The purpose of counselling is generally to help people learn to\nlive in happier, more effective ways, which more often than not means helping\nthem learn how to come together better with other people. In these\npandemic-permeated times, however, we are told by authorities that the most\neffective means of being with others is to keep our (physical) distance from\nthem — at least a little, and sometimes a lot — as region after region engages lockdown.\nDealing with that together-alone paradox is the latest challenge for the\nhelping professions and one way of resolving it, while continuing to extend a\nhelping hand, is for counsellors to see clients in online sessions. In this article\nwe look into what must be considered when setting up an online counselling capability.<\/p>\n\n\n\n
E-therapy, or online counselling and psychotherapy, has enjoyed a\ngood growth rate over the last few years (Ratcliffe, 2017), with recent\nresearchers espousing its efficacy (iCouch, n.d.) as practitioners and clients\nalike have come to appreciate the advantages:<\/p>\n\n\n\n
Accessibility.<\/strong> For those who live remotely or who have\ntransportation issues (such as some people with disabilities), single parents\nwith young children, and those who are time-poor and wouldn’t get to session if\nthey had to drive across town, the ability to simply log on and have a session\nis a great boon to their mental health.<\/p>\n\n\n\n Affordability.<\/strong> Counsellors do not have to rent an office\nspace to see online clients, needing only some privacy, and neither\npractitioner nor client needs to travel, cutting down those costs. Hence, some\ncounsellors are able to bring the cost of sessions down.<\/p>\n\n\n\n Convenience.<\/strong> As noted, the possibility of a one-minute\ncommute down the hall to where the computer is comes to be a seriously\nattractive aspect for time-poor people. Some caregivers may be able to still\nhave sessions if they are only engaged for an hour, and only in the next room.<\/p>\n\n\n\n Anonymity.<\/strong> In non-visual forms of online counselling,\nclients have the added security of remaining anonymous, allowing for less\nfiltering of information and greater honesty in disclosure than the client\nmight feel comfortable with in a F2F session. Perception of stigma and bias\nassociated with face, age, physical appearance, and other aspects is reduced\n(especially helpful for those with trauma or who have a lot of anxiety).<\/p>\n\n\n\n Communication flow.<\/strong> For the asynchronous, written forms,\nboth parties have time to reflect before responding, which can enhance\ncommunication (adapted from Hall, 2020).<\/p>\n\n\n\n As various jurisdictions around the world go into\never-more-restrictive lockdowns, the above advantages remain in play, often\nintensified. But there is the additional, undeniable upside: mental health\nsupport — even more desperately needed now as societal shutdowns create massive\nunemployment and attendant mental health problems — is possible when an in-person\nmeeting would not have been allowed to happen. So, what forms of communication\nare we talking about when we say “online counselling”?<\/p>\n\n\n\n In\naddition to “online counselling”, you may hear terms such as “e-therapy”, “web counselling”, “telepsychology”,\n“internet counselling” (an older term), “online therapy”,\n“e-counselling”, and now “distance professional services”. The U.S.-based\nNational Board of Certified Counsellors (NBCC) includes the following as formats:\n<\/p>\n\n\n\n It is\none thing to agree to give one existing client one session by teleconferencing\nonce if they and\/or you are holed up under lockdown. It is quite another to permanently\nrun a major portion of your practice from the screen of your computer. Here are\nsome considerations to help you determine if you and\/or your clients are\nappropriate for online counselling.<\/p>\n\n\n\n Jane Evans’ book on\nonline counselling includes a checklist which seeks to establish practitioner\nsuitability for working online therapeutically. She asks counsellors to ask\nthemselves these questions:<\/p>\n\n\n\n In addition to a suitable temperament for working physically alone\nand being online for portions of a day, there is the question of technical\ncompetence. The British Association of Counselling and Psychotherapy (BACP)\nnotes that “all practitioners should be sufficiently competent in the use of\ntechnology in their work to be able to provide reliable and adequate services\nto clients and colleagues” (BACP, 2019), a requirement also noted by the\nAustralian Counselling Association (ACA) in their comment that practitioners\nshould be “prudent and conscientious in their consideration of the challenges\nof any new area of practice”. The BACP goes on to state that this means having\nalternative ways of providing services for communicating with clients promptly\nif the primary method of communication fails. Competence also includes having\naccess to technological support that respects the confidentiality of the work\nbeing undertaken. The ACA notes that “very few practitioners will be able to\nengage in online therapy without additional skills, training, and experience. Online therapy is NOT appropriate for\nnovice or inexperienced practitioners”<\/strong> (ACA, n.d.). <\/p>\n\n\n\n The BACP considers it “good practice” for practitioners to have at\nleast some of their supervision in the same medium in which they are working\nonline. The ACA expressly argues for specialist training in online counselling\ndue to the numerous issues beyond mere competence in providing face-to-face\ntherapy. These include:<\/p>\n\n\n\n Many issues influence the choice of medium. Most therapists like\nto see their clients in order to pick up on some of the nonverbal cues; some\nwill automatically be lost in video teleconferencing in that, typically, only\nthe head and perhaps shoulders of the person on the screen are seen. Yet media\nwith video content have more cues than mere audio means, such as telephone. Both\nvideo and audio\/telephone sessions, in turn, provide more nonverbal information\nthan asynchronous distance interaction (i.e., email or text) or synchronous\ndistance interaction (i.e., chat-based media).<\/p>\n\n\n\n Most of the platforms coming on stream now have multiple options\nfor communication, and so could accommodate the preference of either counsellor\nor client to see and be seen — or not. This leads to the question of which\nplatform — which particular software or system — is the “right” one to use,\nwhich we take up in a moment. <\/p>\n\n\n\n It is also important to consider which presenting issues can work with\nan online approach. The so-called “worried well” (clients who are essentially\nhealthy but want to work on certain challenges) may be able to deal well with\nthe therapist being only virtually present. Someone who is suicidal or\npsychotic is an entirely different circumstance; in all cases that assessment\nmust be made early on, and safeguards put in place for the client if\n“on-the-ground” support is needed in an emergency situation. Whom should the\nclient call? Whom should the therapist call if the client cannot be contacted\nand there is concern over their welfare?<\/p>\n\n\n\n If you are caught out in the midst of a lockdown and your client\nreally needs to have a session with you, you might just end up on Skype for an\nhour. But both the ACA in Australia and sources in the United States are\nadamant that platforms such as Skype or Facetime are not ethical choices for\nongoing work. Here is why.<\/p>\n\n\n\n In the United States, there are two requirements: (1) that the\nplatform be HIPAA-compliant and (2) that the provider of the platform has\nsigned a Business Associates Agreement. Unpacking that a bit, we can explain\nthat HIPAA (the Health Insurance Portability and Accountability Act) of 1996 is\nlegislation designed to protect the privacy and security of health care clients\nand their data. As a result, the U.S.\nDepartment of Health and Human Services has the power to establish national\nstandards for the health care industry when processing electronic transactions.\nIt also requires health care organisations to secure electronic access to\nhealth data in order to remain in compliance (Greevy, 2017). <\/p>\n\n\n\n The Business Associates Agreement (BAA)\ncertifies that the service a health provider is using guarantees compliance\nwith the HIPAA and therefore has security practices and policies in place to\nensure that client privacy is protected.<\/p>\n\n\n\n Skype is not HIPAA compliant. The\nowner of Skype, Microsoft, will not sign a BAA covering Skype. Microsoft tells\ntherapists that they cannot guarantee the privacy and security of client data\nwithin the requirements of the law. No BAA means no compliance. The fact that\nSkype is “encrypted” is irrelevant. Similarly, “consumer-oriented” video tools\nsuch as Google Hangouts and Facetime are not considered HIPAA-compliant for\nvideo conferencing (Dear, 2017b). <\/p>\n\n\n\n There is no equivalent (specific) legislation in either the U.K.\nor Australia which has enforceable requirements for therapists doing distance\ntherapy. However, both the BACP in the U.K. and the ACA in Australia have\nissued documents setting out what therapists need to be mindful of in order to\nbe ethical when doing online counselling. Australian practitioners must also\ntake into account the 1988 Privacy Act (see Federal Register of Legislation,\nbelow). Full discussion is outside the scope of this article, but we recommend\nhaving a look at:<\/p>\n\n\n\n Given that choosing a video conferencing solution is one of the\nfirst things you must do in setting up online counselling, which are the\nplatforms that will best accommodate it? We look at options in the U.K., the\nU.S., and Australia.<\/p>\n\n\n\n The Human Givens Institute offers online therapy guidelines,\nexpressly noting that Skype is not advised as a platform (although, with\ncertain safeguards and client consent, it can be used). The platforms the\nInstitute regards as more secure, and therefore a better choice, are:<\/p>\n\n\n\n The Online Counselling Directory (2018) refers readers to several\narticles which discuss the pros and cons of various teleconferencing platforms\nfor counsellors. Their recommendations for the top four (“the best of the best”,\nall HIPAA-compliant with a BAA) are:<\/p>\n\n\n\n Australian therapists are able to use a number of the U.S. sites,\nbut platforms that are specifically for use in Australia include:<\/p>\n\n\n\n As you have seen from descriptions of the platforms above, each\nproduct offers a different mix of features, but important ones to look for\ninclude fit-for-purpose teleconferencing platforms (which Skype is not) that\nare easy for both practitioner and client to set up, access, and operate, with\nzero to minimal cost for the client). The teleconferencing product should be\naccessible for clients who connect with various types of browsers, devices, and\nplatforms, and be able to operate with high-quality audio and visual\ncommunications across the bandwidth available in rural and remote areas\n(particularly important in Australia). Those platforms are best which have the\ncapacity to:<\/p>\n\n\n\n Once you have worked out which is the best teleconferencing\nproduct for your needs, there are a few aspects you must tend to in order to\nget going.<\/p>\n\n\n\n Now that social distancing is required for an indefinite period and\nin many countries, people are experiencing some form of social restriction — if\nnot total lockdown — we would like to say, “No dramas. Just log onto (site) and\ncontinue online where you left off in person with your clients; a couple of\nclicks will get you there.” We would like to say that, but we won’t. The\nrequirement for ethical online counselling is complex, as we have outlined\nhere, involving decisions about which platform and which medium (e.g.,\nvideoconferencing or chat) will be secure and most appropriate to use. You need\nto determine which — if any — clients and which presenting issues to use it\nwith, and to feel satisfied that you are an appropriate counsellor to use\ne-counselling therapeutically given your experience, qualifications, and temperament.\nEthical considerations need to be reviewed, with the ability to feel\ncomfortable online being as crucial as technical competence. Tips for getting\nstarted were discussed. <\/p>\n\n\n\n Online counselling is not everyone’s cup of tea, but as many commentators have already pointed out, when we are on the other side of the COVID-19 pandemic, the world might be changed forever. An increase in online therapy may just be one of those changes; now might be a good time to start getting used to it.<\/p>\n\n\n\n Written by Mental Health Academy<\/a><\/strong><\/p>\n\n\n\n The purpose of counselling is generally to help people learn to live in happier, more effective ways, which more often than not means helping them learn how to come together better with other people. In these pandemic-permeated times, however, we are told by authorities that the most effective means of being with others is to […]<\/p>\n","protected":false},"author":193,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[50,56,69],"tags":[573,30,422,276,466,275,572,574],"class_list":["post-4739","post","type-post","status-publish","format-standard","hentry","category-counselling-theory","category-ethics-legal","category-technology","tag-covid-19","tag-crisis","tag-crisis-counselling","tag-e-counselling","tag-e-therapy","tag-online-counselling","tag-online-therapy","tag-telehealth"],"yoast_head":"\nThe formats of online counselling<\/strong><\/h2>\n\n\n\n
What you must\nconsider beforehand<\/strong><\/h2>\n\n\n\n
Are you the\nright person for it?<\/h3>\n\n\n\n
Technical competence<\/h3>\n\n\n\n
Training and supervision<\/h3>\n\n\n\n
Which choices will be the best for you and your client?<\/h3>\n\n\n\n
Which presenting issues should use online media?<\/h3>\n\n\n\n
Ethical online counselling: what’s required<\/strong><\/h2>\n\n\n\n
The U.S. HIPAA and the BAA<\/h3>\n\n\n\n
In the U.K. and Australia<\/h3>\n\n\n\n
The platforms for teleconferencing<\/strong><\/h2>\n\n\n\n
The U.K.<\/h3>\n\n\n\n
The U.S.<\/h3>\n\n\n\n
Australia<\/h3>\n\n\n\n
Honing in on the practicalities<\/strong><\/h3>\n\n\n\n
Getting started<\/strong><\/h2>\n\n\n\n
<\/li>Summary<\/strong><\/h2>\n\n\n\n
References<\/strong><\/h2>\n\n\n\n