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Is Online Therapy For You?

As technology becomes more and more integrated into the daily fabric of our lives online counselling is gaining in popularity. It does seem to have many immediate advantages. Instead of having to fit travel time, and sometimes time off work, into already busy schedules, clients can arrange sessions at their (and their therapists) convenience.

It might seem like an obvious string to add to your bow if you are a counsellor, no doubt you already have a computer, however, familiarity with the technology goes much further than just knowing how to turn it on. There exists little guidance for clients in taking up online therapy and a whole host of often contradictory opinions from therapists. Whilst this post cannot cover everything a course in online counselling would cover, it hopefully might give some idea of whether it would suit you, whichever chair you might be sitting in.

Familiarity and Fear

It sounds so simple, we all have cameras on our various devices, just sit down, switch on, and away you go, therapy at your fingertips! However if we are unused to cam to cam communication, or instant messaging, it can create a new, often unrecognised barrier to building a good therapeutic relationship. Recently I read of a counsellor talking about working with people online, and her difficulties with not being able to “look them in the eye” and observe their body language. With growing horror I realised that she was staring down the camera at her clients, interpreting it as their eye. . Having used Skype, or other methods of online communication for over 15 years, I wondered at how I would feel if someone was staring “out of the screen” at me like Orwell's Big Brother.

People use cams differently, and, if you have grown up using them, the idea that there even is a cam is one filed away at the back of the mind. If you are intending to offer therapy via Skype, or other media, spending time just talking to non clients online is well worth doing. How do you feel on cam? Does it feel false, as if you need to put on a show? Can you relax and be yourself? You do not have to to be 100% comfortable, either as client or therapist, for online counselling to be effective. However, you do need to be aware of any fear or misapprehensions of the medium you may have, and be willing to explore them.

Over Familiarity

For every action, there is, an equal and opposite reaction, and it's as true of therapy as it is of physics. Being familiar with a medium matters, being over familiar can mean that it takes more effort on the part of the therapist to establish that this is a professional relationship. If an hour with you is slipped in between chatting with friends, checking tinder, popping onto FetLife, and catching up with cousins in Australia a client may approach the sessions differently. When I first started online counselling I was surprised by a client who appeared to be in bed during sessions. Not on the bed (in shared housing a bedroom is often the only private place a client may have) but actually still in bed. I realised that they were setting the alarm just minutes before our session, and treating it as they would a catch up with anyone else they knew online. My inexperience meant I did not challenge this early enough, and it became harder and harder to say anything. Now I discuss this in our initial contracting session. Not just setting aside the time, and emotional space for the therapy session, but also closing it off afterwards.

In face to face counselling the client travels to, and leaves the therapeutic space, and has a physical act of transition which allows them to leave behind what they may need, to be picked up next week. If they simply turn off the cam, then go onto facebook, or to check what is happening on twitter, there is no break between the therapeutic experience and the rest of their life. Even if it is just going to the kitchen to make a cup of tea some form of symbolic change of space is invaluable. In the same way I explore in that first session where the client might choose to have their therapy. Often there are not many choices, especially as so many young people are forced to share due to property prices. Something simple such as sitting by the bed and not on it can demarc the therapeutic space as separate, but still part, of everyday life

Trust the Client

It is not uncommon to read objections to online therapy based on a therapist's own comfort zone and preconceptions. Energy in the room is cited, or the inability to read body language. I always wonder how they would respond to someone disabled, who may not be able to move in a way they expect, or a client of a different cultural background (given that body language is culturally specific). Which is not to say that body language does not matter, but there are many ways we can hide our fears behind theory. We talk a lot about clients projecting their fears onto their therapist, but of course, therapists do it too. Appealing to non quantifiable processes, or claiming that a method will not work because of a perceived difference to how the therapist usually works is around our own fears of stepping outside of our comfort zone. Of course, if we are content working as we are, there is no need to make any changes, but neither is there a need to disparage how others work. On a fundamental level we need to trust our clients, if a client believes that a form of therapy other than the conventional face to face in person appointments will work for them, then, we must consider that they are right.

Technology has opened up new ways of working for millions of people, that's not a good, or a bad thing, it's simply a fact about the world we live in. It doesn't mean we have to change how we work, nor does it mean we have to reject innovation, simply because it is new. Technology, be it the lever of the Mesopotamians or the iPad of the millennials is always simply a tool, to be used as and when we find it makes life a little simpler.

Authors Bio


Karen Pollock is an intergrationist counsellor who offers online and in person therapy. Registered with the BACP and Pink Therapy she works largely, but not exclusively, with gender and sexuality diverse clients as well as being a curator of the The Queerness Magazine, Karen can be contacted via email here or you can follow her on twitter

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