How to get the most from CBT online

Doing cognitive behavioural therapy (CBT) is a considerable commitment. There’s the financial investment of sessions themselves (unless you’re accessing therapy through the NHS or a charity) then there’s the matter of having to regularly block out space in your diary, taking you away from other things that you want or need to do. Of course there’s also the emotional investment in finding a therapist, opening up about difficult issues, thinking about and experimenting with change. Doing CBT takes commitment, but can be very worthwhile.

Much more therapy now happens online. For many people, there are definite advantages to this: no longer being limited by geographical location to find a therapist of your choice; zero travel time to and from appointments; and the continuity of regular appointments when moving between locations for work or study, to name a few. And while it’s not going to suit everybody, research reassuringly indicates that progress in CBT online tends to be comparable to CBT in-person. Whether you’re just starting to consider whether online therapy is for you, or you have already started sessions: this post is for you. Here are my 7 tips to consider to help therapy to go well online.

How to prepare for online CBT

1) Privacy – think about where and when to have online CBT sessions

Most people have online CBT sessions at home. If having the place to yourself isn’t a option, then try to plan sessions for a time when you won’t be interrupted. It can be difficult if you feel inhibited by the possibility of being overheard by others. Testing the degree to which sound travels between rooms, planning your sessions when other members of your household will be busy, and putting a radio on in a different room can help.

2) Allow yourself time to ‘arrive’… step away from your screen

So while not having to take time to travelling across town or sit in a therapy waiting room might be a bonus for you, this can result in a loss of (albeit enforced) time for reflection. It can be easy to find yourself jumping straight from working online into a therapy session, but this might not be the best thing. See if you can allow yourself at least 10 minutes to slow down and do nothing before your session starts. Maybe have some time outside or a stretch, at most.

3) Get comfy

While sitting at your desk may be fine if you like things to feel more formal, you may also wish to take advantage of other possible spaces to have your session from. This can help to switch from being in ‘work mode’, to a space where you can connect with your thoughts and feelings. See how sessions feel from a comfy armchair, or another favorite spot. Grab cushions, a blanket, a cuppa, water, tissues, whatever you think that you might want. A pen and notepad is often handy too. You may wish to be able to see a clock so that you are aware of when the session is nearing the end, although your therapist should provide timing prompts too. It is best to avoid being on or in your bed for therapy, as using your bed for anything other than sleep (or sex) can interfere with sleep.

4) Shut down emails, notifications, and your phone

Perhaps one of the hardest things about online therapy is that it’s right there on the same screen as your emails and social media notifications, all that stuff that is designed to grab for your attention. Closing down emails, switching notifications off, and putting your phone on airplane mode helps therapy to be a time for you.

5) Give your online CBT session time to land

It is likely that you will continue to think about the content of your CBT session after it ends. Allowing a little gentle buffer time between your session and your next thing to do can help to ease this transition. From an EMDR perspective, theory suggests that a short walk while mulling over any new perspectives might help your brain to process emotional information (but be careful not to overdo it if you are someone who exercise tends to become compulsive for).

6) Prepare for online CBT as you would for a face-to-face session

While the above suggestions may be particularly relevant to online CBT, other ways in which you can prepare will be the same whether doing CBT online or face-to-face.

Your first session or two is likely to mostly focus on you and your therapist building a shared understanding the problem that you are wishing to resolve, and how this fits with you and your life. Your therapist is likely to ask about your priorities and goals, so it can be good idea to give this some thought (although lots of people struggle with this – so don’t worry if you don’t know). Of course it’s also about you getting a sense of the therapist, how they work, and whether this seems right for you.

As sessions progress you will start to become familiar with the structure of CBT. This typically includes:

  • Checking in on how you are feeling and any changes to your physical and mental health
  • Discussion of anything that you have been reading up on, observing / recording, or working on since your previous session
  • Making a plan for the focus of the present session
  • Working through the agreed plan
  • Planning how you might work on things during the week ahead
  • Reflecting on the session and having the opportunity to provide feedback

A key aim of CBT is ultimately for you to become your own therapist – to be able to make sense of set backs; notice and understand potential triggers in advance; and have more choices available to you about how to respond. This is mentioned here for the purpose of explaining the process of CBT. Again don’t worry, this does not need to be your starting point. However spending a bit of time trying to think about what you would like to get each session can be a good step in this direction.

7) Speak up if online CBT is not working for you

Again, this one’s relevant to whether CBT sessions are face-to-face or online. The relationship between you and your therapist is important and it’s their job to try to find out about any aspect of therapy that feels hard or unhelpful to you. Sometimes it’s as simple as the therapist needing to alter their approach. At other times challenges within the sessions can offer valuable insights into what things may be like for you in day-to-day life, and therefore working with challenges that are present in session can provide an opportunity for experimenting with meaningful ‘real world’ change. If it seems like challenges are unique to online working and it doesn’t seem possible to address them, then ask your therapist if they can offer face-to-face sessions instead, or look for another therapist who does.

Whether online or face-to-face, therapy is often hard, yet incredibly worthwhile. I hope that some of the suggestions above support you to get the most out of it.

Published by Charlotte Rose

Cognitive behavioural therapist and supervisor

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