Counselling online: What are the odds for success?

This article sets out to answer the following question; "Can online counselling really work successfully?". If someone had asked me this pre-pandemic my answer would have been, "limited success". But I stand corrected as the last five months have taught me as a counsellor that therapy delivered online can be successfully handled by a considerate therapist and a committed client who is willing to work.

I was already working online before with a few clients who travelled a lot or lived abroad but I believed it would have to be limited in the form of short term therapy, for some "simple" symptoms like fear of exams versus complicated symptoms like severe anxiety coexisting with insomnia and childhood abuse. I still believe, and know that face to face is the best experience for clients to develop self-empathy, self-acceptance and trust in themselves and others. But I have also learnt a lot about online counselling in the last few months.

What is significant with therapy?

• A safe space is vital for clients to relax and tell their story and feel accepted.
• A compassionate and accepting listener is key, who believes in the client's story.
• Mirroring, reflecting, partial re-parenting and empathy; key elements that the client needs to navigate through the muddled up thoughts and feelings and find clarity, solutions and trust/confidence in themselves.
• Solutions can be applied with some therapeutic approaches using them more directly than others.
• Cognitive behavioural therapy (CBT) can use 'forms and thought challenging' techniques and trauma therapists can use trauma protocols to shift clients' wiring in their mental and emotional conditioning.
• Therapists apply techniques with the client's permission but somehow in the safety of the therapeutic relationship, the client is more willing to face their anxiety of the unknown. Therapists witness changes that are so rewarding both to the client and the therapist.

How are these techniques offered over the screen?

Nature forced the counselling profession to retreat online and some therapists discovered skills and resources they had not explored before. After the initial shock of a strange face appearing on the screen, the new client nervously darts around trying to gauge the therapist while the latter offers calmness and still reassurance on the screen. But isn't it the same when they enter the therapy room?

The client brings her thoughts and feelings to the table and with a bit of extra reassurance from the therapist, the screen disappears: therapist and client seem to be transported into a virtual "safe space" for an hour.

The impossible has been experienced both by older clients (who had started face to face but had to go online during lockdown) and newer clients (who meet the therapist online for the first time).

The glitches happen more online with the technical problems, loss of connection occasionally due to the internet etc. but once the rapport is built and the relationship is there, I am surprised how clients move beyond the screen and focus more on the work they are here to do. And within the same number of sessions as face to face, they are demonstrating the same progress. 

I accept there are many more people who cannot connect with online therapy, especially if they have shyness issues, fear of exposure, severe depression, dissociative issues, trauma that creates emotional instability i.e. at-risk behaviours. They need face to face therapeutic support to start their journey into the recovery of parts of themselves they are feeling lost about.

Therapists who are still working online have a bigger responsibility to screen their clients' safety more, to check on their emotional stability after each session more, show empathy and presence more warmly to compensate for the distance (and be more flexible with cancellation due to technical glitches or internet problems!). Within these brackets, the counselling world has metamorphosed into the explicit becoming implicit over so many dimensions.