Online counselling

What is online counselling?

Online counselling allows you to talk about your problems and feelings with a trained counsellor in a respectful, accepting and confidential environment. It provides an opportunity to explore personal difficulties and issues in a confidential and supportive environment. It is especially helpful to those who would find it difficult to come for face-to-face appointments on account of their location, work, lifestyle or other practical or personal reasons.

How Does It Work?

Online counselling can take place in a number of different ways.

  • Secure video/ webcam appointments are a preferred option for many if you’d rather we see and hear each other.
  • Text-based online work can be live, via online chat
  • Email exchange at an agreed time each week.
  • Telephone

If you enjoy or are used to communicating through the written word, both chat and email counselling can be a powerful and practical. Some people find expressing themselves in writing easier. Such sessions allow more time to think about what you might want to communicate to your therapist and to reflect – whereas video chat sessions enable a stronger sense of live interaction. With chat and email sessions the interactions with your therapist can be made available for you to look back on over time. Many people find this beneficial.

How do I find the right counsellor?

How do you know who would be the right online counsellor for you?  Please see my Blog about this. Studies show that it’s the relationship between you and your therapist that really influences whether counselling will work for you and if you’ll get the results that you want. I offer a free 15-20 minute telephone chat to see if will be able to work together successfully before you book any sessions. Contact me here.  I’ll make sure that our sessions are tailored to meet your needs, your preferences, your personality and your goals.

What About Security? What Platforms Would We Use?

The security and confidentiality of our connection is paramount if you opt for online sessions with me. I therefore recommend that we use a platform called Zoom for live chat or video appointments. This is because it features end-to-end encryption for an added layer of security. For telephone counselling I prefer to use Signal, which is secure, free to download and free to use and it’s encrypted.  For e-mail work, I use a Swiss secure and encrypted platform called Proton Mail. Zoom, Signal and Proton mail are all easy & free to use & download – even for the technophobe. I’ll provide you with more information, which I’ll email to you when you book your first session.

Is Online Work Suitable For Everyone?

Online sessions work well for most people who are reasonably confident about using computer technology, have access to a reliable internet connection, and who can find a quiet time and space on a regular basis to interact with their therapist. Online counselling may not be the most suitable form of support for everyone  particularly those in crisis, or individuals presenting a high-level of risk.

How long do I need to work with a counsellor?

I work collaboratively with clients, checking with them as to how they feel their sessions are going, establishing aims and goals together and, ideally, working towards a mutually agreed ending. You may feel that you’ve got what you need after three or four sessions. Alternatively you may want to work with me for a longer period to deal with deeper issues.  The length of the counselling relationship is your decision. I offer short-term and long-term counselling across a range of issues.  At our initial meeting, we will discuss how long we should work together.

With corporate/insurance referrals, it may be that counselling is only funded for a certain number of sessions – so we would have to be mindful of that and realistic about what might be achievable within a set period of time.

We’ll usually work together for a long as you feel you need to continue with counselling and to ensure things are going in the right direction. We would have regular reviews throughout the process. With the exception of holidays and unavoidable engagements (which I’d ask we give each other reasonable notice of), I generally ask clients to commit to sessions with me on a regular weekly basis. Once an appointment has been agreed. I require at least two working days’ notice of cancellation or it will be chargeable.

How long and how often are sessions?

Sessions generally last 60 minutes and take place once a week. Unlike some counsellors who offer “a 50 minute counselling hour ” I offer a full 60 minutes. Some people have commitments and can’t always make daytime sessions. To make sure you can access counselling I do hold a few sessions in the evening and may have some availability at the weekend.

Do I need any special IT skills or software to work online?

You don’t need any specialist skills or software for online counselling.  If we do agree to work together using the telephone, e-mail or video conferencing I will discuss with you the ground rules and how you can keep our sessions safe and secure.  I’ll also send you information about the IT aspects of online therapy.

What about confidentiality?

Everything you tell me will be treated confidentially.  Online we work together using encrypted e-mail and video conferencing. There may be some circumstances when I’ll talk to you about passing on information to outside agencies, for example, if I believe that you are in danger of harming yourself or others such as a child is at risk.    If this does happen I will always discuss the next steps with you first.  However, if you disclose information about certain serious criminal offences such as terrorism, then I have a legal obligation to tell outside agencies without informing you first.

Is it Effective?

The BACP supports online therapy and has developed guidelines for practitioners and a competence framework identifying the knowledge, skills and abilities required by practitioners who wish to work with clients via telephone and e-counselling. A number of international studies has concluded that online therapy can be just as effective as face to face therapy.

Case study 1

A randomized controlled trial (RCT) was carried out in Arizona U.S. to evaluate face to face versus home-based video of 132 Veterans recruited from South Eastern Veterans Affairs Medical Centre who met the criteria for post-traumatic stress disorder (PTSD).

Results indicated that home based therapy was not inferior to face to face therapy in terms of reducing PTSD scores at post-treatment, 3 and 6 month follow-up. Non-inferiority hypotheses for depression were also supported at 6 month follow-up.

The study concluded that home based therapy has great potential to reduce patient burden associated with receiving treatment in terms of travel time, travel cost, lost work, and stigma, without sacrificing efficacy. The findings indicate that Telehealth treatment delivered directly into patients’ homes may dramatically increase the reach of this evidence-based therapy for PTSD without diminishing effectiveness. [1]

Case study 2

A study in New Zealand showed that therapy for anxiety and depressive disorders, especially via the internet, has the capacity to provide effective acceptable and practical health care for those who might otherwise remain untreated.

Twenty two RCTs of computerised Cognitive Behavioural Therapy (CBT) for major depression, social phobia, panic disorder or generalized anxiety disorder showed superiority in outcome over control groups. The effect sizes were substantial, and the results indicate both short term and long term benefits. Furthermore, patients adhered to and were satisfied with computerised CBT, despite the significantly reduced amount of contact with the clinician. It was found that computerised CBT is an efficacious and acceptable treatment, increasing convenience and reducing clinician time that would otherwise be required by face-to-face treatment.

It offers increased access to treatment for those suffering from anxiety and depression. The results came from 9 different groups working independently in 7 different countries. [2]

Case study 3

A study in Portland Oregon noted that online therapy, defined as the provision of mental health services through the Internet, is a growing field that has sparked an abundance of interest and controversy.

A primary concern in the practice of online therapy is whether a working alliance with clients, considered a central component of successful therapy, can develop when participants are geographically separated. Working alliance scores were compared between a small, primarily female sample of online therapy consumers and a representative sample of traditional face-to-face therapy clients. Results revealed significantly higher means on the goal subscale and composite score of the Working Alliance Inventory in the online sample, suggesting that a working alliance can be adequately established in therapy delivered online.

No significant differences in the level of working alliance were found within the online therapy sample with respect to modality of communication, client presenting problem, or therapist. [3]

References

  1. A non-inferiority trial of Prolonged Exposure for post-traumatic stress disorder: In person versus home-based Telehealth. Ron Acierno; Rebecca Kemp; Amanda K Gilmore; A non- inferiority trial of Prolonged Exposure for post-traumatic stress disorder: In person versus home-based Telehealth Behaviour Research and Therapy. Volume 89, February 2017, Pages 57-65.
  2. Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis. Gavin Andrews; Pim Cuijpers; Michelle G. Craske; Peter McEvoy; Nickolai Titov. (2010) PLoS ONE 5(10): e13196. https://doi.org/10.1371/journal.pone.0013196.
  3. Working Alliance in Online Therapy as Compared to Face-to-Face Therapy: Preliminary Results Jonathan E. Cook and Carol Doyle. CyberPsychology & Behavior. July 2004, 5(2): 95-105.https://doi.org/10.1089/109493102753770480. Published in Volume: 5 Issue 2: July 5, 2004.