Forever, counselors have been saying that we will meet you where you are, now we mean this literally as well as figuratively. No, we don’t do house calls, but we do the next best thing. We can use all the technology available to make counseling accessible to you. We can work together by phone, instant message chat, video chat, or, as usual, in the office.
The internet and telephone have given us innovative ways of providing counseling when traditional methods are not accessible. It’s private and can be effective when conducted by a skilled, qualified, and ethical professional. For some people, it’s the only way they can get help from a professional counselor. However, there are strengths and weaknesses to all the forms of distance counseling.
Online and phone sessions are not appropriate for all kinds of personal problems, nor are they a complete replacement for face-to-face therapy. For instance, if you have suicidal thoughts, it is important that you seek professional help immediately through other channels that have the resources to help you in person if need be. If you are located in the US, call 1-800-784-2433 or 911 for immediate assistance.
Let’s run through the various forms of distance counseling:
Instant Message Chat
In this method, you and your counselor communicate solely by text, but can do so in real time. Communicating completely by text has both advantages and disadvantages. We may miss all the non-verbal communication that occurs in other forms of therapy and, if we are not good writers, we may not be able to transmit all that we have to say. On the other hand, some clients use this limitation to their advantage; for example, if they are otherwise overwhelmed by non verbal messages, they can focus better using this method. Also, when we are finished, we both have access to a transcript of the session that can be referred to later.
This is the oldest distance counseling method, one that is used by crisis hotlines worldwide. Talking on the phone captures more non-verbals than IM does and it is, of course, conducted in real time. There is no transcript available.
The method that is most like traditional, in-person counseling is video chat. This requires that you have a webcam, a Skype account, are familiar with using it, and have a private, quiet place to talk. Once you are used to it, it feels like you and the counselor are in the same room and have all the emotional connection experienced in an in-person session. There is no transcript, however.
Is distance counseling effective?
Many of the forms of distance counseling are so new that limited research has been done. Here is a list of research studies on its effectiveness of distance counseling. Also, here is an article about “telepsychiatry” that recently appeared in the New York Times.
Phone counseling has been around for many years and used very effectively by crisis hotlines and most traditional counselors in between sessions.
Is distance counseling confidential?
Your counselor will treat the things you say in distance counseling sessions with the same confidentiality as if you spoke in face-to-face sessions. We are still required to report to local authorities if we have safety concerns. However, your counselor does not have control over the privacy of distance counseling sessions that he or she has when you are face-to-face.
Someone can pick up the other line in your home and listen in on phone sessions. Your neighbor may be able to listen in if you use a cell phone. If you Skype your counselor in a café, everyone will hear what you have to say. They may be able to read your text if you use public Wi-Fi. Then, there are hackers.
My wireless network is secure and password protected. Services such as Gmail chat and Skype are said to be encrypted. We will just have to believe them if we choose to use these methods.
Is there an age requirement?
In many countries, including the US, clients must be at least 18 years old to obtain online services from a mental health professional.
Is distance counseling regulated?
The laws in most states and countries have not yet caught up with the technology that is now available. I am licensed in the state of New York. Sessions with me are considered to have occurred in New York State, no matter where you might be, and are subject to the laws of the State of New York. This might prove to be a problem if you live, say, in the Australian outback. Technology no longer limits your ability to work with a New York State counselor, but if you wanted to sue him or her, you would have to go to New York to do it.
Is distance counseling covered by insurance?
Insurance plans vary in their willingness to reimburse for distance counseling. There are some that do, but they are rare. You will have to check with your carrier.
How do I access distance counseling?
Please email me or call my secretary at 585-544-5342 to set up an appointment. If you call, Michelle or Tim will ask you which method you would like to use, exchange contact information, and, if I have never worked with you before, have you complete the information sheet. You can pay by major credit card, Paypal, or mail a check. Payments must be made in advance of the session.