Online Counseling/Online Therapy for Anxiety

What is online counseling/online therapy? I keep hearing these terms…

I’ll start by saying that our counseling team in Columbia, Mo offers both individual counseling and therapy as well as couples therapy and marriage counseling via an online format. And I’ve gone into this a handful of times over the past few weeks (an overview here, faqs here, and an online couples therapy and marriage counseling blog here), but I’ll offer a little bit of clarity before diving into how it can be useful for anxiety therapy.

Online counseling/online therapy is, quite literally, counseling/therapy done via an online video format. We use a platform that links up with an app for clients and also gives clients the option of using their laptop or computer for sessions. We basically ask that folks just find a private space, use headphones (if doing individual work), and make sure they have internet connection. And that’s about it!

Is online counseling/online therapy an effective for treating anxiety?

You can guess my answer to this question, but I’ll say it anyway.

YES. Absolutely yes. With some caveats. If you’re coming in for generalized anxiety or social anxiety, then this is absolutely an avenue that can (and, ideally, should) be effective for treatment. What we offer is coping and treatment for people who struggle with more generalized anxiety, whether this is from an existential crisis, quarter-life crisis, related to body image or self-esteem, or besties (#sarcasm) with shame and guilt.

If you’re looking for online counseling/therapy for selective mutism, separation anxiety, or panic disorder, then it would make more sense to be in person and with somebody who distinctly specializes in that type of work. Additionally, obsessive-compulsive disorder and post-traumatic stress disorder (although note considered anxiety disorders at this point) should be addressed through more specific approaches. If you want or need referrals for folks who do that work, we’re happy to help you! Email us directly and we’ll make some relevant recommendations for you.

Can anxiety be cured with therapy or counseling?

This is a loaded question.

Yes (sorta) and no, but the answer really depends on how you experience anxiety and how you think about anxiety.

If you’re experiencing an acute form of anxiety for the first time in your life and you’re just very confused about what’s happening and why, then yes, it makes sense that some counseling and therapy could help to “cure” your anxiety.

However, if you’ve been experiencing anxiety for years on end with little to no relief, then probably not. It makes sense that we can lower your anxiety, yes. It makes sense that we can learn to manage anxiety, yes. It even makes sense that we can help you to feel better about your anxiety, yes.

But to cure it entirely after you’ve been experiencing it for years and years on end? No, probably not.

And with all that said, there’s also the whole philosophical stance that anxiety is a normal part of the human experience!!!

Big hint for you (if it’s not obvious) is that our online counseling/online therapy approach embraces this, much in the same way our in-person counseling/therapy does. Basically, anxiety is embedded in our DNA. It’s part of being alive and relishing the life you live. To have zero anxiety is a pretty big (and improbable) ask. To have a level that’s able to be joyfully lived with? That’s more realistic (and still hard for some people to attain).

All that said, we’ll do everything we can to help you find your happy level of anxiety. Yes, such a thing can (and often does) exist.

Okay, but can anxiety be cured with online therapy or online counseling?

I’m pretty much going to say the same thing as the section above. Yes (sorta) and no. Yes, depending on the type of anxiety. No, depending on the type of anxiety. And also some anxiety is part of the human experience.

Boom. Roasted. #TheOfficeForever

How long does anxiety therapy take (including online therapy for anxiety)?

Meh. It’s hard to say. Here’s a quick formula for you. Simplified, but based on research.

Therapy > No Therapy

More Therapy > Less Therapy

In essence, you should see an impact in your life relatively quickly. However (and how detailed can I get here?), seeing a change or two or three in your life doesn’t equal long-term success. What we really want to see is a change (or multiple changes) combined with sustainability and maintenance. The hard part about this is that you’ll feel ‘push back’ on changes at different intervals.

Think of it this way. Did you see the movie Cars? As a total side note, I freaking love that movie. I cry every time in the end when Lightning McQueen gives up his win for The King (#spoiler). It’s just so touching (hence the tears)!

My point, though, is that in the movie, Lightning has to repave the road that he destroys in Radiator Springs before heading to California for his big race. Repaving the road wasn’t planned. It was an accident, but he’s kind of a jerk in the beginning of the movie, so you don’t feel too bad for him when he gets stuck.

So, he starts repaving the road while basically hating his life. Stuck in “hillbilly hell” repaving a road (that he has to get done within the week) while missing out on the life he wants to be living. Let’s pause real quick and think about the parallels to anxiety. Feeling stuck and unhappy, and wanting to anywhere but lost in the feeling you’re having. It’s intense.

So then, Lightning gets the bright (read: terrible) idea to repave it lightning (#Heyo) fast. Another spoiler, in case you haven’t seen the move: it doesn’t work. The small amount of road he paved slowly is smooth, but the vast majority of the rest is super bumpy and not really drive-able.

Let’s pause and parallel counseling/therapy again, shall we? RUSHING THE PROCESS DOESN’T WORK. Simple enough.

Ultimately, he slows his roll (#OnPointWithMyPuns), makes social connections and forges meaningful relationships, starts to value where he is while still having a bigger goal for himself, and realizes it’s not so bad. In essence, he submitted to the experience and process while trusting that his work would get him through.

One last time, counseling/therapy parallel. I’m sure you can guess, but I’ll clarify. Submitting to the process doesn’t mean giving up control forever. It simply means accepting where you currently are, making the most/best of it while creating meaningful relationships, and still working towards a bigger goal. This is therapy. This is counseling. This is why we don’t rush the process and also why we don’t try to fix things quickly. There are more reasons, but the above highlights some.

What if I get anxiety before my therapy/counseling session?

Welcome to the club! Sounds kind of wild, but it’s not uncommon that people feel nervous, anxious, or downright scared before their counseling or therapy session.

I mean, think about it. At what other point in your life do you walk into somebody’s (virtual) office and bare your soul? We’re talking no-holds-barred, vulnerable af, open, honest, and raw conversation. That is HARD. It is legitimately difficult to do. It’s not something for the feint of heart, and it sure as hell isn’t easy. To clarify, you don’t have to do this right away! This is something we work up to and you do when you have a sense of safety and trust with your clinician.

At the exact same time, it’s refreshing, relieving, empowering, and can lead to growth you didn’t know or think possible. There’s something really sacred in that space, but all of that doesn’t take away from the fact that it’s terrifying for people. This is more the case for folks who are coming for the first time, starting with a new clinician, or are restarting after having a bad experience with another clinician (yes, this happens and no, we don’t like it happening).

I want to start online anxiety therapy/counseling. Now what?

Simple answer. You can email us directly to get something on the books, you can call us at 573-586-3204, or you can submit your contact information by clicking the link below and we’ll get back to you asap! Kudos to you for taking this big step, as a side note. Getting started can be hard for folks. Be well and happy counseling!

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About the Author

Tara Vossenkemper, PhD, LPC
Individual Counselor & Therapist, Couples Therapist & Marriage Counselor | Columbia, Mo

Tara Vossenkemper is the founder, owner, and practicing counselor/therapist with The Counseling Hub with a Ph.D. in counselor education and supervision (earned from the nationally recognized UM - Saint Louis counselor education program). She specializes in couples therapy & marriage counseling using the highly effective Gottman Method Couples Therapy (and has completed their three levels of training).

Tara has a diverse set of clinical experiences, working with both adolescents and adults on issues ranging from eating disorders and anxiety to spirituality and existential crises. However, she is most passionate about couples counseling. Tara enjoys working with couples looking to decrease or enhance conflict, relearn healthy and effective communication, or are healing from an affair. She's also been formally trained in the Prepare-Enrich Premarital Couples Counseling approach and the PREP Approach for couples counseling.

Tara has presented at national, regional, and state conferences, as well as locally, on the topics of couples therapy and marriage counseling, discrimination, sexual minority distress, spirituality, healthy lifestyle and mental health, and private practice.

Demystifying the Process: What to Do With Bad Therapy

Sooo….

You decided that you were going to do it. You were going to go out on a limb and try this therapy thing that everyone has been saying is so great. It might be a little strange during the first session with your therapist taking an active lead and asking what seem like random questions. But this is normal, right? Well, mostly, yes.

 But what if it wasn’t? How would you know that your session was bad?

 It might be shocking to read (and hard to admit), but there are some therapists that won’t be a good fit for you or the right counselor for what you need. There might even be some therapist who you think do “bad therapy!”

(*cue the audience’s gasps of outrage and terror*)

What exactly is “bad therapy”?

 In order to know what to do about bad therapy, you must first recognize what it is. Realizing that you’re having bad therapy can be obvious, as in your counselor tells you what you should or should not do; or it can be as subtle, as in you continuously leaving the office feeling kind of icky and like you were judged. Occasionally leaving worse than when you came is sort of standard (i.e. some sessions are hard and leave you with more questions), but you should never feel judged by your therapist and you should not consistently be leaving feeling worse.

 Recognizing that you’re not getting the most out of your session might be a horrible feeling. We know how hard it was to seek help and that it can be humiliating and defeating to get your hopes up for some good therapy and then have it turn out poorly.

 How else might you recognize “bad therapy,” you ask? Easy. Here are some ways to recognize if you’re having bad therapy.

 1.     Your therapist told you how you should feel about your situation. You are in control of how you feel. Your therapist shouldn’t tell you how to feel about a situation. Instead, they should ask you to go “deeper” in that emotion. In other words, allow you to have that emotion and explore why it’s there. If your therapist is telling you how to feel, then you may be experiencing bad therapy.

 Therapist: “No, you shouldn’t feel bad! You tried your best/you were right/maybe they didn’t mean what they said?” <- WRONG

 2.     You may be having bad therapy if your therapist is not listening to what you have to say. This may look like your therapist interrupting you when you speak, or it may take the form of the therapist being totally off base over and over. Not feeling heard is a terrible feeling and therapists are trained to be good listeners. Also, you may not be feeling heard if you are leaving session feeling like you were misunderstood, frustrated, or shamed.

You: Talking about your dog suddenly dying in the past week.

Therapist: “Well, at least you have a cat, still!” Or, “I’m sure your dog wouldn’t want you to be upset. Why don’t we go back to talking about why you came in for counseling in the first place?”

You came into therapy (hopefully) to explore your life and become a better you. I don’t know about you, but I would not be able to focus on myself if I just lost my cat or dog. Instead, your therapist should let you explore why you’re sad and how much your pet means to you.

 3.     You may be having bad therapy if your therapist is telling you what you should do. Giving advice is not your therapist’s job. Their job is to listen, build a relationship with you, help you understand yourself and your situation enough so that you can figure out the perfect decision (or options) for you, and then support you in deciding what do to. As we have said before, your therapist is not your friend who says whatever they feel like.

Therapist: “You should just break up with him. He sounds like a douchebag.” #IfIHadEightEyesTheyWouldAllBeRolling

4.     You leave more often than not thinking to yourself, “What did I get out of this?” If you feel like you get nowhere in your sessions, you may be having a case of bad therapitis. Now, you may not feel like you have made enormous amounts of progress in every session, but you shouldn’t feel like you wasted your time on a consistent basis. Your time in therapy should be reflective and thought provoking (more often than not).

Therapist: “We really covered a lot of ground, Stanley the Manley! Same time next week, chump – I mean, champ?!”
You: “Uh, sure.” (thinking in your head: “What ground did we cover?!”)

5.     You feel really distant and disconnected from your therapist after more than a handful of sessions. If you’ve been seeing your therapist for a month or so and you still don’t feel connected to your therapist, you’re probably having bad therapy. Again, therapists are trained to build rapport. Sometimes, we’re just not the right fit (and now I bet you’re wondering how to tell if a therapist is a good fit), but other times, if you feel uncomfortable, distant, or disconnected, you might be having bad therapy.

When do these situations happen?

Keep in mind that any of these situations can happen at any point of the therapy process. But if any of these situations are happening to you consistently, we’re sorry. That really stinks. We love good therapy and do our best to make sure that we’re doing the best we can, but we also recognize that some counselor-client fits are better than others.

What do I do when it does go bad?

Therapy can be the most enlightening and empowering experience you’ve ever known, but it can also be a flop. Before you completely give up hope on your therapist, there are some things you can do to try and improve the relationship without quitting cold turkey (although there are times when quitting cold turkey is the right move).

Reflect

It might be helpful to set aside some time to think about what went wrong. Reflect on questions or feelings you had during and after the session. Were you not feeling heard? Was your therapist not interesting? Did they remind you of someone you didn’t like? Were they too pushy? Many things can lead to an unpleasant experience, unfortunately. It’s important to understand why you didn’t have a good experience. If you understand what went wrong, then maybe you and your therapist can do something to fix it.

Ask questions

If you are new to therapy (or returning from taking a break) then you may have many questions. It may feel like the way your therapist interacts with you is indifferent or strange. It maybe helpful to ask questions about the therapy process. Clarifying what is happening and the purpose may make the process feel less anxiety provoking and strange. It may normalize your experience and realign your expectations. Some questions could include what is the purpose of your (therapist) questions? Why are we not talking about what I want to talk about in the intake? Is it wrong to joke during session?

Give it some time

Give therapy three sessions (at least) before you make a decision to stop or continue. Therapy’s foundation is built upon a relationship. Although the therapeutic relationship is unlike any other relationship, there is one common thing between the therapeutic relationship and all others: time for the relationship to develop. Allowing your therapist time to get to know you will also allow the relationship to deepen. Maybe the feeling of dissatisfaction is because your and your therapist have not had enough time to get to know each other. Also, therapy is not an over-night process. Sometimes we want things fixed right away (I mean all the time!) but it may take a while for you to see or feel the results. Hang with it, it will work.

 Allow for mistakes

Your therapist attempts to understand you and your whole life in a matter of an hour each time you see them. There are bound to be misunderstandings and mistakes. Therapists are human and make mistakes too. If your therapist makes a mistake, give them the chance to apologize. If they are unaware of a mistake they made, then you may have to let them know. Mistakes occur in all relationships including the therapeutic one. When you clarify the mistake, this allows your therapist to know you want to keep working! It also gives you the chance to feel better about working with your therapist.

Negotiate the relationship

Sometimes therapy is not what you expected. When you enter therapy it’s for you- not what the therapist wants. If your therapist is not structuring the therapy sessions the way that feels most beneficial, you may want to negotiate how to spend the time. For instance, if your therapist spends a lot of time talking about how you felt as a child and you think that the here-and-now is more important. You may need to tell them that your childhood experiences don’t feel so important and you would like to spend the time talking about what is happening right now. Again, the therapy is for you. You are putting in the hard work and no one knows you better than you.

 Talk to your therapist.

One common factor in all these hints is that you have to talk to your therapist. Talking to your therapist sounds obvious, right? But it can be very uncomfortable to say that you are not happy with their service. Therapy is supposed to be a time where you can be completely open and honest with yourself. It’s hard to be open and honest if you are uncomfortable with the other person in the room. There may be many barriers as to why you don’t want to talk to your therapist about your bad experience. Maybe you want them to like you. Maybe you are worried they will be angry at you. Perhaps you think that they should already know. You may not even be able to say what it is that is dissatisfying about the encounters. Whatever it is, you need to communicate that with your therapist. The reality is, although your therapist may feel like a mind-reader at times, they can’t read your mind. If your therapist is unaware that you’re not getting the most of your session, they can’t help you fix it. Tell your therapist that you need to check in with them to let them know how therapy is going.

Time to find something different

If you have taken these steps and you are still not feelin’ it, it may be time to find something different. Ask your therapist for a referral. Different clinicians are trained differently. Not only are different clinicians trained differently, there are hundreds of different theoretical orientations clinicians can choose to operate from. It is good to keep in mind that just because one therapist does therapy one way doesn’t mean that all therapy will be the same. What is important for you to do when trying to work with someone else is tell your new therapist what you did and didn’t like about your last therapist. This will let your new therapist know how they can best help you.

In summary, there are many things you can do if your therapy sessions are not going how you’d hoped. Spending time reflecting and talking to your therapist are going to be the most helpful. As in any relationship, time and forgiveness of mistakes are needed in order to build a solid foundation. If you and your therapist have tried these suggestions, then maybe it’s time to consider terminating the sessions. But don’t stop there! Ask your therapist for referrals. Not all therapy will look or sound the same. You are worth continuing your road to self-healing.

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about the author

Molly Lyons- Intern

Molly is currently in her final year of the Master of Science in Clinical Counseling at Central Methodist University (CMU) and is a student intern at The Counseling Hub and Boone County Mental Health Coalition, where she will assess and provide mental health interventions and resources for individuals and groups in Boone County schools. She obtained her Bachelor of Science in General Psychology with a minor in Child Development from Central Methodist University directly before enrolling in the counseling program. Prior to pursuing her counseling degree, Molly received an Associates of Science in Early Childhood Education from Moberly Area Community College. 

Molly has experience in the Counseling Center at MACC's Columbia campus, providing counseling services for students around the topics of identity crises, school-related stressors, depression issues, and coping with anxiety. Molly has co-facilitated Safe Zone trainings which introduce its members to the LGBTQ+ community terminology and basic information. Molly has also completed on online course in LGBTQ+ Counseling Competencies (College and Career Readiness) through the American Counseling Association (ACA). Molly is an active member of both the ACA and the Association for Multicultural Counseling and Development (AMCD).

Molly enjoys working with diverse populations and seeks to always be open to new learning experiences. She works best with individuals who are trying to discover who they are and how they relate to their world, as well as others in their world. Molly believes that a person’s external factors can provide both barriers and resources towards growth and that one must discover these in order to thrive.

Why Am I So Anxious?!

Anxiety is a tricky fiend. It’ll sneak up on you and snatch away your joy when you least expect it. Or it lies waiting all day, just biding its time until you lay down for bed and then it starts screaming in your ear about all the ways you’ve failed, all the things you have to do, all the horrific things that could happen, all the friends who probably don’t even like you, and all the failed attempts at life you’ve had so far.

EGADS, it’s exhausting.

Take heart, my friend, we’re going to cover some common reasons anxiety strikes. Hopefully, you get something out of this. And if you don’t? That’s cool – we’re happy with trying.

With anxiety, we’re looking at a few different things.

Nutrition and Anxiety (yes, seriously...)

First off, food. Yes, seriously, food.

Your gut is legit magical. I mean, if you even knew, you’d be completely blown away by this thing (you might actually already know, in which case I’m preaching to the choir). For example, did you know that about 90% of the serotonin in your body is located in your gut. Yes, your GUT. So wild, right?!

My point is this, though. When we ingest things that cause/increase inflammation in our system or that are poison, in essence (I’m looking at you, alcohol!), then we’re potentially increasing our risk for mental health problems. I’m not saying don’t drink. I am saying to pay attention to how you feel (mentally) after you eat and drink certain things. It’s not uncommon for people to cite drinking (the day before, for example) as an antecedent to feeling extremely anxious.

Cognitions and Anxiety

Second, thoughts.

This is the one that everybody already knows about (probably). The way that we think can actually increase and decrease certain feelings. Yes, our thoughts are connected to our feelings. Crazy, huh?

A simple experiment is to shut your eyes and think about a time when somebody said or did something really thoughtful for you. Just go back there for a minute and recall what that was like. And then open your eyes and notice how you feel. There are probably some vestiges of ‘good’ after thinking about that, right?

Along that same vein, close your eyes and think about the last jackass to cut you off, or that time you were wrongfully accused of something, or the last fight you had. Go back there for a minute. Then open your eyes and notice how you feel. Probably angry – at least I’m assuming angry, but it could also be frustrated, upset, or distressed.

My point is this – anxiety can be related to thoughts. So when we’re aware of how we think about things (and what we think about), we can squelch some of anxiety-as-an-effect.

Basic Needs and Anxiety

Third (and last because this is getting long), basic needs.

This sounds so silly, but is really important. You know what else impacts anxiety? Sleep, sunlight, and connection. Yes, all three.

Sleep is WAY more profound on our systems than we give it credit for. People who consistently don’t sleep enough end up dying sooner, on average, having more illness and slower recoveries, and having more mental health issues. For real. Sleep is important.

Connection and sunlight are also significant, in that we evolved to be outside (not in artificial light) and be in connection with others. When both of those are consistently disrupted, the aftermath can be mental health issues, including anxiety.

The point of this is to highlight some other factors that can be influencing your anxiety. If you know these, you can start to modify some of what you’re doing and just see what the impact is. If it’s helpful, then now you know! And if it’s not, then schedule a session and come through to see us so we can help you figure out what’s going on!