With the Delta surge keeping COVID-19 a prominent national concern, the first semester of doctoral-level training looked different for many students as we took classes and pursued clinical training in various combinations of in-person and online instruction. As a clinical psychology graduate student, I pursued my interests in couples work through a clinical training program designed to teach couples how to effectively communicate, problem-solve, and manage conflicts in hopes of strengthening relationships. Through this program, I became a coach for couples and met with them via Zoom.
In this role, I was surprised to encounter many obstacles that I believe other couple and family-oriented psychologists and trainees have similarly navigated throughout COVID-19. Such challenges require flexibility along with creativity, yet I am convinced that these hurdles will shape us into better clinicians, giving us a deeper, more nuanced understanding of client issues that were perhaps present even before the pandemic.
Having a physical presence–miles away
In-person couples work carries the benefits of physical presence, including the ability to personally intervene, which is hindered when working in a virtual context. During one of my first sessions as a couples coach, I facilitated a practice session of a communication technique with my couple. The skill was new to my couple, and the two shortly dissolved into a disagreement that abandoned the “rules” of the technique. As per my training, I needed to respectfully interject and redirect my couple. I attempted to speak up over Zoom and quickly realized my couple was unable to hear me over their own voices. I raised mine, and, while they may have heard me, their shared physical space allowed their disagreement to dominate over our virtual connection. I was faced with the dilemma of trying to disturb their physical space and get their attention from miles away. Taking some deep breaths, I decided to wave my hands on screen and say “pause” multiple times. While it took a little bit, the combination of visual stimuli on their screen and my verbal directive eventually did the trick.
In consulting with more experienced student therapists, I learned that this challenge is not unique. It is tempting to overly focus on the frustrating aspects of virtual couples work. (At one point I desperately wanted to dive through the screen just so I was noticed.) However, from a trainee’s perspective, I am finding it valuable to focus on growth opportunities. When the potency of our physical presence is eliminated from therapy, we must rely on the weight of our words and intentional visual cues to convey our emotional presence. I suspect these skills will not only translate wonderfully to in-person therapy but will likely improve our ability to maintain long-distance relationships with friends and loved ones.
Finding childcare–an issue all along?
One of the couples I worked with had a young child. Naturally, their little boy wanted to explore everything in his vicinity, particularly during his parents’ coaching sessions. Our initial meetings were characterized by him running around and leaping off the bed skydiver-style, making it challenging for all of us to focus. I considered asking the couple if anyone else could watch him while we conducted our sessions but realized that, with COVID-19, a friend or family member entering the home may not be the safest option. Instead, I inquired about the child’s nap schedule. Unfortunately, the parents were struggling to implement consistent naptime. The creative brainstorming continued until we stumbled upon a wonderful idea–the iPad. Downloading stimulating and age-appropriate apps kept their child busy, as well as entertained, and our sessions focused.
This experience led me to think about the broader challenges of finding childcare for those parents seeking relationship education or therapy. While online tools and telehealth can be more time-effective and convenient for many couples, a lack of childcare can present unique concerns for parents. A study by Lenger et al. (2020) demonstrated that parents are more likely to choose home-based interventions than non-parents. There is also evidence that practical barriers for parents seeking relationship interventions are high (O’Grady et al., 2015; Petch et al., 2012). For example, the average cost of childcare in the United States is nearly $16,000 a year (Workman, 2021). Interestingly, teletherapy may have provided some flexibility for these folks, as many families video-conferenced from their homes due to social distancing. With this adjustment, having a child in the room was no longer so untraditional. Thus, perhaps an important reflection here is how can we, as clinicians, take an active role in brainstorming creative solutions with our clients to address child-caring needs. After all, if our priority is our clients and working with them closely, it is our responsibility to support their needs, so that they too can engage with us in a thoughtful and focused manner.
Moving forward–optimistically
During these unprecedented times, it is fitting graduate students are similarly experiencing unprecedented forms of clinical training through virtual platforms. While my peers and I long for the days when we can administer a psychological assessment tool or conduct a clinical interview in person, telehealth, with its numerous benefits, is here to stay. We must recognize that the training we are presently receiving is uniquely shaping us to implement therapeutic interventions in the future. However, as graduate students navigate these novel forms of training, it is important programs recognize the specific needs of student clinicians during this time. It would be beneficial for programs to continue promoting peer supervision, as based on my own consultation experience, support and guidance from more advanced student clinicians is both useful and validating for lesser experienced students. In addition, incorporating role-playing exercises into classroom instruction when appropriate, would support students in becoming more comfortable with the nature of teletherapy and the challenges that accompany it. While my time as a couples coach this past semester has highlighted the numerous challenges that likely accompany couples teletherapy, I am confident these obstacles have prepared me to deliver effective and dynamic couples therapy in the future. I like to think that the more experiences we have, the better therapists we can be. I look forward to seeing how my fellow peers and I dynamically contribute to the field–virtually and in-person.