We’re Green – Now What?


Back to the Office or Continuing Online

Business owners in Pennsylvania have been more aware of traffic lights lately, at least those that signal we’re starting the process of reopening businesses. While therapy practices were considered “essential” during the pandemic, most of us have played it safe, entering the brave new world of online therapy. Now that many things are reopening, we have to decide whether to welcome clients back into our space, or to continue to offer virtual services. This decision is not confined to therapy practices of course.

A colleague of mine, Deb Owens, wrote a compelling blog about “holding space” for our clients during the pandemic. In it she affirmed that she would hold on to her office space with the intention of seeing clients in person when it is safe to do so. Many of my colleagues are still grappling with this decision. I’ve heard some state that they do not plan to return to a brick and mortar office, and others plan to do so only after a vaccine is widely available. While it’s important to err on the side of caution, especially for folks who have health concerns, have to consider whether people will continue to opt for services delivered on a 15-inch screen.

Information about precautions abound, and we’ve begun taking measures. Masks, plexiglass screens and ventilation can help reduce the possibility of transmission. So can practices like handwashing and temperature checks. Our waiting room currently looks more like a disaster zone than a comfy place to hang out, with blue tape criss-crossing chairs to keep people from sitting too closely.

I’ve started this conversation with most of my clients already, asking some questions about their own safeguards and risk factors. Informed consent is at the heart of any decision: assessing personal risks and benefits. There are also other things I need to look at both from the perspective of a business owner and therapist.


Are Your Services Effective?

The first consideration for any service provider is whether your services are as effective when offered online.

Online therapy services have been around for a while, and there has been some research into its effectiveness. The answer to “is it effective,” seems to remain it depends. What is the therapeutic approach? Who is the audience (age, concerns, individual comfort factors)? How much training and expertise does the therapist have? Does he/she/they have training specific to online therapy? Are there adjuncts to therapy such as online groups, written materials, etc.?

Most studies of online therapy were published in Cognitive Behavioral Therapy (CBT) journals, and CBT, more of an educational approach, has been shown to be effective. This is especially true for anxiety. In the beginning of the pandemic, CBT was by and large the approach I took, emphasizing concrete coping skills. While this has been beneficial for some clients, I have not found that to be the case across the board. Many of my clients with anxiety have gotten more isolative and restricted, anxiety has worsened, and they are rarely leaving their homes. Back in the day I could at least count on them coming in for sessions.

Online services of all kinds do increase access to specialty care, such treatment for eating disorders (my specialty), particularly in locations in which such services are hard to come by.


Looking at Your Niche and Audience

Another consideration is your niche and audience. Some questions to consider. Does your current clientele seem to like the online services? Does the age of your audience, or type of work you do, translate well to the online world? While I have maintained a busy practice, I have found that my client niche is generally better suited to live therapy. Many of my clients have privacy restrictions and are having their sessions in their cars. This does not make for comfort and ease. Ditto for kids at home, and other interruptions. And while their cats and dogs are adorable, I’m not being paid to coo. With eating disorders there’s a lot to be said for seeing the whole body. I also rely heavily on body language, and miss some things without these cues. People who work with children have repeated some of these same concerns.

Many clients I work with note other issues, such as slow Internet speed, technical glitches and general lack of comfort with technology (especially my older clients). There have been times when a good portion of a session is spent doing IT troubleshooting, rather than providing productive services. And privacy issues are a whole Pandora’s box I can’t begin to open.


Relationship-Building and Maintenance

My colleague who described “holding space” for clients by maintaining office space is clearly relationally-oriented, as am I. Thus, I see the therapy space, and the relationship that occurs within it, as sacred. I’ve been conducting online therapy from my office, so that clients see a familiar backdrop. This has been comforting, but not a cure all. But that direct touch is missing.

In relationships yet to be built, I’ve seen mixed reactions. One new client who I’ve only ever met online is doing very well. Several people have postponed sessions or delayed scheduling until they can meet with me in person.

A few other intrepid providers are also working from our office. We’ve built stronger relationships being in the trenches together. I can’t imagine what it would be like to be entirely isolated from professional colleagues.

The online world has challenged me to supplement my services in many ways to increase accessibility. This has included a specialized Facebook group, as well as blogging and learned more about video recording.          Thus I do “see” some of my clients most days, which we like. I’ve also had some great live sessions socially distanced outdoors with people supplying their own seating.



While there have been some positives, there also also definite downsides. First, many people expect a “bargain” for online therapy, and will more readily attempt to secure services at the lowest cost they can. Professionals who negotiate in this way significantly reduce their own earning power. I have not.

The other downside to online therapy and other therapy services is time and administration. While some articles I’ve read say it takes less administrative time, I find it takes far more time to administer and deliver services. From sending Zoom links to confirming and reconfirming appointment times, it just feels more cumbersome at times.


Is an Online Business Sustainable?

While there are pros and cons, I just have not found that the online therapy world to be sustainable. Large providers, such as Better Help, have large advertising budgets and take a cut of what their contactors earn. While their services may be sustainable, they are well-established for people who want to meet virtually.

By and large, I my want to fully return to my office in for sessions when it’s safe. I suspect that a few clients will want to continue online, which is fine, but if I do not put my shingle up on a real building others are likely to find someone who has.



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