Skip to Main Content

The art of virtual connection: Emma Silver (MSW 2015) reflects on the challenges and benefits of online care


During my first year of graduate studies at the University of Toronto’s Factor-Inwentash Faculty of Social Work, I took a mandatory course that centered entirely on mastering the first 15-minutes of an initial therapy session. My professor tirelessly outlined the importance of communication, stressing both the verbal and non-verbal cues.

His belief was that the alliance you build in the first meeting with a patient sets the tone for treatment and the foundation for a positive therapeutic relationship. We would practice using a “speed dating” approach. In each class, half of the class members were delegated as the therapists, while the other half would be deemed the patients. We would then switch roles. This went on for an entire semester.

He emphasized that body language was a key element to rapport building: how the therapist sits, their posture — slightly leaning forward, open palms, and maintaining good eye contact. How the therapist speaks: a gentle, patient, non-judgmental, and inviting tone. What the therapist says, how they say it, when they say it, whether to pause and embrace the silence or prompt and dive deeper into discussion. I remember him saying, “In the presence of silence, one may learn so much about their patient. Embrace it.”

Every facet of the first 15-minutes was examined over the span of a 1-hour time frame each week. At the end of the semester, we had professional actors come into our class to play clients in a simulated therapy session to evaluate our progress.

Emma Silver (MSW 2015)
Emma Silver (MSW 2015) is a Clinical Social Worker in the Child & Adolescent Mental Health Outpatient Program at North York General Hospital. (Photo by Morgan Hotston)


In 2013, this mandatory course in the Master of Social Work program was presented as an integral part of consolidating one’s ability to build a foundation for exceling in the art of clinical practice. Fast forward to 2020 and I am often reminded of how this course has influenced my professional skills.

When I entered my first student placement on the frontlines of community practice, I felt ready to transition from simulated cases with actors to actual clients. My supervisors at the SickKids Centre for Community Mental Health would sit behind a one-way mirror and communicate to me through an ear bud while I continued providing therapy to my clients. This allowed them to provide immediate support and reinforcement as I met with individuals and families. No longer was I being evaluated in my small group class.

Following the completion of the therapy sessions, we would review videotapes of the appointments to assess and evaluate my approach to care. The reinforcements provided by my supervisors were essential for my learning, and it was evident that in order to progress on the frontlines, one had to skillfully create the same safe space that my professor emphasized in that core competency course.

Today, in a COVID environment, where most of my sessions are provided virtually, I think back to this course and the initial sessions and videotapes that were reviewed during my practicum. I contemplate how to best preserve the art of building alliance with my clients through a screen. I often find myself checking my posture, positioning my chair at an angle that will reflect me in the most caring manner, adjusting the volume on my keyboard, and so on. Leaning forward, I place a tissue box in the camera lens, even though I know my clients cannot actually reach for it. I sometimes wish I could go back to this core competency course and practice all of the skills in front of a computer monitor. I wish I could be evaluated based on how my abilities translate through a virtual care model.

From the start of our studies, clinicians are taught that above all else, we must strive to practice from a patient-centered perspective. In order to do this during a pandemic, we’ve had to adjust the art of our practice on the frontlines quickly and thoughtfully. In a profession that prides itself on face-to-face interaction with clients, I am proud of the many ways we’ve adapted to optimize the systems we are working within at healthcare settings across the country. We’ve learned how to compromise and adapt to the current climate in order to maximize our clinical skills.

There have been benefits that have come from virtual care. Certain barriers to access have been eliminated. I work with children and adolescents who no longer have to rely on their caregivers for lifts to the hospital or clinic setting. There is increased flexibility to book appointments that allows for greater access to care. Young individuals are able to see therapists during the daytime instead of being restricted to after school hours. Multidisciplinary teams continue to prioritize time for virtual case consultations and debriefs.

The gap between clinician and patient may be physically wider, but in many ways we are closer than ever: all working together to preserve the art of connection.

Emma Silver (MSW 2015) is a Clinical Social Worker in the Child & Adolescent Mental Health Outpatient Program at North York General Hospital and has a private practice as a Child and Family Therapist at the Family Psychology Centre.

Following her graduate studies, Emma practiced on the Counselling team at one of Ontario’s Lead children’s mental health agencies, as well as on the Child & Adolescent Mental Health Outpatient Team at Credit Valley Hospital. She has experience facilitating evidence-based treatments including: DBT, CBT and EFFT to treat Anxiety, Depression, Obsessive Compulsive Disorder and Emotional Dysregulation.

Last year, she received a 2020 conference grant award from the Patricia Mackey Patient- and Family-Centered Care Education Awards, which will support her goal of implementing a speakers’ series at Phillips House for caregivers called Sharing and Caring.