2.4 Assessing (existing) client appropriateness for online counselling

It is, of course, not just the counsellor’s suitability for working online that needs to be assessed. It’s also critical to consider whether online therapy is the right medium for the client.

What factors might influence this decision? Activity 7 explores this question.

Activity 7: Client suitability

Timing: Allow approximately 15 minutes

Look at the following statements. Are they suitable for working online?

(Don’t worry about the notes that read (T), (P) and (PS) – these will be explained in the discussion at the end of the activity.)

The client has a laptop with a camera and headset that is password-protected and has up-to-date virus protection and secure Wi-Fi. (T)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

The client is not able to easily express themselves in writing, for example due to arthritis or dyslexia. (P)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client has sufficient hearing to manage phone and video conferencing. (T)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

The client is not experiencing any issues with reality testing: that is, they are able to objectively evaluate their own feelings and thoughts against external reality; this is distinct from a state of psychosis. (PS)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

The client is very keen to engage with online counselling and says that the best time to have an appointment is in the morning, while they are looking after their five-year-old twins. (P)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client is not presenting with high risk, for example related to suicide. (PS)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

The client is not able or willing to provide you with GP contacts, emergency contacts and details of emergency services in their area. (PS)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client has difficulty accessing space at home where they can talk without being overheard or interrupted. (P)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client has sole access to a computer, tablet or smartphone. (T)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

The client is anxious about using computers, smartphones and the like. (T)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client’s main presenting concern is their partner, with whom they live; the client talks about how controlling and jealous their partner is. (PS)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is b.

The client and counsellor have agreed clear and appropriate steps about how to proceed in the event of an emergency. (PS)

a. 

Potentially suitable


b. 

Potentially not suitable


The correct answer is a.

Discussion

It is important to assess suitability along several dimensions:

  • (T) = Technological: Is the client open to and comfortable with working online? Do they have appropriate equipment and technical skills?
  • (P) = Practical: Does the client have a suitable space to engage in online counselling – is it private, where they will not be overheard or interrupted, for example by children or partners?
  • (PS) = Psychological suitability: Is the client presenting with an appropriate level of risk for working online? Is there is a clear agreement about steps to take in the event of an emergency? Are there any factors in the client presentation that might make accessing counselling from their home potentially risky?

In relation to psychological suitability for online counselling, the BACP’s competences for telephone and e-counselling (2016a, p. 4) state that it is important to assess for psychological difficulties and presenting problems that may make it harder for clients to make effective use of telephone and e-counselling. These include:

  • clients who need a high level of care and support
  • clients struggling to function
  • clients who present a high level of risk (such as suicide or self-harm)
  • evidence of poor reality-testing
  • evidence of strong transference reactions that may be difficult to contain
  • evidence of a tendency to challenge boundaries and/or present in a fragmented and inconsistent manner across time or medium of communication.

Pause for reflection

Does the current context have implications about how risk might be both assessed and managed for your clients? For example, consider changes in how GPs or mental health services are currently offering services. (This may not be relevant for your work with clients – but if it is, you might consider discussing the implications with supervisors and, if appropriate, clients.)

You should now move on to Topic 3: General considerations for online counselling [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] .

2.3 Assessing counsellors’ competence for online working