking countertransference.
3- Conceptualization of countertransferenceThe next step is to understand the client's template for the relationships. You need to understand the client's representation of self and others that the client has built through past experiences. If the client feels unloved and resented in her life, she might assume that the therapist may feel the same about her. As a therapist, you may feel irritated by your client's misconception and acts on your feelings in the form of withdrawal from the client or annoyance. Once you do so, the client's transferential expectations will be fulfilled. It will bring the therapist's worst dream to life, i.e., sabotaging the therapeutic relationship. So, try understanding the client's need and work on it without being emotionally drawn to it.
Transactional Analysis model of Parent, Adult, ChildAccording to transactional analysis (Berne, 1961), there are three ego states – Parent (demanding, critical), Adult (healthy, rational), and Child (emotional, irrational). Clients often move to the parent or child mode to which the therapist's countertransferential responses may elicit. As a therapist, you may also shift to parent or child mode, complementing the client's ego state. You need to analyze the situation and identify your and the client's ego state to understand countertransference in a better way.
4- Using calming strategies to manage countertransferenceTo manage your emotions evoked by the client in session, you can use breathing techniques to soothe your nervous system. Try to give positive and calming messages to yourself, such as "It is okay. I am having a countertransference response", or "I am aware of my emotional state". By doing so, you signal your brain that you have emotional responses under control and try to calm yourself with mindful strategies.
5- Moving back into the Adult ModeBy this step, you will be aware of the triggers, countertransferential thoughts and feelings, yours and your client's contribution to the countertransference. Now you will be ready to move yourself back to adult mode (from either parent or child mode). Use the calming strategies to strengthen your impartiality and healthy self.
These steps will help to understand and manage countertransference in therapy. Moreover, it will eventually help regain empathy and compassion towards your client. It also helps you understand your emotions and vulnerabilities and teaches you to regulate your emotional responses while working with the client.
Hina Babar, Psychology Intern
Berne, E. (1961). Transactional Analysis in psychotherapy. New York, NY: Evergreen.
Cartwright, C., & Read, J. (2011). An exploratory investigation of psychologists' responses to a method for considering" objective" countertransference. New Zealand Journal of Psychology, 40(1), 46-54.
Lets start with the issue of attraction…it may not be an issue at all. During my psychotherapy training, it was a reassuring relief to learn that attraction - whether from client to therapist or therapist to client - could simply exist apart from the therapeutic process. It is human to find someone good-looking, and simply acknowledging this fact to yourself goes a long way to keeping the therapeutic relationship healthy and intact.
However, when it comes to love, one of two things could be happening:
• A client could begin to develop sexual or intimate feelings for the therapist. This is the most common occurrence.
• A therapist could also ‘fall in love’ with a client. If this is the case, the therapist must keep the client’s emotional well-being at the core of the therapeutic process and reflect upon and process his or her feelings via therapy and supervision. The therapist may need to refer the client to another therapist.
When a client tells you they love you, be aware of these key aspects:
1. The client is most likely experiencing transference, whereby he or she is redirecting unconscious feelings from another person onto you. So, it is best to discuss what the transference is and work it through.
2. Usually, clients who fall in love with their therapists have struggled to feel loved. They find that their therapist is filling unmet needs, and strong reciprocal feelings can result. Therefore, treat this occurrence as a way to unravel your clients’ core wounding.
3. It has probably taken a fair amount of courage for your client to admit the intensity of his or her feelings, so it is best to treat the matter while still ensuring the client is aware that the feelings are not mutual (if you suspect your client has fallen in love with you but hasn’t mentioned anything, also have the courage to bring this up and to work through it). Continued personal growth and self-reflection will enable you to better meet the client, and be as holding and authentic as possible.
4. A therapist’s main role is to support clients in developing intimate relationships outside of the therapeutic relationship. Dependency may exist at the start of therapy, but self-intimacy and ‘other-intimacy’ are the goals beyond client-therapist intimacy.
It is important to acknowledge that the therapy room is a loving space. How else do people heal? Greater intimacy and emotional well-being is why people seek therapy in the first place. Good therapists should feel loving towards their clients. Call it what you will: unconditional positive regard, a healing bond, a safe acceptance; what therapists offer most is their love. And with good enough love, clients can progress through any traumas linked with the lack of it.
Ellen Evans, Transpersonal Psychotherapist
Chances are, if you’re reading this article, you’ve heard of meditation before and how beneficial a daily meditation practice can be. However, many people are scared away from meditation before they can even try it because of incorrect stereotypes or fear of doing it wrong. Many people picture sitting on the floor in an uncomfortable position for hours on end, eyes closed, doing…what exactly? But experts agree, a daily meditation practice has many physical and mental benefits. Are you wanting to begin a daily meditation practice but don’t know how? Here are some tips to help get you started!