How Can We Make Online Therapy Feel Warm and Connected?

A warm connection with your online therapist.

It's therapy on a little screen on your laptop, or on your phone, maybe even in your parked car. Can you feel comfortable with it, get into it and go to all the places you need to go in therapy? Can you feel connected to your therapist and safe and secure? Yes, yes, and yes. With a little extra attention to your privacy and a distraction-free setting, you can prepare yourself for good online therapy. But what about your therapist? How do they approach the experience in ways that connect with your vulnerable, deep personal feelings and experiences? Schema therapists are really good at this. But what makes schema therapy uniquely suited to telehealth?

First, schema therapy is an integrative therapy, which means it cleverly pulls together techniques from many different approaches—basically the stuff that really works well, especially for telehealth. For example, we do chairwork, which is a dialogue between different parts of the self, or take an image from your past and step inside of it together and talk to an earlier version of the self, a technique called imagery rescripting. Schema therapy engages with our imagination to connect with feelings and it’s surprisingly powerful.

Second, schema therapists are trained to approach the therapy relationship by doing what we call “limited reparenting." This means we are very thoughtful about providing for your core emotional needs in the therapy relationship. Our goal is to make you feel safe, that you can be yourself, express your needs, be playful and spontaneous, and keep healthy boundaries. We are not big on “sounding like a therapist” and keep things feeling real.

So, when you click “connect” on your video app with a schema therapist, you should feel genuine warmth and support, and your imagination really brings the session alive.

I chatted with some schema therapists from around the country, and here’s what they told me:

A schema therapist in Philadelphia: “I've just done simple things, like when they first come on screen, I express my genuine delight at seeing them and say something like 'There you are! So good to see you!' What matters is that I really feel it, and I think that comes across, or I try to make it come across as best I can on camera.”

Another, in Indianapolis, has pet-friendly approach: “One thing that has been very connecting in an interesting way is if a patient shows off their pet, I’ll show my cat if she happens to be napping in the other chair in my home office. The parallel cuddles with pets bring a positive connection.”

Our first thought is that it may be hard to connect online, but Mary Giuffra makes a crucial point: Online therapy can sometimes actually be more immersive, so that patients may need ways to distance and distract themselves when it gets intense. She calls this distracting from what’s happening in session “orienting,” as in orienting in your space and the here-and-now. “Orienting works both on and offline,” she says. “Online your client looks away from the screen as he scans the room slowly. It feels more natural in the office than on a small screen. But you can coach your online client how to look away from you and activate the instinctive orienting response online.”

John Gasiewski, who works in New York City, talked about how important it is to connect a current experience or emotion to a past one from childhood, and how immersive that can be in any setting.

As a schema therapist myself, I like to bring interpersonal warmth into online sessions. I’ll say, “You really deserve a pat on the back” and pat myself on the back so my client can see it. This may feel a bit awkward at first, but if you’ve ever been on the phone or online with someone you care about, you know it works.

So while you may not be in your therapist’s office sitting on the couch or having a handshake, I think you’ll find that, at the end of your online therapy session, after you click away from the screen, you’ll still take away a glow of warmth and connection that makes therapy successful.