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***Disclaimer: This article is for informational purposes only and does not provide medical, legal, or health advice and is not a substitute for mental health services
Now, more than ever, the world of virtual counselling and care is booming. With COVID-19 numbers on the rise, health care and social service professionals are increasing their focus on virtual care to reduce the spreading the coronavirus while also ensuring that the general public receives the support that they need and require.
For many clinicians, service providers, therapists, and counselors, virtual counseling and care is a new venture that takes quite a bit of adjusting to - especially if technology has not been a strong skill set in your toolbox.
Not to fear - starting slow and steady can help you build more confidence as you learn to navigate these waters. While you may need some help from colleagues or other supports for your initial set up, what may once have felt very scary to you may become the norm as you gain more practice and experience using virtual tools and learn how to support your clients in a new way.
Keep reading on for some tips that might help you along in your journey.
Optimize your camera and lighting
Make sure your client can see your face clearly - use good lighting and a good quality camera. Try to complete your session near a light source - use an overhead light or a lamp to brighten up the area so your client can see you better.
If you are working from a desktop, use the best quality webcam you can find to help your client view you as clearly as possible. If you are using a laptop, it usually has a camera built-in but you can attach an external one if you feel an upgrade is necessary.
Build therapeutic rapport
Consider your facial expressions, vocal tone, and body language. Extra effort is needed on your part to convey engagement, empathy, and understanding from behind a screen! Building a therapeutic connection is often more challenging with clients virtually due to the significant physical space and distance between you.
You may find that you need to work even harder to achieve the same impact that you otherwise would have with an in-person session. You may need to be a bit more expressive to help clients feel a greater rapport with you, whether that involves using more relevant facial expressions, reflecting back frequently what the patient has said and confirming you understand correctly, sharing empathic statements more regularly, using more warmth and humour (when appropriate), and checking in with your client to verify if you are on the right track.
Take the “Do Not Disturb” motto seriously
Hold your session in a space where you are the least likely to be disturbed, interrupted, or distracted.
Maintaining privacy and confidentiality is crucial during virtual counseling or care - regardless of whether services are offered in-person or virtually. Use a private space or room and put a sign on the door indicating you are ‘in-session’ to make sure others are aware, particularly if online services are being provided in your home setting and you live with others.
Manage competing responsibilities
If you have a child or children and/or a pet, try to make arrangements so that they are well cared for while you are occupied.
If you have a partner or a family member who can support your child or children and/or pet, as applicable, that can help you stay focused and attentive during your session.
Increase familiarity with your virtual platform
Make sure you are familiar with your virtual care platform so you know how to navigate it well. Watch tutorials, read Frequently Asked Questions (FAQ), reach out to customer service, and practice using the application features so you can build your confidence using it. If the platform has a chatbox function, use that for quick tech support if needed!
Learning how to troubleshoot issues will not only help you but may also possibly allow you to help your client if they run into challenges, too.
Share information about your virtual counseling platform with your client so they have a chance to get familiar with it as well before their first session. If your client has to create an account to login to the virtual care platform, give them the website details in advance so they can get comfortable before they actually have to use it.
Having your client understand the virtual platform is also important if they are entering credit card information securely into the platform for session payment purposes.
Doublecheck your settings -- “Testing, testing, check, one, two three….”
Make sure your camera and microphone are working well before the session and ask your client to do the same. This will help you start your session smoothly without glitches.
Have a back-up plan
Be sure to have an alternative set up ready in the wings (e.g. phone counseling) in case you have technical issues that cannot be addressed quickly at the start of the session.
Despite your best efforts, technical issues can sometimes still happen. If this does occur, have your phone charged and ready to go in case you need to switch to this format for your virtual session.
Furthermore, if you find phone counseling to be easiest for you and your client, discuss this with them and see if they would like to pursue this option instead.
Take care of all of the important paperwork
Obtain your client’s completed intake form before their first session so you have their full contact information and emergency contact person’s information in case a crisis occurs in-session. The completed intake form will also help you understand what their specific goals are and what they would like you to help them within your work together.
Similarly, obtain your client’s signed consent form for virtual care services prior to their first session and answer any questions your client has at the start of the session so that they can begin knowing they have made a fully informed decision.
Review the limits of confidentiality
When providing any form of counseling and care services, it is essential to review the limits of confidentiality prior to starting services.
Explain to your client that the information and content discussed in the session will remain confidential except for circumstances involving a risk of harm to themselves, others, or you - or other extremely serious situations. It may help to include a general overview in your virtual care consent form of possible scenarios where confidentiality may have to be broken.
Answer any questions your client may have in regard to the limits of confidentiality before you begin.
Develop virtual care policies, as appropriate, to explain your services -- and their limitations
The same professional boundaries and limitations in terms of in-person services are also applicable for virtual counseling and care. For example, your virtual counseling policy may require a section outlining when clients can expect to hear back from you in regards to phone and email messages (e.g. 24–28 hours, business days and hours, etc.).
Your fees policy - if you are providing private fee-based services - will need to include the session rate as well as if there is a late cancellation fee for short notice cancellations that occur within 24 hours of the appointment (mention whether that cancellation fee is the full session cost or 50% of the cost of a session).
You may also wish to create a social media policy that highlights you will not accept ‘friend requests’ or messages from clients on any social media accounts in order to maintain professional boundaries.
It may also be helpful to establish a complaints policy that directs clients on the next steps if they wish to express concern about your services. It would be helpful to include the contact information for your regulatory college as well.
These are just examples of potential virtual care policies. Write up those that are relevant to you and your services. Ensure you have a section at the bottom where your client has to provide their signature and date to confirm in writing that they understand your policies.
You may wish to combine your virtual counseling consent form and virtual care policies into one document or keep them separate - this is a matter of personal preference. If they are separate documents, include a client signature and date section for both forms.
Reach out to your regulatory body and/or a lawyer if you would like some guidance on important things to consider when creating your policies and consent forms.
Keep excellent documentation
Keeping clear and detailed records from every client session is vital to ensure all major themes, issues, plans, and next steps are noted. If your virtual platform offers electronic documentation, make use of that feature if you are comfortable using it. Otherwise, you can determine a documentation system that works best for you, and that meets your regulatory college requirements.
Best wishes as you continue to provide valuable virtual care to your clients and to the community in general!
Wishing you well on your mental health journey.
Davina Tiwari MSW, RSW, CSFT
Registered Social Worker and Certified Solution Focused Therapist
If you are an adult in Ontario or Alberta seeking virtual or online therapy and you would like to request a free 15 minute phone consultation with Meaningful Independence, please Book An Appointment or reach out directly under the Contact page.