I have provided on-line therapy for clients and who have either moved away from the area but wish to continue seeing me, or those based in other countries who want an English therapist. The comments here apply equally to my clinical supervision work.
Online work is highly effective although the ‘gold standard’ for counselling is face-to-face, in the same room. This has been impossible for all clients and supervisees recently because of the Covid19 virus threat. As a consequence, I moved some but not all of my work on-line.
The threat of Covid19 is now diminishing and I offer all my clients the opportunity to meet with me in my therapy room in Plymstock. Any client wishing or needing to continue (or start) counselling on-line can still do this.
There is some residual risk in meeting. I therefore must undertake a risk assessment with each client I meet in person, which involves consideration of likely contacts and their risks from the virus (for example, if a client lives with an elderly family member, or works in a high-risk environment). I will carefully manage my non-work contacts to minimise the risk of my passing on any infection. I will also maintain high hygiene standards in my therapy room, disinfecting surfaces between appointments. I request that each client also takes due care with hygiene and virus avoidance. I am fully vaccinated with a booster.
On-Line: Pros and Cons
Working on-line means no travel. It is possible to talk from home, saving time, risk and expense.
The technology can facilitate the sharing of documents – guidelines, questionnaires etc if these are helpful (although that can also be done via email).
Seeing someone on-screen is neither as ‘together’ as meeting in person, nor does it provide such a full experience. From a counsellor’s perspective, Direct eye contact and much body language is lost and the interaction can be a little less ‘intimate’.
Confidentiality is vital; a client sitting at home often has to consider who might overhear the conversation, inhibiting open sharing of issues.
At home, clients can be distracted by insistent pets – though they can also be calming and helpful. However lovable, the session time is limited and care is needed to avoid unwelcome distractions.
This is the biggest factor. After carefully researching all the systems available I have decided that Microsoft Teams, Skype and Zoom are the best options. These are free, easily available and many people already have experience of using one or more. All are encrypted end-to-end (E2E) and so secure (unlike many other systems). Unlike systems such as WhatsApp and Duo (which are E2E encrypted and very effective) these are not so commercialised and personal data is not used to target ads in the same way. I keep these systems under review and update this information as things change. Of course, I will take into account each clients preferences and I am able to use whatever system a client prefers, understanding that the risk of using any of these systems is, in reality, very small.
A number of simple things are important in on-line meetings.
- You may use a Personal Computer, laptop, tablet or smartphone – even a smart TV! Obviously, a larger screen improves visibility and gives a greater sense of connection.
- The positioning of the camera and microphone is important. It is better for the therapist if your picture includes at least your head and torso.
- Arranging the camera so that it is held steady helps a lot – a phone that is constantly moving around and needs to be held up for an hour can be a problem, so it’s best if it is propped up securely.
- Battery life can be a factor – ensure that the charge is sufficient to cover the whole meeting.
- Be aware of your background – is there anything there you don’t want me to see?
- If there is anyone else around, make sure you will not be interrupted and that you are happy with the level of confidentiality available at your end. I always work from my therapy room so I guarantee confidentiality at my end.
- Please avoid dealing with emails and other matters during therapy – sometimes computers are set up to flag these and the temptation to deal with something ‘urgent’ can be irresistible – it is better to turn off notifications for the duration.
- Bandwidth is a common problem. Current technology cannot maintain a completely reliable link on all occasions. It is important that you have a reasonable bandwidth capacity at your ‘end’. I have a high-speed link installed to support on-line work.
So the choice is now yours, subject to there being no identifiable, unacceptable risk. Please consider all of these factors and let me know your preference.