Think before you send that link

Much as the pandemic has altered — perhaps permanently — where many people do their work, so has therapeutic counselling seen a migration from the physical space of the therapist’s office to the virtual realm.

Lawrence Murphy thinks the shift is a permanent one.

“I mean, think about somebody who has to take the last hour off work, pay 20 bucks an hour for parking, wolf down a McDonald’s hamburger, find care for their kids… you might charge them 100 bucks an hour, but they end up spending $150,” he says. “Why would you do that?”

Murphy, an instructor in the Department of Psychology at Wilfried Laurier University, is a few years ahead of the curve in terms of adjusting to this new reality of online everything. Twenty-seven years ahead of the curve, to be precise. In 1994, he founded the world’s first online clinical practice, Worldwide Therapy Online and also authored the first ethical code for online counselling in collaboration with National Board of Certified Counsellors.

He’ll be bringing those decades of experience to the table on Oct. 22 when he’ll lead a special half-day webinar offered through UCalgary and jointly presented with Alberta Health Services entitled Doing Therapy Online: Ethical, Practical and Clinical Aspects of Video Counselling.

Murphy spoke to us about what participants can expect from the course, and a discussed just a few of the things you need to consider before sending out that Zoom invite to client.

Q. What are some of the considerations you need to consider by virtue of not being in the same physical space as a client?

A. You see me [but] what's on the other side of my computer? Who's there? Who else is here? It may not matter that much if everybody in my family knows that I’m in my room and I’m getting counselling, but if I’m 17 and I’m seeking services or if I have some difficulties in my marriage and maybe I’m a bit at risk, what are the criteria you're going to use for deciding on how to work with me? What are the steps you need to take to make sure that I’m safe?

We don't really need to do that in the office: we close the blinds and keep the door shut. But, when you're at a distance, those are fundamental ethical considerations. Another one that most people have not thought through — that most clients have not thought through — is the fact that when the camera goes on, you're entering their home.

So, the example I give is: You and I are talking, I’m your client, and all of a sudden we hear screaming in the background — the sound of a slap and a child crying. You say to me, ‘Lawrence what was that?,’ and I say, ‘uh, that was my kid watching Netflix — golly she always watches these violent movies…’  You say, ‘It sure sounds like a someone smacking a kid and the kid crying,’ but I say, ‘no you're wrong.’ What do you do?

Q. What do you do?

A. You should have a policy in place! You should have thought this through beforehand. Time needs to be spent talking about policies and procedures, developing strategies, because most clients have not thought through the implications of you coming into their home virtually.

Q. Are there other strategies that are commonly overlooked but that really need to be in place beforehand?

A. You need to think about the space that the person in. You need to think about where they are. One thing that we should always do when we start a virtual session is just check in with the person and find out where they are, because if something terrible happens and you send emergency services to their home and they're not home… what was the point?

Another interesting aspect of policy is making sure that we tell clients how to look after their own confidentiality. Clients think that somehow we're going to still take care of their security and confidentiality. When they're in our office it makes sense — we close the door, shut the blinds... But when they're at the library or in a park or at a friend's house, they still think it's all on us. So, there's an incredibly important part of policy at the beginning in the client consent form: you have to make sure you spend some time talking to clients about how they look after their own confidentiality and their own security.

Q. What can people who sign up for the webinar expect?

A. First of all, people can expect it it'll be fun. People can expect that not only will I provide them with critical Information around practical and ethical and clinical issues, but they will have an opportunity to ask questions and get their own personal, professional needs met. There are three times during the webinar when I address questions and answer queries from participants, so it's not just paying attention and listening and going away. You get to engage and connect and get specific questions answered.

One thing I would add is that there are interesting consequences of being in this online environment. The big one is what we call disinhibition — people say and do things online that they wouldn't normally do in person, i.e., making rude, ignorant, abusive comments on social media.

In therapy, that has significant consequences for people's behaviour in a counselling session. People behave differently [online]: people can dissociate and decompensate, people can just up and leave a session because they feel distressed. If you don't understand the implications of disinhibition for the online environment in counselling and therapy things can go terribly wrong. [There will be] key material on that in the webinar.