A Peek Inside My Email Counselling Office: A Role Play

Today, you get to be a fly on the wall, and peek inside my email counselling office!

Email counselling seems to inspire strong feelings. Most people I talk to are very intrigued. There are a few who have said: “that would NEVER work for me!” (If this is you, please read this.) As I say below (to my fictional client Sandra), email counselling can feel very out of the box. I have created this role play both for the curious and for the doubters.

Setting the stage: As you drop in to observe, Sandra has already written me for the first time, telling me a little bit of her situation. To find her letter, scroll down and look for the italics. You might want to start there, just reading the italics. You are dropping in at the point where I am responding to her. I start with an introduction at the top and then respond to her specific concerns below.

Dear Sandra:

Congratulations on taking the first step to look for a counsellor! For some people, especially those in a caregiver role, it can feel very out of the box. You have recognized that it is not just your mom who needs care (not to mention your grandchild). But in order to be there for them, you need to care for yourself. Counselling is a form of self-care. It’s so easy to put yourself last, and you have courageously stepped outside that.

Email counselling is also something that is very out of the box! I have responded to your concerns below. You can see I have also attached my welcome and consent forms. These forms explain more about my approach and how this whole thing works. In the meantime, keep reading to learn a little more about what to expect.

Our letters are meant to be a conversation, just as if we were meeting in person. The approaches and techniques I use have been designed to facilitate that sense of face-to-face communication.

  1. For example, when I reply to your letter, I hit return in key sections, and type my comments there. I preface my comments with my initials so that it’s clearer who is saying what. When you read it, you will see how it reads as a conversation between the two of us.
  2. Have you ever noticed how easy it is to misinterpret what is said over email or when texting? I avoid this by using square brackets [ ] to convey some of the non-verbal parts of communication (e.g., body posture, facial expressions, or tone of voice). If you want to try using square brackets yourself, please feel free! It can be therapeutic, in that it forces you to increase your own self-awareness of what you are feeling. And it will help me to better understand you.

When you want to reply to me, go ahead and continue our conversation! I invite you to click on my message at the appropriate point. Hit return, and insert your response, starting with your initials.

Then, I also ask that you also compose a new message, as you normally would respond to a regular email … with a letter at the top. In this letter please let me know any updates since the last “session”. What’s changed? Anything new you want to share?

Take your time in composing your response. This is important work. I also suggest that you don’t hit send immediately. Sleep on it. Come back the next day. Inevitably, there will be things you will want to change. In this process of writing, reflecting, revising, and writing some more, you are reflecting more deeply, and moving closer to achieving your goals.

Okay. On to your letter …!

 

Dear Kirsten,

I’m writing to you because I am way too busy to see a counsellor, and in the small town where I live, there’s no one really appropriate anyway. I am at my wit’s end with my 92-year-old mother. All she does is complain and criticize, and she won’t accept any help from anyone except me. She is driving me crazy! I don’t know whether this is something you can help with or not?!

 

KM: Welcome, Sandra. If you were coming to see me in my home office, I would be greeting you at the door [warm smile and extending my hand to shake yours]. I have a sign on my door with my business name that invites you to, “walk in”, so you know you are at the right address! (I know it can feel a little weird going to an office in someone’s home for the first time.) In my office, I have a comfortable futon for you to sit. I also have a lot of art on the walls. I’ve made a cup of herbal tea ready to offer you. Perhaps you’d like to make yourself your favourite hot drink while you read this? Don’t worry, I’ll wait! 😉

From this brief introduction, it is evident that this situation with your mother is really distressing. Refusing to accept help, and constant complaints can be a common problem I hear about from adult children. You are not alone. Although it can be common, every situation is unique [leaning forward in my chair with interest]. I’m looking forward to hearing more about the details of your family life.

 

I should mention that she lives in our basement suite. It’s actually a contained ground level suite, in a home that my partner and I co-own with her. This has been a long-standing arrangement, and it may be that we have all outgrown the situation. She finds it difficult now to even go out to the mailbox to get the mail on her own, let alone do anything else out of the house.

 

KM: [concerned expression] It sounds like she has become somewhat housebound. And if she is refusing help, that puts quite a burden on you.

 

I am constantly worried about her having a fall, and me not noticing until the next day. She is lucky to have a scooter, which should be helping her get out of the house. But she refuses to use it because it scares her (even though she won’t admit it).

 

KM: That is true – she is lucky to have a scooter. They are very expensive. Some older adults have a difficult time feeling dependent on scooters, walkers, and the like. I like to say that these are tools to facilitate independence for the people that need them. NOT to create dependence and frailty. And when you are comfortable and confident using them, then you don’t feel so scared to leave the house! [voice rising slightly with enthusiasm]

Hmmm…. As you can tell, this is something I feel strongly about!

The trick is … like most new skills – learning something new takes time and outside help. [sitting back] From what you have shared, this does sound like a situation where an assessment from your local health authority may be a good idea. They would be the appropriate party to teach her how to use her scooter, for example.

 

Really, she’s the one that needs the help, not me. But as I said, she refuses to accept it. I’ve talked to our local health authorities, but there is little they can do without her consent unless I am abusing or neglecting her, or she is neglecting herself!

 

KM: That is so frustrating isn’t it!? [feeling curious] Correct me if I’m wrong, but are you feeling a bit angry at the system? At your mom?

Actually, I’m planning to write a whole blog post on the topic of how to handle it when your parent won’t accept outside help. There is a lot of general information and ideas I could share that would be outside the scope of this letter. If you like, I can also point you towards resources to help with this.

For now, here is a quote from psychologist and author Donna Cohen. “Many older people see themselves as proud survivors. They think ‘I’ve been through good times and bad, so I’ll be fine on my own.’ Plus, they don’t believe their children understand the physical and emotional toll of age-related health declines.”

Do you think this applies to your mom? Or not? [hesitating with uncertainty.] Please let me know if I’m on the right track.

In the meantime, I would love to talk more about the details of your situation. Can you tell me more about your mom? Has there been a time when the two of you gotten along well?

 

More about me: I have a chronic condition that causes pain in my hip and so I walk with a cane. I am the primary caregiver to my 8-year-old grandson, who also lives with us. He is a handful. Actually, he’s the only one who can make my mom smile – she brightens up when he is around, and they are close. I work almost full time, and (as I mentioned) I have a common-law partner. My partner works full time, contributes to finances, and is busy a lot.

 

KM: WOW. [eyes grow big] Sandra, you have a LOT on your plate! [feeling concerned for you] Anyone would feel overloaded with all of this, but chronic pain adds an extra burden, making it difficult to cope. What do you do to take care of yourself? When do you get a break?

 

I’m not sure what I am hoping for in writing to you. I guess I thought this might be a way to find support and a place to vent. I can’t talk to well-meaning family or friends because I often get too emotional (and I don’t want them to worry about me). Or they try and tell me what to do to fix it, without really listening or understand how I’m doing.

 

KM: It sounds like you are running into some roadblocks finding support in your day-to-day life. Your comments remind me of my favourite quotes from a relationship expert named John Gottman is “understanding must precede advice”. You have echoed this in your reference to well-meaning friends.

[leaning forward] When you get “too emotional”, what does that look like? Can you give me an example? Please tell me more about what you are feeling.

 

I also thought you might have some insight into what was going on with my mom and our relationship. Why she is so critical and angry, for example. We weren’t always this way. We used to be close.

 

KM: Ahhh. [smiling with hope] Earlier I asked if you two had ever gotten along well. I see you have begun to answer it. I would love to hear more about when you used to be close!

As I won’t get the opportunity to meet your mom, what I can do is present some possible paths for you to pursue. It may be that as we talk more, you will be able to connect some of the dots in your current relationship with her. I am hopeful that together we can make some progress.

 

Thanks for any help you can provide.

Sandra

 

KM: You are very welcome! [big grin] I have asked a number of questions in this initial response. My purpose is simply to highlight possible paths we might follow in working together. It is completely up to you where you want to go with this. In other words, take what is helpful, and don’t worry about the rest! If anything is confusing or doesn’t make sense to you, please send me a brief note in a new letter with the subject heading “clarification requested”.

We have not yet really discussed the frequency of our “sessions”. I would like to hear back from you within a week. In that letter, I would either like your response, or just a quick note to say that you have read my letter, and plan to respond in x time. Because of the nature of email, if I don’t hear from you, I start to wonder.

Okay, I don’t know about you, but my cup of herbal tea is empty! If we were meeting in real life, our attention would start to turn towards the rest of our day. As I walk you to the door, I notice some blue sky out there!

It has been a pleasure to meet you. I look forward to our next session. [warm smile, extending hand to shake]

Goodbye!

Kirsten

Communicating with your Counsellor Online: Ethical Concerns

Have you ever emailed your counsellor? What about your kid’s teacher? Last fall, I took an eye-opening course on Cybercounselling. In the process, I gained a much clearer understanding of the ethical concerns associated with communicating with your counsellor (or kid’s teacher) online. Twenty-three years ago, in 1994, the head of the school Lawrence Murphy founded Worldwide Therapy Online. In 1998, together with with the National Board for Certified Counsellors, he created a distinct code of ethics “to address the unique situations created by Internet technology”. (Wow. I didn’t even have a computer in my office yet!)

The Backstory

You’ve come a long way, Internet.

Way, way back in 1995, as a fresh young graduate starting out in addictions counselling at a non-profit society, I didn’t even have a computer on my desk. Rather than emails, we copied interoffice memos and stuck them in our colleagues’ mailboxes. Sometimes, when I tried to reach a client, they didn’t even have an answering machine. Remember those days?

Flash forward about five years later: I have a memory of sending a quick email to a colleague, hearing an email ding, then looking up from my computer and catching her eye. Turned out she and I both had our office doors open. (We were across the hall from each other.) We both burst out laughing at the absurdity.

In the last decade funding sources slowly dried up and caseload pressures grew stronger. And yes, I took shortcuts. As email found its way into almost every home, it also became a very efficient time-saving tool in communicating with clients. The purpose of emailing may have been to share a resource, book an appointment time, or even respond to a concern or question. I simply did not have the time to deal with all of these communication needs by phone.

The thing is, I am not alone. “It is more than hyperbole to suggest that the use of insecure email by professional clinicians may be the single most ubiquitous breach of ethics in the history of psychotherapy” (Murphy, Cybercounselling Level 1 class, Worldwide Therapy Online Inc., September 2016).

So, you and your counsellor are communicating online. After all, that’s the world we live in now! Maybe you are getting some counselling, or maybe you are just scheduling your next appointment. What are the ethical considerations you need to think about?

Communicating by Video 

Many sources equate online counselling with Skype. Many counsellors are offering Skype counselling as a way to make things easier on some clients. If your counsellor is using Skype, are you aware that Skype is licensed for personal use only, not for business? Check your terms and conditions. Both of you have agreed (when you first signed up) that Skype can review content at any time. Or, your counsellor may use Skype for Business (launched in 2015). If so, you may want to ask her how its integration with MS Office impacts how data is shared between the programs. For example, are contact names shared?

In addition to privacy concerns specifically related to Skype, there are other ethical considerations that stand out. I have seen a counsellor’s web page that advertises their Skype sessions as “just like real life”. This is a misnomer. For example,  you may have noticed that it is difficult to meet the eyes of the person you video chat with. How do you hold a therapeutic conversation when the other person is looking at your chest the whole time?

There are also space and lighting concerns to think about, as well as technical! When we meet over video, where am I in your space? What can I see and hear in the background? How does the lighting and/or video quality impact my impressions of you?

Communicating by Email

Further considerations unique to email exist, especially if you are going to communicate with your counsellor through regular, non-encrypted email. They will not protect you completely but may go a little way towards keeping you safe.

  1. Avoid giving away personal information and/or names of individuals in the subject heading. (As a parent, I have been guilty of using my child’s name in the subject heading when sending an email to their teacher!)
  2. Avoid discussing anything personal, especially information that may be damaging, in the content of regular email communication. Once the two of you have developed a rapport (and given the informal tone of many emails), this can easily happen without thought. You need to know you are then making yourself vulnerable.
  3. Look for a counsellor that uses a generic domain name that does not immediately reveal their role. Eg. kirsten@kirstenluise.ca, rather than kirsten at rainstormcounselling dot com.

BEST PRACTICE: Look for a counsellor that provides secure, encrypted email that allows you to talk more privately!

Speaking of Encrypted Email…

My Cybercounselling teacher has said it is a breach of ethics to use regular email for any communication with clients. A conversation about an appointment time can easily slip into sharing information about something upsetting that happened that day. You may want your counsellor to be aware of it. After all, they are supposed to be a safe person for you to talk to, right?

“The rationale for encrypted email requires no more comment than does the rationale for a locked filing cabinet in a face-to-face counselling office” (Ibid, September 2016).

Very simply put, the web may route any email from within Canada through the US on particularly busy traffic days. Once it reaches the US the USA PATRIOT Act (and related legislation) applies. This is still the case even if you are sending elsewhere in Canada, and using a Canadian based email company. If you are using US based company such as Gmail, or Yahoo, the same American legislation automatically applies. It is not going far enough to exchange confidential information through regular email as long as they give informed consent. It is not going far enough to provide a warning in small print at the bottom of your email. The issues are too complex; we cannot be properly informed.

“It is akin to telling a client that you might break confidentiality ‘if bad stuff happens’ and then assuming they understand that disclosure of child neglect will lead to them being reported” (Ibid, September 2016).

Finally …

Online counselling goes by many different names: telemental health, cybercounselling, online counselling, e-counselling, and more. In all types, there are ethical concerns that cross the modes of communication. Whether it is by email, phone or video, you need to consider who else in your world can see and/or hear. Does anyone else know your password? Is there someone in the next room that you don’t want to hear you?

Working online can be notoriously unreliable. What if the application goes down? What if your account locks you out? What if there is an emergency? What if a space of time goes by when I don’t hear from you? Both of you need to have phone numbers you can use for backup, or in the event of an emergency. For crisis counselling, getting services online may or may not be the right choice. All of these things need to be considered carefully.

The new frontier, (especially for counsellors who work with young people) is communicating with each other by text. All of the above ethical concerns still apply. Free encrypted texting and email products are commonly available. (Most systems require both parties to sign up in order for the exchange to be encrypted.)

Are you feeling worried now?

Despite all these concerns, I am still a big believer in this form of therapy. (Check out another blog post I wrote to learn more about that.) When I started Rainstorm Counselling & Consulting I researched the various choices. Currently, I use Proton Mail for email and Signal for texting. (Communicating by video seems to be another matter. Several choices exist but they all cost money. Video counselling is coming soon!) Contact me if you have further questions about what I learned in my consumer research. If you are interested in getting training yourself, check out Therapy Online. This article only covers a small amount of what there is to learn.

A CBC article shows that more Canadians are worried about their privacy online. How about you? Do you communicate with your counsellor online? Have you ever tried out encrypted email?