3.2 The online counselling relationship
Building and maintaining a good therapeutic relationship might feel challenging if you have never practised beyond the face-to-face format.
Depending of the type of online therapy, you will have fewer cues available to you when you communicate with your client: non-contextual and non-verbal cues in text-based online counselling, for example. You might be worried that you could miss any subtle cues that you often pick up in the counselling room. You might also wonder how it might feel to (virtually) enter your client’s private space – for example, on a Skype call – and how this could potentially affect or shift the therapeutic boundaries.
Pause for reflection
How do you feel about relating to you clients online or on the phone? Are you worried about any of the issues listed above or the risk of miscommunication in this medium?
While it might take some time to adapt to the new medium, research shows that it is possible to establish and maintain an alliance that is sufficient to facilitate psychological change (Hanley, 2012; Berger, 2016). Facilitated by disinhibition processes and feeling safe, clients have been reported to have quickly developed a good and trusting relationship with their online counsellor (Fletcher-Tomenius and Vossler, 2009; Ersahin and Hanley, 2017).
Counsellors and clients seem to be able to compensate for the lack of cues (for example, in text-based online counselling) and instead create mental representations of each other that help to build the therapeutic alliance (Suler, 2010). However, counsellors who work with clients online should be aware of a potential shift of control and power balance in this context.
Activity 10: Power and control in technology-based counselling
How do you think issues around control and power balance differ in online counselling compared to face-to-face provision? Make a few notes in the space below.
Clients in different types of online counselling typically report a shift of control over counselling processes and interventions, for example about. how much clients want to disclose (Fletcher-Tomenius and Vossler, 2009; Gibson and Cartwright, 2014).
In videoconference counselling, clients commented that ‘the enhanced control and personal space that they feel in video therapy can enhance the therapeutic alliance’ (Simpson and Reid, 2014, p. 295). The increased degree of autonomy can also mean that clients have more control over session timing and endings: for instance, a session can be ended with a mouse click.
This shift of power and control can potentially be empowering for clients; however, for counsellors new to online counselling, it might take some time to become accustomed to.
Finally, because it seemed odd not to recognise this when talking about the therapeutic relationship, the coronavirus crisis will affect engaging in online counselling currently. ‘The constant fear, worry, uncertainties and stressors in the population during the COVID-19 outbreak’ are recognised by the World Health Organization, which consequently has specifically targeted efforts towards mental and psychological health and wellbeing during the epidemic (WHO, 2020, p. 3; see also Huang, 2020). As counsellors, it’s likely that you are already thinking about the potential manifold impacts of such widespread fear and anxiety on your clients, on yourself and hence on your counselling practice. For example, you might be thinking about:
- the question of what the right ‘depth’ of counselling should be (for example, focus on support versus trauma work)
- how to approach planned endings and respond to unplanned endings, including considering what happens if client or counsellor falls ill and what it means if the end of counselling coincides with the country being caught in a pandemic.
Additionally, for clients with whom you previously worked face-to-face, it will be important to discuss how they feel about the fact that their counselling has had to become technology-mediated, and how they are experiencing this new at-a-distance counselling relationship.