The difference between a telehealth session that works and one that does not is usually not the therapy. It is the ten minutes of setup beforehand. None of this is complicated, but almost nobody thinks about it until a session has already been spoiled by a flatmate walking through.

Sort out privacy first

This is the one that matters most, and the one people most often leave to chance. If part of your attention is on whether you can be overheard, you will edit yourself, and the session will stay on the surface.

A room with a door is ideal. A parked car is genuinely excellent and I have had many good sessions with people sitting in one, as long as you are not driving. Headphones make an enormous difference: they contain my side of the conversation entirely, so even a thin wall becomes workable.

If you live with people, tell them you have an appointment and you will be an hour. You do not have to say what it is. “I have a call” is a complete sentence.

Get the technical part out of the way early

Click the link five minutes before, not at the exact minute. It runs in your browser and there is nothing to download, but browsers occasionally want permission for the camera and microphone, and you would rather deal with that beforehand.

Test your audio. If you have a choice between the laptop's built-in microphone and any set of headphones with a mic, the headphones will be better.

Plug in, or start charged. An hour of video will take a real bite out of a battery.

Position and light

Put the device on something solid at roughly eye level. A laptop on your knees produces an unflattering upward angle and, more importantly, moves constantly, which is subtly tiring for both of us.

Have the light in front of you rather than behind. A window at your back turns you into a silhouette, and I lose your face, which is a fair bit of what I am working with.

Sit back far enough that I can see your shoulders and hands. A screen filled entirely with a face is oddly intense and it removes information I would ordinarily have.

Small things that help more than they should

Have water within reach. Talking for fifty minutes is drier than you expect.

Have tissues nearby, before you need them. Getting up mid-sentence to find some interrupts something.

Turn off notifications, or put the phone in another room if you are on a computer. A message arriving at the wrong moment can derail a difficult thread.

Close the other tabs. Email visible in the corner of the screen is a genuine pull on attention.

Give yourself a margin at both ends

This is the part in-person sessions do for you automatically. Driving to an appointment gives you time to arrive mentally, and driving home gives you time to come back down.

Telehealth removes both, and people go straight from something difficult into a work meeting. Try to leave ten minutes on either side. Even standing outside for a few minutes afterwards does the job.

If the connection drops

It happens occasionally and it is not a problem. Do not panic or assume the session is over. I will get in touch to either pick it up another way or reschedule, at no extra cost.

You will be asked for your physical location at the start of each session. That is a standard safety measure so that, in the unlikely event of an emergency, I can contact the right local service. It is not an oddity of my practice, it is standard telehealth practice.

It gets easier

The first session on video often feels a bit stilted for the first ten minutes, in the way any video call does. By the second, most people have stopped noticing the medium.

You can read more about how telehealth works here, or about whether it is as effective as being in the room. To get started, send an enquiry and mention telehealth along with a few times that suit you.