Hello, friends! This is a neat Q&A episode where I answer two really interesting questions that talk about being able to get the most out of video therapy, and coping with anxiety when communicating in a second language.
I’m new to the podcast and I’ve been finding it super helpful and interesting, so thank you!
My question is about video therapy sessions. I’m sure most of us are doing our therapy sessions over the phone right now, myself included. It seems like I’m not really making much progress, and I’m on the fence about continuing therapy during the pandemic. I do like the once a week check-ins, but I feel like I want to get more out of it and I don’t know if that’s an unreasonable expectation during these difficult times. It’s hard for me to get into the best headspace to be able to make progress when I’m not in the office, especially since I’m home with my daughter. How can we get the most out of therapy while we’re unable to have that face to face interaction?
This is a good and timely question. You’re right that most people who are in therapy have switched to phone or video sessions. If you have never done video sessions or phone sessions before this can be kind of a shock. I have done video therapy for quite some time now, so I have some perspective on this. A lot of my therapy clients have been ones that I never saw in person. There’s definitely a difference between starting off that way and transitioning to online out of necessity.
Personal preference matters
Outcomes wise, online therapy appears to be as effective as in-person therapy for a wide variety of issues. Personal preference definitely matters though. People who seek out internet therapy are obviously somewhat comfortable with that format or may feel even better about that format to start with. One thing that’s very different about the situation that we find ourselves in right now is that people don’t always have the best environment for online therapy. For me, I’ve basically had to stop doing most of my video-based activities because the kids are always home and my house isn’t big enough to get away from them. If they yell or scream, which is often, you will hear them. My online therapy clients that I’m still seeing have had to find creative places to do therapy, such as in their shed or garage.
With in-person therapy in an office, you get a certain level of comfort that comes from being in a space that is away from home and private. When you’re forced to do therapy from your home AND you can’t get away from your family, it can definitely make things less comfortable. You might not be as inclined to get deep into issues because you don’t feel like you can speak as freely or it’s simply distracting. So it’s not unreasonable to feel like you might be getting less out of therapy during this period of time. What you do with that depends on where you are at in your mental health journey, and what sort of things you have been working on with your therapist.
First off, let’s tackle the time interval. Therapy is done at a lot of different intervals and it is sometimes normal to switch back and forth from weekly to biweekly or monthly depending on the circumstances. If you have done a lot of work and you were naturally slowing down in the pace of therapy, then it might make sense to use this opportunity to have less frequent sessions. However, if you are still thick in the work of it, or you are still ramping up, it might be worth trying to figure out how to make weekly sessions work better. Are there some adjustments that you can make to help make phone or video sessions work better for you? For instance, if there is another place you can go, in or outside of the house, to get some privacy where you can’t hear other people in your environment, that might help. It might also be just an area that one or both of you need some more practice and time to get used to the format of remote sessions. It can be a little awkward at first, but it tends to get easier as you get used to the format.
Consider the situation
Be careful not to overinterpret the remote aspect of sessions as being the only reason that you’re having a hard time feeling like you’re making progress. It is possible that you are having a more difficult time concentrating due to everything going on. It could also be that it’s time for you to start doing work outside of therapy or speak up about things that you’d like to work on more. For more information about how to get the most out of therapy, check out episode 74. If you think that it is basically all related to the situation and remote therapy rather than other issues, it may be reasonable to just pause therapy until the pandemic is over so that you can get back to the good work that you do with another in person.
Overall, the most important thing to do would be to talk to your therapist about this issue. Tell them that you’re feeling like progress has been slower and let them know what you suspect could be the issue. Between the two of you, you might be able to find some solutions or agree that adjusting the time between sessions could be helpful. If you have family or friends that you speak closely with or live with, ask them their opinion. It could be that you don’t see the same benefit from therapy that other people do, even if it’s just the check-in.
So overall, gather some extra info, make sure you are considering the different possibilities, and trust your gut. If you’re too uncomfortable to really benefit from it, that’s fair. Perhaps you can work something else out. During this period of time, I’m sure most therapists will be open to being more flexible than usual as well.
I struggle with depression and anxiety. One of my most intense anxiety cycles begins when I try to speak a second language.
I am proud to say that I am a Greek-American and I spent some years living in Greece, but most of my life here in the USA.
I learned Greek because I grew up hearing it most of my life. I have no trouble understanding the language. However, when it comes time to speak the language my brain just won’t have it.
Its’ strange because with a few people, I can speak easily to them. But with the majority of people in my life, including my immediate family, my partner, and my friends, I am unable to do it. I become nervous. I start sweating, I can’t look anyone in the eye, and I’m usually fidgeting with my hands. My heart starts pounding faster and louder and it’s as if the cat’s got my tongue. I just can’t push the words out, even though I know what they are. Although sometimes, it does get bad enough where I really just can’t even think of a word to say.
It takes a huge toll on my relationships and I believe communication could be stronger if I was able to express myself naturally in Greek. I also want to return to Greece for an opportunity to complete my MFA for free! However, as much as I want to make this my reality – I realize I first have to cope with this severe anxiety before I can move forward.
This is really interesting. I haven’t worked with anyone with this exact issue, but I can definitely understand how this could be a real and troubling experience for you. Essentially we are talking about a specific type of anxiety that you get when using your second language of Greek while around unfamiliar people. Or rather there are only a few people that don’t cause this type of anxiety. It sounds to me to be similar to social anxiety and also a bit like selective mutism. You will see some kids that can talk up a storm at home but have literally never said a word in front of their teachers.
Coping strategies and Exposure
Regardless of what you want to call it, it’s a selective form of anxiety that significantly impacts your physical and emotional state when you are in these certain situations. As with most other forms of anxiety, a big part of the answer is going to be exposure. You need to combine general anxiety reduction and coping strategies with practice in enduring the anxiety caused by this situation. You will want to develop a plan to gradually and intentionally work your way up. Decide on your top-level activity. Something that you couldn’t fathom doing right now. Something like going to a Greek-speaking restaurant alone and ordering food. From there, you need to make a hierarchy of steps from least challenging to most. Something completely unchallenging might be practicing the language on your own or with close family. You are already good at those lower steps, so that’s not where you need to start. You need to find something that is more challenging than that, but not so challenging that you are having a full panic attack or bailing out. Perhaps speaking the language with your safe people in addition to one or two other people that you don’t know.
The way to do exposure correctly is to stick with this step until it becomes no big deal before moving on to the next step. The steps will need to be personal to you. I talk you through the whole process of developing an exposure hierarchy in my online course. Sometimes, it can be helpful to brainstorm these steps with someone you trust, or a therapist. Work your way step by step and have some patience. Over time, you will realize that steps that felt impossible before are now no big deal. All along the way, you are building a better tolerance for anxiety and more practice at speaking this language comfortably. If you can, in-person or online conversation groups can also be a helpful tool.
When it comes to anxiety coping skills, a lot of this is going to come down to breathing strategies, grounding strategies, and challenging any distorted thoughts that come up about why you aren’t able to speak Greek in public or how you will embarrass yourself.
Keep working at this and don’t be discouraged if it takes some time!
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