Jul

7

2015

Online Counselling: How to Start on Skype and email

Online counselling is the future. There’s no two ways about it – the digital age is here and it’s slowly but surely disrupting industries that have been operating in the same way for centuries.

Education is shifting towards online platforms, ecommerce grows year on year, and we are beginning to see shifts in therapy too. To quote John Kim of The Angry Therapist, “it’s kind of like bookstores and Blockbuster. Everything is shifting online. The same thing will happen with mental health.”

Getting started in the world of online counselling can be a confusing and worry-ridden process. Key questions about how to begin, confidentiality, and whether it’s worth the effort rear their head again and again. This guide will help you understand how to develop an online therapy practice, and the benefits it can offer you.

The benefits of online therapy

  • The time is ripe! Technology has advanced to a stage where stable internet connections, software like Skype, and growing internet use means that there’s never been a better time to start counselling online.
  • And it’s only getting riper… We’re not at a stage with Star Wars-esque talking holograms, but with virtual reality being set to be the biggest innovation of the next decade, it’s not unfeasible to suggest we could have virtual counselling rooms accessible via headsets
  • Expand your client-base. Therapy has typically been constrained to specific areas. Clients are unlikely to travel far to find a therapist unless seeking a very specific niche or expert. By launching online therapy, you have access to people nationally, or even internationally.
  • Cut your costs. A PC with a good Internet connection is all it takes to get online and begin your work. Typically, this is available from home.
  • It’s flexible. You can commit to undertaking work when it suits you most. In addition, email counselling in particular is beneficial to clients who cannot commit to a specific timeslot in their schedule. It offers an extra level of convenience.
  • It is confidential. Or at least no less confidential than face-to-face counselling. Confidentiality is a big issue in counselling, but it’s just as at risk from someone listening in at the door, or a phone being left off the hook, as it is from interceptions from hackers. The internet has come a very long way in its short lifespan, and risk decreases everyday.

Online counselling is simple to set up and allows you to access the world through your computer.

Synchronous or asynchronous online counselling

When venturing into online counselling, you need to make a choice about whether you’ll offer your services synchronously or asynchronously. In a nutshell, this breaks down as follows…

Synchronous: here both you and your client will be connected at the same time and be engaged in a two-way conversation. As such, this is similar to the traditional therapy setting.
Typical platforms: Skype and instant messenger services

Asynchronous: this works via a series of ongoing exchanges. Neither of you have to be at the computer at the same time; rather, you will pick up messages from the client and respond, and they will then do the same, adding a further level of flexibility.
Typical platforms: email

Despite falling under the broad banner of ‘online counselling’ these are vastly different approaches, and thus we shall deal with them separately.

Synchronous: Skype counselling

When it comes to synchronous services, there are a number of available platforms, but Skype is by far the most commonly used, and most clients will likely already have it.

Skype is a free software platform that enables 1-to-1 communication between people who have the software installed and have set up accounts. You can download Skype here.

You will need a webcam and a microphone – most laptops come with these as standard now though.

Skype is arguably the most commonly used video chat tool on the planet, and is a fantastic way to do online counselling.

Steps for Skype counselling

  1. Set up Skype on your computer – whether you’re a Windows or Mac user, download Skype and set up your account. Get familiar with the platform. Feel comfortable. Perhaps ask a friend to join your for a conversation, and get to know the key functionality. Skype also has a ‘test call’ function to check your audio and microphone work properly.
  2. Ensure your client has Skype – send them a link to download if necessary, and explain what they need to do to set up the account.
  3. Get their account name – they will need to set up a username. Ask them to send you the username well before the appointment so that you can add them to your contact list in preparation.
  4. Set up the appointment – pick a time when you will both be undisturbed and available to truly focus on therapy. Ideally, suggest that the client is alone in the house.
  5. Sort out payment – due to the online nature of the process, you’ll need to decide how to process the payment. A simple platform like PayPal can process this.
  6. Get set up early – before the appointment itself, ensure you are logged onto Skype and ready to go. This gives you one more opportunity to test your audio and microphone before the meeting to ensure that everything is working smoothly.
  7. Relax – get into the therapy frame of mind. Sometimes, particularly when you first start out, Skype meetings can feel a little unusual and put you on edge. Practice a few minutes of mindfulness yourself.
  8. Await the client – once they logon, you can activate the call and begin the session.

Pricing Skype counselling

As with counselling offline, typically counsellors charge per session. It is worth considering your pricing structure – you may wish to offer a slightly lower rate due to the lower cost structure of counselling online. This will also help you undercut the ‘going rate’ for counselling in your area, offering a further benefit to potential clients when you’re marketing this service.

Benefits of Skype counselling

  • Once you’ve got to grips with the platform, Skype is easy
  • Room hire isn’t needed
  • Mounting evidence suggests this method is no less effective than face-to-face counselling
  • Skype counselling captures many of the nuances of communication, such as voice and tone, and some gestures

Pitfalls of Skype counselling

  • Again, we can’t stress enough… check your equipment!!! Microphone, sound and video issues are the most likely culprits. Ensure you’re settings are optimised.
  • The internet is  pretty stable in 2015, but loss of service is still a potential problem.
  • Ask the client to familiarise themselves with Skype too, if they aren’t already. They need to have a basic understanding of how the platform works. If needs be, once you’ve learnt how to use the software yourself you can always guide them via a traditional phone call.
  • Whilst you can still see each other via webcam, your ability to read body language may still be a little lacking.
  • Disturbances are more likely. Ensure you have a quiet place for the consultation, and also set your Skype status to ‘busy’ in case any other users attempt to initiate a call.

Email counselling

Of the two key approaches to online counselling, asynchronous email counselling is definitely the more unfamiliar. However, in practice it is quite simple. Clients will send you emails with concerns and issues, to which you can take a considered therapeutic approach and respond as such.

Steps for email counselling

  1. Get an email account – You probably already have one, but you may consider keeping a separate one just for your work. Whilst we believe that most major providers such as Gmail and Hotmail provide more than enough security for therapy purposes, you may like an added level of security by using encrypted email such as Hushmail.
    NB: BACP guidelines recommend an encrypted email service; we just feel this is outdated based on the leaps and bounds technology has made.
  2. Categorise your account as necessary – Try to keep folders for each client to ensure your emails don’t get muddled.
  3. How you will work – Make some general structural decisions, frameworks and boundaries that will apply to all clients – Details such as how long a client will need to wait before expecting a reply (e.g. 24-48 hours), and the typical length of an email are important.
  4. Set up payment gateways – as with Skype above, decide how you’ll take payment. Paypal is a common choice.
  5. Get the client’s email address – Once you’ve secured your first client, you will need their email address.
  6. Communicate clearly – explain to the client how your particular service works, and the associated fees.
  7. Develop an understanding – Try to gather as much background information as possible from the client. Relay a few emails back and forth to gain an understanding of the client and their situation as you’d do in an initial consultation meeting.
  8. Begin therapy – Advise the client to send their first email when ready.
  9. And continue therapy – Once received, read it thoroughly and consider every point. Respond with a therapeutic approach.

The asynchronous nature of email counselling can take a little getting used to, but the benefits include enhanced flexibility and more measured responses.

Pricing email counselling

Typically, counsellors will charge per email they send. A common pricing strategy is to charge for a full 1 hour session per email received and sent – this gives you an hour to consider the contents of the client’s email and respond appropriately.

Benefits of email counselling

  • Clients can more fully relay their thoughts and feelings by writing everything down, thus building a bigger and more detailed picture than they perhaps could in person.
  • Some clients prefer the enhanced level of anonymity that email gives them.
  • Clients can unload their feelings whenever they deem appropriate rather than having to wait for your next appointment to come around.
  • After responding, your client can access the response whenever they need to.
  • As conversation isn’t back and forth, email grants you the possibility to craft the best response. You don’t have to think on your feet. It also means that you may be able to refer to books or documents that you feel may benefit your response.

Pitfalls of email counselling

  • Slow typing can lead to the process taking unnecessarily long. Writing out emails of 500-1000 words can be a challenge for some people. Ensure your typing skills are sharp.
  • You are reliant on words alone – tone, body language, the use of space and any other clues are gone. This can be severely limiting.
  • Clients are also granted the opportunity to put more consideration into their words – sometimes their slip-ups are important (We more than anyone should be familiar with Freudian slips!)
  • Email is not advised for scenarios where the client may be at regular risk, such as if they are suicidal or harming themselves.
  • Some people can struggle with reading and writing comprehension, due to literacy levels or learning difficulties.

Some broad tips

This introduction to online counselling has covered two of the main methods, falling into the separate synchronous and asynchronous camps. However, there’s a handful of important things to bear in mind, regardless of the method that you use.

  • Remember to take other contact details. You’ll need a phone number and email in case of problems.
  • Try testing the waters with a couple of online clients whilst maintaining a face-to-face practice still. It’s a very different world and can take a little getting used to.
  • Whilst a huge benefit of online counselling is enabling you to access clients all over the world, stick to languages and cultures you know.
  • The biggest risk to confidentiality isn’t actually anything techy – it’s leaving your laptop open with client’s emails on it! Make sure you keep this hidden from prying eyes, and don’t leave your laptop unattended with confidential documents open on it.

Other resources

One easy method to get started with online counselling is to sign up to Plus Guidance – a directory for online counsellors. You can also sign to to ACTO which features a directory of online counsellors.

Our blog post on business skills and IT in counselling can help you begin marketing your counselling work online, and gives you ideas for skills to develop.

The BACP have guidelines for online counselling. Training in online counselling for UK readers is available at Online Training For Counsellors.

10 Comments

  1. rosa on 21 March 2017 at 9:28 am

    very useful. thank you

  2. Natalija Rascotina on 19 April 2017 at 11:42 am

    I’ve only recently started with online consultations, this will help me a lot going forward.

    really good read!

    • Brighton Therapy Partnership on 27 April 2017 at 9:16 am

      Good luck Natalija!

  3. Teresa Wilson on 8 May 2017 at 7:54 pm

    Thanks for sharing this informative blog with us. great stuff. I like your content of list you included. please
    keep sharing such innovative ideas with us.

    • Brighton Therapy Partnership on 12 May 2017 at 5:03 pm

      You’re welcome Teresa!

  4. Graham Kim on 10 May 2017 at 9:27 am

    You have given the total information in detail about the online counselling this helped me out to solve my problems regarding the Skype and Email.
    This blog cleared my doubts regarding this content. Thank You!

    • Brighton Therapy Partnership on 12 May 2017 at 5:04 pm

      Glad to have been able to help Graham!

  5. Debby on 2 June 2017 at 7:57 am

    It just happend a client walked in the other day. The biggest problem the client was facing is making appointments. Just the thought alone was making him panic. I was looking for a way to help him. Thru email we can still have regular contact without having to make an appointment. So for now this could be the solution for him. Thanks for the tips and how-to’s!

    • Brighton Therapy Partnership on 5 June 2017 at 1:34 pm

      That’s an excellent addition – many feel less anxiety about maintaining an online relationship with their therapist compared to offline and face-to-face situations. Thanks for your input Debby!

  6. Léa Pereira on 2 August 2017 at 8:13 am

    Hi!
    I always read your articles and find them very interesting and helpful.
    About online counselling I would just like to add that skype is not considered safe in several countries (both in Europe and USA) for therapy, due to privacy issues.
    Currently there are other platforms that have been made specifically for telehealth/telemedicine, like zoom.us and doxy.me and that are HIPPA compliant (rules for this are stricter in the US I believe).
    In any case here’s an example of a list of platforms: https://vsee.com/telemedicine-platform-reviews
    And you can also get a lot of info about this here: https://www.onlinecounselling.com/podcasts/

    Good luck to all of us adapting to new times!

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