Tag: confidentiality

The Community of Mental Health Counseling

When a person plans to become ordained in the Episcopal Church, he or she must first obtain the support of a parish. They then enter what is called the “discernment process” with the full backing of a community. I sometimes wish graduate school for counseling had a similar system, so that in the overwhelmed moments of doubt, I could step forward with the knowledge that there is a group of people who think I am not only qualified for pursuing the education, but that I am suited for the job and am on the right path.

I had my first clients at my practicum site a few weeks ago. It was a wonderful and overwhelming experience, and when I returned home I found I did not know how to process it and my usual confidants were not available to me fully (due to confidentiality) and also did not understand the context of my emotions. So I called my classmate, who was able to relate to my experience of nerves, excitement and accomplishment, and who made me feel less alone in my first experience as a “real” counselor. When I hung up I realized that I do, in fact, have a community backing me up in this process… my classmates, my professors, my supervisors, my fellow counselors. We are supporting each other and receiving support as we realize our lack of competence in some areas, our unexpected preparedness in others, and the ways we are developing as professionals.

Online Counseling

Upon the death of Steve Jobs, a friend of mine* posted on Facebook, “Three apples changed the world: the one that Eve ate, the one that hit Newton on the head, and the one Steve Jobs offered us all.”  Jobs, the founder of Apple, certainly changed the way we use technology today.  It is more accessible, and constant, and personal. But how has Jobs (and his technology) impacted the world of counseling?

Well, in the trend of online counseling, he has enabled clients to literally keep their counselor in the palm of their hand.  Some counselors offer services via Skype or other live internet communication; clients can be in touch on their iphone or ipad while maintaining physical distance.  Some counselors also offer email communication (known as asynchronous communication, where the interaction does not occur in real time).  Clients also have access to lots of information about mental health, both accurate and inaccurate, through the web (Gladding & Newsome, 2010).

With email, counselors and clients can keep in touch conveniently and work with a flexible schedule, in a way that may even out the spread of power between client and counselor (each can communicate with a home court advantage).  However, email shares many risks with other internet counseling methods; namely crises in which the counselor is not present, issues of confidentiality and protecting privacy in a secure manner, as well as third-party payments (Gladding & Newsome, 2010).  In addition, there is a greater chance of miscommunication when technology is involved.  When videochatting, there is the potential for the connection to break up at a key moment.  In email, a sarcastic phrase may be taken as fact or adolescent slang may be difficult to decode.

In a recent New York Times article, one psychologist (Elaine Ducharme) discusses her long-distance practice. Ducharme uses Skype to videoconference with patients from her former practice, and is licensed to practice both in the state in which she counsels online and the one in which she lives.  She will only videoconference with a patient she has already met, and periodically returns to have face-to-face appointments.  “‘There is definitely something important about bearing witness,’ she said. ‘There is so much that happens in a room that I can’t see on Skype’” (Hoffman, 2011).  The article continues on to address the pitfalls and benefits of online counseling.

The National Board of Certified Counselors (NBCC) began putting together a task force to address technology-assisted counseling in 1995, an endeavor that tackles ethical and practical issues and led to today’s Standards for the Practice of Internet Counseling (Gladding and Newsome, 2010).  With the massive presence of the Internet in our lives, it is necessary to set these guidelines and enforce a standard in order to protect the professional integrity of counselors, both online and off.

As a beginning student, I see myself working in a more traditional face-to-face practice, as opposed to using Skype or email as a central mode of communication.  There are already so many concerns in the practice of counseling as to how to best work with a client and act in their best interest, without worrying about a dropped videocall or a crisis thousands of miles away.  I recently read what constitutes malpractice, and sat staring wide-eyed at the textbook for a good five minutes, contemplating all the ways I could screw up.  I don’t feel I need to add any additional potential for disaster to the list.  I appreciate the momentous contributions of Steve Jobs and the impact of the growth of technology on my daily and professional life, but as a starting counselor I think I may check the technology at the door.  I’ve been spending a lot of time lately learning how to be with someone, how to listen and share time and space in a therapeutic manner, and I plan to put those skills to use by counseling face to face.  As I learned in my orientation, the only real technology you need in a counseling session is a box of tissues and a clock.

Gladding, S. & Newsome, J. (2010). Clinical Mental Health Counseling in Community and Agency Settings  (3rd ed.).  Upper Saddle River, NJ: Prentice Hall.

Hoffman, J.  (2011, 23 September). When Your Therapist is Only a Click Away. New York Times, pp. ST1.

*Thanks to Michael Fleischmann for sharing this popular post.