What is TeleHealth for Counselling?
In recent years, in the same way that telehealth options have been used by physicians and other health care professionals, many counsellors are also using technology and digital communication devices (e.g., phones, tablets, and computers) to virtually and remotely provide counselling services. With the COVID pandemic, these options have generated wider interest.
Internet counselling involves a number of services, from internet self-help interventions to individual therapy and psycho-education (see resources below). Other online resources involve career assessment, psychological testing, and support. Therapeutic uses include email, private e-chats, and videoconferencing. As well, each of these methods is applied through services such as tele-psychiatry, internet psychotherapy, and web-counselling. So many new terms!
The BC Association of Clinical Counsellors (BCACC, 2020) reports that over 1300 counsellors currently provide online and telephone counselling. More than 200 registered counsellors provide online services in the Vancouver area (Counselling BC, 2020). Alongside this, the number of unlicensed practitioners is unknown.
Advantages of Tele-Health in Counselling
Some advantages of using phone and online platforms such as Skype and Zoom for counselling are obvious in situations where there is geographical distance between family members, where family members are reluctant to attend in-person therapy, and where clients in rural or isolated areas have limited access to resources. There are also equalizing benefits when clients have the choice to meet via online platforms, in the comfort of their home, rather than in the therapist’s office(1). Online counselling is also not as greatly impacted by limiting factors such as long waitlists, hours, location, or medical, mobility, or transportation challenges. An additional positive factor is that clients often feel less inhibited by the (perceived or real) anonymity of online counselling; that is, they may feel safer expressing feelings and vulnerabilities (4).
Cautionary Notes for Tele-Health Counselling
Despite these benefits, there are clear concerns (2): First, when utilizing licensed counsellors, across jurisdictional lines, there may be practice boundary issues to consider (e.g., BC to Alberta). Second, tele-communications may not be secure from hackers; for example, "Zoombombing" with non-business platforms. Zoom has since added password protection and virtual waiting rooms where counsellors must allow access to the session.
When choosing tele-health options, it is important to consider that we are in uncharted territory as online counselling is a fairly new service delivery option; therefore, questions emerge about requirements for practitioner training. Similarly, online counselling is not appropriate for some clinical situations, such as severe psychiatric disorders. It may also be helpful to note that non-verbal cues, which provide key information for therapists, may not be as easily accessible in phone therapy, which could lead to a misdiagnosis. Counsellors, then, need to inform clients about the potential for misunderstanding and miscommunication, which can also occur in the process of informed consent and risks.
Other considerations include the use of platforms in a way that does not alienate clients with limited technological literacy. Despite these initial concerns, the benefits of online counselling are numerous, with the widening of access and service delivery from the comfort of home. As well, for clients who would not have previously accessed mental health services because of remote location, or because of hesitancies, inconvenience, or language barriers, online platforms are opening access (4).
During the pandemic, I have used online platforms with clients across British Columbia. Many clients are not wanting to work on change-making issues right now. Instead, they are using the time to check in regarding issues of anxiety, isolation, or uncertainty. Our time is often used for mindfulness exercises, emotional regulation, and breathing. Other clients are looking for a safe sounding board to release their pandemic-induced fears. This space can also be culturally sensitive, as I offer words of comfort, use arts-based activities, or traditional music and objects for meditation and setting intention. If you have further interest, please visit my contact page. We can find creative ways to work together!
References & Resources
Barak, A. (1999). Psychological applications on the internet: A discipline on the threshold of a new millennium. Applied & Preventive Psychology, 8, 231-245.
BC Association of Clinical Counsellors. (2018). Find a counsellor, online counselling. Retrieved from www.bc-counsellors.org
Counselling BC. (2018). Online/virtual counselling: Directory. Retrieved from www.counsellingbc.com
Virtual Mental Health Supports During COVID-19: https://www2.gov.bc.ca/gov/content/health/managing-your-health/mental-health-substance-use/virtual-supports-covid-19
Virtual Mental Health Supports for Indigenous Peoples:
Notes
1. & 2. Negretti, M., & Wieling, E. (2001). The use of communication technology in private practice: Ethical implications and boundary dilemmas in therapy. Contemporary Family Therapy 23(3), 275-293.
3. Rummel, C., & Joyce, N. (2010). “So wat do u want to wrk on 2day?”: The ethical implications of online counseling. Ethics & Behavior, 20(6), 482-496.
4. Harris, B., & Birnbaum, R. (2015). Ethical and legal implications on the use of technology in counselling. Clinical Social Work, 43. 133-141.
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