Life

Here's Everything I've Learned About Starting Therapy at Home

I've said goodbye to my therapist's couch thanks to the lockdown and I'm not the only one. Here's a guide to maximising that precious time.

by Hannah Ewens; illustrated by Lily Lambie-Kiernan
31 March 2020, 8:15am

There was a print of a magpie and a playing card on the wall at my previous therapist’s house. Other miscellaneous objects were in the frame too, but that bird and playing card worked their way into my dreams more times than I could count. Sometimes I’d be strolling along in a dreamland and notice an ace of diamonds underfoot; through the lucidity of my sleep, I’d think to myself: 'For fuck’s sake, nowhere is safe.'

The physical space of a therapist’s office is enormously important to the act of therapy itself – and it's certainly always been central to what I’ve gone to therapy for. Whether it's a sterile hospital block in southeast London or a musty living room off a high street, these places provide a safe space far from every day life to discuss intimate things that no one else knows about you; to understand the strange connections your brain makes.

Now, like pretty much everyone else currently in therapy, I call my psychotherapist from my flat. My therapeutic safe space has become my actual safe space (bed). After a couple of half-failed attempts at recreating the privacy, intimacy and undivided attention I am lucky enough to have, I've worked out how to maximise the at-home therapy session. This is how you can do the same:

Establish and cherish a designated therapy space

Therapy spaces, whether private or NHS, are always two things: either clinical or academic and quiet. They’re usually uncluttered, bar some art or books. It’s hard as it is to use both parts of your brain to remember events and search for words that accurately convey nuanced feelings and experience, so don’t add a load of visual and audible mess to your new designated therapy space. Find a quiet corner of your house, bring a comfortable blanket or pillow, a glass of water, a notebook for writing down what the therapist is saying or any action points and homework, and anything else you might need.

Remove all distractions

I knew that haunting the flat like a ghost with my phone in one hand on loudspeaker was not going to be conducive to a quality session. But did I do it at first? Obviously! Once you've created your space, ensuring you're not going to be interrupted should be a priority.

“It's very hard to be open and reflective if you think your partner, dog or mum is going to barge in,” says Eleanor Morgan, a psychologist-in-training and author of two books on mental health. “Communicate that need to those in your home. Protect the space. I would also say that, if you are not used to communicating with your therapist in this way, you might be tempted to have your phone in a reachable distance. Don't. Put it out of the room. Your mind deserves 50 minutes without it as a distraction; just as you would if you were in your therapist's room.”

Top and tail your session as if it’s a normal one

A therapy session is a ritual of sorts. As with every ritual, it’s the intricate order of events that adds the subtle magic. Before entering their office or house, I do a quick mental recap of what we discussed the previous week. I try to remember if I’ve done all the homework and I try to be as calm and present as I can be before walking in the room. When I leave, I use the bus or tube journey into work to make notes about the session and, on a rare occasion, have a fruity little cry.

You won’t have a journey home before jumping back onto a Skype call or Zoom meeting, and if you still have to go immediately back to your place of work during the pandemic (perhaps you're even having to do it in a meeting or prayer room there), you may be extra stressed and ruffled. Take ten or 20 minutes to sit with yourself after your session: meditate, go for a walk, or journal what you discussed in your session. If you can, even take the journey time you would normally have to do the above. Treat it as if it’s a normal therapy session.

Take advantage of the phone or screen acting as a barrier

I used to have a problem making physical eye contact with therapists because I might glimpse their thoughts on what I’m saying (or worse: what I imagine they’re thinking). Emily Reynolds, a mental health advocate and author of A Beginner’s Guide To Losing Your Mind, believes we should look at this new barrier of the phone or screen as an opportunity.

“Having a face-to-face conversation with someone is not the same as a video-call, which means you might find yourself drawn to say different things or even talk about what you find embarrassing or difficult in person," she says. "Having some distance from your therapist might actually make you more likely to explore different issues.” Perhaps note down some of the topics you now feel more capable of working on virtually or over the phone, and some you’d rather avoid.

Communicate with your therapist

If you find the medium as uncomfortable or strange as I do, tell your therapist. Explain how speaking on the phone is working out for you and work with the therapist to decide what can be adjusted. “It won't be the norm for them, either,” reminds Morgan. “It'll take some getting used to, but, it's your time, and recognising how you feel in the moment – and communicating it – is a productive thing.”

I spent the last couple of sessions talking about OCD symptoms in relation to the pandemic. I’m not particularly anxious about the pandemic specifically, and the practitioner and I are on a limited schedule. It almost felt like we had to do the news cycle chat out of obligation. I relayed that and now we’re steering clear of it unless I bring it up.

But also: don’t forget that it’s normal to feel anxious or unsure at the moment

Most of us have few reference points for this pandemic, the closest being the fact that the entire global population has now watched Contagion on Netflix. Don’t worry, then, if your therapy doesn’t seem as useful as it normally is or if you’re feeling like you want more sessions.

"It is absolutely healthy to be afraid, feel 'triggered' or very sensitive in a pandemic," Morgan explains. "The disruption of routine will be awful for some people and, depending on variables like lack of human contact and physical health issues, some may feel the disruption more acutely than others. But the temptation to sever these human reactions – that we can make space for, rather than pathologise – from the source isn't really being kind to ourselves.”

Even – and especially – outside of a therapy setting, we're in a period where it pays to be present, practice some acceptance of our predicament and understand that so many of us feel the same. Unfortunately, we just have to think about that in a room of our own.

@hannahrosewens

Tagged:
anxiety
psychotherapy
Coronavirus
COVID-19
self-isolation
skype therapy