Five things I have learned from offering online counselling

Not better, not worse, just different

This is what I said at the start of the lockdown in a communication to existing clients and new enquiries. While counselling for many means a human face to face experience, perhaps to overcome interpersonal issues or to benefit from being with a human that cares, video or audio calls may or may not have the same meaning. Indeed I did not go into counselling with the aim of staring at a screen either.

So although we have been robbed of the therapy room experience, we can reflect on what it means to see our therapist on our kitchen table or in our bedrooms. Equally for me as a therapist, I have the added dimension that my clients reveal a small part of their homes (or not) and what that might mean. And I reveal a small part of mine. Is my choice of a wall with a picture on it appropriate or not? Or does it matter? Perhaps I should set up my space to look like a therapy room? But that would lack genuineness.

In a webinar, for which I would provide a link if I could remember where it was, the speaker proposed that two people might not have a physical closeness when entering into online therapy, but there is no suggestion there’s an absence of emotional closeness. I think that’s right, although I find I have to “listen” for emotions at a more subtle level that when I engage face to face.

We like our hot drinks

I wouldn’t stop a client bringing a hot drink into a session, but I wouldn’t bring one in myself nor offer to make one. But with the change of situation, I started bringing a drink to video sessions and, as if something was resonating in the group unconscious, so did clients. I am not reading too much into this, other than a recognition that, in my case at least, counselling online can be quite tiring and I need to speak more clearly. (I have a propensity to mumble.)

A drink helps my throat stay clear.

Headphones, earphones or speaker?

It was actually another counsellor that said to me in a video catch-up: Have you considered what your clients might think when they see you wearing headphones? I hadn’t. I decided on headphones for the best audio experience. Indeed I got one of the last items of headphone/mike hardware from Argos as the lockdown was about to start. Did I look like a Cyberman from Dr Who? Like an ageing Radio 2 DJ? Or just me with headphones?

I could equally have chosen earphones with an integral mike, and these would be less intrusive. Ideally I would be sitting in a dedicated AV room with large screen, sound insulation and separate mike and speakers. But that simply won’t happen.

Seeing each other for the first time online can feel quite exciting. And the choice of hardware is part of that.

The seating angle becomes less important

This was from another counsellor, and again I hadn’t thought of it. I arrange seating in the therapy rooms I use to be at an angle of about 45-60 degrees. It means it’s easier to look away and feels less like an interrogation. But with video calls, we’re often looking at each other face to face.

Except we’re not. Because the camera is never at the same place as the other person’s eyes, and what we often see isn’t the eye contact from face to face sessions. It’s one person’s eyes looking at the screen with their camera a small distance away. So we’re never eye to eye.

So maybe hardware limitations give us much of what the seating angle gives us – a feeling that this is not an interrogation so much as a conversation. And that’s before we start analysing whether we’re really looking at each other or if it’s just pixels.

Security of our video software matters

When investigating which video platform to use for online counselling, the issue of security came up. And this is one of those issues I believed I couldn’t ignore, because to congruently offer a safe, boundaried counselling space, I couldn’t compromise by using a channel which is not sufficiently encrypted. Nor was I prepared to use a product from a major player in big data like Facebook or Google. Will our sessions be stored on a server somewhere?

I came across this site which lists some providers with HIPAA compliance – a US standard for the protection of sensitive patient data for health professions. I tried out three and went for doxy.me as it seemed to be the simplest to use. The quality is usually good, although less good when using smartphones, from what I can gather. I think the quality of Zoom is better, but is it compliant? I would hate to change to Zoom only for there to be some kind of data breach.

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