Virtual therapy, teletherapy, online counseling are all synonymous. Virtual therapy is therapy that is assisted by technology (internet/wifi, video streaming, and a computer/tablet/smart phone).   It is similar to in person mental health counseling in some ways and very different in some ways. The similarities lie in the presence of the counselor and client share face to face time, the treatment modalities and tools the counselor shares.  It is different in that you and your counselor are in different physical spaces, your counselor may use a platform that requires an application download to conduct the session.  So, how do you determine if it is the right fit for you? 

If you are looking to have the support of a therapist and need the flexibility virtual counseling offers ask yourself these questions:

Do I have the space and equipment?

In order for teletherapy to be effective it is important to have a quiet, well lit, preferably confidential location where you are safe to speak openly and have a strong internet connection.  It is beneficial to establish a space where you are physically comfortable and your camera is angled so that your waist to face is captured in the frame.  This could be your bedroom, office, stationary car, or even a park (granted you have enough privacy and the weather permits-I don't recommend this as your primary location for therapy sessions, rather as a resource to use when it is available).  Only the people attending the therapy session may be present in the same immediate space space, other people can be home or around the location where you are attending session but not in a shared space.

Am I currently in crisis?

If you are in crisis, meaning you are experiencing a heightened level of distress that puts your safety or the safety of those around you at risk, for example active psychosis, domestic violence, suicidal ideation with a plan and intent to carry out your plan, you are in need of urgent in person support.  A crisis not only feels urgent, it requires immediate in person intervention.  Initiating virtual counseling is not appropriate during a crisis situation.  If you experience crisis while working with a therapist via teletherapy inform them of your crisis so they may direct you to appropriate resources.

If you are ready to do the messy work of therapy, have the space and equipment, and are stable/not currently in crisis then virtual counseling is a great option to investigate further! 

Many folx come to counseling sessions with hesitancy around what they are able to speak about openly.   Here is a guide to ease the fear that may be keeping things bottled up.  

You can talk about whatever is on your mind or in your heart in a session!  You can talk about (in no particular order):

 gender, gender identity, gender expression, sex, sexual history, sexuality, LGBTQPIA+ issues, race, racism, ethnicity, political issues that cause you distress, genital/reproductive choice and health, cultural differences, your experiences with religion or spirituality, trauma,  aging, disability/ableism, BDSM, kink and fetishes, neurodiversity, domestic violence, sexism, consent, body image, difficulty with sleep, nightmare, prioritizing, concentration/focus, fears, self harm, goals, values, identity, microaggressions, labels, intersectional identities, complex family dynamics, grief and loss, navigating conflict, communication, existential crisis and dread, chronic pain or illness, systemic oppression, mental health history, if it is in the realm of the human experience-your counseling session is meant to be a safe place to begin to explore it!

If something you share with me would be better addressed by another professional because it is beyond my scope of practice I will let you know and assist you in finding a better fit.  

To be transparent, most things you share with a counselor are 100% confidential, though there are some important exceptions; these limitations of confidentiality are in place for your protection and the protection of others in the community.  The information is reported to the state department of health (Department of Children and Families) and other mental health agencies as it is relevant.  They are: 1. if you share that you are going to cause imminent bodily harm or kill yourself or someone else, and based on a clinical assessment the counselor believes there is a legitimate plan and intent for you to follow through with these actions.  This does not mean that if you share you are having thoughts about death that I will automatically  report it or have you involuntarily hospitalized.  What is does mean is that when thoughts of death are shared with me I ask more questions to understand what is going on and address underlying issues such as overwhelm, depression, anxiety, lack of connection, etc.  Based on the assessment, we may make a safety plan or I may ask you to voluntarily go to a hospital for assistance.  If neither a safety plan or voluntary hospitalization are appropriate and there are further concerns for your safety I will contact a mobile crisis unit in your county to come and offer you support, this is an alternative to calling the police for a mental health crisis when the option is available.   If you are LGBTQPIA+ it is important to know you are not alone; people who are LGBTQPIA+  contemplate suicide approximately 4-6x more than their heterosexual counterparts according to the CDC (2016).  It is common for people to talk about present and past self harm and past suicide attempts in counseling sessions!  This is an important part of your story.  Self harm is not usually connected to suicidality, it is a coping mechanism to try to relieve stress.   2. If an official subpoena is issued due to a law suit.  This occurs sometimes in the case of civil, disciplinary, or criminal court cases.  If you believe that your records might be subpoenaed let your counselor know!  3. If you share that a minor youth (someone under 18 years of age) or a vulnerable adult (someone who is dependent upon a caretaker for example) is being abused or neglected.  Abuse means that these folx are being emotionally degraded or humiliated with intention, physically assaulted, in fear for their physical safety, sexually assaulted or molested; and neglect means they do not have their basic needs met, such as food, water, clean clothes, etc.  4. If you consent, in writing-typically through a form called a release of information, to your counselor sharing your information with another party.

As a counselor, if you share something with me that meets criteria to be reported, I will inform you and we will work together to create a plan that keeps you as safe as possible.  

Why Does Mental Health Matter                                           

Personally, I can’t think of any aspect of life that is not impacted by mental health.  You have probably heard people say mental health matters. Though they are right, how often do people share their mental health struggles and successes in a way that helps the people in their life know why mental health matters?  So, let’s talk about why mental health is such a big deal. Mental health impacts more than just our mind; it impacts our bodies and our relationships!  

Firstly, let’s focus on what happens internally.  When we are feeling overwhelmed, depressed, dealing with grief, coping with anxiety symptoms, having an excessive amount of restless energy, etc. how our body feels is a big indicator of what is going on on a deeper level.  When people are experiencing mental health concerns their body communicates that to them. For example you may note how your mood is connected with your energy level and posture. Don’t get me wrong, there are also other valid reason people experience feeling low energy and poor posture.  A mental health counselor would use a holistic approach that would take into account all of the influences that come together to create these symptoms, and assist you in coming up with a plan to address them. We know we often behave the way we feel, and how we behave often has interpersonal consequences.  

Now let’s talk about how our mental health can play a role in our relationships.  When you do not feel like your best self it can be a challenge to engage with others.  You may feel burdensome because you feel so low, or you may feel like you are too much because your anxiety is out of control.  These feelings get in the way of maintaining relationships, or creating new meaningful connections. Then the stories you tell yourself about why and how morph into a prophecy.  How do you set yourself free from this vicious cycle?

Taking care of your mental health can improve your relationship with yourself, and in turn your relationship with others.  Have you heard the saying: hurt people hurt people? There is truth to the opposite too: healed people heal people. That is why mental health matters!     

Written by: Steph Ostrow