Share more, and ask more. There will be gaps in the things that we can do in a virtual space. There will be things we can’t feel or can’t see. There will be internet problems or times when we need to turn away from our cameras. I find that gaps and challenges can often be addressed by stating them aloud, and sharing them transparently with our clients. My relationship with clients is improved when I share a little bit more about my experience, and let them know when I am encountering limitations or challenges. People understand this, and increasing communication and transparency on my end improves our sense of trust and shared humanity. Then, ask more questions. If you can’t see your client’s whole body and what they are doing with their hands or feet, ask them. If you aren’t sure how they are feeling, ask them. Bring your clients in as teammates, as active participants in your assessment process.
One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Lauren Pass Erickson.
Lauren Pass Erickson, MA, LPCC, R-DMT is a somatic psychotherapist and dance/movement therapist in private practice in Colorado. She is the creator of the Embodied Identity Development Model and founder of Natural Embodiment LLC. She helps adult clients work through complex trauma, relationship and attachment issues, anxiety, self-confidence, and authentic self-expression. She is a certified movement meditation facilitator and leads regular groups in embodiment and dance meditation.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
I view my journey to becoming a therapist as a confluence, a merging of my various passions and life experiences. First, I have always been a dancer. Over the years however, I grew away from dance as a performance art and into dance as meditation and reflective practice. This has been integral to my own process of healing and self-discovery. Second is my love of humans. My prior career was in education, working as a writing tutor and teacher of English as a second language. I loved talking with people from so many different backgrounds and seeing my students learn and grow. I found that what made people thrive most academically was simply compassionate attention. My teaching often blended into mentoring, and I found that conversations with my students about life’s joys and challenges felt far more impactful than the academic homework, which inspired my later transition into counseling. Third is my experience with meditation and Buddhist teachings. My BA in Religious Studies as well as my time travelling and living in Buddhist communities overseas have been highly influential on my world view and understanding of the human experience. I then earned my counseling degree at Naropa University, a school with a Buddhist lineage and contemplative focus. The field of somatic counseling and dance/movement therapy allowed me to weave together all these previously disparate aspects of my life and work into one united path. My mission is to create positive change for both individuals and society through the healing power of movement, embodiment, relationships, meditation, and presence to our true nature. After completing my counseling education, I was excited to start private practice and offer somatic therapy as well as movement groups to my community here in Colorado.
Can you share the most interesting story that happened to you since you began your career?
By far the biggest rollercoaster of my career was when the pandemic stay-at-home orders hit in March of 2020. I was an intern therapist at a local counseling clinic at the time while I was also completing my masters degree. There are times in a therapist’s career when the experiences of a client will hit really close to home, when the client is going through something very similar to what the therapist has faced, or is facing, in their own life. When you resonate so personally with what your client is sharing, it can feel so intimate and meaningful but it can also be emotional and personally challenging. This was such an extreme case where all of my clients were going through the same wild experience that I was! Especially as a new clinician, it could sometimes be really hard to help my clients manage their fear and anxiety when I honestly felt the same way. At the same time, there was also a beautiful way that some of the more traditional, rigid professional barriers got to dissolve a little bit and we could relate to each other on a more human-to-human level as we shared this collective experience.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“You only have to let the soft animal of your body love what it loves.” ~ excerpt from the poem Wild Geese by Mary Oliver
I love this quote because it speaks to the simple yet profound practice of tuning in to our bodies and our authentic joys and desires. My own personal journey has really centered around the theme of authenticity, of deeply listening to what is true for myself and for my body, and letting go of all the other external messages and distractions that were steering me away from the things that I loved. This is also central to how I work with my clients and how I encourage them to listen to their own bodies and their own truth. We live in a world that can be very fast-paced and focused on productivity, but there is much more nourishment found when we soften into our senses and follow our natural impulses towards what we genuinely love and value.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
Wow, there have been so many! I’ve had a lot of teachers and mentors who have been so supportive and influential at different points in my path. But by far the person who has been there for me the most throughout everything is my partner. I’ve always been a big dreamer, and he has not only been unconditionally encouraging but also really helped me translate my dreams into reality. I remember over 10 years ago when I was considering taking my first leap into self employment. It was really scary to think of leaving my 9–5 to start a business, especially considering I was living in San Francisco at the time — not exactly a cheap location! It felt overwhelming, but my partner sat down with me and really helped me crunch all the numbers and figure out if it was feasible and what I would need to do to make it work. This was so empowering, and long-story short I took the leap and ran a successful small tutoring business in the big city for about four years! I think ever since then I have been braver in my career choices. My partner has offered similar support and encouragement during a lot of other big leaps since then and he’s always had the perfect balance of optimism and practicality that gives me the courage to believe in myself and what’s possible.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
As a somatic psychotherapist and dance/movement therapist, the mental health support I provide to clients is not just ‘talk therapy’ but relies on body awareness, nonverbal communication, and expressive movement. Being in the room with a client just gives me so much more information about them and their experience. When a person is in front of me, I can see their whole body and how they are carrying themselves. I can see more detail and nuance in facial expressions and breath quality. My own body is also an important tool in how I work, and when I am with a client I can much more fully resonate with their emotions and sense their nervous system state. Humans naturally regulate emotions and nervous systems through social connection, so if I am grounded and regulated it will help my client ground and regulate as well. Being in-person also gives me the opportunity to use my body language, proxemics, and eye contact to provide emotional support and sense of connection. Even if someone is not a somatic practitioner, these are all things that are happening constantly in human interactions, often outside of our awareness, and have a huge impact on our relationships.
On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?
First, I just don’t get as much information about my clients when I am online. Often, only their faces are in view and I have very little information about the rest of their body such as their posture, how they’re using space, or how they’re expressing themselves nonverbally. It’s harder to pick up on things like breath, muscle tension, or subtle emotion. I have a number of clients that talk to me in their cars because they don’t have private space in their home. While that’s a great option for privacy, it really inhibits the type of work we can do with somatic movement and emotional expression. I also think that people tend to dissociate from their bodies a little bit while engaging with screens, so it can be harder to guide people in developing somatic and emotional awareness.
Another challenge is in developing a close and trusting relationship with clients virtually, especially in a short amount of time. Research shows that the outcome of therapy is highly dependent on the quality of the relationship between therapist and client, so this is really key. Just like I am not receiving as much nonverbal information about my clients, my clients are also missing out on some of my nonverbal communication and body language. For example, eye contact is a simple and yet vital part of any relationship and this is very hard to re-create online. Either I am looking at my client on the screen, or I may mimic eye contact by looking into the camera but then I can’t see their face at the same time. Also, video calls tend to require very direct facing, where I am sitting squarely in front of my computer and camera, and hence sitting squarely in front of my client. This is actually very direct and strong body language that can feel threatening to some people, especially those who have experienced trauma or danger in relationships. If we were in-person, I would adopt less direct posture and probably sit at more of an angle to my client, but in a video call that can then seem like I’m less engaged or not giving them my full attention, so it’s a bit of a double-bind.
The last main challenge is around personal self-care. I find that taking care of myself is a lot harder when working on the computer. Like many people, I entered this field because I love people and I never thought I would have a profession where I was in front of the computer all day. I definitely develop ‘zoom fatigue.’ I think this is both due to a high amount of screen time and the extra energy it takes for me to assess and connect with my clients. Physically, it is a lot harder on my body, my posture, my eyes, and my overall energy levels and mood. This of course can have an impact on how effective I am with my clients if I am not careful to take care of myself and my body throughout the day.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need To Know To Best Care For Your Patients When They Are Not Physically In Front Of You ? (Please share a story or example for each.)
1.Remember that we still have bodies! People often ask me if somatic work is still possible online, and I would argue that it is not only possible but necessary to include our bodies during telehealth sessions to foster a real connection through the screen and combat zoom fatigue. This is true regardless of your profession. Here are some simple somatic techniques that anyone can use to stay embodied while on the screen. You can use these yourself without anyone needing to know, or you can coach your clients through them as well.
- Make sure you and your client are physically comfortable at the start of the call. It’s all too easy to forget about this basic element and end up tight and hunched over, or with a foot falling asleep, or an arm aching from holding up a phone or other device. Asking a client if they are comfortable or if they need to adjust anything before proceeding with the meeting is a very simple way to encourage body awareness and presence, show care, and model self-care. Usually when I do this, clients will take a moment to shift or grab a pillow. Keep checking in with your physical body throughout the call and don’t be afraid to make adjustments as needed.
- Take three slow breaths with your client, using an extended exhale that is 2–3 counts longer than the inhale. Breathing together promotes interpersonal connection, while the longer exhale activates the parasympathetic nervous system that is necessary for rest, relaxation, and social engagement.
- Use mindfulness of the body as a grounding technique. Feel your feel, your seat, or anywhere that your body is contacting the chair or the ground. Notice the sensations of inhaling and exhaling. Name three different things you can feel in your body (such as touch, temperature, vibrations, pressure, pain, tension, softness). Try your best to maintain this awareness throughout the call, coming back to these check-in points whenever possible.
2. Maximize use of your video and coach clients in doing the same. It’s fairly easy to address the challenge of decreased visual information by optimizing the placing and spacing of your camera. You want to find a balanced distance from your camera. Be close enough that your client can still see detail in your face, but far back enough that as much of your body is as visible as possible. Walk your client through this process as well. Many people will not be thinking about this when they come into an appointment — they are thinking about their problems and the help they are hoping to receive! It only takes a simple conversation to communicate the importance of visual information and give them some tips on what camera placement would help you serve them best.
3. Tend to facing, spacing, and eye contact. These aspects of nonverbal communication can be easy to forget when we are relating to a screen instead of a person in a real room. However, they still have a big impact on how we perceive each other. Notice your distance from the camera and consider how that might communicate closeness or distance relationally. Notice if you are facing the camera straight on or at an angle, and consider how that might communicate connection or disconnection relationally. Find a balance between looking at your client and occasionally looking into the camera to mimic eye contact, and notice how this impacts your relationship. I also encourage you to check in with your client about their preferences. Some people want really direct, close contact while others find that intimidating or overwhelming.
4. Lean back. First of all, yes, literally lean back. I notice a tendency for people to lean forward as if being sucked into the screen. Take a breath, lean back, feel the length of your spine from your neck down to your sacrum, and maybe feel your chair back supporting you. This is physically really important for your posture and health of your body, but it is also a symbolic way of coming back to yourself, remembering your body and your own experience, and remembering to take care of yourself while you are with your clients. Providers tend to put their own needs aside while helping others. We are natural caregivers! However, provider burnout is a real and serious issue. It is vital that we are taking care of ourselves and tending to our own needs, including while we are with our clients. So lean back, deepen your breath, take a drink of water, allow your eyes to leave the bright screen and look at something else in the room for a moment. This type of micro-self-care is vital for reducing stress, combating zoom fatigue, and allowing us to stay present, energized and on our game for the people who need us.
5. Share more, and ask more. There will be gaps in the things that we can do in a virtual space. There will be things we can’t feel or can’t see. There will be internet problems or times when we need to turn away from our cameras. I find that gaps and challenges can often be addressed by stating them aloud, and sharing them transparently with our clients. My relationship with clients is improved when I share a little bit more about my experience, and let them know when I am encountering limitations or challenges. People understand this, and increasing communication and transparency on my end improves our sense of trust and shared humanity. Then, ask more questions. If you can’t see your client’s whole body and what they are doing with their hands or feet, ask them. If you aren’t sure how they are feeling, ask them. Bring your clients in as teammates, as active participants in your assessment process.
Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
There is something special about seeing clients in their own homes. I’ve had clients give me tours of their house, show me their artwork, introduce me to their pets and their children. This is a really unique opportunity to see more of their lives then I ever would before. People have brought special pieces of clothing, photos, or other items of significance into our sessions. Pets are able to serve as emotional support while we are processing difficult emotions or experiences. I often work with trauma survivors, and have noticed that many of these clients seem more at-ease in their own space, which enables them to be more vulnerable and open in our therapy sessions compared to in my office. Additionally, I’m interested in how doing therapeutic work at home might help people to integrate their healing process into their daily lives more quickly or more fully. There may be a benefit for some people of having therapy in their natural environment, so to speak, rather than something that exists in a separate space.
Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
I haven’t used anything too advanced myself, but I’ve definitely come to appreciate the importance of having good gear. A big screen (and multiple screens if possible), comfortable chair, high quality camera, and good lighting are a must.
If you could design the perfect Telehealth feature or system to help your patients, what would it be?
I would love to have a more immersive virtual experience that can mimic spatial interactions and interactions with the environment better than just a video call. I would also love a less cumbersome form of screen sharing and shared virtual white boards that would allow me to open content on my computer that we could then both interact with through drawing or writing or other manipulations. I think this kind of technology is out there, it’s just not very common or accessible in the current popular platforms.
Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?
I would point my clients to the same five points I mentioned for providers. I want them to know the importance of tending to our bodies and nonverbal relationship, the importance of maximizing video and use of space, and the importance of taking care of ourselves while on the screen. Most of all, I want my clients to communicate with me so that I know how virtual sessions are going for them and so that we can work together to overcome any challenges that are arising. We are in this together.
The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?
I’ll be honest, I am really not up on the latest technology, so I can’t name anything specific. In general, I am excited about evolving virtual spaces that allow for better group interactions compared to a video call meeting, such as being able to recreate social mingling and proxemics. I also think there will be some interesting therapeutic application for virtual spaces where clients might be able to manipulate their environment or create certain experiences that are not possible in the real world.
Is there a part of this future vision that concerns you? Can you explain?
My biggest concern around any virtual space is disembodiment. We already live in a society that highly preferences the cognitive over the somatic, and being on the computer or in a virtual space can really deepen the disconnection from the body that is already a problem for many people. Body awareness and the mind-body connection is key to physical and mental health, emotional intelligence, social connection, and sense of self. Virtual spaces need to be designed so that they deepen connection to ourselves and our communities rather than become an escape or a bypass of our embodied reality.
Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
I would love to see embodiment and somatic movement practices integrated into larger movements working on social justice, the climate crisis, and other forms of large scale societal progress. In order to create deep, lasting change in the world, we must be connected to our shared humanity and we must feel that not only in our minds but in our bodies, in our cells. We must be able to metabolize our personal and collective trauma and grief in our bodies, and transform it into energy and resilience. Embodiment and dance or movement engaged in at the community level is a powerful way to bring people together, connect to what is important, and move forward from a place of strength and unity. I think this could really ground and energize our current social movements, and also provide a foundation for working across differences.
How can our readers further follow your work online?
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.