(Updated in January 2020)
A long term client of mine (17yr old, female) went overseas for 6 months to study and work. She was a high-risk client with a history of both self-harm and suicidal ideation, writes Integrative Health Expert and Clinical Psychologist, Leanne Hall.
It was a tough decision, and one we discussed and planned at length with her family. What support will she have while overseas?
In addition to setting up a range of local supports (wraparound care) for her, we all decided that it made sense for her to continue her weekly sessions with me. Thankfully, this was made possible through Skype and email.
Online counselling or web-based counselling basically encompasses anything from Skype therapy sessions and chat rooms to email and even text messages. Whether the communication is in real time (for example Skype or chat rooms) or not in real time (for example email and text), or focuses on written communication or face-to-face communication – there are a number of advantages and disadvantages.
This “technology-assisted therapy” is relatively new on the scene in the world of counselling and therapy and is changing and developing at a rapid rate. As such, the research into its efficacy is struggling to keep up.
For me, it has provided a wonderful way to provide care to existing clients with whom I have a face-to-face relationship. Whether it’s via Skype, email or even text, technology is a wonderful way to remain engaged with clients who feel comfortable communicating through technology, and I would be lying if I didn’t admit that it took some adjustment for me to get used to it!
However, working with clients exclusively through technology is another story - one that presents a number of interesting challenges. So let’s take a look at some of the pros and cons.
Pros of online counselling
Without a doubt the best thing about online counselling is that it’s accessible, which is fantastic for clients who live in rural or remote areas, or for clients who work long hours and/or those who cannot leave the house for various reasons, such as young people, single parents and those experiencing illness. It’s also great for clients who travel or move overseas.
Not having to pay rent or office costs also means that it’s more affordable for clients, in addition to the fact that neither the client or counsellor need to pay costs associated with travel/commuting.
Also, the convenience associated with online counselling makes it an attractive option, as it allows counsellors/therapists to extend their hours. This was extremely useful for me when my client travelled overseas as it allowed me to Skype her outside office hours due to the time difference.
In non-visual forms of online counselling, clients have the added security of remaining anonymous. In some cases, this can allow for greater honesty and less “filtering” of information. It also reduces perceptions of stigma associated with race, age physical appearance. This is particularly beneficial for clients who have experienced trauma, and/or those who experience significant anxiety.
5. Communication flow
Having time to reflect and respond can also enhance communication. With written online counselling, there is also a sense of being more attentive to what is communicated. Communicating this way also allows for issues to be externalised thereby increasing objectivity which can facilitate the therapy processes.
However, before you decide to close the door on your office once and for all – there are a number of challenges associated with online counselling that may mean it’s not the “perfect” option after all.
Cons of online counselling
1. Absence of non-verbal and non-visual cues
In non-visual forms of online counselling, the absence of non-verbal/visual cues can lead to misinterpretation. Even in real time, visual online counselling certain subtleties associated with body language and tone can be missed.
2. Greater chance of miscommunication
In addition to the above, the absence of spontaneous clarification can lead to misunderstandings. Sometimes it’s not only what we say, but our body language that demonstrates the need for further clarification (raised eyebrows, frown, arms folded, head shaking etc.). Obviously, this is missed through online counselling.
3. Cyber security risk
A common concern is also around security. Can information be “hacked”, and can confidentiality be assured? Thankfully there are a number of measures that be taken to prevent this, and it’s often helpful if this is explained to the client before counselling/therapy begins.
4. Ethical implications
While online counselling can transcend state and international borders, this can have ethical implications. Which jurisdiction is the counsellor operating under? Are they qualified? In fact, it can be difficult to really confirm the identity of both counsellor and client when there is no face-to-face contact.
5. Technological barriers
In some of my Skype sessions with my client, her WiFi would drop out due to the area she was in. Technological difficulties can present annoying challenges with online counselling. In counselling/therapy that is not in real time – this can lead to a perception that the client or counsellor is “too busy” or “not bothered” to respond both of which can impair impact the therapeutic relationship.
While online counselling and therapy in all its forms present a number of advantages for counsellors, using it instead of face-to-face counselling presents some rather unique challenges. However, using it in addition to face-to-face therapy can most certainly enhance the therapeutic relationship.
Like anything, it’s important to consider what works best for you and your client. While you may be more than comfortable using technology-assisted therapy, many clients are not comfortable using technology for something that is so personal and at times distressing.
Furthermore, research does suggest that it can lead to misdiagnosis if used as the sole medium in assessment and diagnosis of major mental health illnesses. As such, it’s not a good idea to provide online counselling to clients requiring assessment and diagnosis or for those who are experiencing significant distress.
So should you consider using online counselling in your practice?
If both you and your client are comfortable communicating through technology, then it’s absolutely worth considering. However, it’s important to put time into planning how this will work – while ensuring that your client's confidentiality is protected at all times.
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