By Catherine Brown, co-host of the podcast Eating Disorders: Navigating Recovery and co-editor of Hope for Recovery: Stories of Healing from Eating Disorders
When COVID began spreading through the US and individuals were required to shelter in place, most therapy and treatment options moved online. Significant numbers of clinicians who had never before experienced virtual therapy were suddenly forging new territory.
Admittedly, many clinicians and clients were concerned about what our forced experiment with virtual therapy would look like. Would clinicians and clients be able to recreate the therapeutic relationship virtually? Could virtual therapy be effective?
Certainly, virtual therapy has had its challenges. Patients living in a space with other people may struggle to find a private location for open and vulnerable conversation. Patients and clinicians alike are feeling burned out by spending so much time in virtual meetings. And many clinicians and clients feel the loss of the connection they experience in face-to-face interaction.
That said, clinicians have found surprising, unexpected benefits that may inform treatment after social distancing restrictions have been lifted.
Focusing on patients’ own emotions
One of the biggest benefits seen by Jacqueline Cowell, MS, LMFT, of Madrone Mental Health in Eugene, OR, is a willingness to take more emotional risks in therapy. “Patients with eating disorders tend to avoid their own emotions,” Cowell says. At the same time, patients recovering from eating disorders tend to be particularly sensitive and attuned to the emotions of the therapist.
“That empathy is a strength among those with eating disorders, but they can become overly focused on others’ emotions to the detriment of their own emotional experience.” Cowell says. She has found that her patients are less focused on her during virtual therapy than in an in-person session, perhaps because the virtual format provides a sort of emotional containment they wouldn’t otherwise have when sitting in a room with someone. As a result, some patients are more able to focus on and process their own emotions to a fuller extent than in in-person conversations.
Working through seeing one’s image
It can be challenging and potentially triggering for clients to see themselves in that little square on the computer screen during therapy and other online interactions. Working through that experience and those feelings with a trusted clinician can be healing. “I can sit with my clients in a space of seeing themselves and work with them on having compassion toward that image,” Cowell says.
Working through tough fridge feelings
That relates to another benefit of virtual therapy. Therapists can address their patients in their home environment and help them through feelings that might emerge while they’re confronting the refrigerator or the pantry. “Some patients will tell me they’re able to eat in the treatment facility but have trouble eating at home,” Cowell says. “I can literally walk through with them why it’s hard and work with them in that environment in that moment to address the emotions they may be feeling.”
Eating at home
Dietitian Erin Adams, RDN, LDN, of the Body Image Therapy Center also finds benefits with working virtually with patients through mealtimes. “I was very skeptical of how meal support would work virtually,” says Adams, “but I definitely have seen the benefits.”
Adams is used to working in a partial hospitalization program where clinicians and clients typically eat three meals a day together. As treatment shifted from in-person to virtual, her team had to adapt the way they provide care.
Whereas clients used to have meals cooked from them by chefs in the facility’s kitchen, now they carry the responsibility of preparing their own food. During that time, they have direct access to Adams and other members of the team. “We are bringing treatment into their homes,” Adams says.
The virtual setup has its challenges, but it does allow patients the opportunity to prepare and eat the foods that are appealing to them. “We couldn’t accommodate everyone’s individual tastes in the shared kitchen,” says Adams, “but now they can prepare what they like as a base, and we can help them level up the difficulty the next time they prepare their food.”
Eating at home with direct access to the treatment team provides another benefit: clients get used to eating in their homes at an earlier stage in their recovery process. That can be challenging, but it enables clients to confront behaviors in their homes, where they are more likely to happen.
“We’ve had several clients struggling to avoid purging because they’re in the space where they would have purged,” says Adams. “It’s like an automatic behavior pattern that wouldn’t necessarily happen in the center.” Adams and her other team members hold their clients accountable by having them stay on the screen with them to ensure they fight that instinctive behavior.
Will virtual therapy change the way therapy is done?
Virtual therapy is by no means perfect. It cannot fully replace the in-person interactions that take place in a conventional treatment setting.
That said, working with patients virtually has revealed that there can be benefits. Virtual therapy can be more accessible and could be particularly useful with patients who are further in their journey to recovery. Perhaps in the future, when social distancing guidelines are no longer in effect, clinicians will continue to incorporate virtual therapy as a means to enhance treatment.