We know that many counselling services have been working hard to develop ways in which to best support their clients during this period of lockdown, social distancing and self-isolation. Indeed, many have introduced online (video) and telephone counselling as an alternative to their normal face-to-face work. We understand this has been a difficult and exceptional situation and that some flexibility is required to support clients and staff.
Clients continue to be at the centre of decisions currently being made at BACP. The information and resources related to training and services all aim to support members in working out how to ensure basic competence of their trainees and practitioners in online or telephone working so they are ‘…..competent to deliver the services being offered to at least fundamental professional standards or better’. (BACP Ethical Framework, working to professional standards, point 13).
The UK Government advice on business and premises recognises that ‘services relating to mental health’ may be an exception when it comes to continued remote working. This document directs people to take into account the advice of their regulator, professional body, Chief Professional Officer or the NHS as appropriate.
New UK Government guidance has been released enabling many companies in England to open for business from 4 July, provided they implement new safety measures to ensure staff and customers can follow social distancing rules.
We appreciate that while some members will wish to continue with online and telephone counselling in the future, a return to face to face counselling is once again becoming a possibility.
Devolved governments in Northern Ireland, Scotland and Wales, are easing lockdown restrictions at a different pace and we’ll update our guidance accordingly. Until then, previous guidance around seeing clients face to face still applies.
We'll provide further updates on this as soon as possible but initially you may wish to read our initial thoughts on returning to face to face practice, which includes some useful considerations for counselling services.
The decision to return to face to face work needs to be considered contextually, carefully and in the best interest of both staff and clients. Moving back to face to face working will have its own potential issues, so take time to fully consider and pull together a plan of action for the next six months. The lockdown is easing, it’s not ending, so there's plenty of time for thoughtful and advised transition.
The current government guidance outlines five key points for businesses to consider which include:
- continuing to work from home where you can
- carrying out risk assessments
- maintaining at least one metre social distancing
- managing transmission risk
- reinforcing cleaning processes
We also advise you check that your insurance covers your practitioners for face to face work. Not all insurers have adopted the same position on this issue.
We advise that services review the updated government guidance carefully and still consider the following points regarding working online or by phone if that is not your usual way of working:
- whether the practitioner or trainee is competent and confident in working by phone or online
- what training the practitioner or trainee has had in this way of working and whether any additional support, training or guidance can be given
- how services through supervision, or where applicable training providers, can support practitioners and trainees to work differently and support clients through this change
- whether working differently is suited to the needs of each client – counsellors may need to ask their clients if working online or by phone would be a supportive alternative. Re-contracting may be required to include a different way of delivering therapy.
- whether telephone or online check-ins might be a possible alternative rather than full therapy hours
- whether safely suspending practice might be the most ethical outcome if the trainee isn’t competent to work online or by phone, and how trainees can be supported do to this
How can we continue to support service users during the coronavirus pandemic?
The ongoing support and safety of clients, balanced with the safety of staff, is uppermost in minds of counselling service staff during this uncertain time.
It can be tempting to try to continue providing the same service by ‘simply’ moving to online working. Important considerations include:
- does the service have sufficient existing online provision to meet current and future demand? Are there enough counsellors and therapists who are competent in providing therapy online in the team?
- are the existing technology, platforms and processes sufficient to support an increase in demand?
- is there sufficient IT support and access to this from home?
- do the counsellors have access to work laptops, with appropriate virus protections and software
- in what ways, other than formal counselling, can you support your clients?
- what support can be put in place for staff expected to work remotely from home, when they're used to the support and connectivity of an office environment?
Online or telephone work will not be suitable for all clients, especially if they're unable to secure a safe, confidential space for counselling. In such cases, we encourage you to find ways to bring work safely to a close or temporary break until face-to-face sessions can resume.
When you do start to consider moving back to face to face work, make it a gradual move. You may find that some clients wish to continue with their therapy online or by phone rather than return to face to face sessions. If you wish to continue offering online or telephone counselling in the long term, there are specific training, assessment and competency issues that need to be considered and formally put into policies.
How can services support counsellors delivering online counselling for the first time?
Under normal circumstances it wouldn’t be appropriate to deliver counselling online unless you're adequately trained. However, as attending training may not currently be practically or financially possible, online courses, such as the OU primer, may help to upskill counsellors who haven’t received training to work online or by phone.
It would be good practice for services to have a means of assessing whether your staff are competent to practise online. If a member of staff does not feel competent to deliver counselling online, they should not feel obliged or pressured to do so. Equally, when returning to face to face work during the lockdown easing, be careful not to pressurise staff unduly to return to the office environment.
These are meant as interim measures and not a substitute for full training. The Open University (OU), in conjunction with BACP, has introduced a free, primer course for the transition to working online, which is free and based on its Open Learn platform. It has proved to be very popular with those not used to providing online or telephone therapy. ACTO (The Association for Counselling and Therapy Online) provides a list of online training providers who offer courses meeting the criteria for ACTO professional membership, and recommended competences for online counselling and psychotherapy developed from the original competences written by Anne Stokes in 2014.
You need to prepare for working in this way so practitioners and trainees know how they can safely and ethically support clients. We're not expecting services to deliver ‘substantial training’ for online or phone working but we're encouraging you to think about how employees can receive some training, so they have at least basic competence.
You can prepare to work online or by phone in several ways, such as a combination of some service input, our web resources or other online resources. We can't recommend any specific training, but you can find various CPD courses on the internet.
In what ways, other than counselling, can counsellors support clients online?
- provide brief, supportive, wellbeing focused check in sessions via the telephone or webcam, if you're confident in communicating in these media. The focus should be on coping mechanisms, and connecting to and developing their support network, not providing therapy.
- signpost to mental health support websites and apps, by compiling a list from trusted providers and sites
- signpost to trusted online support forums to help the client develop a support network
- provide clear information about who they can contact in an emergency, if they experience a dip in their mental health or increase in risk factors. Ensure that they are aware of the boundaries that you are not an emergency or 24-hour support.
- provide links to trusted YouTube content to help support management of their wellbeing
Can services take on new clients via online or phone counselling?
In principle, counsellors or trainees can begin working with new clients online or over the phone provided they are competent to do so and there are adequate support structures in place.
Several new areas need to be addressed before counsellors or trainees can begin to take on new online or telephone clients. We propose that trainees or counsellors will need some additional training on:
- contracting, and how to obtain written or verbal agreement to the contract
- undertaking risk assessments and managing risk
- working with and managing disinhibition
- working safely and securely online
- relevant UK legislation, for example GDPR
The focus of any online training and practice would be on using online video platforms, not text-based counselling.
Clients will need to be based in the UK as there are additional legislative and insurance issues for practice in other countries.
Services also need to ensure that:
- there is capacity (ie competent practitioners) to undertake assessments of new clients for their suitability to work with a counsellor or trainee and for receiving therapy online or over the phone
- there are sufficient support structures for counsellors and trainees to debrief or take issues of concern about their remote client work
- counsellors and trainees know what to do and where to go if they have concerns about client risk
- counsellors and trainees have access to a list of additional support services and referral pathways that can be shared with clients when needed
- online and telephone counselling sessions are adequately spaced to take account of the intensity of working in this way
How can counsellors deliver online counselling from home?
Counsellors who are competent to work online may still be used to working within an office environment and so not used to the uniqueness of working remotely at home.
There are several areas to consider when embarking upon lone remote working for the first time:
- have you been given appropriate equipment (with a working charger), and appropriate virus protections and software?
- do you know how to access IT support when you need it?
- what happens if your hardware fails or breaks down?
- do you have a private space where you will not be overheard or interrupted?
- have you got a set up that is comfortable in terms of table and chair positioning and lighting?
- what arrangements do you have for regular contact with, and support from, colleagues and managers?
- what does the balance of your caseload look like in terms of severity of issues, mental health and risk concerns?
- what support do you have ready access to should you want to talk through a challenging session?
- can you plan a routine for your day that includes regular breaks away from the screen and time to re-energise
What are the pitfalls if I work online when I am not trained?
There are many pitfalls that therapists who have not been trained in online work could fall into. Here are a few, to help you understand how different working online is to face-to-face work:
- not appreciating how online disinhibition influences and impacts on the therapy and getting out of your depth
- delivering therapy through an insecure platform
- maintaining client notes in a way that does not comply with GDPR and could lead to problems with inadequate confidentiality
- falling foul of other countries' legal obligations regarding who can conduct therapy in that country and what qualifications and professional membership is needed to do so
- missing important aspects of the client’s issues or making assumptions due to lack of understanding about how working online affects how and what we communicate
- poor risk assessment and missing clues related to client safety
- detrimental impact on the therapeutic relationship from lack of competence with technology and knowing how to respond when there are glitches that disrupt or delay the session
- continuing supervision with a face to face supervisor untrained and experienced in online working would lead to you missing important understanding and exploration that would ensure you are working ethically and effectively
During the pandemic, we're worried that our data protection practices might not meet our usual standard or our response to information rights requests will be longer. Will the ICO take regulatory action against us?
The ICO has published the following response to this question:
"No. We understand that resources, whether they are finances or people, might be diverted away from usual compliance or information governance work. We won’t penalise organisations that we know need to prioritise other areas or adapt their usual approach during this extraordinary period.
"We can’t extend statutory timescales, but we will tell people through our own communications channels that they may experience understandable delays when making information rights requests during the pandemic."
What health and safety should services consider for staff who are working online all the time and at home?
You may wish to reduce the number of clinical hours a day you require from your staff, as working online can feel more intense than face to face work, especially for those not used to working that way. Consider allowing a longer period of time between sessions, and provide some regular debriefing discussions with your staff.
You should also consider providing staff with information about the physical impacts and considerations needed when working with computer monitors for any length of time. Search the web for ‘workstation assessment’.
What about appropriate supervision for our practitioners, whether working online or by phone or not currently practising?
Online or telephone supervision is an acceptable substitute for face to face supervision and it's good practice to have at least some supervision in the same medium as a practitioner is meeting with their clients. Ideally a supervisor will have some experience of working online, but we accept these are difficult times, and most supervisors are familiar with talking to their supervisees on the phone, even if they've not worked online.
You may wish to consider providing shorter supervision sessions on a more frequent basis to ensure there has been enough supervision in place in line with policy. Enabling weekly peer supervision by qualified practitioners is also a supportive option.
We held a webinar specifically for supervisors which your supervisors may find useful if they are BACP members. Supervisor members also have access to our supervisor support from the Ethics hub.
If any of your practitioners decide not to practise during the current pandemic, they would not need supervision. However, we would encourage continued contact with all staff through the lockdown period as this is a time of anxiety for all of us. This can prove really beneficial when you start to return to face to face practice.
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