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Data Cleansing to comply with GDPR – Private Practice Hub

General Data Protection Regulation (GDPR) compliance is important to us. But what is GDPR? In short, it is a legal framework which sets out guidelines for collecting, processing and storing any personal information about others obtained during the course of running your business. GDPR was brought into effect in May 2018 to protect the privacy and security of individuals personal and sensitive data.

It is a very broad subject in itself and certainly not one that we will attempt summarising here. For the purpose of this article, we are going to explore some key points around keeping data clean (by way of data management) for GDPR purposes.

As a professional practitioner there’s a high possibility any paper and digital records you create and use in your day to day practice will contain personal client data. For a start you have client consultation notes, invoices, diary appointments, handwritten notes, treatment plans, referrals … the list goes on and all of which most probably have some kind of personal identifiable information relating to your clients such as email address, tel no, health, sexual orientation, religion etc. and therefore GDPR will apply.

During times of change, many therapists will be considering different ways of working or even just taking the time to review the systems and processes they currently have in place. With GDPR in mind, here are a few of the measures you can put into place to help get you started:-

  1. Refresh or familiarise yourself with GDPR – take a look at some basic concepts from the information Commissioner’s Office (ICO)
  2. Audit the data you have – carry out a quick review of what data you hold and where you keep it
  3. Review the information you hold – data should only be collected for specified, explicit or legitimate purposes and only be processed in a manner compatible with those purposes
  4. Organise – when gathering information, some data will need to be kept for different periods of time so consider intended use, legal requirements and how easy or not it will be to keep any relevant information up to date etc. and whether any such data can be anonymised
  5. Storage – any relevant data gathered should be held for a legitimate period of time (no longer and no shorter) for the right purposes, in a safe and secure place … this doesn’t just mean plugging in the shredder and fueling it with data rich records!
  6. Implement a data protection policy to ensure and demonstrate compliance – ensure to outline the roles and responsibilities for anyone handling (processing) the data from collecting, storing, securing, updating and disposing of data
  7. Consider using a secure practice management system, designed and built with the function to help practitioners comply with GDPR

The Information Commissioner’s Office (ICO) has helpful tools and checklists to help improve your knowledge and understanding of data protection compliance which will help to underpin the information in this article.

If you would like more business advice to support you in running a private practice therapy business, Private Practice Hub is a leading business advice website packed full of free resources.

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Text, transition and transference

This article first appeared in the December 2019 issue of BACP Children, Young People & Families, published by the British Association for Counselling and Psychotherapy. BACP 2020© https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/ 

Felicity Runchman discusses the potential and the challenges of text-based online counselling with young people

Over recent years, articles portraying young people’s relationship with technology unfavourably have not been hard to come by. The sorry and rather discouraging story that’s often conveyed is that teenagers and young adults are becoming locked into anxious, reactive and solipsistic worlds, aided and abetted by their smartphones and devices.1 However, many such articles take a narrow focus on social media and gaming. As the most recent parliamentary report into the impact of social media and screen use on young people’s health conveys, much research into this area thus far has failed to capture the nuance between what constitutes ‘active’ and ‘passive’ screen use.2 The report reminds us that, among other beneficial online pursuits (such as researching and campaigning about social, political and environmental issues), many young people go online to seek and actively engage with support regarding their mental health.2

Text-based online counselling is one such type of support available. As a mental health practitioner who engages in this style of work with 11–26 year olds, I want to present and explore the potential – as well as some of the challenges – of this specific approach. While rapid advances in online communication have made far-reaching changes in the world of therapy, audio-webcam sessions – with the approximation of face-to-face contact that they provide – are often what come to mind when online counselling is mentioned. Text-based sessions, where a relationship between counsellor and client can be forged without either party seeing the other’s face or hearing their voice, represent something qualitatively different. An online therapeutic space, created and sustained through the written word alone, is something that holds particular appeal to many young people seeking support with their mental health. For practitioners as well, it can create new opportunities and perspectives, as I hope to explain.

Contracting, client suitability and managing risk

As with any kind of therapy, establishing structure and boundaries before text-based online counselling starts is fundamental. Given how ubiquitous online chatting is in most young people’s lives, it’s important to present the text-based online counselling space as distinct from other online communication. This might, for example, include gently giving guidance to new clients about making appropriate time and space for the therapeutic work. Of course, as a text-based online counsellor, I can never know for sure where my clients are physically situated when they interact with me. However, I can advise before the work begins that the hectic, public or distracting spaces that young people are so often drawn towards might not be the most appropriate setting. From an ethical perspective, it’s also essential to ensure the use of secure and confidential platforms for therapeutic exchanges, particularly if young clients are using shared laptops or devices. The confidentiality policy, shared with clients at the beginning of the work, outlines how their information is kept confidential on the secure platform (which both they and their counsellor require a password to access). We state that we will not share information without their permission unless there are exceptional safeguarding concerns, such as the counsellor thinking the client or someone else is at

serious risk of harm, or the counsellor feeling that the client is not able to take responsibility for their decisions. In keeping with GDPR,3 the confidentiality policy also details how client data are used and stored, and how long they are kept for – seven years after a client’s last contact with the service or seven years after their 18th birthday, whichever is longer – along

with their rights to view or request the amendment and deletion of such data. Clients are actively encouraged at the contracting stage and throughout the counselling process to request clarification from their counsellor about how the confidentiality and security of their data are maintained.

Gauging how suitable text-based online work will be for any new client is something to be approached carefully, and on a case-by-case basis. In an initial contracting exchange, I express curiosity about a client’s presenting issues and reasons for seeking online counselling and ask about their familiarity and ease with using online mediums to communicate. I then pose a series of questions about risk. At the agency where I conduct the majority of my text-based work, we aim to hold and work with risk in an online context, particularly if a client is reluctant to engage in face-toface counselling and may not actively seek support elsewhere. However, we are clear that online support may not be sufficiently holding, or the best means of support, for young people who are especially vulnerable. Key contraindications include suicidal ideation with intent, frequent or particularly risky incidences of self-harm or substance misuse, serious eating disorders, or clear signs of psychosis. While a high degree of relational rapport can be built through text-based work, with practitioners developing the ability to sense subtle changes within their clients in any given interaction, the absence of physical presence and visual cues can put the practitioner at a particular disadvantage when assessing and responding to risk. Therefore, a plan regarding how any increased concerns about risk would be handled in the work – for example, through the practitioner or agency liaising with a parent, guardian or GP– is mutually agreed at the contracting stage.

How text-based online counselling works

Another key thing to establish at the contracting stage is how clients would like to conduct their text-based online sessions. Asynchronous or message-based work involves the client sending a message (or, indeed, several shorter messages) to their counsellor each week by a mutually agreed day and time, with their counsellor subsequently responding within an established period. Synchronous or chat-based work requires both counsellor and client to come online at a specific time for a live instant-messaging interaction.

Allowing the client to select and change the way they work, not only invites them to exercise choice and agency, but can also prove a useful inroad to therapeutically relevant material. I recall several clients switching from what, for them, felt like the ‘safe’ realm of writing carefully crafted and highly edited messages to daringly entering the more spontaneous world of live chat. In each of these cases, the change appeared to signify a broadening in the client’s relational style and an increase in their general levels of confidence. Similarly, I have worked with very ‘chatty’ chat clients who have seemingly avoided reflection and genuine connection with their feelings during synchronous interaction – simply on account of their liveliness and charged verbosity. Changing to

message-based interactions has encouraged them to slow down, allowing time to process and think between communications. While the choice ultimately remains the client’s as to whether they opt for chat or message-based sessions, I’ll sometimes suggest they experiment with the other style if I feel there could be therapeutic gain.

What text-based online counselling can offer:

A means of reaching clients who would struggle to access face-to-face therapy

For some individuals, such as Jonathan, who was selective mute, text-based online counselling might be the only route to psychological support when conventional talking therapy is not an option.4 While I wouldn’t suggest that online work should be the default way of working with younger clients with physical disabilities or mobility issues, it can bypass many of the challenges around access that might otherwise deter such clients from seeking help. Disability and health issues aside, there are many other practical reasons why certain young people find face-to-face support difficult to engage with. Clients from more chaotic or disadvantaged backgrounds may miss sessions if parents or caregivers fail to bring them, for example, or if they cannot find the means to use public transport.

A safer, more manageable, relational space

Even when such ‘concrete’ barriers regarding access are absent, the most common reason I hear young people give for choosing text-based online counselling over other forms of support is that it feels safer. Clients often present it as a comfortable ‘testing ground’ prior

to face-to-face work. Social anxiety is an increasing issue among young people, many of whom would find the prospect of speaking face to face with a therapist just too daunting. For some, typing out a message feels more manageable, and the sense of anonymity this affords can discount feelings of shame and self-consciousness. This was the case with Nathan, a young man from a Christian background, concerned about his emerging sexuality and use of pornography – and the conflict these issues raised with his strong

religious beliefs and the values his family had instilled in him. Over a series of weekly message exchanges, I was able to normalise some of Nathan’s sexual curiosity and experimentation from a physiological and developmental perspective. In our emerging correspondence, we also explored his conflict from more philosophical and spiritual angles, by speculating on what Nathan’s God might want for him as he became aware of new feelings and possibilities, and how other men of faith might deal with similar challenges. With a presenting issue that seemed to be about a compulsive and ‘out of control’ behaviour, the pacing of weekly exchange sessions introduced a regulated ‘thinking space’ for Nathan. This helped break the shame-based loop he had created of acting on his impulses then instantly berating himself.

Some might argue that working online with young people who are socially anxious or chronically ashamed only serves to collude with their isolation and avoidance of the challenge of face-to-face relating. While I appreciate this rationale and would indeed, take concerns about any client who seemed ‘stuck’ in a closed-off online world to supervision, I see online work as a ‘way in’ and a route through which such difficulties can be worked with and gradually challenged.

An amplified opportunity for fantasy and transference

Working without a shared physical presence can unlock much therapeutic potential. It can be liberating, for both counsellor and client in text-based work, to strip away the audio visual cues and assumption-baiting ‘clutter’ that can influence people when they meet face to face. Who can honestly say we haven’t sometimes jumped to swift and unfair conclusions

when first taking in someone’s appearance, or hearing their tone of voice or accent? I have noticed an increase in younger clients who identify as trans, non-binary or gender-fluid, registering for the text-based online counselling service where I work. This could simply be due to the growing number of young people who define in this way, and the heightened mental health challenges that they face. However, I do wonder if working in a therapeutic space where one’s physical appearance and apparent gender identity aren’t as foregrounded as they might be face to face, specifically draws gender-nonconforming clients towards text-based online work. The same might be said for clients with concerns about body image.

Besides gender, lack of physical presence in the counselling relationship also makes awareness of age, class, ethnicity and social status less immediate. My clients know my first name so will likely imagine that I identify as female. However, they have no access to indicators of how old I am, what colour my skin is, whether I wear a wedding ring, or where my accent might suggest I’m from. Many clients show little curiosity about these things – perhaps feeling no need to ‘flesh me out’ or use me as anything other than a responsive listening presence. However, others clearly wonder. How they speculate and fill a space that is more ‘blanked out’ than in face-to-face work can be telling – illustrating how a context that may initially seem more ‘neutral’ is still fertile for fantasy and transference.

Jodie, 15, was stressed about her impending GCSEs and anxious about which career options would be available to her. She was also navigating various friendship groups and seeking to find her place among girls who wore make-up and were starting to date, girls who were more studious, and girls who were more ‘homely’. An upcoming break in our work, due to a holiday I was taking, brought up a surge of questions at the end of one of her weekly messages – ‘I hope you have a nice time. I’m not sure if I’m allowed to ask you this, but I wonder who you’re going on holiday with? Like, are you married and do you have children? As I can’t see you, it’s hard to know what you’re like’.

Over the weeks that followed, Jodie’s questions helped further our exploration of what it was like for her becoming a woman, what kind of woman she wanted to be, and what ‘models’ of womanhood were available to her – making her heightened curiosity about what kind of woman I was all the more understandable and therapeutically useful. Of course, Jodie may also have wondered about my personal life had I been seeing her face to face. In a text-based context, though, it felt more pronounced and perhaps easier to work with. While I don’t aim to uphold a ‘blank-screen’ neutrality in my face-to-face practice, I have found the inbuilt blank screen in text-based online practice provides a useful springboard to explore therapeutic relationships, speculations and fantasies.

Adjusted attunement and embodiment

Working without access to visual or auditory information about clients means certain key concepts in counselling have to be rethought. How, for example, can empathy or attunement be achieved when a client can’t be seen or heard? In my experience, being unable to rely on the sensory realms of conventionally ‘seeing’ and ‘hearing’ sharpens my sense of intuition. When the pace and length of Shanana’s usually swift and lively text interventions suddenly dwindled during a chat session, I sensed something had changed. I asked, ‘Can I check how you’re doing? I’ve noticed our communication has slowed down and you seem to be sharing fewer words in your messages’. She replied, ‘Actually, I’m crying and feeling really panicky – there’s too much going round in my head’. This led to a pause in our discussion of Shahana’s therapeutic material while we focused on some grounding techniques – with me guiding her through several breathing exercises and encouraging her to name three things she could see in the physical space she was in. As this example illustrates, there is potential to work with themes regarding embodiment in text-based online counselling – and both counsellor and client can make use of their embodied responses and ‘felt sense’ within the work. Guidance and communication around this may need to be more explicit – an example being when I might share with a client that I’m smiling in response to something they’ve written, or when I enquire as to what they’re feeling physically as we discuss certain themes.

Text as transitional object

A clear advantage of text-based online work is that links to websites and attachments can easily be shared with clients as an aid to psychoeducation. This allows clients to create their own set of easily accessible resources to refer back to as needed. On a more personal level, the text of therapeutic exchanges in itself can serve as an ongoing resource, which I conceptualise as being rather like a transitional object. Both synchronous and asynchronous styles of online working automatically generate a ‘transcript’ that the client can save and look back on. Given that I often work with clients at transitional times in their lives – for example, as they prepare to go to university – many have described this aspect of text-based online work as something that feels anchoring. I have also found it can ease the process of ending with clients who, for so many reasons, may struggle with saying goodbye.

Conclusion

Given that so many aspects of our lives have migrated online, it is unsurprising that traditionally face-to-face psychological support has followed. Text-based online counselling has emerged as a distinct form of support that, for all its apparent ‘click-of-a-button’ modernity, draws upon several time-honoured themes. As described, there is potential to return to a Freudian state of blank-screen neutrality in the counselling relationship. Also, for clients, there is the appeal of, what feels like, anonymity, as they dispatch their difficulties to be received and responded to by a seemingly faraway other. This brings to mind problem pages and agony aunt columns integral to traditional teenage magazines.

As I hope to have illustrated, online work can remove many conventional obstacles to young people seeking support. However, it can present new ones, and will not meet every client’s needs. Alongside more high-risk clients, for example, clients struggling with literacy and self-expression through writing may be less likely to find it a suitable medium. Technical problems sometimes mean sessions do not go according to plan and clients can still miss sessions and fail to engage for a variety of reasons. Pre-empting and working through these frustrations in a boundaried manner, for example, by agreeing at the point of contracting what to do if the connection drops, can strengthen the working alliance and provide a model of responsibility and perseverance.

I am not suggesting that online counselling should be a replacement for face-to-face support. However, further recognition of the possibilities that text-based online counselling provides, when carried out and supervised by specifically trained online practitioners, may see many more young people ‘clicking’ towards the support they need.

This article first appeared in the December 2019 issue of BACP Children, Young People & Families, published by the British Association for Counselling and Psychotherapy. BACP 2020© https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/

Felicity Runchman is a BACP accredited counsellor, and a member of the Association For

Counselling & Therapy Online (ACTO), with a particular interest in providing online psychosocial support to young people and staff working overseas in remote and

challenging contexts. She has carried out online counselling with

the organisations Off The Record (https://www.talkofftherecord.org/) and Young Concern Trust (http://www.yctsupport.com/) and also works in private practice

References

1 Guardian [Online.] https://www.theguardian.com/society/2017/may/19/popular-social-media-sitesharm-young-peoples-mental-health (accessed 15 September 2019).

2 House of commons science and technology committee. Impact of social media and screen use on young people’s mental health. https://publications.parliament.uk/pa/cm201719/cmselect/cmsctech/822/822.pdf (accessed 16 September 2019).

3 Guide to the General Data Protection Regulation. https://www.gov.uk/government/publications/guide-tothe-general-dataprotectionregulation (accessed 16 October 2019).

4 Runchman F. My work with Jonathan. Stillpoint Magazine 2019; https://stillpointmag.org/articles/my-workwith-jonathan/ (accessed 15 September 2019).

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Can online therapy mitigate coronavirus?

There’s no getting away from the news that is dominating the press at the moment. We are experiencing a global pandemic of Coronavirus Disease (COVID-19), an illness that can affect your lungs and airways. It’s widespread and it’s a public health crisis.

The UK government has implemented special measures in an attempt to contain and mitigate the virus. Public Health England is advising health professionals, businesses, schools and other organisations to protect yourself and others against the spread of Coronavirus. Working arrangements might have to change.

This level of extreme disruption, challenges and disaster we are faced with will increase demand for the services provided by therapy and coaching professionals and also the way in which therapy is delivered. Online Therapy could be the answer for many health professionals due to its low risk in terms of spreading disease. But are you equipped to carry out your therapy business online?

Having a resilience and disaster recovery plan in place means business can continue even when work practices change. But not many small businesses already have one of those in place. The government has published free downloadable guidance on business continuity planning.

Private Practice Hub is a UK leading business information and advice website designed to help small business owners, therapists and coaches run a business.

In addition to this resource we also bring you the Online Therapy Hub website which is specifically for those already working online or contemplating this way of working. We offer tips and resources to point you in the right direction and aim to help you develop your online presence, then your online practice and, perhaps ultimately, the way you work therapeutically online.

We can help you with the tools you need to coordinate all you do and operate efficiently as an online therapist wherever you might be working. From understanding and engaging potential clients, marketing yourself in a digital world and making sure you have sufficient security measures and software in place to protect clients confidentiality, data and privacy.

Membership is absolutely free with access to a variety of articles and resources ranging from the very basics to the more advanced including business plans, marketing strategies, financial advice, administration, support on professional issues and exclusive special offers. Join here today.

We’re here to support you in maintaining the effectiveness of your professional therapy or coaching activity wherever you might be working. Get in touch today to find out more info@privatepracticehub.co.uk.

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ACTO clarification on use of platforms

This is ACTO’s very short clarification on the use of platforms.

We do not have the time or the expertise to say something about every platform. Another reason is that technology changes fast that what we say today may not be true tomorrow.

We are pointing towards one of our organisational members Privacy4  who are offering a free month now.

And this article has a lot of useful information. It was written with children and young people in mind but there is useful information about the use of platforms that applies to us all.

If you have any other questions about working online please don’t hesitate to contact us. Keep in mind that we are all volunteers and we are getting a lot of questions at the moment, but we are trying to get to yours as fast as we can.

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COVID-19 (Coronavirus) Advice from ACTO for CLIENTS and NON-ACTO THERAPISTS

covid-19

Please look here for the latest guidance

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Anne Stokes on how she became an online counsellor

Anne Stokes

Our new patron Anne Stokes was one of the first to provide online counselling training in the UK. We asked her to share with us how she became an online counsellor.

How were you introduced to online counselling?

Anne Stokes

Just over 20 years ago, a good friend of mine, who I had trained with as a counsellor in the mid-80s, talked to several of us about a project she was currently involved with. A group of counsellors had got together and were looking at the possibilities of using the internet to work with clients. They wanted to set up a pilot scheme in which they would each work with a client and then talk together about what had happened – what worked and what didn’t.

They were therefore in need of ‘clients’. I volunteered to be a client, obviously not for my friend, but for one of the other members of the group who I didn’t know. In those days, the idea was to counsel through the medium of email exchanges. I think that because no one was quite sure how that would go, they were looking to use counsellors as clients because most of us would have supervisors and probably our own therapists to support us if things went badly wrong.

My counsellor sent me a contract and we began to work together, exchanging emails roughly once a week. I used a real issue as I have never been a big fan of role-plays as I think that it is nigh on impossible to truly pretend to have a problem which is made up, without a bit of one’s self creeping in unbidden and probably out of awareness. This has the potential to turn the whole thing into a disaster!

We exchanged a number of emails – I can’t actually remember how many now – and included various creative ways of working. I seem to recall the use of images, metaphors, drawings and a poem.

After we had ended, I gave my counsellor feedback on how I had found the experience. Though I was not involved with this part, I know that the group then looked at their combined learning and from there, what would be necessary to train counsellors to work online.

 

Did you like the idea straight away?

No, I most certainly did not! In those days I was a total luddite and thought the whole idea was completely bonkers. How on earth could a relationship be formed online, without ever meeting the other person? If that was so, then therapy couldn’t possibly be successful since the relationship is fundamental to the process. Basically, I volunteered to prove that this thing would not work.

When my colleagues (and some of my counselling students) at the University of Bristol knew that I was going to be part of this pilot, they fell about laughing as I was well known for having as little to do with technology as possible.

How I had to eat my words L . Not only did I form a sound and trusting relationship with my counsellor, but I discovered that she was well able to convey the core conditions throughout our email exchanges. I chose to concentrate on an issue which had been around for years and which I had looked at on and off within my face-to-face therapy without anything much changing.

Perhaps it was ‘good timing’ in my life, perhaps it was to do with the skill of my counsellor, perhaps it was because my expectations were so low, whatever…… it unblocked the issue and it was possible to make changes in my life and in a particular relationship, as well as gaining insight into to the underlying blocks. I could no longer say rather sniffily that e-counselling wouldn’t ever work and that it was a ridiculous notion.

The immediate consequence was that I decided that I would have to train as an online counsellor as the pilot group had then set up a training scheme. You can see what a leap I made – total sceptic to total convert in a few months. What a revolution and what an effect it had on my subsequent years as a therapist, trainer, supervisor and writer.

Along the way, I have been able to enjoy interactions and relationships with colleagues who I have met online. With a few people, these have turned into friendships sustained both online and face to face.

One bizarre occurrence was meeting someone face-to-face after a couple of years training together and then developing our close friendship online. We almost didn’t know how to conduct ourselves in person so to speak, until she asked why we were so stilted with each other when we could talk so easily online. As so often happens, this naming of what was happening broke the issue and we laughed at ourselves. We still know each other 18 years later.

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Working online with an interpreter – is this even possible? Kate Thompson

globe with translations of the word translation

I wanted to share some reflections on working with interpreters in online psychological work. This is in relation to a piece of work I did for an International NGO after three staff (all Afghani) were kidnapped and held for 24 hours by an unknown group in a remote region of Afghanistan. The three staff members had been affected differently by this experience and their employer wanted some support for them and turned to InterHealth Worldwide, a social enterprise providing medical and psychological support to the aid and mission sector, where I was then working.

Something about me: I am a counselling psychologist with around 2 decades of experience in the UK National Health Service (NHS) working in the main a specialist project for refugees and asylum seekers in London. I have a long experience of working with interpreters in face to face therapy and when it was clear that two of the three men concerned spoke limited English, the stage was set for us to think about what we could provide with interpreter.

I was lucky enough to have worked closely with Newham Language Shop (a London based interpreting service) and to know a particular Dari speaking interpreter, Idrees Rasikh very well. To do this rather innovative piece of work, it was reassuring to be working with a colleague I knew and trusted, who knew my style of working and who I knew would be open to reflecting about the work as we went along.

There was no published literature to draw on for this work but I had some notes prepared by Beverley Costa of the organisations Mothertongue and Pasalo (www.pasaloproject.org) about interpreter-mediated therapy via Skypei. The situation she was discussing was different however, as the therapist and client were envisaged as being in the same room, with the interpreter joining them by web-cam to cut costs and make interpreters more widely available. Costa noted the need for clients to experience talking via a screen to test out technology and make sure clients felt at ease. She also spoke of the need client and therapist to be positioned more closely than normal so that they are both visible – something that might prove uncomfortable to both. Further she stressed the need for back up plans when things go wrong with technology and of setting some ground rules about how to manage turn taking. As she says, “the clinician needs to remember to look at the client, for the benefit of the therapeutic alliance, although it will be very tempting to look at the screen”.

laptop, paper notebook and phone

In the work that I am describing, things were different. The interpreter and I were in the UK on one side of the web-cam screen, while our clients were on the other side in Afghanistan. This meant that myself and the interpreter sat close together, side by side (with perhaps reduced opportunity to observe each other) and both
looked at the client on screen. However some of the observations made by Costa were definitely of relevance: the need for a back up plan, the need to create a setting in which all parties could see and be seen and the difficulty that could arise around turn taking were just as relevant.

I am convinced that having me and the interpreter in one location was crucially important, to build a therapeutic team and contain the two clients we worked with. The interpreter and I had worked together in therapy already, meaning that we were better able to read each other’s communication and used to the setting. Had I used an interpreter in Afghanistan, a stranger, communication would have certainly been more difficult. There could also be difficulties if the interpreter became involved with the staff outside the therapy work in ways I as the therapist could not monitor or control. Added to this would be questions of quality control as interpreters based outside the UK may have different training standards, different contractual requirements around confidentiality and be operating under different codes of practice. In a country like Afghanistan, it is also important to be mindful that pressure could be brought to bare on an interpreter for political or economic reasons without the therapist being able to protect and support their colleague in any way.

In a further option, the therapist, client and interpreter could all be in different places and meet only in the online space, or perhaps employ three windows on a platform like Zoom, so each joined independently. However, it is my opinion that this would lessen some of the relational gains of the client seeing the psychological therapist and interpreter as a therapeutic team. I have written about this at more length elsewhere (Tribe and Thompson 2009 a & b). Our time before sessions started (prior to launching the web-cam meeting) allowed us to review and plan together, and the time following the session also allowed for reflection on the work and on communication glitches.
A second observation was that things worked very much better when there was a “fixer” on the client side, someone more adept at setting up meetings, ensuring connections and trouble shooting when things went wrong. In our work in Afghanistan, a particular staff member who was more confident with technology acted as a liaison and stood by to help when technology let us down. As the time difference was 3.5 hours (and later 4.5 hours) and the working days were very different between us in the UK and the clients in Afghanistan, our fixer was also really helpful in making sure appointments were kept and times were finalized, particularly given that our times on the UK side were quite fixed by the availability of interpreter and my availability.

offline

As might be expected, connectivity was very variable and I noted that our fixer in Afghanistan was checking connectivity in different locations in the office building meaning that we “met” in a number of different locations and occasionally had to move mid-session. All this meant for quite a bit of disruption, but we were able to manage this with some humour and a sense that nonetheless the work was
“good enough” and we were able to create safety. We also met for 90 minute sessions to take account of time lost for with connection problems and other disruptions and maximise our use of our interpreter.

So, I have discovered that it is possible to have therapy using web-cam with an interpreter, despite the challenges. I found I was able to support staff members who had lived through a critical incident and although the interpreted sessions were more challenging than those with the staff member who spoke English well, we were still able to work on symptoms like nightmares, intrusive images, fearfulness, problematic self-beliefs, anger and difficult trauma narratives with some effectiveness. As Harries (2018) states, “language is the primary currency of therapeutic work” and in work of this kind, in which two languages are interacting directing to create space for therapy, consideration of the “particular language relationship” being created between therapist, client and interpreter can shed important light on the work being done.

Harries, L (2018), Online Supervision and managing risk in an international context. In: Stokes, A. (Ed) Online Supervision a Handbook for Practitioners. Psychotherapy 2.0 Series. Routledge: Oxon.

Tribe, R and Thompson, K. (2009) a. Opportunity for Development or Necessary Nuisance? The Case for Viewing Working with Interpreters as a Bonus in Therapeutic Work. International Journal of Migration, Health and Social Care 5 (2), 4-12.
Tribe R & Thompson K (2009) b. Exploring the three-way relationship in therapeutic work with interpreters. International Journal of Migrant Health and Social Care 5 (2) 13–21.

For more information about the way in which Pasalo project works with interpreters using online platforms please visit the website and view a short video.

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OCTIA 2019 – Were You There? Jan Stiff

OCTIA 2019 were you there

Unfortunately, I could not make the time to travel to Manchester but, as delegates can attend OCTIA online, I chose to do just that …. And felt that I got my online fee’s worth.

On the OCTIA website the day promised …

“The 2019 conference theme is focused towards those online counsellors, therapists and health care professionals who are engaging with their clients and service users using the full range of online platforms and media. There’ll be the opportunity to share how we care for our clients, but how we care for ourselves and each other as fellow professionals. We are stronger together!” https://www.octia.co.uk/

Working as a therapist or supervisor in the online world can sometimes feel isolating, bewildering and frustrating. These are negatives amongst the many benefits. The passion emanating from  today’s speakers was strong. Where organisations are often struggling to maintain a steady flow of funding, it was clear from today that everyone present had a deeply held belief in the difference that online therapy can make to clients of all ages. I felt that we are finally entering a time where online therapy  does not need to feel “second best” to face to face therapy. Instead it is well recognised that some very vulnerable clients would not access counselling face to face.

There was an interesting discussion around qualifications for working online. The age-old questions of “are they necessary?” As always, my thoughts turned to “we can never know what we do not know”. I might be biased as I have tutored in online counselling and supervision over the years, but I still remember just how much I did not know when I trained. Those moments of “OMG … !” Todays speakers clearly agreed with the need for appropriate training and good support.

A discussion around providing online therapy from volunteer counsellors was summarised well by Catherine Betley who believes strongly that no counsellor should be asked to work voluntarily. The attributes that they bring need to be respected. I agree and wonder whether the world of online therapy has many therapists passionate about the benefits of online therapy and would even work voluntarily to make it accessible. I know that this is why I worked voluntarily for an online organisation in the past.

My sense is that conferences like OCTIA will help ensure that ethical and safe online practice for the sake of clients will always be the standard at a time when online therapy can still be heard of as “the stepping-stone into face to face therapy”. Putting clients first, we need to stamp this out as being inaccurate and disrespectful of online therapy at a time when online therapists can often be faced with having to make a decision to hold the emotional needs of a very complex client . The passion of many online therapists comes from their desire to meet the needs of clients where they can be best met – whether that is sitting in their bed struck with grief or too full of shame and guilt to sit with a therapist, directly, face to face.  I can’t remember who said this today, but it is  “horses for courses”. The choice of face to face or online therapy can only continue to benefit clients.

Thank you to the OCTIA team – see you next year.

Jan Stiff

CYP Director ACTO

 

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How to keep online therapy safe and secure

In early November, The Guardian posted an article about Tim Berners-Lee idea for a new “contract for the web”. Tim Berners-Lee is the founder of the web and he is very concerned with the privacy of online users on the internet.

Tim Berners-Lee has launched a global campaign to protect the online users for abuse and discrimination among other important issues with the use of the internet.

He wants governments, companies and individuals to support a “Contract for the Web” with the main goal to protect people’s rights and freedom on the internet. He calls it a “Magna Carta for the web”. The aim is for all to have access to the internet, in a freely, safely, secured and without fear of abuse.

“Magna Carta for the web”

ACTO welcome this campaign and is very pleased with already so many companies supporting a contract for the web. More than 50 organisations have signed the contract so far and the number is hopefully growing every day. 

The online world is a wonderful and exciting world where opportunities are endless. Unfortunately, the internet also brings fake news, online bullying, websites being hacked and personal information might end up being shared online, which was never intended to be shared for the wide public.

At ACTO we work very hard to keep online therapy safe and secure but accessible for all. We keep up with current research in the area, we keep developing as online software becomes available and the technology furthers.

We only promote and work with online platforms that can show evidence of a secured and confidential service to clients, therapists and counsellor.

ACTO is using its strong relationships with other professional therapy. and related, bodies to ensure that these high standards are maintained across all modalities and online work.

ACTO’s online training requirements

ACTO is also working with the growing number of online training providers to create high standards of training that will give therapists confidence in the course they choose, that it will equip them to embark on online therapy. 

ACTO believes strongly that to practice as effectively and ethically as possible specific training in online therapy is vital.  In the same way that any professional would seek training if broadening out their career and skills in a new area.  All therapists have a foundation training that is robust, with ethics a core aspect running through it.  As we develop our careers our professional bodies expect us to continuously train and keep open to new approaches and learning.  And if we were to begin work in a new way would look for an appropriate course to support this. 

For example, core therapy training is to equip the therapist to work with adults, and so we know that to branch out to work with children and young people, we would seek a course that helped us to develop the skills to work ethically in this specialism.  In the same way, we would expect a doctor wanting to practice in a related, but a different part of medicine to undertake appropriate training.

ACTO believes that maintaining high standards of online training and practice supports both online therapists and the public.  The legal and technological world is ever-changing and can be complicated to understand, potentially leading the untrained online therapist into difficulties.  So ACTO has recently led in a pilot with CORE-net, gathering evidence for the use of CORE in online therapy, with a fascinating and very positive result, which will be used to take this pilot forward to the benefit of all ACTO members.

This gives a flavour of the range of work that ACTO is undertaking on behalf of online therapists, and those wishing to train.  ACTO’s ethos is to be professional, ethical and inclusive, and the Board is always keen for ACTO members to join either the Board or the range of working groups that are doing so much of the valuable work of ACTO.  For example, there are working groups for research and development, children and young people, the CORE project, and the development of the website.

ACTO is happy to engage in open and robust discussion and offer guidance and support to anyone interested in online working.  ACTO’s members have a wealth of experience, skills and backgrounds that they are keen to share.

Sources:

Read the guardian article.

www.acto-org.uk

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Self care when working online Sarah Worley-James

Self-care when working online

In this age of digital technology, smart phones and improving Wi-Fi signals across the world, it is increasing possible to work across time zones and almost anywhere.  This brings a flexibility and potential to reach out to a wider range of clients, and fits with jobs that often encompass a variety of roles.  For private counsellors their work portfolio will often include supervision and training alongside their client work; working part time or sessional for public, private and voluntary sector organisations, and perhaps running your own website and social media content.

This mix of work roles and media with which to work in can be exciting and stimulating.  At the same time we are working in an age of innovation and rapid change.  Only now are children being taught the importance of boundaries, netiquette and considering how much screen time they have, and when to switch off.

Many of us (myself included) have got swept up in the excitement and possibilities of digital technology.  And are often only stopping to consider how to achieve a balance and how to, literally, switch off our devices, once we become stressed and overloaded.

When our smart phone is our watch, our alarm, calendar and access to email, it can feel impossible to turn it off or set it down.  How many of us cringe inwardly as we discuss self-care with our clients, knowing how poorly we look after ourselves?  How often have you explored ways for a client to reduce dependency on their phone or device whilst going to bed checking emails, catching up on news or checking social media?

We know there are many apps and websites devoted to helping us relax, be more mindful, limit our time on social media; yet how often do we pause to reflect on how we are taking care of ourselves?

‘Context’ is a word I use a lot with clients and supervisees, when looking at the theme of self-care.  How much time do I realistically have to focus on self-care in relation to my other work and life demands?  What types of self-care fit me at this point in my life?  What variety of self-care do I have, so that there is always something available?

I encourage you to take a few moments to think about your self-care; write a list of the different ways that you relax.  I appreciate that with busy lives this can feel like a pressure in itself.  As a mother of a young child I have come to realise how the time available for self-care is often severely limited.  Hence my great belief in the quality of self-care (what it means to me) over quantity of time spent.  I am an avid reader, and in my pre mother days would happily spent an hour or more reading.  Now I give myself fifteen minutes as my little one falls asleep.  This few minutes is a part of my evening that I relish.   I have learnt, through becoming stressed, to take a full break at lunchtime, and to go outside for a walk, whatever the weather (!), and have found I am more productive in the afternoon.  From years of rarely taking a lunchbreak, I now fiercely protect it, and become quite annoyed if it is eaten into!

Think about what you used to do to relax – maybe some of these things you would like to reconnect with?  Perhaps there are things you want to try? I have been given several colouring books, but have never quite got into this.  Whereas a year ago I took up knitting (having learnt as a young child) and enjoy this as I get a sense of achievement from creating something tangible, that I didn’t get from colouring.  I keep the pressure off, so may go several days without knitting if I feel too tired, enjoying it more when I choose to pick it up again.  My daughter is the happy recipient of my efforts – along as I use purple wool!

So experiment, find a range of activities.  Things to do alone, with others, at home, outside, quiet, active, free, for different seasons, for different energy levels. Things that make you feel virtuous, things that are ‘guilty pleasures’.  And most of all, remember quality over quantity – a few minutes is all it takes to give yourself a message ‘I am worth taking care of’.

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