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To train or not to train, THAT is the question!

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I’ve been working therapeutically online, alongside face to face counselling, for around six years now providing therapeutic interventions via VOIP, synchronous and asynchronous text and over the phone.  I’ve worked with groups, one to one and supported an entire global online therapeutic community.  Believe me when I say the switch incurred a steep learning curve in the early days and I’m still learning now!

So, when I hear other practitioners saying that they’re qualified to work online because they’re qualified counsellors, therapists, psychologists or psychiatrists I break out in a cold sweat and develop a bit of a twitch!  Is it true that the BACP don’t tell you, you HAVE to undertake additional training to work on line?  Well…yes it is, but what they actually say is:

“Practitioners who offer online services need to ensure that they are suitably trained and qualified for their work and BACP recommends (Anthony, K. And Jamieson, A., 2005) that online work should be considered as a specialist area and practised only by those with extensive post-qualification experience of face-to face work. In addition, appropriate further training or professional development is strongly recommended before deciding whether to use the Internet for provision of therapy.” (BACP, October 2007)

And in my opinion we need to take their recommendation very seriously.

To work online, particularly with text, you need to find beauty and power in the words you use to sculpt your responses.  You need to be able to find the hidden meaning (where one exists) in a pause or typo and you need to enjoy creating vivid pictures, and indeed worlds, with your text.

Now….it will be of no real surprise to you that I love words :).   I’ll reread a well crafted phrase and the insights it allowed a client to reach with a sense of deep satisfaction and reflect on things I could have said differently to promote further development for the client.  There is a clarity provided by a complete transcript of a session that can’t be obtained through the subjective reflection on a face to face session that I relish.

To work online takes passion, and faith that this type of therapy works…it also takes preparation and training because you’ll feel things you didn’t know where possible, you’ll be frustrated at times and you’ll be surprised and even shocked if you haven’t done your research!

Imagine for a moment that you’re in your counselling room sitting opposite an acutely distressed client…they hold their head in their hands and clutch a tissue as tears stream uncontrollably down their cheeks.  Struggling to breath, and on the verge of the disclosure you’ve been working towards for several months, they promptly disappear…into thin air…..POOF!  How would you feel and what would your concerns be?  What would you have in place to make sure that client was safe?  Of course this doesn’t happen outside of the realms of sci-fi but when you’re working online a disconnection (deliberate or otherwise) will feel very much as I’ve described.

The considerations involved in working online are numerous they include the technology you would need to look into, a difference in the way we practice, the law, insurance issues and many other areas.  In all honesty it’s a minefield…but it’s worth it.

If you’d like to contact me to talk about the subject please e-mail me at jane.fahy@hushmail.com and if you’d like to learn more about some of the training that’s out there please go to http://onlinetherapyinstitute.com/ .

Thanks for reading 🙂

Jane Fahy (RMBACP)

 

Clinical Services Manager, Gambling Therapy

Tutor, Online Therapy Institute

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Running Online Support Groups

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Making the move from musician to conductor

I love all of the therapeutic work I carry out online, the one to one interventions are both challenging and rewarding due to the speed with which they progress, and the forums allow for the intervention of a therapeutic online community which complements the support I, and my team, provide.   By far and away my favourite method of support and therapy online though is group work. For the purpose of this blog “group work” refers to a synchronous, text based, group of up to nine attendees and one practitioner.

I run a range of online groups from structured therapy groups to themed groups and groups for people new to me and to recovery from addiction. Each group has a different feel to it dependent upon the group type, who’s in it and how many people are there.

Small groups require a lot of practitioner participation…at times I find myself posing hypothetical questions or sharing something about my own experiences to get the ball rolling (so to speak). In other small groups I might find myself in a situation where I have to remind people that others entering the group (if the group’s access isn’t restricted in some way) may be able to see some of what they have typed in order to ensure they’re mindful of the depth of material they’re sharing. I do this because it’s easy for people talking about intense emotions online to lose track of “where” they are and get drawn in by the anonymity of cyberspace and the feeling of intimacy created when talking to only a few people. In these kinds of groups I feel like a musician in an orchestra…playing along and harmonising to make sure the overall effect is what it needs to be.

A larger group is a different beast altogether 🙂 it takes focus and fast fingers to facilitate a large group and keep them on track…at times it feels rather like trying to herd cats but most of the time it’s captivating. It’s my role to make sure the flow of the group makes sense and that everyone has the opportunity to share. Of course this is something that counsellors do in a face to face group but online we have the disadvantage of not being able to see who’s leaning forward…chomping at the bit with a desire to share…or who’s been upset by a comment and may need support or clarification. Part of what I do is to involve people and clarify what is meant and understood by comments throughout the session. At times I encourage people to explicitly state what their bodies are doing so the group can see a mental image of how a discussion is affecting them. It’s up to me to spot if someone has withdrawn from the discussion and involve them again if appropriate. I also have to manage potential group monopolisation in a sensitive way. Ultimately I have to make sure people feel safe and heard in groups and to do this I make the transition from musician to conductor as I view the group as a whole and pay attention to the nuances in the conversation to better direct the symphony.

If you’re a counsellor considering trying online groups I can’t recommend them highly enough but I would strongly urge you to ensure you have taken part in the appropriate training before hand. Training providers I used, and was very happy with, are http://onlinetherapyinstitute.com

Thanks for reading 🙂

So you’re thinking of delivering therapy online?

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A few points you might want to reflect on when it comes to online therapeutic interactions 🙂

When working online, using real time typed or “synchronous” chat for the purpose of therapeutic interventions, there are certain drawbacks you need to accept. If you work extensively with body language and base your insights predominantly on facial expressions it can be difficult to make the shift to taking advantage of a new form of “body language”.  The body language I’m referring to is evident in the text the client provides and the length of time taken to provide it.

Pay close attention to the way responses are being typed…….as well as their actual content. If a client starts the session typing in quite a precise manner, taking care to ensure correct spelling and grammar are used, but when a certain issue is raised typing becomes faster and less accurate that would give you an idea of some kind of emotional distress taking place linked to the subject at hand.  If a client takes a great deal of time to respond to a question but they then provide only a one word answer have they deleted something or was the question particularly hard to answer?

Something often talked about in the field of online therapy and support is the “disinhibition effect” (J, Suler) this term relates to the speed at which painful disclosures occur online. Seemingly, because of the anonymity and physical distance between client and counsellor present in online work, clients feel more able to discuss personal and painful information at an earlier stage of the helping process than they would have done in a face to face support situation.  This is something you need to bear in mind as you will need to manage the client effectively so they don’t later reflect on their rushed disclosures and feel embarrassed or ashamed.

As clients are unable to see the face of their counsellor you need to become used to explicitly stating how you feel in response to what the client is disclosing. As the client can’t see a smile you simply need to say something like “When you said that, it made me smile” or “When you talked about ….. it made me feel sad”.  This kind of statement helps the client to feel that they’re cared for and understood and it strengthens the therapeutic alliance.

Unlike face to face support, a client can quite literally take the information being discussed away with them; they can save it or print it off.  Whilst this creates a valuable point of reference for clients it also means you need to be mindful when typing responses.  You need to be very clear in your interactions with a client and make sure to clarify with the client any points they are unclear of.

As you can see, there are a few things you’ll need to consider about the actual nuts and bolts of working online that go beyond what level of encryption you need, what colour your website should be to make it look calming and which VOIP provider you should use….Don’t get me wrong, those are all important things but we are in the business of talking…and we have to make sure we can get the talking thing right first 🙂