Navigating the Challenges of Counseling Couples Virtually

Though virtual mental health sessions are convenient for many clients, they also present some special considerations that counselors can learn to navigate to increase positive outcomes when working with couples.

In a 2022 Journal of Health Service Psychology article titled “Conducting Couple Therapy via Telehealth: Special Considerations for Virtual Success,” author Jasara N. Hogan, PhD, writes that “It cannot be overstated that the main difference between seeing couples via telehealth vs. in person is that the therapist has less ability to control a room they are not in,” which can complicate safety concerns and sessions with high-conflict couples. Many counselors set ground rules for couples including hand signals during interruptions, safe words, and other tactics to maintain control of sessions.

Counselors typically use emotionally focused therapy (EFT), cognitive behavioral therapy (CBT), and/or the Gottman Method when working with couples. We spoke with Grayson Wallen, NCC, BC-TMH, LPC, LPCC, a Certified Gottman Therapist, about the considerations associated with counseling couples virtually. Proper screening is essential, Wallen says, adding that in addition to interviewing the couple individually and jointly during assessment, he includes a telehealth plan with the clients’ intake forms.

“This plan is short, but has a safe word listed, address, preferred emergency contact, and preferred hospital. I have only needed these a few times, but over time I have learned that being prepared is also essential to making therapy safe online.”

Wallen says most of his clients do quite well with virtual counseling; however, when navigating the world of telemental health, it’s common for counselors to face challenges including privacy, clients interrupting each other or not paying attention, technology issues, interpreting nonverbal cues, other distractions (children, pets, phones, deliveries, etc.), and similar obstacles.

“In most relationship sessions, I keep in mind the medium of therapy (virtual or in person),” he says, “this is more relevant when it is difficult for me to intervene or interrupt, or technical difficulties prevent therapy from being efficient. These are my worst case–scenario situations, which cause the most objections for couples therapy online, but they happen so infrequently that I think most couples can have a good experience online with their therapist, so long as the therapist is comfortable with the medium.”

The better the view of a couple online, the easier it will be for a counselor to assess their nonverbal communication. To optimize conditions, counselors and clients should use a steady device with a large screen that is not handheld (computer rather than phone), position cameras at eye level, and have clients adjust their distance to make sure both partners are fully visible within the frame. Additionally, make sure both spaces have sufficient lighting to see clients’ faces and avoid backlighting when possible. Clients should also remain in the room when their partner is speaking and pay attention to what is being said.

“Another challenge happens when couples forget that I am on a call with them, especially during disagreements,” Wallen says. “I have found that when I cannot interrupt an interaction, my role in this symptom is that I didn’t intervene soon enough and/or often enough and have let the conflict go too long without interruption,” he says. “I also think that the interruption is welcomed in couples therapy since that is what they are employing me to do. By interrupting them more in online sessions than in-person sessions, I keep a sense of mutually desired influence.”

Though distractions should be kept to a minimum, occasional interruptions outside of the session are inevitable, he says. Acknowledging these unexpected challenges as normal can sometimes build trust and help put clients at ease, Wallen says.

“In my practice I have normalized these things,” Wallen says. “This takes some finesse, but it can also build rapport and connection with my clients in new and meaningful ways that would have been lost in in-person sessions. I often say, ‘That’s real life’ and continue the discussion without skipping a beat to keep the therapy process moving forward. When there are unwanted interruptions like a roommate walking in, or an unwanted person hearing or seeing the session, I pause the appointment and mute my camera/mic until the client’s safe word (that is previously established) is used as the ‘all clear’ sign we can continue.”

Some clients may need to begin with in-person sessions before potentially transitioning to telemental health, depending on the circumstances, Wallen says. Others are not as well-suited for virtual counseling, which may be determined during assessment or sometimes later, after sessions have begun.

“Couples who are not able to be interrupted, where there are safety concerns for physical safety and self-regulation, are major barriers for online therapy being effective in general,” Wallen says. “With this said, I have also found that earlier intervention in escalating conversations is crucial. I have learned to set the tone early in online therapy, that I need to be able to interrupt, and if I cannot, then the therapy can be less effective or even ineffective. When people get to these types of zones, then I offer in-person sessions.”

Counseling couples who are logging in from different locations is more challenging, Wallen says.

“This is by far the hardest way to do couples therapy but is sometimes necessary when the relationship is separated or faced with a unique logistical situation like work schedules, travel, or deployment cycles. When this happens, I name it, I help the clients see the potential problems, and we work together to come up with a plan to make it as best as possible. This generally makes the therapy the best it can be in these situations, which can include a pause until the physical distance between partners is closed.”

NBCC’s Code of Ethics requires professional counselors to verify each client’s location before beginning telemental health sessions to ensure that counselors are working within their licensure restrictions. Wallen stresses the importance of counselors working with these clients to be attentive and detail-oriented to avoid any ambiguity.

Overall, Wallen says offering virtual couples sessions is rewarding and has helped him expand his reach as a counselor. He often finds that couples who were initially opposed to online sessions end up preferring them once they become more comfortable.

“I am so happy to offer relationship therapy online, and I would encourage people to do therapy this way (provider and clients) if they feel comfortable with the medium,” he says. “As a hybrid provider, I don’t see a significant difference [in success rates] for those who are interested in online therapy.”

For counselors interested in telehealth best practices and sharpening their virtual counseling skills, he recommends considering the Board Certified-TeleMental Health Provider (BC-TMH) credential offered by the Center for Credentialing & Education, an NBCC affiliate.

“The training and certification process was outstanding learning,” Wallen says, adding that the knowledge he gained “made me feel 100% certain in my scope and competency for online therapy.”

Learn more about eligibility requirements for the BC-TMH and apply here.

Interviewee bio: Grayson Wallen, NCC, BC-TMH, LPC, LPCC, is a Certified Gottman Therapist and offers therapy for adult survivors of childhood trauma and their relationships in person and online. He is a Licensed Professional Counselor (LPC) in several states. Visit www.graysonwallen.com for more information.

** The views and opinions expressed by interviewees do not necessarily reflect the practices of NBCC and Affiliates.