How To Keep Clients Engaged In Online Therapy

Mental health professionals tell me it can be difficult to translate traditional talk therapy to online therapy.

Mental health professionals tell me it can be difficult to translate traditional talk therapy to online therapy. 

With traditional therapy, face-to-face sessions allow professionals to adjust pace according to body language and other in-person clues. So how can we keep our clients’ attention in an online environment?

I have found when we supplement online therapy with visual tools, our sessions can be meaningful and effective. Clear visuals provide a roadmap to keep clients engaged.

In addition, mental health counselors confess moving to online counseling is quite a shift from their formal training modalities. Understandably, that can be uncomfortable.

In this article, I share some tips for online therapy.

Long before the COVID-19, the Family Trauma Institute delivered the FST| Family Systems Trauma Model online. I invite you to use these real case videos as an on-ramp to developing online treatment skills.

In this video case example using the FST Technique called Seed/Tree Diagram, you will see how the visuals keep the family engaged in therapy and focused on the toxic seed of “Misuse of Power”.

Pay close attention to how the diagrams, the misuse of power handout, and manualized script remove the barrier of technology and immediately engage the grandmother, Robin, and her grandson AJ in online treatment.

Family Trauma Step-by-Step Tools with Dr. Scott Sells: Episode #6 – A Case Example: How to Do Online Therapy With Excellence

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Downloadable Video Transcript


Let’s discuss the misuse of power. And AJ, this is not meant to be like we’re trying to pick on you. I’m just trying to be a good doctor and figure out if this seed is in your family right now. Because if it is, we have to remove it. Okay, so misuse of power…

It’s is a very important process step. When I do have the child in the room with me it’s an older child, or a teenager. Misuse of power is really a difficult one for them, because what’s happening is I have this seed, I’ve got an upside-down hierarchy, which means I’m the alpha leader of the family. I control the mood as a family. I have a lot of power, and kids, based on Minuchin’s research and other researchers, we found out that an upside-down hierarchy, where the parents do not have the parental rights, leads to symptomology in the kids over time, because they get drunk with power.

And so I mitigate that a little bit by saying,” I’m not here to blame you, AJ. I’m just here to just talk about this. That happens in a lot of families.”  And so it’s a process step that sometimes I don’t use, and I regret it because a teenager or older child is thinking, “Boy, he’s about to dethrone me off of my throne, and I’m not too happy about that.” But this helps take the stinger out before I put the stinger in.

So, let’s go on.

Power, here’s what it is. When kids misuse of power, when they control the mood of the house, they use behaviors such as disrespect, aggression, running away. They either use it to bully grandparents, parents, caregivers into saying, “I want the authority in this house.” In wolf packs, in the animal kingdom, if the kids are the alpha males, or the pack leaders, the wolf pack actually tears each other apart. And adults may of course do this by committing emotionally or physically abusive. So how do I know that a family has misuse of power? These things on the left side: empty threats, caustic communication, which means that they’re really good at arguing, fighting, inconsistent discipline, parents not on the same page, lack of nurturance, dance of violence.

So, I love transition points. When you’re learning a model, you’re thinking to yourself, “Okay, how do I go from the definition to the cause,” which is what the undercurrents are? And so, because I know I have a good sense that this family has this seed, I’m going to spend some time here.

Dr. Scott Sells

Dr. Scott Sells

Dr. Scott Sells is the founder of the Family Trauma Institute and developer of the FST | Family Systems Trauma model.
Read Dr. Sells’ bio.

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