By Gill Jones
If you’re planning to offer a therapeutic service online or already working online, I hope this article will help. The ideas in here have been drawn from my 12 years’ experience as an online counsellor and the accumulated experiences of students who have trained to work online with Online Training for Counsellors Ltd (1). The article is divided into three parts. It begins with a list of points which spotlight some ethical issues of online therapy. The second section considers working with emails/text messages showing how some of the pitfalls might be avoided and part 3 considers live sessions (webcam or text) from the same viewpoint.
If you are planning to work online as a therapist – the following checklist may help you get started.
● Belong to a professional body who understand and accept online therapy within their code of practice? They can offer you support and provide a place for clients to bring a complaint.
● Plan to take specialised training to work online? This is no longer a ‘best practice’ suggestion – BACP for example “strongly recommend” specialised training in their latest guidelines (2)
● Check your professional indemnity insurance covers you for working online including any limitations that apply?
● Have a supervisor for your online work who also understands the world of online counselling and supervision? This offers you the best support in what can be an isolated environment.
● Enjoy working with a computer? Online practice can often be done in isolation, sitting alone at your computer responding to another person’s distress.
● Belong to a reputable online directory so clients can check out your training and qualification credentials independently? People are setting up online as counsellors/therapists without any prior training.
● Are you registered under the Data Protection Act as a keeper of sensitive data? (3) This is not only a way of showing clients you are clear under what circumstances you would release information about them and to whom but is another way a client can check you out by searching the register.
● Protect your computer from online and offline intrusion (viruses, malware, other people using your computer in your absence). Online therapists need good internet security software and password protection for their computer.
● Take steps to keep, your work with your client confidential? Password protection, encryption, etc.
● Have a written contract/agreement which covers the specifics of online counselling?
● Have a policy about social networking websites and your client’s further use of the transcripts of the work you do together? Some online counsellors will have this written into their contract/agreement.
● Now let’s consider how some ethical situations might arise within the context of emails or live sessions.
Many face to face clients as well as online clients now make contact using one of these methods. The purpose and content of the messages varies. For those counsellors who use homework tasks or record keeping, they can be an effective way of managing the flow of information, keeping contact between sessions, sending reminders, receiving completed tasks. For others they can be a useful way of receiving new client enquiries, as pre-counselling information, client background information and a written contract/agreement can all be exchanged as file attachments. If the client is seeking face to face therapy, these messages are likely to be occasional and no more time-consuming than making a phone call. If the client is an online client, they will be underpinning the working alliance.
Managing confidentiality both for yourself and your client is very important and most online counsellors use email programs which encrypt their emails both in transit and in storage. They also clarify the limitations to confidentiality that exist online with their clients, emphasising the need for both to have a private space when working. Storing client work on a computer means having a strong password to protect it (ideally 16 alphanumeric characters and symbols) as well as up to date internet security.
Working by email/text allows a precise written contract/agreement to be made between you and your client which can help to support the work you do together. The boundaries in online work can be very similar to face to face but they do benefit from being specified in a contract/agreement as some clients imagine that just because they don’t have a scheduled session with you, they may contact you when they like and you will be there to respond. Text counselling does benefit from being storable (clients can re-read what you have written) and online counsellors may specify their expectations about any further use the client may make of the transcript of the work and whether or not they are prepared to have further contact with the client via social networking websites. (E.g. Can they quote your words in their blogs or tweet them to their twitter followers, will you ‘friend’ a client on facebook if they ask you to?).
This instant form of communication, though convenient, becomes intrusive when clients send unexpected emails or texts asking a ‘quick question‘ following a live session; or ‘help me I don’t know how to deal with this situation‘ between sessions. How do you respond in a professional way without spending too much extra (unpaid) time writing back? Ignoring the email until your scheduled session time is an option, if this has been agreed in your contract. If you haven’t, you may lose your client altogether if you ignore them. More likely, you will want to acknowledge you have received the email but cannot read and respond to the content outside the session time (wise online counsellors schedule their email clients into their diary just as they would live session clients). Some online counsellors have a stock answer for such emails and will copy and paste this as their reply. Others will write a brief note and hope they don’t receive such emails/texts too often.
And how do online counsellors manage online silence from the client? At what point do you send an “I am concerned I haven’t heard ….” message to them? Do you know if they’ve received your email or might it have gone astray? You may have added a ‘read receipt’ but some clients ignore these. If your contract contains specific scheduled timing for your work with the client, you may also want to tell them what action you will take if you haven’t received a message from them within an agreed timescale. Online contracts which are imprecise mean your personal judgement must decide whether to re-send the original in case they haven’t got it or when to send your ‘concerned’ email. A promising online working alliance can break down when the flow of communication is disturbed and sometimes there is no way to restore it.
Live session counselling (webcam or text).
Working in live sessions brings the added dimension of technology (yours and the client’s) which, although continually improving, can also become an issue outside your control when it fails. You may want to contract for a variety of disturbances to a session, such as someone interrupting the session; internet connection failure; computer/phone battery failure; platform where the session is being held failure; etc. Best practice would be to have an agreed alternative plan ready (e.g. send text messages to set up an alternative meeting or continuing by phone if appropriate). Interruptions to live sessions can come at critical moments in the work; having an emergency plan helps to reduce the impact for both you and the client.
Finding and agreeing a rhythm for live text sessions with a client builds with experience, as does adapting to client preferences for how much they write before pressing the Send button. Other skills like allowing space for reflection or finding alternatives to the non-verbal communications you use face to face will benefit from roleplay and other training experiences.
Online therapists in live sessions will want to ensure the client is in a confidential space where they won’t be interrupted. Checking this out at the beginning is prudent even if you have to wait for the client to close a door, or find an alternative place. If speech is being used it is more confidential to wear a headset if you are not alone in the building. Good lighting for webcam counselling is very important (to see each other’s faces clearly). Light needs to shine on the person’s face, not behind them. A good broadband speed (above 2 Mbs) is essential if you are to offer live webcam sessions.
I hope this article has given you some food for thought, whether you already work therapeutically online or are thinking about it. I’ve only been able to introduce a few pitfalls and I would recommend anyone contemplating online work do take further training for it.
© Gill Jones MA, MBACP (Senior Accredited Counsellor) Director Online Training for Counsellors Ltd. Online Counsellor, Supervisor and Trainer
Gill Jones MA, MBACP Senior Accredited Counsellor works online as a counsellor, supervisor and trainer. She has been working in this field for 19 years and working online since 2001. Gill moved her practice entirely online in 2008 and now offers therapy and supervision over the internet. Online Training for Counsellors Ltd, (where she is Course Director) is a practitioner/trainer company who train other practitioners to work online. All their training courses are delivered over the internet. Gill is co-author of “Online Counselling: A Handbook for Practitioners” (2009), Jones G and Stokes A, pub. Palgrave Macmillan.
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