The arrival of Covid, prompting phone and video counselling to overtake in-person sessions has changed many aspects of the traditional counselling session. I wrote about some of these changes in a previous article.

I’d like to dig a little deeper this month and speak more specifically about simultaneously doing other activities while in a counselling session and how this can change not only the session itself, but both clients’ and therapists’ experience of it.

And this is not meant to be a polarizing article where I take a stand on whether or not multitasking in counselling is a good idea, because if there’s one thing that stands out to me over the course of my career, it’s that clients can overall be trusted and there are valid reasons for why they do what they do. And, given that therapists are people too, I thought it might be also interesting to look at therapist multitasking behaviour and the effects that this can have on counselling sessions.

Counselling and Multitasking: A Historical Perspective

The Old-Timey Days: Mostly Just Counselling

Sometimes I like to scare people by telling them that I am old enough to remember when the Internet didn’t exist. And then I like to ramp it up a little by saying that I didn’t get my first cell phone until my 30s, and it was a little flip phone that made texting extremely inconvenient. Perhaps this little party trick is best pulled out at Halloween, but the one thing it does do, is lend a longitudinal perspective.

When I graduated with my Master’s in Social Work (MSW)  in 1998, counselling sessions were one of two choices: in-person or phone. If you were a therapist practicing in the city, almost all sessions occurred in your physical office. Phone sessions were usually reserved for clients in remote or small communities who couldn’t otherwise access counselling within their geographical sphere, or where local counselling options included dual relationships or a lack of anonymity.

For office sessions, clients would come into the office, the session would happen, uninterrupted (unless a bathroom break was needed or the client had a numeric pager that went off) and then the therapist and client would pull out paper calendars or “Daytimers” as they were called back then, to book the next session.

Historically, clients had their phone sessions at their homes or places of work, where landlines could be found. And because it was a landline, most of the time, people had to sit exactly where their phone was. Ah, the memories.

The Emergence of Cell Phones

Now almost ubiquitous, there was a time when cell phones were available but not widely used. For a little perspective, the first iPhone wasn’t introduced to the market until 2007.

Cell phones intersected with counselling sessions in several ways: clients’ or therapists’ phones might ring in session if they forgot to turn them off, and for phone sessions, clients could have sessions at different locations other than their home, providing they had service. Also, therapists could call their clients with more ease than before, getting around many privacy/confidentiality issues that existed when landlines were shared with family members or roommates.

The COVID Era

Some of what I’m about to describe below existed pre-pandemic, but with much less frequency.

As you are aware, public health mandates forced many of us to work from home and there were restrictions on health professionals’ ability to practice. For example, I did not use my downtown Vancouver office for almost a year and sadly most of my plants died! I found myself doing way more phone counselling than every before, and pivoting to introduce video sessions, which was a challenging adjustment.

Multitasks

Obviously, as we are living in the present, I’d like to focus on multitasking in counselling in the here and now.

Note Taking

Note taking has often featured in therapy sessions historically.  For many people it aids with memory retention, focus and information processing. For others, it’s distracting. I typically write my notes in- between sessions, because the way my brain works, deep listening and note taking don’t go together well.

Texts, Notifications and Other Beeps

Sometimes clients and therapists forget to turn off their ringer or their notifications, which can have the inadvertent effect of interrupting therapeutic conversations or pulling away focus. This can be problematic for folks with anxiety, trauma, or even those with a strong startle response as well as for some neurodivergent people—clients and therapists—who may find it difficult to re-focus after an interruption. Therapists who respond to non-emergency notifications in session take the risk of seriously damaging the therapeutic relationship. Clients are astute and notice such things.

For all the talk of disruptiveness around notifications, sometimes clients do need to leave their ringer or notifications on if they are expecting a critical or time-sensitive message. Being able to do so can give clients the peace of mind needed to have a productive counselling session. Let your therapist know if you think there could be an urgent interruption.

Use of Technology

Computers and phones can be important tools for looking things up in session, or to clarify points or locate resources. Both clients and a therapists have this option, but if it’s a frequent thing, it may have the effect of distracting from core therapeutic issues.

The therapist’s computer may also be used in session to reference notes from past sessions, particularly if the client is seeking a refresher.

Using computers or phones during a video call may give the appearance of being undetectable, since the device is already in use for the call, however, I have witnessed familiar blank stares as emails are simultaneously being read, or noticed when microphones pick up keyboarding noise. I would imagine that some clients might also notice such things if their therapist is doing something similar!

Another common task, particularly since Covid, is troubleshooting technology snafus, often to a humorous extent, although this can also be frustrating if it is eating into session time. I stand firm with the 50-minute session as it allows a little buffer time in case technology problems occur, while still allowing for a full session length.

If clients need to look up something while in their counselling session, it can be helpful to let the therapist know this, so that therapists can refrain from reflecting or summarizing, understanding they won’t have clients’ full attention at that time.

Employment

While some people are returning to the office after over two years of working from home, Covid has changed the work setting forever and many folks continue to work solely from home or in a hybrid arrangement.

The one significant change during Covid is that phone and video counselling has increased dramatically, with people recognizing how convenient it is to no longer have to travel, or arrange around a busy schedule.

However, one offshoot of this is that work can invade the counselling space. This is not necessarily a bad thing because without this option, some folks would not be able to access counselling at all. In an ideal scenario, however, having to work in the background while also trying to attend to a counselling session results in competing foci that can dilute the counselling experience. Sometimes there may also be a false sense that counsellors aren’t aware that the client is distracted by work if the counsellor can’t see it, as in a phone call.

Counsellors can feel a little weird and unnerved when they are summarizing, making suggestions or making reflections and they can hear the clattering of a keyboard in the background. If work during a session is unavoidable, be sure to bring it up with the counsellor so they know or could work with you to brainstorm other ways of structuring a session that might benefit you more.

Housework

Similar to the work scenario above, when you’re not in a therapist’s physical office, it can be nice to make yourself a cup of tea for your session. Sometimes, especially if we’re on a phone session, we may also wonder if we can get a few things done while we have our session: throw on some laundry, mop the floor, etc. Is this a distraction, or perhaps a way of being able to tolerate the emotional intensity of a session? Or something else entirely? It can be helpful to reflect on what you want to get out of your counselling experience.

Leisure

Some folks may be tempted to do something passive like mindless knitting, whittling or another fun task—particularly when you’re not on camera or in a therapist’s office. Again, it really depends on how much attention this takes and whether you feel it is detracting (or not) from your session experience.

Eating

It can be difficult to find time to eat and sometimes the precious time we’re reserved to talk to our counsellor seems like the only time that’s actually available to have a snack or a meal. My philosophy is that I want clients to be nourished so they can better focus on a session, and if this isn’t possible beforehand, to please eat. Some people prefer to stay away from super-chewy foods that make talking more difficult or harder to understand.

Substance Use

I can’t speak for other professional disciplines, but the BC College of Social Workers’ Code of Ethics and Standards of Practice clearly stipulate that social workers “do not engage in the practice of social work while under the influence of any substance.” To me, this is very common sense: psychoactive substances affect judgement, memory, inhibitions and more, and counsellors are in a position of trust and influence.

Using before a session, or during (if you’re not in the therapist’s office) will have an effect on how much you get out of the session, including the ability to focus, be present and retain information afterwards. I definitely recommend a conversation with your therapist if you feel that you can’t attend a session sober. Some therapists are dead against using before a session, while others will not prohibit it. It can also be useful to explore with a therapist your reasons for wanting to use in therapy, which can help the therapist better understand what is going on for you and how to better support you.

Driving

Please, good people, it goes without saying that attempting a video call when you are driving should never be done. Besides the serious potential for human harm, the fine for those caught distracted driving in BC is $368, in addition to points on your driving record.

Sometimes folks wonder about phone sessions and driving, particularly if they have a hands-free arrangement and voice commands. While this may not necessarily be breaking the law, focus is diverted from a therapeutic conversation in order to operate a vehicle safely, or conversely, attention will be diverted from driving, if one is deeply engaged in a counselling conversation.

Many successful phone and video sessions have occurred in safely parked vehicles! I recommend that you ensure that you’re in a parking zone where it’s legal to park and you won’t get ticketed and where you have sufficient privacy. I also recommend that you dress for the weather and that there is sufficient lighting if you are on a video call. The liberating part about car sessions is that they sometimes offer the only privacy we can find outside of a private therapist’s office, particularly for folks that live in shared environments.

Walking

Walking has become a viable alternative to phone sessions—particularly when there is no privacy for a video session from home. Also, during Covid, walk and talk therapy sessions have increased in popularity. Some of the reasons for this include: therapists who have given up their offices during Covid and therapists and clients recognizing the value of getting outside. If you are walking solo during your counselling session, please stick to the phone. Video sessions, when walking, can increase the chance of you injuring yourself if you are trying to look at your screen and the pathway in front of you. They also bring a lot of camera shake to the sessions and can be disorienting for the therapist. Many people like to opt for quiet benches where they have sufficient privacy. If possible, avoid walks on windy days unless you have adequate noise cancellation on your headphones, as your therapist may not be able to hear you adequately.

Reflection Questions

There’s no denying that the environment that counselling sessions take place in has seen dramatic changes, and with that, the ability to multitask like never before. When considering multitasking in a counselling appointment, key questions may include:

• Will doing X enhance or detract from my experience of my counselling session?
• Will not doing X prevent me from accessing the counselling I need?
• Would it benefit my therapy, to share with my therapist what I am doing while receiving counselling
• Does multitasking help me avoid something that I don’t want to talk about or avoid experiencing feelings that are uncomfortable? Do I want to bring this up with my therapist?

As always, talk to your therapist, if you have questions or concerns. And if you think your therapist is multitasking in a way that detracts from your counselling experience, I encourage you to bring that up too.