How should I do a site visit with my client when working remotely?
Site visits are a core procedure in cognitive therapy for PTSD (CT-PTSD) but they are under-used by therapists for a variety of reasons. Sometimes it relates to practicalities like not having service support for working out of the office or not having enough session time, but often it is therapist anxiety that holds them back – for example, that something unexpected might happen on the site visit.
Working remotely need not be a barrier to site visits. Ideally, the therapist would go on the site visit with the client and this might be possible if the therapist isn’t too far from where the scene of the trauma is. It might require negotiation with the service, for example to book a double session to allow time to travel to and from the site but, in our experience, this is worth the effort, because site visits are often so valuable in treatment.
If the therapist can’t accompany the client to the scene, they could still arrange to speak to them on the phone or a video call while they are there. Alternatively, or additionally, a supportive friend or family member could go with the client to the site. They can be prepared in advance for how to support the client on the visit, perhaps joining the preceding therapy session. Remember to encourage them to take a selfie at the site - it's a good reminder that the visit has been very different to the trauma.
Sometimes the site is inaccessible for some reason, for example if it is a long distance from where the client now lives or if there is a risk associated with revisiting the scene of the trauma. In such cases, we do virtual site visits, using Google Streetview or Google Earth if the trauma happened in a place where Streetview is not available. Many of the same procedures can be used during a virtual site visit, such as reliving the trauma, looking for evidence to address trauma-related appraisals and using ‘then versus now’ (i.e. looking at how the site is different now from at the time of the trauma). There is a time travel feature on Google Streetview which enables viewers to see how the site has looked at different intervals over time which can be helpful in looking at how differences have changed over time, which can assist with ‘time-stamping’ the memory and making it feel more in the past. A virtual site visit can also be used as prelude to an in vivo site visit, to help the client prepare and overcome any anxiety they have about revisiting the site.
For more information on doing site visits, we have written
a practice paper on the topic. There are also videos on both in vivo and virtual site visits, including demonstrations, on the OxCADAT resources website. Just a reminder that OxCADAT resources has loads of free resources on PTSD treatment, you just need to register for access.
Murray, H., Merritt, C., & Grey, N. (2015). Returning to the scene of the trauma in PTSD treatment–why, how and when?. The Cognitive Behaviour Therapist, 8, e28.
Key practice points
· Site visits are a core procedure in CT-PTSD but are often neglected
· Site visits are possible when working remotely, either by the therapist travelling to the site, phone or video calling during the visit and/or with a supportive person accompanying the client
· Virtual site visits can also be used, via Google Streetview or Earth, and many of the same procedures can be used