Taking Therapy Online

E-sessions have emerged as a key, if not, the only option for therapy amid tightening social distancing measures.


I work mainly with children and adolescents and engaging this demographic through a screen had initially been a concern as mandatory work from home measures came into play. However, after a couple of weeks of working remotely, I have concluded that e-therapy can be a viable option and have actually observed some benefits compared to in-person consultations.

For instance, since starting work-from-home orders, I have racked up a 100% attendance/ participation rate with all my clients. Compare this to roughly 1 in 5 appointment default rate over the same period of time for in-person cases. Of course a lockdown means few other distractions, but I’m also attributing this to the convenience of being able to avoid a long commute and simply logging on to their home desktop or mobile device at the appointment time.

Additionally, most of the appointments have taken place on schedule despite the occasional technical glitches while initially setting up their device for the online platform. Perhaps more interestingly, the clients that have participated in my remote sessions have so far been more engaged than usual. A client who was active and moving around the consult room when we had our in-person sessions, was engaged and remained seated throughout the e-therapy sessions.

Finally, with today’s technology, distance can no longer be considered a barrier to engagement.

Functions such as ‘share screen’ have allowed me to share social stories with clients. It’s given me the ability to complete activities while I provide guidance over the screen in real time. The ‘virtual whiteboard’ functions have allowed me to write ideas and present in real time, as if the client were right beside me. Of course, this complements good, old fashioned prep work in making sure clients have materials ahead of sessions. So far, feedbacks on the sessions have all been positive.

The point I’m trying to make is that the reservations I’ve had over E-sessions have so far been unwarranted. At the end of the day, the conferences I’ve conducted have proven to work well at a time  when social distancing and various restrictions on services are being tightened further.

 As therapists, we will continue to do our best to provide a high level of care and service to our clients regardless the therapy format.  Meanwhile, stay safe and stay home.

Written by:
Dr. Jamie Ong

Clinical Psychologist

Silence is Golden

In the song, ‘The Sound of Silence,’ there is a line about people talking without speaking and people hearing without listening. Silence can be a haunting sign of the struggle to communicate. But is it always such a terrible thing?

If you have been in a lift, up at 5 am or on a bad date, you will have experienced silence. It may be something you vaguely remember from your younger years. Or silence may be fleeting, appearing for a moment with a power enough to shock you, before being consumed. Perhaps between family life, work and the busy streets of Singapore, silence may have been lost altogether. And with it may have gone the chance to contemplate, to reflect and to listen. Which is perhaps why some people find themselves wandering into a counselling room.

We may be tempted as therapists to fill a silence when it descends. It is awkward between people and may encourage a great deal of anxiety in you too; perhaps someone has nothing to say, or seemingly doesn’t care. Maybe you have run out of words. It may feel like you are not there, or perhaps that they are not and you are on your own. These are powerful feelings which encourage speaking just to break the silence (even in words, it is fragile). It may be experienced as a loss of something, which may be too much for some – including Paul Simon!

But there may be a different experience too. If you consider that ‘…silence is complementary to words in general…’ (Sabbadini 2004, P.229), it could be easier to see a role for it, one which offers something rather than taking it away. Buddhism and Mindfulness both speak of the benefits of silence. Perhaps allowing for a ‘…silent space within…’ (Sabbadini 2004, P.231) may give you something to make of these moments. Silence may be an opportunity to consider someone or something else, whether they are there or not. It is a communication, encouraging attention, both in you and in others, in contrast with the perpetual noise of modern life. It could be a chance to digest – try talking and eating at the same time to get a clearer idea of this – or simply a chance to pause. It also offers hope, even expectation – think of a silence falling over a crowd at a cinema or a concert as the performance begins. It is therefore something that can be recognised and even used, rather than avoided.

You are perhaps reading this in silence; or you may have life going on in the background. This may indicate how it feels to you, a good starting point to consider its role in your life. So next time it all goes quiet, perhaps hold on for just a moment before you allow the noise to kick in. You never know what you might hear.  

References:
Sabbadini, A. ‘Listening to Silence’, British Journal of Psychotherapy, 21 (2), pp.229-240
Simon, P & Garfunkel, A. ‘The Sound of Silence’, Columbia Records (Originally released as ‘The Sounds of Silence’, October 1964)

Written by:
by Robert Leveson
Psychotherapist & Counsellor,
Children and Families (Reg; TSP, BPC)

Managing Your (Consuming) Mind (PART 2)

In the first part of this article, I suggested that to manage your health, eating and activity you could

  • Pay attention to your environment, your workspace and your cupboards;
  • Take time to imagine the future you want, in detail and in colour;
  • Accept that your aren’t fully aware of everything you do, yet;
  • Learn to manage the stresses you are under – learn from mistakes.

Then,

Track yourself:

The best way to get yourself to behave is to keep an eye on yourself. Keeping a diary has been shown to reduce mindless snacking, smoking and even nail-biting, by bringing our unconscious habits to our attention, and encouraging better choices. Apps that track activity, including exercise, can make this an interesting, easy and reliable activity, but you need to be careful of the bigger picture – monitoring exercise alone may allow unfettered snacking!

Think Negatively:

Yes, not positively! Positive thinking has a huge following, but imagining a successful future may not be enough to imagine the steps needed to get there. Studies of positive thinking have not always shown it is enough to maintain effort over time. If we think about how bad it might get this might be more effective, and generate the motivation to keep up the effort we need (for example in overcoming fear of public speaking). So, imagine the (positive) solutions a step at a time, not forgetting the fear.

Train your brain:

We know more about the brain’s executive function system in the prefrontal cortex now, and “brain training” by doing daily practice (often on an electronic device) can make a difference to our control habits. But does it generalize and maintain? The evidence so far is that brain training is very difficult to generalize. But it probably gets better with coaching – someone to support and remind you of the longer-term goals.

The bigger picture:

The theme of all this advice is really to keep returning and adding to the big picture: if you want to eat better, you might join an exercise class – it may give you a head start on your diet, as a 2015 study found. There are no guarantees, though. You need to keep enlarging your awareness of yourself, your environment, imagining, training, learning from mistakes, and thinking ahead. A coach or counsellor may be able to help you enlarge your self while trimming your body! You are not alone.

(with thanks to New Scientist, “Outsmart Yourself”, 27.7.19)

Written by:
Dr. Tim Bunn
Consultant Educational Psychologist