Online Counselling: Challenges and Opportunities
The coronavirus crisis has hit us hard. Social distancing is affecting both counsellors and clients. Yet, the field of counselling is among the few to adapt quickly to the situation thanks to the option technology offers us: Meet on the screen.
I have been providing online counselling via video since 2012. Between 10 to 20% of my sessions are conducted online. The statistics show a clear trend: ever increasing percentage of this form of counselling. In this article I would like to share some reflections and tips which I draw from my experience.
As much as we all love technology and use it often, we also hate when we get stuck. We feel frustrated and helpless. Fixing a tech issue can feel like a daunting task. We feel as if we are now being controlled by the technology. Those in our profession naturally focus on people and emotions rather than computers. The task of managing technology can also be daunting to some professionals.
You invest all of your attention and effort in managing the relationship with your client, and now you also need to manage the medium through which all of that is done. Internet connections can be unreliable and you may encounter occasional disruptions which interfere with communication. These moments can be frustrating for both clients and counsellors as they can break the flow of the conversation.
The comfort and ease of use come with a price. We cannot always control the environment from which the client is speaking. Over the years I have seen clients speaking to me from the car, airport, the bush and of course from home while kids keep interrupting.
You may assume that it is a sign of a poor level of focus or interest, but this is not my experience.
It requires flexibility and adjustment from the counsellor. You simply don’t have the same level of control as you have in your own room.
When clients travel to meet their counsellor in person and sit in the room for one hour, they experience a different level of commitment compared with online sessions. In face-to-face sessions,they share deep thoughts in an intimate space behind closed doors with a stranger. They face vulnerability and it is not easy to avoid and disconnect. They are more invested practically and emotionally. This is different in the case of online counselling. So different that the counsellor themselves may feel vulnerable as well.
Counselling is a kind of cultural ritual: both clients and counsellors expect it to take place in a certain way, with certain structure and rules. E.g reception, meeting behind closed doors, unique sitting arrangement, credentials on the wall, dress code. These things help build your professional status and presentation. They create the counsellor’s comfort zone. When meeting online this will change. Your face on the screen is all that your client will see, not an impressive context. It means that there is a little more pressure on you to impress from the first session with the skills and wisdom you offer.
How does it all affect the process?
It creates a fragile holding environment.
Sitting in the closed room gives both the client and the therapist a sense of secure and uninterrupted connection. The structure of time and space create an environment which is more predictable and secure. Such an environment will allow a slower and deeper process of exploring needs and vulnerabilities. In the case of online counselling, the holding environment is compromised.
When we don’t share the same space with our clients they can not tell if we are totally there for them. Not only because they don’t see the environment from which we operate, but the medium itself will compromise how much one can trust and rely on the support. At any moment, the connection can be broken or something may distract them both.
These issues will impact the strengths of the holding environment. In the case of a highly distressed client it can be crucial. I believe that it is this sense of fragile holding environment which deter both clients and therapists.
A review of 23 studies (2-14) compared the two forms of counselling: video and in person. The review concluded that while clients perceived the therapeutic alliance in video counselling “at least equally as strongly as in‐person”, the counsellors perceived it to be not as strong. In particular, the client ratings of bond and presence were higher than therapists.
My own experience is that the relationship can be very strong but it will depend on factors such as personalities, style and needs of both therapist and clients. (To be explored in a future article).
What will it take from you as a counsellor?
Flexibility and Resourcefulness
When you try hard to focus on your client’s needs it can be frustrating if unrelated issues grab your attention. Issues of technology, connectivity and other distractions may test your patience and concentration. It will require you to adapt quickly, switch attention easily and respond elegantly to various challenges as they emerge.
Furthermore, the same flexibility is required when you apply your interventions. You will need to adapt to the medium.
In my experience, the formal style and somewhat hierarchical structure which are enhanced by the context of the environment (see above) does not serve us well when we meet clients on the screen. The medium is very egalitarian. Clients expect a more friendly, warm and relaxed approach.
With online counselling, you can reach clients anywhere in the world. If you are highly specialised in a particular niche, or if you developed a specific intervention, then this can work to your advantage. The dilemma of any specialist is how to maintain the flow of clients with the more common issues. But with online counselling the potential for reach is far greater than within your local community.
Furthermore, there are certain types of clients who are not as comfortable with the intimate and closed setting of the consultation room.This can be quite intense and confronting for them. The video option gives them an easy exit. They may naturally take small breaks from the screen under the disguise of tending to things in their environment. Eg. respond to the dog, move the car, or get some water. It feels more relaxed
Video-conference has been used by universities and businesses for a long time. Tele-mental health is slower to catch up. I believe that the reason for that is that the medium itself is more conducive for higher executive functions of learning and concentration. (“system two” in the book “thinking fast and slow”). Meeting on the s screen – for various reasons – will accentuate the communication of ideas, knowledge and skills. No wonder online learning is flourishing everywhere. In counselling, the medium opens opportunities for more directive methods such as coaching and psychoeducation.
Use of Psychoeducation Tools
The option to share screens (e.g. Zoom) will allow you to easily access tools on your computers and use them with clients. You may share a video, exercises, images, powerpoint and more.
The chat option will enable sharing links or even a summary of the key ideas in the session.
I have recently started to allow clients to record brief segments of the session when an important message or information is emerging in the session. It is often in the form of a short summary at the end of the session. The clients are very grateful for this opportunity and in some cases they may enthusiastically share the recording with family members or partners.
As you progress with using the medium,you will discover more and get creative.
Dynamic Interventions for Relationship Issues
Since my main interest is relationship issues, I have been very excited to discover the new opportunities which this medium opens up for us. It makes the process more creative and dynamic.
When I try to address relationship issues it is very easy to bring other people onto the screen and just as easy to move them out of the screen. Here are a few examples that I have experienced: family therapy – speak to the parents first and then get the child to join. The child may leave the screen and come back later. Let’s remember that children are fascinated by screens! Couples therapy – get both partners on the screen when they are far from each other or during a break-up crisis. While working with one partner, ask the other to join the screen even if only for a little while.
Family mediation – when family members don’t talk to each other, the option of meeting on the screen is far more comfortable. Again, it is the ease of exit which makes the medium less intimidating for people to meet when emotions are running high.
Continuation of Relationship with Clients
Clients may move interstate or intercountry. With online counselling you can keep your relationship going. If clients highly regard the relationship with you they are likely to prefer to maintain this relationship instead of starting with a new counsellor. They need to know that you offer such a service. It may help if you invite them to try it out.
Online counselling allows you to work from home and from practically anywhere in the world. The hassle of arranging an appointment is omitted, You only need to make the time.
The technology of communication is constantly getting stronger, faster and more reliable. New design makes it increasingly user-friendly. Those of us who have not grown up using technology will find it easier to manage.
There is no doubt that the stumbling block of this coronavirus crisis is turning into a stepping stone for the method of remote counselling. As we grow with the numbers and experiences, more data will be collected and more research will be conducted. A big boost to our skills and strategies as online counsellors is coming.
About the author:
Guy (Hagai) is a psychologist with more than 30 years of experience.