San Francisco Therapists Move Practice Online Amid Coronavirus Shelter-in-Place Orders

'Eye contact is the hardest part.'

Shelter-in-place orders have forced businesses of all kinds to adapt to the new social-distancing normal. For millions of workers in the Bay Area, that’s meant having to learn, almost overnight, how to work remotely.

Including therapists.

“Eye contact is the hardest part,” says Jennifer Normoyle, a Licensed Marriage and Family Therapist (LMFT) who has been practicing in San Francisco for five years, and recently started seeing clients via videoconference. “I feel like to get actual eye contact — for them to feel like I’m looking at them — I need to look at the green light. But then I can’t see their face.”

The solution? When her client is speaking, Normoyle looks at their image on her computer screen. When she’s speaking, she looks at the green dot on her camera.

The camera also limits the field of view to just the patient’s head, which can make it harder for a therapist to observe body language, Normoyle says.

“If they cross their arms, or cross their legs, there’s body language [to indicate] that we’re touching on something,” she says. “There’s something to be said for actually seeing that person in front of me, and [now] I only get the top of their head, or the neck up.”

Being remote can even dictate clothing choices.

“I was told to only wear solid colors” on camera, Normoyle says. “I tried this one shirt, and I didn’t like how it looked, so I changed shirts between sessions.”

They’re little things, but ones many therapists have been forced to quickly figure out in order to continue seeing patients — and keep their practices afloat.

“I really should have thought about the emergency savings fund I’ve been reading about for years,” Normoyle says, while laughing. “I’m doing okay right now, but if the economy really starts to turn and people can’t pay for therapy, that becomes an issue for everybody involved. They can’t access services, and we can’t pay our bills.”

For now, Normoyle says all but one or two of her clients are continuing therapy. Of those, most are using video chats, while a couple are doing phone sessions.

“I think that’s something on the mind of a lot of therapists,” says Carrie Johnson, an LMFT who has been practicing in the city for six years. She says she’s lost a couple clients for various reasons, including financial. “I anticipate as this goes on it may happen a little more. I might lose some clients, or the frequency might be reduced.”

Before the global pandemic upended everything, Johnson says she would occasionally do phone sessions with clients, but it was rare. She says she’s grateful for the technology that allows for video sessions, and that the crisis has accelerated plans many therapists had for exploring telehealth options — even if those remote solutions aren’t always quite the same as seeing someone in person.

“I do think it’s an adjustment, and it’s a little bit more challenging than being in person,” Johnson says. “I think we all have a little bit of a bias and we prefer to do face-to-face connection, but in actuality and reality, it doesn’t have to be that way.”

Michelle Leao, an LMFT in San Francisco, has a practice that largely focuses on children and adolescents.

“What’s helpful on Zoom, and a couple of the other platforms, is you can show them your screen,” she says. “I’ve done drawings for kids, which has been helpful. I had a kid draw me pictures just to see how he was feeling.”

Leao normally has an arsenal of toys and props in her office to use with younger clients.  At home, she’s found other creative solutions to use over video sessions — including her pets.

“I have two dogs and two cats,” she says. “I was using my cat to talk to a kid’s cat. … A lot of therapy with kids is having them feel safe and special.”

Seeing clients remotely isn’t a new experience for all therapists. Paul Silverman, a psychotherapist in San Francisco, has been offering video sessions for clients for nearly 10 years.

“It’s been an option for a long time, because there have always been people who have had limitations for one reason or another in attending an in-person therapy appointment,” he says. Some clients may have limited mobility, or may not have reliable means of transportation, he says.

“They do feel a little different, but it is very easy to get used to,” Silverman says. “You’re still forming the interpersonal connection with the other person.”

Silverman estimates that about 20 percent of his clients were remote before the pandemic. Now, of course, all of them are.

“Not only is this a way to provide care that we’ve been providing all along, but people who are experiencing this level of isolation need this human connection that they might not be getting if they’re confined to their home,” he says. “Right now, we are experiencing something in the world we’ve never known before, and people are dealing with isolation and depression.”

Silverman encourages people who feel like they may need help to consider reaching out to a therapist.

“What I always tell people to do is select a few therapists who you think might specialize in the type of issue that you’re dealing with, and talk to them,” he says. “Go with your gut. Go with the person who feels like they get you, and feels to you like they have some real help to offer. Have your first consulting conversation with them and trust your instinct.”

If you’re searching for a therapist in San Francisco, there are several listing services, including Psychology Today, Bay Area Open Minds, and Gaylesta.

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