Monday, July 15, 2013

Cyber Counselling and Online Therapy: Pioneering a Virtual Future for Social Work

How does a social worker turned mental health counsellor and gay mens therapist find his way into webcam counselling? Here's a story from Ash Rehn, one of the Therapy Market practitioners, about commencing as an online therapist.

For the past 4 years I’ve been delivering counselling and talk therapy over the Internet. A typical day might involve discussing homophobia in Hong Kong over webcam, composing an email on Mindfulness for a client in Manchester and chatting around communication with a couple in Capetown. When people hear I have an online private practice they usually have many questions. This is the story of my transition to cyber counselling.

It started with enrolling in a masters degree at Stockholm University and planning a move to Sweden. My partner was Swedish and this was the opportunity to live there. Excited by the challenges of exploring a different culture and learning a new language, I had one reservation: how would I support myself in a country where English was not the primary language?

My Sydney based counselling practice had been quite successful. So when someone suggested working over webcam with existing clients, it seemed a better option than pulling beers at an expat waterhole in Stockholm. Anyone who has set up privately will recognise my reluctance to give up that investment of time and energy. I already had a website and background in telephone counselling but there was steep learning curve ahead.

Marketing was probably my biggest challenge. The Medicare rebate is not available for online consultations and my Aussie clients quickly dropped off. After a year of trial and error I realised advertising as an Internet counsellor was pointless. By the time they decide on counselling, most people expect to be sitting in a room with a stranger. I had to find a way to pop up when prospective clients were still Googling their problems.

The web gives you a global client base. That might sound advantageous but if you want to be found, you need to stand out. I threw myself into learning about ‘search engine optimization’, blogging and specialising in niche concerns. Now most of my work is with gay men on issues of coming out or mid-life and men generally around sexual matters and pornography use. Shame presents a high threshold for anyone seeking help, which makes these issues ideal for addressing at a distance.

Web counselling doesn’t suit everyone but up against in-person services it’s like the proverbial apples and oranges comparison. Many of my clients simply would not meet face to face due to the value they put on their privacy, their relative geographic isolation or travel time. It’s also been suggested that Internet counselling poses greater risks to confidentiality or client safety. Certainly some subjects are not suitable for a solo practitioner working over the net but hopefully we all work with reflexivity. Online counsellors also require supervision, ongoing professional development and ethical standards. And there are the usual business factors like getting paid and insurance. The way our services are delivered might be different but the professional considerations are similar.

The biggest surprise has been the level of interest from other social workers and psychologists. I started offering fee-for-service mentoring and also provide supervision online. When the time comes to relocate, I will continue online as well. I see the future of online therapy as about growing specialist knowledge and a sophisticated skills-base. Being available online makes us more accessible and offers choice. I’m looking forward to the future.
 
Ash Rehn is a Therapy Market online practitioner. Take a look at his page on Therapy Market if you are interested in making an appointment.

This article first appeared in a slightly altered form in the 2013 winter edition of the AASW National Bulletin.