Best practice
Disagreement Views di ff ered on the following issues: ¢ Change of setting – therapists reported seeing more of the client and their home life such as a bedroom, which they felt was intrusive. Other therapists saw advantages in the client being at home and more able to relax and reveal more about what was troubling them. ¢ Therapeutic relationship – this was seen by some as better online and by others as worse. Equally, the ability to work with transference and countertransference was seen as both better and worse by practitioners. ¢ Creative potential – for some the online space limited creativity and creative interventions with clients. For others it provided an opportunity to develop new and di ff erent ways to facilitate creative work. Overall it appears there are some therapists who enjoy working online, with others preferring to continue to work in person. Technology can sometimes be challenging for counsellors and clients, yet there is also evidence of people embracing and working well with video therapy. What is clear is that there are many areas of online working that would bene fi t from further research to consolidate and extend what we currently know or have observed. ■
Hybrid supervision : The service provider suggested that it may be helpful to have some supervision sessions in person to allow the supervisor to see the counsellor more fully. Within the literature there was much debate about how well counsellors could use online working for their therapy work but no substantive mention of supervision. Nevertheless, the same issues of how much you can truly ‘see’ online and whether it is enough within a longer-term supervisory or therapeutic relationship remain to be studied and answered. Further challenges There was broad agreement among therapists on the following additional areas: ¢ Experience matters – the research indicated therapists who were more comfortable working with technology were also more likely to feel more competent in delivering therapy online. ¢ Adaptation is needed – some therapists felt that the video connection limited the information available to them, reducing their engagement or ability to observe compared to their in-person work. While some were happy to continue working online post-pandemic, others were more interested in either returning to in-person working or a hybrid option. ¢ Wellbeing is impacted – some therapists reported feeling more tired and drained at the end of a day of online working than they would do in person. It is possible that this is related to their own relationship with technology and their therapeutic style. ¢ Counselling process is changed – losing the opportunity to chat with the client on the transition to and from the counselling room, or for the client or counsellor to re fl ect on session content either before or after the session (due to joining immediately after another activity), was seen as a loss. Practice had to be adapted to allow this to happen in a di ff erent way. ¢ Regulation can be challenging – some felt that it was harder to facilitate emotional regulation and containment with a client online, compared with in-person. It is possible that this issue also links directly with the client safety section earlier.
REFERENCES 1. Lin T, Heckman TG, Anderson T. The efficacy of synchronous teletherapy versus in-person therapy: a meta-analysis of randomized clinical trials. Clinical Psychology: Science and Practice 2022; 29(2): 167-178. 2. Nguyen J, McNulty N, Grant N, Martland N, Dowling D, King S, Neely L, Ball J, Dom G. The effectiveness of remote therapy in two London IAPT services. The Cognitive Behaviour Therapist 2022; 15: E23. 3. Capobianco L, Verbist I, Heal C, Huey D, Wells A. Improving access to psychological therapies: analysis of effects associated with remote provision during COVID-19. British Journal of Clinical Psychology 2023; 62(1): 312-324. 4. von Below C, Bergsten J, Midbris T, Philips B, Werbart A. It turned into something else: patients’ long-term experiences of transitions to or from telepsychotherapy during the COVID-19 pandemic. Frontiers in Psychology 2023; 14: 1142233. 5. Full W, Vossler A, Moller N, Pybis J, Roddy J. Therapists’ and counsellors’ perceptions and experiences of offering online therapy during COVID-19: a qualitative survey. Counselling and Psychotherapy Research 2023; 00: 1-16. https://doi. org/10.1002/capr.12707 6. Roddy J, Gabriel L, Sheehy R, Charura D, Dunn E, Hall J, Moller N, Smith K, Cooper M. Mental health practitioners’ perceptions of online working: a literature review. British Journal of Guidance & Counselling (currently under review).
About the authors
Dr Jeannette Roddy is CEO of Dactari Ltd, an online counselling and counsellor training organisation specialising in working with domestic abuse. Professor Naomi Moller is Professor of Psychology and Psychotherapy and Head of Discipline at The Open University.
Dr Wayne Full is Director of Diversity, Development and Research at the British Psychotherapy Foundation. Dr Andreas Vossler is Senior Lecturer and Deputy Director of Teaching (Counselling) at The Open University.
27 MAY 2024 THERAPY TODAY
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