Are you wanting a therapist online: Using video or email?

Compare and contrast two different online media: Video and email

Written by R. T. McDonald.

© R. T. McDonald 2019

 No part of this essay can be reproduced without my expressed written permission.

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Essay:

Introduction

The following essay will discuss, compare and contrast the two particular online therapy medium; video conferencing and email. Within this paper, there will be discussion of the limitations and strengths of both modes of online work. There will be no comparison of online work in relation to in-person sessions, rather, central to discussions, and the narrow focus to this paper is solely online work. Conclusions made will relate to ethical, practical, legal, privacy and professional implications for online therapeutic practice related to best-practice regarding video conferencing and the use of email for online therapy.

Initially, it is imperative to discuss the nature of online work for therapists. Online counselling, psychotherapy, or telepsychology, consists of five specific therapeutic medium; namely, video conferencing, email, audio only (whereby video conferencing is used without vision), chat services (and this can be live instant chat), or finally, virtual and augmented reality (McDonald, 2018a; McDonald, 2018b; McDonald, 2019). ACTO (2019) suggests there are four modes or medium when working online; video, audio, email and instant chat, and for the purpose of this assignment, there are four modes to choose from, as per the assignment outline. Weitz (2014) aptly indicates that there are now a multitude of technologies that can be used for therapy, including many different applications (apps), programs and systems. Therefore, the focus of this paper, due to the brief nature of this essay, can only be concentrated on these two modes of working. Whilst there are three other ways of working online, and even more than that, if we include all forms of digital contact with clients, though the point of this paper is to just compare two.

Video counselling or video conferencing: Important information for service delivery

In recent years, there has been a large advent of change in online therapy, due to the advancement of online video counselling and conferencing programs and applications (Weitz, 2014). It is imperative then to consider the programs that are used for video conferencing, for the sake of our client’s privacy (McDonald, 2019). Weitz (2014) discusses the use of Skype and VSee in her text, though it is noteworthy that Zoom is often seen as one of the best products to use due to its encryption, private links and ability to hold boundaries around a boundaryless space (McDonald, 2018a; 2018b; 2019). Video counselling and conferencing has changed dramatically in the five years since Weitz published her text (McDonald, 2019; Weitz, 2014).

The use of video conferencing facilitation of online therapeutic sessions has been in use for some time (Anthony & Nagel, 2010; Weitz, 2014). Skype is a well-known product to be used by counsellors and psychologists in the online environment (Anthony & Nagel, 2010; McDonald, 2019; Weitz, 2014). Though, it is Skype that is problematic, from the point of encryption, as Skype is owned by Microsoft and it is well-known how big business in information technology (IT) circles work with data (McDonald 2019; Weitz, 2014; Wong, 2019).

It is essential to consider the backgrounds of companies who offer technology, in order to choose the best available products on the market that consider client privacy and encryption in a post- General Data Protection Regulation (GDPR) world (EU GDPR, 2019; Weiner, 2017; Wong, 2019). Facebook has changed in dramatic ways over the past 14 or so years since its inception, and with it has been the way privacy is seen, particularly due to the changes in privacy and encryption legislation globally, hence it would be recommended not to use Facebook’s platform for video conferencing, despite its abilities to do so (McDonald 2019; Wong, 2019).

Over the past year, the Facebook privacy data breaches and Cambridge Analytica scandal has changed the way that the world views Facebook and the way that large corporations may hold our data (Wong, 2019). So it would be counterintuitive to rely on Facebook video conferencing for the private and sensitive data of counselling and psychotherapeutic clientele (EU GDPR, 2019). It could be said that with large amounts of data, comes civic and legal responsibility, one in which large companies, despite their amazing use of technology have abused the trust of their users (Wong, 2019). Though, it is intriguing, that the background of the company, Zoom, with its founder Yuan, has set themselves aside from their competition and delivered a better, more caring platform (Weiner, 2017).

Practitioners are legally compelled to be seen to care about their welfare and wellbeing of their clients and it is intriguing that the values of Zoom is to ‘care’, which is generally a core value of practitioners delivering services to clients in the field (EU GDPR, 2019; Weiner, 2017; McDonald, 2019). Therefore, whilst Facebook may provide a good user experience, practitioner considerations for service delivery must consider the reasons for using particular systems and whether or not they value empathy for our clientele, client privacy and encryption, to ensure all private data remains private (Weiner, 2017; Wong, 2019). As the GDPR has been implemented across Europe, from 2018, there is a legal imperative now that online practitioners protect and are concerned about the care of the client, along with privacy, how data is stored and managed, which in IT terms is carried out with encryption, especially end-to-end encryption, like that which Zoom delivers, through its integrated and encrypted web-conferencing platform (Anthony & Nagel, 2010; McDonald, 2019; Weiner, 2017; Weitz, 2014; Wong, 2019).

Skype deserves a conversation on its own, as a choice in the marketplace, regarding whether or not to use its service and exactly how private it is (Bass & Lanxon, 2018; McDonald, 2019). It is important to acknowledge  the origins and ownership of Skype, due to the most recent Facebook privacy and data breach issues (Bass & Lanxon, 2018; Wong, 2019). Online practitioners cannot work around privacy, with new far reaching and sweeping regulations, like the GDPR, and confidentiality to provide ideal services to their client groups, by using products that care about the clients they servce, privacy and accountability (EU GDPR, 2019; McDonald, 2019; Weiner, 2017; Wong, 2019).

Email counselling: Important information for service delivery

The provision of email counselling, email telepsychology, can only be delivered using the written word and is generally considered asynchronous, or in other words, not able to be responded to immediately (Anthony & Nagel, 2010; Francis-Smith, 2014; Weitz, 2014). Email counselling is vastly different to video counselling and to any other form of counselling, like in-person (Francis-Smith, 2014). Considering the confidentiality and privacy of our clients, has been discussed above as being critical to online practitioners (EU GDPR, 2019; McDonald, 2019; Weitz, 2014). This results in a need for practitioners utilising the best-practice safety and privacy standards for written and all email communication (Francis-Smith, 2014; Jones, 2018; Weitz, 2014).

Initial discussions in this paper, relating to video conferencing services and use of vision for online therapy pertains to encryption (McDonald, 2019). Jones (2018) suggests the four best email services for privacy provision and encryption, that meet best-practice standards, are; Protonmail, Tutanota, Hushmail and Runbox. Protonmail, Tutanota and Hushmail all have the capacity to be used for free and client groups can use such email systems for free, for enhanced privacy between clinician and client (Jones, 2018).

Francis-Smith (2014) suggests that beyond the service of email counselling, online practitioners need to consider their own anxiety levels and how they work in a ‘cueless’ environment with their clients. The waiting, anticipation and asynchronous nature of email can often bring about miscommunication and missteps with therapeutic engagement and alliance factors (Anthony & Nagel, 2010; Francis-Smith, 2014; Weitz, 2014). The author of this paper has found similar with clients and has opted to mainly work online with video counselling and live chat services. Any therapeutic ruptures can then be dealt with in the therapeutic moment, in real time. The pondering about what has been said can lead to problems within the therapeutic relationship and spill over to real-life engagements (Anthony & Nagel, 2010; Francis-Smith, 2014; Weitz, 2014). Anthony and Nagel (2010) indicate that how the client writes to a practitioner can give us clues as to whether or not a client is suitable for email counselling.

Limitations of both email and video

The author of this paper has found that there are many limitations of video and email online counselling (McDonald, 2019). Though, it is essential if we are providing online services that it must be done in the best way possible (Weitz, 2014). Discussions above were of the importance of encryption, privacy and accountability of the practitioner for which service and platform delivery is provided to clients, especially relating to privacy, encryption and data protection (EU GDPR, 2019).

With the advent of how matters change drastically, like with the above-mentioned Cambridge Analytica scandal (Wong, 2019), it is ethically, morally and legally vital for practitioners to provide services that care about client safety and privacy, as clients may or may not be aware of how their data can be breached (EU GDPR, 2019; Wong, 2019).

Video counselling removes the need to wait for a response and therefore could be seen as a better alternative if clients are inappropriate, for a variety of reasons, for email counselling (Anthony & Nagel, 2010; Francis-Smith, 2014; Weitz, 2014). If clients are inappropriate for email counselling, they could be offered video counselling, or referred on to an in-person service. If practitioners have trouble with obtaining the correct encrypted services, it is important to at least use a similar, private option, especially when considering the new GDPR laws.

Video counselling has many limitations and considerations to note; clients cannot see the clinician ‘in the flesh’, or as a whole-body experience. This poses some problems with the visceral, though with communication can be worked around (McDonald, 2019; Weitz, 2014). Often it is said that video at least we can see the client, so any ruptures can be repaired on the spot (Francis-Smith, 2014; Weitz, 2014). Email is certainly problematic and has issues regarding how therapeutic relationship can be established, maintained and resolved (Francis-Smith, 2014).

Conclusion

Here in this paper, there were discussions around comparing and contrasting the two different mediums of video counselling and email counselling. Some of the discussions surrounded proper and appropriate use of systems and ensuring adherence to the latest privacy and legislation. In addition, email counselling was noted for its limitations regarding being able to therapeutically hold the client in the moment. Providing asynchronous therapeutic delivery can pose problems if there are therapeutic ruptures. Video counselling would be this author’s choice of medium due to its ability to immediately deal with any issues in the therapeutic moment. Whilst the visceral and in-person experience is removed, therapeutic outcomes can be just as valuable and worthwhile with either medium.

References

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Association for Counselling and Therapy Online (ACTO). (2019). What do I need to know when looking for online therapy? Retrieved from https://acto-org.uk/i-need-know-looking-online-therapy/

Bass, D., & Lanxon, N. (2018, May 10). Don’t Skype Me: How Microsoft turned consumers against a beloved brand. Bloomberg. Retrieved from

https://www.bloomberg.com/news/articles/2018-05-10/don-t-skype-me-how-microsoft-turned-consumers-against-a-beloved-brand

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Evans, J. (2009). Online counselling and guidance skills: A practical resource for trainees and practitioners. London, UK: Sage Publications.

Francis-Smith, C. (2014). Email counselling and the therapeutic relationship: A grounded theory analysis of therapists’ experiences. DCounsPsych, University of West England. Retrieved from https://pwtacademy.online/francis-smith-c-2014-email-counselling-therapeutic-relationship-grounded-theory-analysis-therapists-experiences-dcounspsych-university-west-england-httpeprints-uwe/

Francis-Smith, C. (2016). Peering through the spyhole: The importance of eye contact in therapeutic engagements via webcam. Retrieved from https://privatepracticehub.co.uk/onlinetherapyhub/blog/peering-through-the-spyhole

Jones, G., & Stokes, A. (2009). Online counselling: A handbook for practitioners. Basingstoke, Hampshire: Palgrave Macmillan.

Jones, T. (2018, Dec 6). 4 encrypted email providers for people who like privacy. Gizmodo. Retrieved from https://www.gizmodo.com.au/2018/12/4-encrypted-email-providers-for-people-who-like-privacy-australia/

McDonald, R.T. (2018a). 5 secrets to online therapy success: An easy to follow confidence booster eBook for online therapy practitioners. Australian Online Therapy Training (AOTT) Pty Ltd. Retrieved from https://www.aott.com.au/wp-content/uploads/2018/08/5steps.pdf?

McDonald, R.T. (2018b). New age practice: Online work and practice in the 21st Century. ACAP Conference. The future of the human services industry: Implications for training and practice. Sydney, NSW, Australia. 29 October, 2018.  Retrieved from https://www.researchgate.net/publication/332251721_New_Age_Practice_Online_work_and_practice_in_the_21_st_Century_ACAP_Conference_Sydney_campus_29_October_2018

McDonald, R.T. (2018c). New age supervision: Supervision for the 21st Century. Australian Clinical Supervision Association (ACSA) Inaugural Conference. ANMF House, Melbourne. 22-24 May, 2018. Retrieved from

https://www.researchgate.net/publication/332250072_Online_Supervision_New_age_supervision_for_the_21st_Century_ACSA_Conference_Paper_Renee_McDonald_22-24_May_2018_ACSA_Inagurual_Conference_ANMF_House_535_Elizabeth_Street_Melbourne

McDonald, R.T. (2019). Level 1: Fundamentals. Online therapy: Connect to your clients  effectively (Training course). Australian Online Therapy Training (AOTT) Pty Ltd. Retrieved from

https://www.braincert.com/course/14830-Level-1-Fundamentals-in-Online-Therapy#

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Weiner, Y. (2017, Oct 2). The inspiring back story of Eric S. Yuan, Founder and CEO of Zoom. Thrive Global. Retrieved from https://medium.com/thrive-global/the-inspiring-backstory-of-eric-s-yuan-founder-and-ceo-of-zoom-98b7fab8cacc

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Wong, J.C. (2019, 18 March). The Cambridge Analytica scandal changed the world – but it didn’t change Facebook. The Guardian. Retrieved from https://www.theguardian.com/technology/2019/mar/17/the-cambridge-analytica-scandal-changed the-world-but-it-didnt-change-facebook