Reflections on the Current State of Online Counselling

“Rather than fight how people reach for help, let’s optimise how they actually heal online” 

Emily Sorensen 2017


Online counselling has been around for decades, but it is only just becoming better known in the public. Some leading providers are Talkspace, BetterHelp and Breakthrough, but these are just the tip of the iceberg – and only of the all-in-one platform type.

You see, as a counsellor, you have many options and difficulties if you’re brave enough to venture into e-therapy. During therapy training, you rarely learn how to practice online or get online clients. Traditional counselling diplomas only cover face-to-face work and the important skills of the counselling itself. But transfer that onto video, voice and messaging scenarios, and you get a whole new set of legal and practical considerations to address.

Let me explain some of these challenges.

Verifying a client’s identity

UK-based counsellors can take clients from most of the world and still be insured. However, American and Canadian counsellors can only serve clients residing in their region. This is difficult if the therapist hasn’t got a way to verify the other person’s identity, so they’re faced with taking a risk every time they’re not sure. It’s the same for everyone who are not qualified or set up to help children (most counsellors in the UK). And when you’ve got a suicidal or at-risk person, your ability to send for help depends on whether you recorded their address and contact details prior to facing the critical situation.

This exemplifies why it’s important to have clear procedures, communication and a means to record information, should you need it for insurance or emergencies.

Face-to-face versus online skillsets

Even the best face-to-face counsellors can struggle to make an impact online if they’re not good at communicating through a screen. It doesn’t matter how many diplomas or titles you have – if you’re uncomfortable with video, sound too cold or bot-like over messaging or can’t type well enough, the other person will perceive that.

For example, emojis are a visual language more and more people use to express complex emotions. You can use that to prevent misunderstandings that can easily occur in messages between strangers. Video sessions have the benefit of facilitating body language – but you’ll still need to sit somewhere with good lighting and talk clearly to prevent misunderstandings.

There are other knowledge- and skillsets that arguably all online practitioners should learn to call themselves proficient. For example, people are more likely to blurt out their deepest issues right away online compared with meeting face-to-face. And people are more flaky online, so it takes a tactical set-up to make clients stick to their appointments. Planning for those things helps cushion the effects that would otherwise impact on treatment success.

Setting boundaries

Online practitioners will eventually be faced with suicidal clients, because many people reach for their phones when they’re most vulnerable. Counsellors can either obtain the necessary training to deal with this, or communicate clearly before or at the beginning of a relationship when they’re available, messaging schedule and where to get immediate help if needed outside work hours. Especially in asynchronous counselling (e.g. email counselling), setting rules for when and how a counsellor replies is essential to maintain their work-life balance and a sense of treatment structure.

Setting up a virtual practice and what it means for marketing

Counsellors now have several pathways to providing online counselling. They can choose to apply for all-in-one platforms like Talkspace, which offer all the payment-processing, messaging and video technology they need – but at a cost. All-in-one platforms are great for counsellors who want someone else to handle their marketing and tried-and-tested procedures, because the platforms are spending lots of money on this. But counsellors usually pay a high cut from their earnings to fund this, and platforms often decide on the therapy price to make it simpler to market.

For more autonomy, counsellors have to decide on their own video, scheduling and payment processes or pay for a B2B service that customises a solution for them. In these cases, they’ll need to spend their own money or time on marketing, as otherwise they won’t reach new people to counsel. Alternatively, they can work for established charities and organisations – like Survivors West Yorkshire – which offer virtual counselling for males: Ben’s Place.


Technical and privacy issues

Working online carries with it a risk of technical failure. It doesn’t matter what “reliable” software you use – Skype, VSee, FaceTime, etc. – it won’t work if your network connection or devices are not suitable. You need to set up the best circumstances for all sessions and communicate clearly to the other person what to do in the event of failure. With a clear plan B, you can reduce the impact of a failed session substantially.

There’s also the highly debated issue of data privacy and whether technological services that own your data (e.g. Skype) are trusted enough for therapy. You’ll need to decide for yourself where your priorities lie: what compromises are you willing to make to accommodate convenience?

The future of online counselling

That said, all counselling modalities have their unique challenges. When you’re following technological developments and people’s natural user behaviours, you’re leaving behind outdated approaches and meeting people where they are today. There’s this fear among some counsellors that online therapy could kill traditional in-person therapy, but this is simply not true. The online route opens new pathways to treatment for people unable or unwilling to seek face-to-face help, while many other people continues to need or prefer in-person help. Therapists are simply helping a wider range of people by offering online counselling too.

If we all put our minds together, we can work out the best ways and rules applicable to internet-based counselling internationally.

Emily Sorensen
Founder and Director

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