2 years of the pandemic: How COVID-19 changed therapy forever

Coronavirus: The woman filmed herself and her date doing everyday tasks like ordering food and laundry.

How has the COVID-19 pandemic changed societal attitudes towards mental health?

Goa-based clinical psychologist Shobhika Jaju says that people have become far more forthcoming, “seeking therapy, talking about mental health, and accepting that anybody can struggle with mental health issues”, since March 2020 (the World Health Organization declared Covid-19 a pandemic on March 11, 2020). The volume of conversation about mental health has apparently had a positive impact on how people view it.

Tanvi Patil, a Mumbai-based expressive arts therapy practitioner, says that therapy has been “demystified and de-stigmatised to a certain extent during the pandemic.” People now recognize that mental health is not the responsibility of the individual alone; institutions and systems must provide support, especially to those who are socio-economically marginalized.

Also read: Dance Therapy Comes To The Aid Of COVID-19 Frontline Workers

How have therapists adapted themselves to “the new normal”?

Patil uses Zoom for her sessions as it offers “functions such as reactions, community whiteboard, screen share, breakout rooms” that she can incorporate in her work with clients. When the network is not strong enough to support Zoom, she uses Google Meet and WhatsApp calls. Clients can reach out via email and texts between sessions. She uses online tools to help them “access art modalities in the online therapy space as they would in person”.

During the pandemic, Bangalore-based psychotherapist Siddhika V.L. Pathi, who works with Tvam Mental Health Spaces, was able to extend services to clients across India, the US, the UK, Poland, Malaysia and Singapore, in Hindi, English, Bengali, Tamil and Telugu. She says, “Offering therapy online has helped me reach people who are most comfortable in their own spaces, and may not have the energy to shower, get dressed and travel to the clinic or the home office of a therapist."

Anindita Kundu – another psychotherapist from Bangalore – serves clients in India, the UK, the US, Australia, and Canada. She finds that online therapy sessions are particularly helpful for clients who are neurodivergent (ADHD, ASD) and/or chronically ill and have chronic pain. Accessing sessions in their own space takes away the anxiety associated with travelling.

Also read: World Mental Health Day 2021 | Do I need therapy?

How do therapists build a sense of safety for clients online?

Clients in abusive households struggle to access online therapy as they fear that someone at home might overhear their private conversations. Pathi advises them to schedule sessions during lunch breaks at work or in college. Other options include joining the therapy session from a coffee shop or a park, depending on clients’ risk perception and financial constraints.

Anahita Bhandari, a queer affirmative therapist “who shuffles between Bangalore, Mumbai and Goa” and has an online practice, says that “clients may be coming in for sessions, without their family members knowing.” They dial in from wherever they “feel comfortable” – a terrace, friend’s house, office, or a vehicle when they are not driving. She gives them helpline numbers and online resources to access between sessions.

Delhi-based psychotherapist, Ambika Singh, who has written the book Interruptions in Identity: Engaging with Suicidality Among the Indian Youth (SAGE India, 2021), says, “The most important part of building safety for the client with suicidal ideation online involves regulation of the psychotherapist's own anxiety - through supervision with senior colleagues and peers. Often therapists believe that talking about ideation can precipitate it but there is no research evidence to suggest that. On the contrary, ignoring it can be catastrophic.”

How do therapists address concerns around security breaches and data theft? 

Bhandari briefs new clients on “the ethics of therapy” and discusses confidentiality, anonymity and privacy. She does not record sessions or save them to the cloud. She says, “Some clients prefer Google Meet as meetings cannot be recorded so easily. Any therapy notes that I maintain are backed up on a hard disk, which is password-protected.”

Pathi learnt “how to secure client information, and communicate openly about the fear of data theft.” She has a 30-minute intake call with new clients to discuss low-risk options that they can use while talking about political opinions, drug consumption and other sensitive topics. She says, “They can journal their thoughts, and just show me the journal on a video call, so that there is no record of it. They can also use agreed-upon codewords while emailing me.”

What are the challenges that clients and therapists face with online therapy? 

Initially, Jaju was not comfortable with online sessions but now she finds them “close to working in person.” Many clients who were used to offline sessions found it tough to transition to the offline mode. They dropped out of therapy but Jaju found new clients from India, the US, Canada, the UK, the Middle East, who adapted well to online sessions.

Singh, who works at Family Tree: Child and Adolescent Mental Health Team, says, “Therapy or counselling is an invitation to a relationship - like all relationships that have evolved by moving online, so has therapy. There are lags, gaps, glitches, internet fluctuations to account for which can make the relationship challenging. At the same time, clients who are willing to work on themselves, have found the switch rather conducive.”