I have no training in online counselling. Is it ok for me to start working online with my clients during the coronavirus crisis?
The safety and well-being of clients is the main priority, but we also need to be supportive and pragmatic to respond to these unprecedented circumstances.
BACP has always recommended that members should receive dedicated training before working online. There are many practical issues to consider, as well as significant implications around how people may present differently online and communicate and respond in ways that we may not have expected. There's also GDPR and other data protection considerations.
However, we recognise that many clients and counsellors currently have no alternative to online therapy. We're doing all we can to provide a basic toolbox of skills and knowledge so you feel able to start working in this way. We'd strongly encourage you to seek more formal training in the longer term. We're seeing the provision of online training developing rapidly in response to the crisis.
Many therapists are in contexts which involve services and organisations with different and sometimes conflicting needs. As always client safety comes first. There's no single right answer and we can only encourage dialogue and communication between all parties.
It's important to pause and reflect on your own competence for this work. You should also negotiate with each individual existing client about whether this is what they'd like to do and if it feels safe and ethical for them to work in this way. If you're unsure, you may find the Ethical Framework helpful, to see if you can continue to meet its principles and values. Each practitioner will be in a unique and individual situation. Take time to think this through and continue to seek support from experienced colleagues and supervisors. It may be better to take a little time out to pause and think clearly, before making important individual decisions.
I've been asked by some clients if I can continue to see them via the internet from home. I can't decide whether to do so or not -can you help?
You need to think carefully about this. You'll need to ensure you have somewhere at home where you can set up a safe and confidential space to work from and that you have the necessary equipment. Each therapist needs to assess their individual circumstances and make informed decisions about ethics and safety. We're working hard to provide resources to help members in this decision-making process so keep returning to these pages for support!
Does my insurance cover me for working online from home?
Many insurance companies that provide professional liability cover also cover you for online or digital working in the UK. Contact your insurer directly if you're in any doubt.
The situation is more complex if you're working with overseas client so you'll need to seek your insurer's advice.
The Ethical Framework says I should work ‘within my competence’. What does that means if I start working online?
You'll need to make this decision yourself, together with advice from your supervisor. Refer to the telephone and e-counselling competences for guidance.
In usual circumstances, it would always be wise to have dedicated training to fully meet these, but you may feel you can largely meet them with support of resources and your individual knowledge and expertise. If you're in any doubt, seek further advice from your supervisor before you start.
I don’t have a computer at home. Is it ok for me to use a phone or tablet to work with my clients?
There are security implications that are relevant to smartphones and tablets as well as computers. You'll need to ensure your devices are adequately protected and your procedures are safe and ethical.
You should password protect any devices you use to communicate with clients. You'll also need to ensure you install anti-virus software and the manufacturer's latest updates.
Many of the secure platforms have versions that perform well on a phone or tablet, but they have limitations and you may not feel sufficiently connected to your client.
More traditional telephone communication with clients (telephone counselling) may be a suitable alternative to face-to-face work.
I’m worried about the security of my computer. I don’t know what I need to do to make sure my work continues to be safe and confidential.
It's important to consider security and confidentiality at all times, and to do all you can to protect yourself and your clients. You'll also need to advise your clients about basic ways of ensuring confidentiality and security.
You can't guarantee absolute security but there are many things that will help your set-up be ‘good enough’. See the resources on these pages and seek advice from organisations with experience in this area.
There are many different platforms available. Which one should I use?
The security of the different platforms varies enormously.
Skype is encrypted and so ‘safe’ at point of delivery, but because of the way its owners Microsoft operate, it's not generally considered ideal for confidential therapeutic work. Skype does not meet the USA's HIPAA regulations which govern the transmission of sensitive health information over the internet. There are a number of other platforms which do and which provide a more robust connection as well as good support.
I'd rather use a telephone than go online. Is that ok?
Therapists have used telephones for many years as a valuable alternative to face-to-face work. So if this is your preference, and your client agrees, working by telephone may be the right way forward for you.
How can I prepare my client for working online? Should I give them any guidance before starting out?
It is always helpful to discuss things carefully with clients and prepare them for the things they may need to think about when moving to online. Many online therapists send clients an information sheet to set out some important principles relating to:
- arranging sessions
- using platforms
- back-up plans if the technology fails
- keeping therapeutic material separate from business communications such as making appointments or managing cancellations
Do I need to get my clients to sign a new contract? What do I need to put in the contract and how do I get them to sign it if they aren’t coming to sessions in person?
We don’t advise writing a completely new contract, as much of what you've already agreed still stands, but there's likely to be some important additional clauses you need to add.
You could create a new set of clauses to send to your client before commencing online work covering, for example:
- waiving 24 hour cancellation fee
- confidentiality, including the management of online communication and payment arrangements
You can send these as an email attachment and explore different ways of gaining your clients’ consent either in writing or verbally. (Always keep a dated record of any verbal agreement you make. )
How do I decide if it’s safe for my clients to continue working with me online. What about risk?
Initially you're likely to be moving work online with clients you already know. This may raise additional factors that complicate the risk assessments you've already made, and you'll need to review this on a client-by-client basis with your supervisor. Try not to be over-anxious and trust your existing skills and knowledge, but also listen to your instincts and seek advice if you have concerns.
It will be important to check how your clients are experiencing the transition and what issues are affecting them which may not be immediately obvious, for example other people or family members in the house, feelings of psychological distance.
There are further considerations if you consider taking on new clients, so it might be wise to delay this to find out more about assessing suitability for telephone and e-counselling.
I think I’m ok to work with my existing clients. Is it ok to take on new clients and advertise that I can work online?
There are additional things to consider when carrying out client assessments online. We suggest you proceed cautiously and begin working with your existing clients.
There are many trained and experienced online therapists already able to assess and offer sessions to new clients. However we understand that as the lockdown period extends you'll be considering the continuity of your practice. If you do decide to take on new clients, we recommend that you participate in training that at least covers all aspects of the assessment process and the initial stages of online therapy.
Please share any training opportunities you become aware of as they may be of help to other members.
My supervisor has never worked online either. Should I find a new supervisor?
We're all working together to try to provide the best service we can for our clients. Your supervisor knows you and your clients and it's important to continue to use this supervision as your first source of advice and support, if you can. Most supervisors are familiar with talking to their supervisees on the phone, even if they've not worked online.
Some supervisors are experienced in online work and have completed additional training in online supervision. The ‘usual’ guidelines for online work are that you have a supervisor who meets these criteria and that you have some supervision through the same medium in which you're meeting clients. If you or your supervisor need further advice, check the usual directories to see if you can find a supervisor able to offer additional advice and support.
The Association for Counselling and Therapy Online (ACTO) has a directory of supervisors trained in online supervision. However, their numbers are limited and other supervisors can fulfil this role. Check their individual experience and training with them.
How do I deal with payments? My clients usually pay me in the session.
There are many ways of transferring money electronically which are secure and effective. You can issue invoices to your clients via email attachments. If you're familiar with online banking, you can set up a BACS transfer system with them using your bank details. If you feel uneasy or unsure about this, you could use a third-party payment system such as PayPal, which will guide you through setting up an account.
If a client pays by BACS, their name is likely to feature on your bank statements, which you may need to submit to your accountant, financial advisor, mortgage provider etc. Most of these will be bound by strict confidentiality policies, however you should make your client aware of this possibility as redacting information on bank statements, such as blanking out their name, is not always allowed (because of money laundering checks for example).
I work for an agency and they've asked me to work from home. Should I agree?
If you're working for any organisation, they have a responsibility to support you with the additional factors discussed here. We recommend you consult carefully with them about any concerns. Seek further advice before proceeding if you feel that their provision is not working in clients’ best interests or complying with ethical framework.
If you don't feel able to work in this way and are facing hardship, support may be available through new government grants and payments. We're producing resources so keep checking our coronavirus pages.
I'm worried about data protection. What records should I keep and how should I keep them?
If you're working in private practice, you'll already have good procedures and practices in place. Don’t try to recreate these in a different form immediately if you can continue to use them with some adaptions.
You need to keep records of online sessions in the same way that you keep records of face-to-face sessions. You can keep records online or on paper.
If you're using new technology to create records (for example a recording of an online session) make sure you know where the data is being stored and that it's being protected properly.
If you've moved your organisational or agency work to your home, ask them for further advice about how they'd like you to keep records.
GDPR regulations relate to all forms of data you keep, whether these are paper-based in a filing cabinet or online. Security is essential.
Do I need to register with the ICO now I’m working online from home?
You should register for your own protection, as well as others.
It's not a complicated process. You can apply through the ICO (Information Commissioner's Office) website and it costs £40. You'll find a lot of new information there relating to coronavirus and the special circumstances too.
There is considerable panic on social media and a lot of conflicting advice is flying around. Do you have any guidance around how we should use social media?
Communication on social media is very different from other forms of communication. We always advise care and caution in any social media postings and responses and hope therapists can apply their usual considered, thoughtful and respectful approach.
Some therapists are finding the postings on social media about what to do now very distressing, overwhelming and confusing. If you feel like this, we'd advise that you protect your own wellbeing and avoid these platforms for now. There are many other sources of support available, through websites and other forms of networking.
If you're engaging in social networking, please consider the need for 'netiquette' at all times and apply etiquette 'rules' to your communication much as you might in any other interaction.
I feel very isolated as a therapist working alone from home. How might I address this?
There are many practitioner groups you can join online. It's important to choose carefully - as online groups and instant communication can raise your anxieties as well as alleviate them!
Look out for something that matches your own way of being and ethical standards for your own behaviour. Be true to yourself! There's a wide range of support out there, both locally and nationally (and indeed internationally).
Concerns over coronavirus mean many members are having to consider offering telephone counselling or working online. Here are some resources to help you work ethically and effectively.
Telephone and e-counselling competences and curricula
A framework for delivering effective counselling via the telephone or e-counselling
Guidance and resources for members