I wake up, take a shower, get dressed and go to the office. I'll see my first customer of the day at 9 a.m. and got to my desk half an hour earlier. I go to the office much earlier these days.
I prepare myself and my room for work, spray sage and light a Palo Santo stick to clarify and bring in positive energy. I turn on my music, a spare sound diffuser, and then close my eyes. Sitting in my high back chair, I ask the universe again today to equip my mind, ears, eyes and words to assist my clients on their healing journeys.
This is my new normal, but not so normal for me because my clinical office is now in my house. This is not a room I originally set up for private practice. It was more of a cave that I designed for family escape, reading, relaxing, and spiritual basics.
As I ponder my schedule for the day, I turn my attention to the bookshelves in the room. Among the different tufts there is a bobblehead doll by Jack Sparrow, a figure by Ruth Bader Ginsburg, angel ornaments and angel sculptures. Even on the shelves, scattered and taking up space, stones ground. Some are open so that I can see one word on them from my point of view: peace, calm, harmony, laughter.
I reflect on my past personal sessions. At the beginning of the sessions or during the sessions, I invited clients to select a grounding stone, hold it in their hands, and either verbally or silently provide confirmation in accordance with the word on the stone. Or I would ask a fearful client to pick a stone and then guide them in a tactile grounding exercise. Most of my established customers are aware of stone availability – when to use them and how they are going to use them. Among the comments I've heard from clients who have used a rock in session: "This gives me the focus"; "It is comforting"; "I'm less concerned."
There are notepads on the table where the computer is located, which I previously gave customers to take with them to record or as a storage tool for those who have trouble remembering. In a corner of the sofa, which is on the back wall of the den, there are several squeeze balls that are great for relieving anxiety during the session. My business cards are in a cream-colored 5 x 6 inch box on the middle shelf of my computer workstation. These elements all seem almost meaningless now as they are things I once made available to clients in face-to-face sessions.
Teletherapy vs. personally
The reason I now work entirely from home and provide therapeutic services to clients via video and voice calls is because I work with a population that is at higher risk for serious illness. This has been the protocol for many behavioral practitioners for many months. The current environmental situation dictates this change, and my obedience to moral and ethical obligations to customers leads me to protect and minimize damage.
I have found that teletherapy, telecounseling, telemental health, and remote counseling – including defining the provision of distant health psychotherapy – have a slightly different way of working with clients than providing face-to-face sessions. I compare the two approaches of watching a film with reading a book of the same name.
A personal therapy session, such as watching a movie, involves the art of active listening. I pay attention to what the client is saying while focusing on their body language and behavior. The body language and non-verbal gestures can easily be recorded in face-to-face sessions.
On the other hand, I compare teletherapy to the way in which written words in a book describe a story and convey information. It takes an increased attention to detail to see the entire picture. I need to use sharper observation to discern the subtle messages of facial gestures and voice tones in teletherapy sessions.
Five priorities
Here are five main points that have helped me make clients feel more comfortable and secure with the teletherapy process.
1) Remote Advisory Technology: Verifying the identity and location of a customer is important. These things should be determined before the start of the first session and at the start of each session afterwards. Know that the person you are offering counseling service to is who they claim to be and where they live. Also, understand the scope and practice definitions and professional practice regulations in both your state and the state your client lives in, as these elements may differ between state licensing agencies.
Make sure the platform you are using for your teletherapy session is secure. Use applications with an end-to-end encryption function (bidirectional). There are several good ones out there, but do your research.
Also, be careful not to use SMS and email applications that do not comply with the Health Insurance Portability and Accountability Act (HIPAA). Outside of the use of HIPAA compliant SMS applications, HIPAA allows SMS clients to be sent on the condition that they have been informed of the risk of unauthorized disclosure and have consented to communication via SMS. Both the communication of the risks and the customer's consent must be documented.
Personally, I limit text messages to clients to schedule or confirm appointments. These text messages do not contain any personal customer information, not even in the form of address. When it comes to email, I never assume the client has an internal email network with firewall protection. For this reason, all email correspondence I send is done through a secure messaging application.
2) Consent and Confidentiality: In teaching aspects of the teletherapy process, counselors must provide clients with a clear understanding of the therapy they are starting with and ensure that they are comfortable and safe with the process feel. In this way, clients can choose to undergo therapy. The "Consent to Treatment" form should contain at least the following:
Platform from which advice is provided (Zoom, Google, etc.)
Therapeutic modality that is used (cognitive behavioral therapy, solution-oriented brief therapy, etc.)
Risks, benefits, confidentiality, and limitations of teletherapy, and confirmation that while measures are being taken to ensure the confidentiality of the session, there are no guarantees
Potential for a technology failure and alternative methods of service delivery
Location and attitude of the practitioner as well as credentials and contact information of the practitioner
I found it helpful to show clients the confidential area I work in before the meetings begin. I pan the monitor camera around the room so they can see that the room I am in is safe and free from distraction. I also encourage clients to use a quiet room for their meetings if possible. It also helps practitioners align with the location and background of the consultation room that clients see on their screens from session to session. This enables customers to become familiar with predictability.
3) Technology slips and customer crises : Slips inevitably occur. It is therefore advisable to prepare as well as possible before a session. First and foremost, test your video connectivity so that problems don't cause session delays. Unfortunately, some things cannot be anticipated, such as: B. Audio or video problems in the session. I have found it beneficial to discuss difficulties and concerns of this type in initial meetings with customers and to plan a backup alternative together, such as a telephone session.
As with technology slips, crisis situations can arise. During the first customer evaluation, it is important that potential crisis situations for the customer are discussed and that a crisis plan is developed, documented and created. I ask a series of questions to consider the client's risk of a crisis. As part of the contingency plan, it is important to include the customer's emergency contact numbers, local and national emergency crisis numbers, and the language that indicates that the police can be called for a social check if the customer's safety is an issue.
At the end of a particularly difficult teletherapy session, there can sometimes be a crisis for clients. In these cases, I have used various techniques, such as relaxed breathing, holding the person in hand and carefully describing the person, and using grounding exercises to help clients orientate themselves back to space, time and place.
4) Practical Tips: Sometimes I would concentrate on the computer's video camera and check my eye alignment so that I am not looking down or looking up too high. As a result, my awareness of the client's subtle movements and body language became obscured. Even when I am actively listening, I sometimes miss the tonic detail of the information provided.
Some of the techniques that I find most useful for aligning myself with the client in the therapeutic process are based on the principles of mindfulness practice. Knowing what is going on visually and tonetically from moment to moment can help my clients feel supported and understood.
When I carefully remember to lean back from the screen, I see a larger area. I can better grasp the client's slight expressions and eye gestures and use these observations to ponder how I can help the client become aware of the messages they are conveying. Nowadays I pay special attention to noticing, understanding, and writing down what the client's vocal nuances, tempo, pitch, and inflection convey. These have the same meaning as visual focus in creating a therapeutic alliance with the client.
5) Best Self Forward: Bringing the best self forward begins with self-care. A big part of self-care is maintaining good boundaries inside and outside of customer meetings. This includes establishing a clear line between work and personal time, as well as creating a period between each scheduled client so that you can replenish your mind and body.
I like to replenish my mind through meditation and my body through movement. Meditation helps me to find inner calm and renews my focus. Fitting short exercises into my work day, such as Doing short cardio workouts, dog walking, and resistance band exercises help me recharge my batteries. I also find great mental empowerment in connecting with clinical colleagues with whom I can share challenges, solve problems, and receive general support.
Given the changing times of our new normal, it is useful to know that we can move forward by thinking, preparing, and moving proactively. The better equipped we are, the fewer obstacles we will have. The fewer obstacles we have, the better we can help our customers and preserve inadequacy, benevolence, justice and respect for person's autonomy.
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For more information on the pros and cons of tele-behavioral health, visit the American Counseling Association's resources page for counselors: Counseling.org/knowledge-center/mental-health-resources/trauma-disaster / telehealth information and consultants in health care
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Andrea Chandler is a licensed consultant with over 12 years of experience. It is her passion and privilege to serve individuals through counseling and advocacy. Contact them at [email protected].
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It should not be assumed that opinions or statements in articles appearing on CT Online represent the opinions of the editors or guidelines of the American Counseling Association.
