Quick guide to online therapy for clients

Jules Haley online counselling

It seems that we are all having to be flexible, adaptable and creative due to this dreaded Coronavirus, and online therapy is one example. I’m thankful now that as a qualified online therapist I am comfortable in continuing to support my clients online, and yesterday I made the difficult decision to move all my practice online for now. It feels like the safest and most responsible option for me as someone with a chronic health condition. Since Johnson announced the move towards self-isolating and social distancing in London and across the UK, I have been busy reassuring clients and supporting other therapists with online working. I will be writing more blogs over the coming weeks to support clients, offering to continue to work online, and also letting people  know that it is of course ok to not work online too or to change your mind if things change in a week or too. And that when this has all passed, which it will, we will work together again.

It occurred to me today that, as we are all in this together, I would share my experiences and learning around online working more widely. This may be supportive for everyone, but it is mainly for my clients – current ones and new ones. I hope this will be helpful.

So here are some thoughts that are emerging for me around my experience of offering online therapy:

Online therapy just it isn’t for everyone. Not all clients, and not all therapists, want to work online especially on webcam/video. You may not want to be seen or to see yourself on screen – I know that I didn’t when I first started, but I did get used to it and now it feels fairly normal (if normal exists in these crazy-making times). If you live in a house share or a small flat, you may not have a safe and confidential space. I have worked with clients who were sitting in their cars as it was the only space available to them. You may not be confident using technology. You may just really want to work face-to-face and feel like online therapy is second rate. There are many reasons you might not want to work online; I really get that. But these days we bank online, shop online, date online, read our newspapers online, now more than ever we have to work online… why not try doing therapy online too?

Yes, it is different – there is less body language to read, and fewer personal cues and you may feel less connected at first. You might find it a bit surreal – as is the whole situation we are facing right now. Webcam is more like face-to-face working than any of the other online options, such as email, instant messenger and voice. But like all new things, with a little time and practice you can get used to it and stop noticing the distance. And after all, at the moment it is all we’ve got.

If you do decide to work online as a client there are a few things to consider:

Space – make sure you have a safe, confidential space where you will not be disturbed, and you may want to use headphones with a microphone to keep the conversation private. The therapist usually sets up their therapy room – I check that I have a bin, tissues and water, but this is different online. As a client you will have to prepare your own room –  make sure you still have tissues and a drink, that you are warm enough, and that the lasagne you just put in the oven is going to be ok for an hour. Therapists may not be able to use their therapy room at the moment and may need to relocate to new spaces, and you may not have any space in your house other than your bedroom so you may also want to check what is on display in the background – your washing up or toothbrush!

The relationship – it may feel odd working online, whether we have worked together for a while or only just started. It can be valuable to talk about how we are both finding the online experience. It’s important to just acknowledge that working online is different, and not seeing each other face-to-face may feel like a loss – that something is missing. It may not feel as real to meet online as it would if you were in person. But again, we can all get used to this with some time and practice.

Now let’s look at technology. Zoom is a popular choice at the moment, it is secure and safe for online therapy. How it works is that I send a link via email so all you do is click on it or cut and paste to your browser a couple of minutes before the session start time. I send out guidelines and details about a plan B if technology fails which given the high demand now is more likely. There are a few options for online therapy, not just webcam if this isn’t for you. If you don’t have a confidential space, then Instant Messenger / chat could be an option, as well as email or voice which is when we speak through Zoom but switch off the webcam. Traditional telephone calls work too of course.

If you would like to try online and you think that you may benefit from some counselling at this stressful time, drop me an email: jules@juleshaleycounselling.com

Top Ten Tips for Online Working for therapists

20200320_161053

Due to the Coronavirus many counsellors are, with some reluctance, turning to working online to support their clients though this anxiety-provoking time. Normally I would have recommended doing some online therapy training as it’s a different skill set and has professional, ethical and legal requirements that need to be understood. But many therapists are now facing the dilemma of needing to do something – to offer to work in ways they have never done before and may not be entirely comfortable with, and the wish to continue support clients and keep their practice open.

I qualified in online therapy with Online Counselling Services and Training (OCST), and I am a member of the Association of Counselling and Therapy Online (ACTO), who can provide a list of online therapists if you do need to refer clients at the moment. Online Events has more information and training on working online.

Below is a list of Top Ten Tips, considerations and practical suggestions for online working. It is not comprehensive, but it will hopefully provide a little support for anyone just starting out with online working.

  1. Check with your insurance that you are covered to offer online working.
  2. There is lots of new guidance currently being produced about online working including BACP guidelines for online working.
  3. Ensure that you have online security in place and register with the ICO.
  4. Online working includes webcam but also voice/phone, Instant messenger (IM) and email. Check with clients if they are comfortable with working online. Not all clients can or will want to. For clients who cannot find a confidential space to do webcam work, I am offering chat / IM or a combination of webcam and IM. I am currently offering weekly 15-minute calls to check in, connect and support with those clients.
  5. Clients may feel more or less connected to you online than face-to-face. Be aware of disinhibition, where they share more online than they would feel comfortable in person.
  6. You may need to amend your counselling agreement to reflect online working and recontract with your client.
  7. Therapists are usually responsible for setting up their room, but this has now changed. I sit in my usual chair in my counselling room and so my laptop is opposite me in a space that the client would normally occupy in person. Clients have said that they feel comforted by this – seeing me in my room, and this familiarity helps to ground them and feel more comfortable with this new way of working. Clients also invite you into their space so there is something about acknowledging this and the feeling of equality in this. I learn a bit more about my client’s physical world too.
  8. I send guidelines on online therapy to clients before we meet so they can prepare for their session. It includes information about the online platform we will be using usually Zoom, how to access it, what happens if technology fails, and outlining a plan B. I also suggest that clients turn on their pc / laptop at least 15 mins before the session so any updates that need to run won’t delay the session. I also suggest they make sure their space is private, to ensure it is confidential, they have a drink, headphones if required, are warm enough and have their diary to hand. Some clients use their cars if their home is not suitable for a private conversation. Some clients may use a mobile so I request that they have it landscape as it means I can see them better. I do not use Skype or WhatsApp as these are usually used with friends and family and therefore can feel less professional and boundaried for therapy. Mainly I use Zoom and Vsee because they are safer and have better security.
  9. There may be misunderstandings in online therapy due to the lack of personal cues. I usually rely on my felt sense in face-to-face work so online I tend to ask more questions to clarify my understanding. I also try to communicate more than I would in person, my experience of the session as it evolves.
  10. Practice, and practice some more with peers if you have not worked online before. Clients deserve to feel held and well supported and if we are struggling with technology this can be stressful for everyone. Having a plan B if technology fails, which at times of high demand is likely, can help you to remain calm and feel in control.

If anyone has any questions about the move to online therapy, please drop me an email jules@juleshaleycounselling.com

 

New series of Dining Room Dialogues 2019/20

Dining Room Dialogues, Autumn 2019

‘Dining Room Dialogues’ is a monthly, themed, peer-based group interactive discussion for qualified therapists and trainees or people who work in the health, education and social care professions who have an interest in the Person-Centred Approach. At each discussion a group of 7/8 people meet around a dining room table, with the opportunity to learn together by each bringing our knowledge and experiences.

Each discussion is facilitated by Rachel Yates and Jules Haley. Rachel is a qualified counsellor and mental health trainer with over twenty years of experience of working with alternative “models of madness” (Read & Dillon, 2013) and the person-centred approach to mental distress. Jules is a qualified therapist who has personal and professional experience within a drug and alcohol wellbeing service, supporting people’s recovery journey, and facilitating recovery groups.

The Autumn set of Dining Room Dialogues will develop new ideas and understanding of ‘Ways of Coping’. You will have an opportunity to learn and raise thoughts, ideas or ask questions. It is totally up to you how much you want to contribute and take away, at your pace and perhaps at times based on what is relevant within the discussion to you. Please be aware that although these groups are a confidential space, they are not an alternative to supervision and/or therapy.

The ‘Dining Room Dialogues’ are held in Walthamstow, East London, E17. Each session starts at 11am and we will finish at 3.30pm. A homemade vegetarian lunch, snacks and unlimited good coffee and herbal teas is provided. Please let us know if you have any specific dietary requirements.

Cost is £40 per person/ per discussion group (this includes lunch, summary content notes after the day, and a certificate for CPD). Payment is by BACS in advance. If you would like a place please email:  jules@juleshaleycounselling.com. A list of relevant and interesting reading such as books, articles or videos will be provided before each session for you to look at before the discussion, although it is not an issue if you do not get to it before the session.

Dates and themes:

‘Ways of Coping’ – November 2019 to February 2020.

  • Self-Injury – Sunday 3 November 2019
    • We will be talking about why people harm themselves, and the links between self-injury and suicide. Our own attitude towards self-injury. The impact on people’s lives and the people around them, and ways to support people including referral options.
  • Relationship with Food – Sunday 1 December 2019
    • Looking at the difference between problem eating and an eating ‘disorder’. Why people may develop eating ‘disorders’. The health impacts. Our own relationship with food. How we can safely support people who use food as a way of coping.
  • Selfcare or selfish? – Sunday 12 January 2020
    • We will be looking at what the concept of self-care means to us and the people we work with and its importance. Self-soothing and the nervous system. Looking at ways in which we may look after our whole wellbeing – physical and mental, and the concept of developing a spiritual discipline (Thorne, 2003).
  • Drugs and Alcohol – Sunday 2 February 2020
    • We will be thinking about and discussing why and how people use alcohol and drugs, the concept of ‘addiction’, the effects on them, families and the people around them. Ways to support people who are using alcohol and drugs as a way of coping and referral routes. Ethics of working with people currently using or under the influence.

Dining Room Dialogues

Dining Room Dialogues – a discussion group for therapists and trainees.

‘Exploring Madness’ runs from February to April 2019. Each session starts at 11am, finishing at 3.30pm on a Sunday.

Next discussion is on Paranoia and Unusual Beliefs – Sunday 3 February

  • We will be thinking about and discussing why and how people feel paranoid and hold unusual beliefs. Ways to support and work with unusual beliefs. Rachel will draw from her experiences of 8+ years running a community peer-led Unusual Beliefs group.

More about ‘Dining Room Dialogues’
They are a monthly, themed, peer-based group discussion for qualified therapists and trainees or people who work in a caring/supportive profession i.e social worker, teacher, support worker and who have an interest in the Person-Centred Approach and a belief in a more trauma-informed and non-medicalised approach to mental health and mental distress. It will be a small group of 7/8 people sat around a dining room table, with the opportunity to learn together by each bringing our knowledge and experiences.

Each discussion will be facilitated by Rachel Yates and me. Rachel is a qualified counsellor and mental health trainer with over twenty years of experience of working with alternative “models of madness” (Read & Dillon, 2013). Her career has been at St Mungo’s, a homelessness organisation, within a client-facing role where she led and delivered psychologically informed and trauma-responsive environments based on the person-centred approach to mental distress. I am a qualified therapist with lived experience of mental health issues, including the good, bad and ugly ways of coping.

We will develop new ideas and ways of understanding through our discussion together about specific issues, starting with ‘madness’ over a set of three Sundays followed by a set on gender and identity. You will have an opportunity to learn and raise thoughts, ideas or ask those questions that you may have just keep to yourself over the years. It is totally up to you how much you want to contribute and take away, at your pace and perhaps at times based on what is relevant within the discussion to you.

(Please be aware that although these groups are a confidential space, they are not an alternative to supervision and/or therapy.)

Details

Each of the ‘Dining Room Dialogues’ is held in Walthamstow, East London. A homemade vegetarian lunch, as well as unlimited good coffee and herbal teas is provided at the dining room table. Please let us know if you have any dietary requirements. Cost is £25 per person/ per discussion group, payment is by BACS. A certificate will be provided for CPD use. Each discussion is stand alone so you do not have to attend all three in the set.

A list of relevant and interesting reading such as books, articles or videos will be provided before each session for you to look at these before the discussion group meets, although it is not an issue if you do not get to it before the session.

Dates and themes

‘Exploring Madness’ runs from February to April 2019. Each session starts at 11am, finishing at 3.30pm on a Sunday.

  • Paranoia and Unusual Beliefs – Sunday 3 February
    • We will be thinking about and discussing why and how people feel paranoid and hold unusual beliefs. Ways to support and work with unusual beliefs. Rachel will draw from her experiences of 8+ years running a community peer-led Unusual Beliefs group.
  • Hearing Voices – Sunday 3 March
    • We will be talking about what hearing voices is like, think about where the voices may come from, the impact on people’s lives, and ways to support people with this experience.
  • The label of ‘Personality Disorder’ – Sunday 7 April
    • We will be looking at the diagnoses of personality disorder that clients may acquire – the validity, impact and meaning. How we can support someone through exploring the person-centred work of Margaret Warner (Pearce & Sommerbeck, 2013). Client processes at the difficult edge on Difficult Process); looking at the experience of fragile, dissociative and psychotic process. I will drawn on my personal experiences of living with difficult processing styles.

‘Exploring identity’ runs from May to July 2019

  • Non-binary and trans identity – Sunday 5 May
    • We will be thinking about and discussing our understanding and language of gender, trans, non-binary and gender expression. The impact of being gender non-conforming and thinking about ways to support non-binary and trans people.
  • Non-monogamous and ployamorous relationships – Sunday 2 June
    • We will be talking about reasons why people are in these relationships, issues that they may bring to the counselling room, our prejudices and understanding, and thinking about how we support them.
  • Sexuality – Sunday 7 July
    • We will be looking at how the experience of growing up, coming out and living as gay/lesbian/bi in a ‘straight’ world affects people’s mental health, self-esteem and relationships. We will be thinking about how this can bring them into counselling, and the support they may be looking for.