Tag Archives: working with risk online

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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Unleashing the Training Brain

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I was recently called upon, by Kate Anthony CEO of the Online Therapy Institute, to empty the contents of my brain, concerning working with problem gamblers, into a platform for remote training. It’s an odd sensation trying to pick over the knowledge and experiences you’ve accumulated over six years to try and determine what information might be interesting and useful and help others to support a client group you’ve developed quite a passion for. I think part of me was initially reluctant to share too much, what if everyone started supporting problem gamblers and I had no one left to work with?!? But then I thought about that, what if many more counsellors, social workers, support workers and addiction specialists started to support problem gamblers? Surely that would mean the client group I cared so deeply for, and frequently commented there wasn’t enough support globally for, DID get more support? That’s exactly what I want! 🙂

So here I am, after weeks of wondering… “Will they want to know about this” and hunting down other online resources each time asking myself…”Will they find that useful?” I’ve finally finished writing the course content! I’ve tried to cover as many of the aspects of working online, offline or both, with problem gamblers as I could fit into a ten hour course. I feel it will give anyone with an interest in working with problem gamblers by blending face to face and online support a robust grounding in the subject.

The areas covered are:

  • How do you know if someone has a gambling problem?
  • The theory of problem gambling
  • Working with problem gamblers
  • Working with friends and family
  • Online support for problem gamblers
  • Gaming and internet use for problem gamblers
  • Managing suicide and risk online
  • Using blended technology in a face to face and residential setting

If you’re interested in helping problem gamblers and you want to know more about the course please drop me a line at the following e-mail address, I’m eager to share my passion for working with this remarkable client group with others!

If you want to learn more about online therapy in general, the Online Therapy Institute have some amazing short courses that might be of interest to you 🙂

jane.fahy@hushmail.com

 

Same Day…Different Username :)

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Do you meet people in online therapy groups over and over that seem familiar?

 

People using online support often adopt online personas or “roles” within groups that coincide with an associated set of behaviours which can often appear unhelpful at the time. These sets of behaviours are referred to, in counselling terms, as “Games”. What I’ve attempted to do for the purpose of this blog is to identify some of these patterns of behaviours, using the Transactional Analysis Model as a loose framework to look at ways of working with them.

I’ve experienced a degree of psychological game playing in some of the groups I’ve facilitated and in one to one online therapy sessions over the years. They can be both frustrating and confusing at times, especially when I was new to all this :), because I might have had a sense of a game being played, but it felt like no one had told me the rules!

So….what I wanted to do was to blog about my perception of the kind of roles that seem to be reoccurring most often in my groups to see if anyone else had experienced similar things. During my group work I’ve spotted some of the following roles and the games they typically play, let me know if they sound familiar:

The Lurker – The lurker will spend most of his or her time saying nothing. Attempts to involve them in the group discussion will receive monosyllabic responses, if they respond at all. Whilst they may outwardly appear to avoid receiving attention their behaviour indicates a strong need for attention which others provide as they become “hooked” into the game and repeatedly attempt to elicit a response. The game usually ends when the lurker has received enough attention, positive or negative, when they will abruptly log out.

The apparently contradictory behaviour can be very frustrating so it can be easy to make numerous attempts to engage this person and effectively “play the game”. In order to manage the flow and dynamics of the group it’s important to fight this urge and ask only once or twice whether the individual has anything to contribute to the group.

What I’ve found is that if the individual isn’t getting the desired outcome they’ll choose to either log out, or engage with the people around them…of course we always hope for the latter outcome 🙂

Now, I KNOW that many people are shy and don’t really know how to use therapy groups when they first arrive and they’re not the people I’m talking about…of course it’s ok to be shy or reserved and all efforts should be made to encourage new people to feel at home. A Lurker is someone who carries out the above behaviour repeatedly over time without considering the impact it may have on others in the group which I feel is something completely different.

The Monopoliser – This person will talk (type) a great deal. They will often ignore what’s being said by others and carry on with their own train of thought regardless of any questions they’re asked. The aim of the monopoliser during this game is to receive collusion and sympathy. Ultimately to offload without being challenged in order to continue doing what they‘ve always done.

As no other comments have been made, or if they have been made they may not have been “heard”, the monopoliser can reassure him or herself that no one can help them to change their situation and there’s nothing to be done.

In order to counteract the game, the facilitator will need to involve others in the group by asking if they’ve ever been in a similar situation. The facilitator is required to manage the flow of the group to ensure that others all have a chance to share.   This might mean explicitly stating that time is limited and others in the group might be in need of support. If forums are available, it can be a good idea to direct the monopoliser toward them so they can share at length without being restricted by the group format. They’re then also unable to “block” responses from others by simply continuing to type.

The Joker – Diversion, distraction, smoke and mirrors are the currency of the joker. During this game the Jokers intention is to feel that he or she is working on their emotional wellbeing by attending the group whilst avoiding any meaningful discussion about the issues at hand. As their name suggests, the Joker will make jokes and potentially inappropriate comments during the group which can often derail the conversation and upset other group members.

It’s my job to tentatively challenge this behaviour by acknowledging that it can be very difficult to discuss emotional issues and making light of the situation can make it feel less intimidating.

Whilst we would like the Joker to engage on a deeper level they might not feel able to do so at this stage so we’re only able to manage their input to a certain degree and exclude them as a last resort if they become too distracting or offensive.   Terms and conditions, a contract or code of conduct are useful tools when it comes to challenging inappropriate behaviour online.

The Rebel – The rebel will appear averse to any suggestion. Ideas that the rebel is presented with by the facilitator or other attendees will typically be responded to with the words “Yes but….” before they go on to list the reasons why the idea wouldn’t work.

….”Yes but I couldn’t get to that meeting because….”

.…”Yes but I tried that and it didn’t work because……”

….”Yes but I would have done that if….”

My own experience of providing support online would seem to suggest that this is the most common game played by the people accessing online help. Individuals who are not ready to fully engage in recovery may use a site to “dip a toe in the water” but when faced with suggestions that could appear too difficult or even frightening they’ll discount them.

It’s important not to simply keep putting forward a myriad of ideas for the Rebel to discount as this leads to frustration on both parts. This could lead the Rebel to feel misunderstood or even bullied, potentially leading them to discount counselling altogether.

The facilitator can put an end to the game by reassuring the Rebel that recovery is a very personal thing and not all suggestions will suite everyone. The rebel should then be encouraged to take a creative look at their recovery and use groups to seek feedback on the ideas they come up with.

Online psychological games are common place, perhaps even more prevalent than during face to face support or counselling. The games people play are their way of confirming the facts as they see them whether that is that no one understands, that no one can help or that no one cares and our role is to attempt to show people that this perception is incorrect.

It can be frustrating when faced with any of the games I’ve talked about here and this frustration will only be exacerbated if we allow ourselves to be hooked into playing. With these, and many other psychological games, the only way to avoid frustration and hurt feelings is not to play.

The idea of psychological games is an integral part of the Transactional Analysis model for counselling. For further information on this please visit the following site: http://www.ericberne.com/Games_People_Play.htm

Thanks for reading 🙂

World Suicide Prevention day

It’s world suicide prevention day today so I thought I’d pen (type) a few words on the way in which we can work safely with suicidal clients online.  I’ll be talking about problem gamblers specifically as they’re the client group I work online with.

It will come as no surprise to anyone that problem gamblers can sometimes be suicidal….people who are addicted to gambling are often able to hide the addiction for quite some time, maybe even years, from those closest to them.  If you’re in a relationship with a problem gambler you might get the sense that something is wrong…your partner might be distant, anxious, depressed and even have angry outbursts for reasons you can’t identify but none of these things would necessarily lead you to the conclusion that he or she was a problem gambler.

Thoughts of suicide thrive if the thinker feels no one cares and in their distorted view of the world a problem gambler might interpret a loved one’s lack of understanding as apathy.  Of course it’s pretty difficult to show understanding regarding a situation you know nothing about!  Another contributing factor to the consideration of suicide as an option for many problem gamblers is the fear of being “found out”.  Think about it….you’ve spent a long time hiding your addiction….getting rid of the betting slips…clearing your browser history….taking the bills away and putting them somewhere “safe” before they even have a chance to hit the mat and you’ve managed to keep all of your balls in the air BUT you know that tomorrow you’re going to get caught.

If a problem gambler knows that the secret is going to come out because there is some form of communication on the horizon that can’t be controlled heading in the direction of a partner, such as a call to the bank the partner intends to make to find out just what the hell is going on, they may feel utterly desperate!  The idea of facing someone they love as the extent of the chaos they’ve created is unearthed before they’re very eyes can be too much to bear for some and there only seems to be one way out.

I work for an international online counselling and support site for problem gamblers and sometimes I “meet” people who have reached the exact state of mind I’ve described.  Now, I don’t want to go into the ins and outs of what can and can’t be done to get help to people in distress when working online because although there may be a few things, involving IP addresses etc, they are very limited if you’re working on a “drop in” basis to provide emotional support.  Obviously if you’re working in a structured way, with a contract and details of Doctors and next of kin, which you would have if counselling someone, you have greater control over what you can and can’t do.  So, for the purpose of this Blog, let’s focus on the people who click a button and get through to us without having had any prior contact with our staff team.

First and foremost and in the words of Hitchhikers Guide….DON’T PANIC! If you receive contact from someone who implies or explicitly states that they are suicidal.  The service user is seeking help by speaking to you which is a positive thing.   There’s no empirical or anecdotal evidence to suggest that talking about suicide or indeed naming it, if service user talks about “not wanting to carry on” etc, will increase the likelihood of a suicide attempt.  In fact, quite the opposite is true as many people report feeling relieved at being able to explore their feelings about the subject.

Discussions around suicide should be handled sensitively and if your client hasn’t mentioned the word “suicide” explicitly, word your questions carefully and seek clarification about what they’re trying to tell you.  Questions such as “You seem to be saying to me that you don’t want to be here anymore, would I be right in thinking you’re having thoughts about ending your life?” can offer the client the opportunity to open up because it shows them suicide isn’t a “taboo” subject.  You don’t want the client to think they’ll freak you out if they tell you what’s really going on after all.

When a suicide risk has been identified the first step to take is to find out where they are and who, if anyone, is with them.  The primary aim of the conversation at this point is to encourage the client to get some face to face help…whether that’s from a friend; family member, mental health professional or doctor is irrelevant.  If the caller tells you they’re alone and have no one to turn to it’s important to make sure they have a link or telephone number for services such as the Samaritans or Befrienders (outside the UK) before the call comes to a close.  If you build up a rapport they may even give you an address or telephone number you can use to get help to them if it comes to that, which in my experience it very rarely does.

One thing you can do to take the pressure off both of you is to employ a brief “no harm” contract that applies to that particular session.  This means that the service user agrees not to act on suicidal thoughts during or immediately after the session and they agree to access additional support from a friend, family member or organisation following the session.  Without this commitment from the service user you may struggle to have peace of mind and should decide for yourself if you can be effective with such uncertainty in the air.

Some suicidal thoughts are fleeting and vague and occur only when an individual is in crisis whereas other thoughts can be constant and well considered.  In order to help the service user to better understand their feelings you could ask them to rate the intensity of their suicidal thoughts on a scale of 0 to 10 (0 being no strong thoughts and 10 being a determination to act on their feelings in the immediate future).  This will help you determine the level of risk you’re working with.

Another method of assessing risk is to ask the client whether they feel this way as a result of a prolonged period of depression or whether they may be feeling this way as a response to another situation which will pass.  If the feelings are being driven by current circumstances allow the client to explore the possibility of resisting the feelings until their circumstances change.  The emphasis here should be on the way in which circumstances change, has the service user considered coping strategies that are flexible and can change along with their situation instead of employing such a permanent solution?  You can do this by looking at different scenarios with the service user such as talking to the people in their lives that they find to be supportive and helpful.  If the clients’ feelings appear to be more prolonged, encourage them to access a mental health service or their GP to assess whether they may be clinically depressed and identify potential treatment.  Whether clinical or reactive we know that depression can be treated and the low feelings will eventually pass, so try to focus the client on the fact that however painful, their feelings are temporary and death is permanent so wouldn’t it be more logical to look for ways in which to cope until they pass?

Encourage the service user to look at times in the past when they may have felt this way, ask them about what coping strategies they employed before in order to survive.  When working with our client group we have to be aware that the answer to this question may be “I gambled” in which case exploration of other methods of coping in a healthy way should take place.

Always remember that if someone decides to end their life it’s their decision.  I know it’s sad and monumentally frustrating but there are no magic words we, or anyone else, can pluck out of the air to “fix” anyone.  By letting a person talk about suicide openly and without judgement you’re giving them something very special, you’re accepting them….and maybe that’s what they need.

When ending the call the service user should have a clear idea of what to do next and what methods of support are available to them and you should make a note of your experience so you can talk it through with your clinical supervisor.