Comment: Coaching, telemedicine and the dilemmas of the pandemic

Coaching can be helpful for those who want to manage their well-being and positive mental health, but does it always have to be carried out face-to-face? Not necessarily, says Smriti Joshi, head of coaching at Wysa.

It's said that silence is one of the great arts of conversation. When it comes to any kind of talking therapy, there's clearly an element of truth to this. The skill of a good practitioner lies in the ability to listen attentively and accurately, creating the kind of safe environment that allows the client ample space to reflect on their own situation.

Most people imagine that this happens in a room, sitting on a couch with the physical presence of another person. However, coaching has been delivered remotely, via telephone or online platforms such as skype, for quite some time. And now a new mode of delivery - texting (also known as chat) - is becoming more common, making support far more accessible for those who might not be ready to open up to a stranger in person.

But can you get the same benefits from this form of coaching as you would from a face-to-face appointment?

A new method
While telemedicine and virtual primary care appointments were initially met with a level of suspicion from the public, they have been slowly gaining momentum in recent years - and catapulted further into the mainstream consciousness by covid-19. In the same vein, my experience suggests people are very open to virtual coaching via text, if curious about how it will work.

To begin with, boundaries between therapy and coaching are often misunderstood, so it's not always immediately obvious to people what to expect. To clarify, empathetic listening and a non- judgemental stance form the basis for both therapy and coaching. But whereas therapy is often treatment focused, coaching helps with self-assessing any barriers to goals and building problem solving skills to work through them. It also enables people to build positive coping skills to improve their emotional well-being.

Then, the text element itself adds another layer of curiosity, despite most people feeling comfortable communicating with friends and family in this way. Interestingly, as a format for coaching, text provides many advantages. Some people find it easier to open up.

The physical presence of a coach can be overwhelming, restricting what people say for fear of being judged so anonymous support at a time and pace that suits individuals can seem less intimidating. It also aids accessibility, particularly for younger Millennial/Gen Z audiences - research shows that, if needed, over 70% would prefer to tap into online help over traditional face-to-face support, feeling it alleviates the stigma of seeking help.

Shifting significance
One thing I've noticed since covid-19 is that the topics people want to discuss have shifted from personal growth and everyday stressors to issues that have been exacerbated by the virus. These include health anxieties, work-life balance, conflicts at home with partners, parents and/or children, job insecurity, the furlough process, people expecting you to be always available …… the list goes on.

During such a turbulent time, it helps that potential clients don't come to us 'cold', being directed instead via AI technology in our app. From the beginning, our conversational well-being chatbot provides an atmosphere conducive to gentle self-reflection and signposts appropriate self-help resources according to need.

For example, if someone is feeling anxious, various exercises and coping techniques are suggested as the first line of defence. If these don't go far enough, coaching is the next suggestion. And if a mental health diagnosis and medical treatment is required, our coaches are trained to provide a pathway to the next steps necessary to get that. It means that as well as efficiently bridging a spectrum of need, text creates a safe, anonymous space to have these first conversations, without the risk of being overheard.

Pros and cons
However, as you might imagine, coaching over text has its drawbacks. It takes extra effort from the coach's side. Non-verbal cues can be powerful indications when it comes to someone's emotions, but coaches aren't able to pick up on body language via text.

Also, formal industry-recognised training is not available in text-based coaching so it's important a practitioner is experienced in other modalities before they start, with a good intuitive sense of expressions and terms. Furthermore, we currently only operate in English. If this isn't a client's mother tongue, there is a risk that a client may try to say something, that a coach misinterprets.

However, to guard against this, we've developed our own set of guidelines, focusing on ensuring a good rapport by asking clarifying questions and rephrasing what the client is saying. Texting can actually help those who speak English as a second language as it gives time to frame things well and accent or dialect aren't considerations. Of course, just as with face-to-face sessions, we always encourage people to say if they are feeling unheard or misunderstood. Clarity and honesty are the cornerstone of any good coaching alliance, so transparent feedback is essential.

While it potentially takes more effort to type out your thoughts than simply speak them, the very process of doing so offers therapeutic benefits of its own. By writing things down, clients start to create some distance between themselves and their feelings, which helps enormously in organising one's thoughts.

It's for this reason that journaling can help people gain perspective, improve moods, recognise potential triggers, and learn how to control them better. It's also an opportunity to shift to more positive self-talk. The client might write ‘I'm feeling low, I've had a bad day' but then see for themselves how the day has unfolded and come to understand that, more likely, it was a day with highs and lows.

So the power and the beauty of texting is that it enables less self-conscious sharing, while naturally promoting self-soothing therapeutic skills such as perspective and self-reflection. It enables private conversations when private space may be at a premium. It's a chance to be heard, to vent and to be guided to the next stage in your own personal well-being evolution. In other words, it's a talking therapy in which the audio silence of both client and practitioner can be extremely advantageous.

Smriti Joshi is a practising psychologist with more than 20 years of experience across diverse settings, including NGOs, hospitals, and schools, and is head of coaching for the Wysa app. Wysa is available free of charge to Aetna International members. For more information, please click here

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