Some of you know that the pressures of the COVID pandemic pushed me squarely in the arena of video counselling. I had been doing in-person and phone counselling for years, content and obstinate in my belief that keeping it simple, and as decidedly un-technological as possible, was the way to go.

Folks had repeatedly asked about the possibility of video counselling, but I steadfastly resisted it, partly because I wanted a highly-secure, Canadian-based platform and I hadn’t found one that impressed enough to make me want to try. And I’d even taken a 12-week course on cyber counselling last summer and still, I was sitting on my newly acquired skills.

And when my current practice management software mobilized in the wake of COVID, to offer secure video conferencing, it was time to make a move—time to embrace needs borne out of the current reality.

I bring up my newness to the (online counselling) sphere to acknowledge that introducing video counselling revealed some surprises about counselling in this context, while also expanding my thinking about traditional phone counselling too.

The Counselling Office

In my career, a counselling office has always had four walls, a door, and a window if I’m lucky. My Willow Tree Counselling downtown Vancouver office is like this. My remote office is like this too, only it’s in my home, below ground, and tucked away from the hubbub of family life. I’m incredibly fortunate.

But what happens to the counselling room when we take the counselling experience online or by phone?

I became aware, and even more so doing video counselling, with its visuals, that counselling clients are an equal architect in this process. Both counsellor and client are co-creators of the counselling space.

Let’s look at a metaphor: The counselling room “opens” to now include two spaces: the counsellor’s and the client’s. I think of it as two rooms (client’s, counsellor’s) with an adjoining hallway (the Internet or phone connection) in one house (the shared counselling space).

The COVID Catalyst

Why is it important to think about the counselling space, especially now? COVID-19, unlike any other historic event in my lifetime, has altered the physical parameters of counselling.

1. The traditional “4 walls” counselling office no longer reigns supreme: counselling is increasingly being offered with the help of technology, like never before.
2. More people are working or self-quarantining from home, and may not want, or be restricted from going to an outside counselling office.
3. Counselling clients are choosing more varied settings to receive remote counselling and therapists may now have additional or fewer counselling office options.
4. Increased demand for phone and video counselling sessions has also increased privacy concerns, as clients and therapists search for private spaces to have remote counselling sessions and therapists search for secure platforms to deliver counselling remotely.

Counselling, Where?

The range of places to conduct a counselling appointment have expanded considerably for clients, and not always ideally.

Counsellors, too, have struggled to find private spaces, particularly in the beginning of the pandemic where few of us were leaving our homes.

What kinds of spaces are being used?

Counsellor Spaces

Some therapists have remained in their in-person counselling offices, seeing clients there if they:

• Have enough in-office space to support physical distancing
• Do not have an underlying health condition(s) or are not immunocompromised
• Have no local restrictions

Other therapists use their in-person counselling offices to counsel clients remotely, either by choice or by necessity.

Still other therapists are working in private, home-based offices with appropriate privacy provisions to allow a session to be conducted confidentially.

Client Spaces

Never in my career have I experienced such a wide variety of settings chosen by clients to receive their appointments, including:

• Bedrooms
• Common areas of a home (if alone)
• Offices
• Parks and in nature
• Walking outside (“walk and talk”)
• Parked vehicles
• Even a boat!

Again, choosing a space which affords privacy is key.

Issues, Issues

Now that we’ve identified different remote counselling venues, let’s look at some of the issues which come with them.

Privacy Issues

Privacy has long been one of the pillars of the counselling experience, helping clients feel safe and secure when opening up emotionally.

Does the client and their counsellor each have a door in the room that they are using that they can close, particularly if others are in the home/building? This is important!

How soundproof are the rooms that client and counsellor are using? Most personal residences have not been equipped with soundproofing, like some professional counselling offices, however are there options to decrease noise transmission? I’ll get into this below.

Who is in or around the counselling space? Increased numbers of people at home or in common areas such as parks, raise concerns about privacy. How do clients and counsellors insure that others are not overhearing their conversation?

Dressed for Counselling?

Many counsellors, at the beginning of the COVID pandemic reported that getting dressed, as they would at their in-person offices, was a critical factor not only in re-connecting with the feeling of being a professional counsellor within a world in chaos.

Clothes matter! To use an extreme example, I have never and will never, counsel in my bathrobe, whether it is by video, phone or in-person! Just because there is not a visual associated with a phone call does not mean that I should not be dressed for work.

Similarly, clients make a decision about what they wear as well. Are your clothes in line with what you would wear to an in-person counselling appointment?

The Vibe

Is the space peaceful or chaotic? Both client and therapist may encounter noisy neighbours, loud music, screaming children and various media, particularly in home-based environments. If out and about, are clients, for example, trying to dodge traffic or crowds? Is this safe?

Posture

Counsellors should be expected to be sitting upright in a chair, not lying in a bed. But what about clients? Would you normally be lying on your therapist’s couch in the in-person office, or sitting?

Food

My personal standard is not to eat during an in-person counselling appointment, unless it is a blood sugar situation. The same should apply to my online counselling and phone counselling too. But what about for clients? This is tricky, because participating in counselling does require brain-power and being faint or hungry will certainly detract from one’s counselling experience. Some foods, like crunchy chips, will certainly be more distracting!

Substances

Should clients or therapists smoke, use substances or consume intoxicants before or during a counselling session? While some of us may respond with a reflexive “of course not!” it is well known that a feature of online therapy is the disinhibition effect : whether we like it or not: clients and counsellors have the potential to make choices, or say things that they normally wouldn’t in a live counselling office.

Certainly, substances will effect one’s ability to participate fully in counselling sessions and retain important details, decreasing the emotional or material value that clients receive from their appointments and possibly creating confusion for the counsellor, if the therapist is unaware of the situation.

And counsellors have a duty not to consume substances before or during their sessions. For example, the BC College of Social Workers (BCCSW), LINK of which I am a registrant, prohibits in its Standards of Practice, the practice of social work while under the influence of any substances.

Distractions

These can include factors touched on above like food and substances, but can also include pets and more commonly: messages, notifications, emails and other work tasks/requests that can pop up during a session, interfering with concentration and/or disrupting the counselling session’s flow.

Some folks don’t have the option of shutting down notifications because of work restrictions, however if it is possible to do so, this can make a significant difference in clients’ session experience.

This applies to counsellors too: as therapists, how are we configuring our notifications so as not to be alerted during an online or phone counselling session?

Tips

Counselling remotely is a two-way street. Certain measures can improve the counselling experience.

Privacy Aids

Sound Maskers

• A fan placed on high, outside of the closed door
• A white noise app/unit, placed outside a closed door
• Leaving the radio or TV on or playing music in a common area (but not so loud as to interfere with your appointment!)

Sound Absorbers

• For those that are particularly ambitious, installing weather-stripping on an inside door can help tremendously
• Area rugs, carpets, wall hangings, curtains and soft furnishings can all absorb sound

Other Means

• Earphones or headphones prevent others in your area from hearing what the counsellor is saying to you, and for counsellors, what a client is saying
• If you must be outside, ensure that no one is within earshot

Camera Considerations

For those participating in video counselling, the visual experience should be clear, so that both counsellor and client can see each other properly and better read expressions. Light in front of you is best and behind you is worst. Even a cheap external webcam can be very helpful in improving image quality.

Ensure that your camera is at eye level, to replicate natural eye contact. On some laptops, cameras are positioned very low, which makes it especially important to place your computer on a raised platform. I use a sturdy step stool, others use solid boxes or books. Bring back the encyclopedias!

Determine how close or far you want the camera to be as there are advantages and disadvantages to both. My personal preference is to simulate a view that is similar to being in my physical counselling office, which includes the torso. This allows for hand gestures to be communicated. For some folks, though, this may feel too far away. Talk to your counsellor if you have concerns.

Others like a ‘head view’ which may feel more intimate for some, but too intense for others. Therapists and clients can read facial expressions better but will have no sense of the client’s body language.

Internet and Phone Connections

For video sessions, the Internet should be as fast as possible and both counsellor and client should be using a secure, password-protected connection. I personally like to skip the wifi and plug in directly to my modem for the fastest, most secure experience possible. You can check your Internet speed at fast.com and should have, bare minimum 16 mbps. Anything in kbps is bad news.  Lags, missed speech, poor audio, pixilated images and freezing can drastically diminish the counselling experience; Consider switching to a phone session.

If you are participating in phone counselling, please do yourself a favour and minimize frustration by calling in a location with good reception. Voices cutting in and out on a call can be very frustrating for both parties.

Clothing Considerations

Wearing what you normally would to an in-person counselling session is generally a good practice. Ensure that what is being projected on camera is what you want projected. V-necks, mini skirts and other clothing items, particularly if your camera is badly positioned, could leave you being or feeling unnecessarily exposed.

Fake Backgrounds

While it might be soothing to have your favourite beach scene in back of you, or tempting to use a background to cover up a messy space, your counsellor cannot see where you are in the event of an emergency, nor can they see whether someone else may be sitting in your counselling session, which is a risk to your privacy and potentially, your safety.

Speakerphone

As convenient as it might be, please choose earbuds or earphones over going with a speaker phone. If you are talking and your counsellor says something simultaneously like “mm-hmm” as they are listening, or both of you talk simultaneously, your audio will soon be filled by gaps in the conversation.

Also, if you must use a speakerphone, please ensure that you run it by your counsellor, out of politeness, respect for the counsellor’s privacy, and to discuss possible implications for you. Please also ensure that there is no one else in the room that you are using for your counselling.

Please don’t participate in distracted driving by using a speakerphone to have a counselling session. This is potentially very dangerous. Please find a safe spot to pull over to have your session.

Counsellors should never put a client on speakerphone unless there is a clear clinical reason for doing so.

Minimize Distractions

Close down other programs and notifications if possible. Put away devices. I like to put my phone face down so I won’t be distracted by incoming message notifications while I am conducting my remote sessions, especially when my phone is out for a phone appointment.

Advise of Location

Please let your therapist know where you are, in the event of an emergency, should the therapist need to summon help.

Avoid Intoxicants

This helps to ensure full participation in your session, including memory retention, as well as helping to prevent the therapist from getting distracted in your session, wondering what is different. If this is a struggle for you, and you have sufficient trust in your therapist, please let them know so that they can support you in a discussion.

Be Prepared!

• If you are outside, do you need sunscreen? An umbrella? Do you need to find a covered area in the case of rain?
• Have you used the washroom before the session?
• Do you need water or a cup of tea? Have you dealt with your hunger?
• If your therapist has asked you to do homework, is it accessible from your location?
• Are you warm enough? Consider a warm coat or hat, if outside or a blanket it inside.

Communication

Please let the therapist know if someone else has entered the room.

If you are having a phone session and are crying silently, please make this known to your counsellor so that they can be sensitive and responsive to your feelings.

If you think that there is something that the therapist is not picking up on, please let them know!

Ask Questions

If there is anything that you don’t understand about phone or video counselling or something is rubbing you in the wrong way, please contact your counsellor! It is their job to answer questions and assist you to feel comfortable in this process or find a suitable alternative.