The Highs and Lows of Online Counselling During COVID-19
13th June 2020
There’s been a lot of talk about winners and losers out of the Covid-19 pandemic. Perhaps the biggest winner, if we adopt this terminology, has been Zoom. ‘Zooming’ and the ‘Zoom quiz’ have become so seamlessly accepted into our culture as a replacement for pre-social distance forms of socialising (the pub). But there is one, less light-hearted use for the online video chatting platform, for which the transition has been less smooth. Counselling and psychotherapy services have been moved online, though met with some reluctance on the part of both counsellors and clients.
Like many with experience of face to face counselling, I initially baulked at the suggestion of online counselling. The thought of shouting my innermost insecurities at a buffering, floating head on my laptop, while my family sat in the next room, would surely serve to raise my stress and anxiety rather than diminish them. But I questioned my preconceived notions. Why was I dismissive? I also wondered, are there others like me? Perhaps there are people seriously suffering in silence out of reluctance to try a new form of counselling. I spoke to counsellors at the forefront of this new and novel practice to find out.
Despite the seriousness of Joe Heffernan’s counselling profession in Cork, and the solemn situation about which we were speaking, our conversation was extremely pleasant – and not merely because of the chance to speak to someone other than my family or the dog. He had a sort of classically loud Cork enthusiasm and retained a jocular irreverence despite the dour topic.
“It seems (with lockdown restrictions) like a trip to some exotic location to be able to go to the local Supervalu to buy a packet of biscuits!”
Joe noted that it was “without doubt” a strange time for peoples’ mental health.
“As time goes on, resilience is being eroded. One client I had just today told me she was ‘feeling extremely frustrated and tired of it all’. She’s looking after her husband who’s not well and her 4 children. We’re all very used to hearing sayings like ‘one day at a time’ and ‘don’t focus on the things you cannot change’. But when it goes on and on and on then one begins to doubt one’s resilience to hold up”
It is indeed a strange time for people’s mental health, and in conjunction, counselling as a practice is facing a strange transition. The practice of online counselling is, for most, novel. One of the main concerns for both counsellor and client is the logistics of conducting counselling online.
“Traditionally I would have skyped or zoomed with a very large head. A lot of the papers noted that this was potentially detrimental. It could be off-putting. You never see your counsellor or client that close up.“
Many important aspects of face to face counselling are taken away when ‘Zooming’ or talking over the phone. The use of non-verbal cues; facial expressions, body language, noting both the time and manner of arrival to the session, nuances in tone of voice, to name a few. All the counsellors I spoke with, accepted that this vital part of their practice, was now largely gone. Ian O’Grady, chartered counselling psychologist and past president of the Psychological Society of Ireland, noted another logistical issue.
“Traditionally I would have skyped or zoomed with a very large head. A lot of the papers noted that this was potentially detrimental. It could be off-putting. You never see your counsellor or client that close up. So I quickly invested in a stand-alone microphone and lighting which allows me to sit further back from my computer and be seen from the waist up.”
That’s my floating head fears abated, then. Ian struck me as extremely proactive in his approach to online counselling. It struck me that he didn’t see online counselling as something he was simply resigned to until face to face was legal again. He was embracing it. He’d read much of the academic writing, he’d invested in equipment and was dealing with this as a serious aspect of his job. He exuded a confidence and comfortability with both the software and the practice involved in giving counselling remotely, which I can only imagine transmitted itself to his clients. And it seems to be borne out in the numbers too “there’s only 1 or 2 of my clients that I don’t see remotely now”.
Another logistical concern was the issue of people being in the next room. Many of us don’t have the luxury of space in our homes or apartments. Many feel uncomfortable divulging the kind of sensitive information necessary in a counselling session when family, partners or flatmates are sat in the next room or close by. It was a problem flagged by all four of the counsellors I spoke to. Ray Henry, counsellor and chairperson of the Irish Association of Counselling and Psychotherapy had the strangest anecdote in this regard.
“There was one situation when I went through an entire session with my client, and at the end he says ‘now isn’t that right Mary’. His wife was obviously in the room. And sure what else could I say other than ‘howiye Mary I hope everything is going well!’.”
As funny as the ‘Mary’ story is, this is a serious concern for people. It got me thinking, shouldn’t the physical therapy space be a kind of sanctuary, insulated from any stress? For many, home could never provide this sanctuary. It doesn’t require any feat of imagination to conjure up such situations. People in the midst of a divorce with children in the house or houses with toxic parent-child relationships are two that might come to mind. For these, the ‘sanctuary’ of the physical therapeutic environment has been breached. When the stressful environment and the therapeutic environment are one and the same, isn’t the demarcation between stress and therapy blurred?
“Many feel uncomfortable divulging the kind of sensitive information necessary in a counselling session when family, partners or flatmates are sat in the next room or close by.”
The message from all the counsellors was that communication was key. They accepted that this could be an issue, and that online counselling was not ideal in certain cases. But with proper communication the issues could be mitigated. All the counsellors noted that the majority of family members were very accommodating. Many clients would book their session in for a time when the house would be empty, maybe while their spouse took their 2k walk, or while their mother did the shopping. Some would even go on a walk, or use a park bench, weather permitting.
A worsening problem?
Joe Heffernan had noted that peoples’ resolve was faltering. Joe, like the other counsellors I spoke with, acknowledged that the reason a crisis like Covid-19 affects our mental health, is multifaceted. It varies from person to person and can’t be summed up in a couple of sentences. Two main factors kept coming up in my conversations with counsellors, though; Anxiety over the physical health of ourselves and loved ones, and also the toll of social isolation.
“We are social beings. We have 4 sons living in Cork city that we haven’t seen for the duration of the crisis and that’s extremely tough. It goes against our instincts. One client I have, described other people at the moment as a ticking time bomb. Other people are now potential carriers of a serious illness. We never saw people like that before.”
An interesting observation. As he says, it seems to flip one of our most basic instincts on its head. Instead of cherishing social contact and the presence of other human beings, it has turned into a threat. Not only are we cooped up in our own houses, unable to see our friends and loved ones, but the people we do see on the street or in the shop are dehumanised into simply ‘carriers of a disease’. Which can only serve the creeping retreat into our own minds.
So, anecdotally there seems to be a worsening mental health crisis. But just how crucial could this time be for mental health? Covid-19 has brought with it large amounts of death, which might intuitively point to negative mental health outcomes. Empirical evidence on this ‘natural disaster’ element of the virus is inconclusive, though. In a 1999 paper in The New England Journal of Medicine, researchers looked at communities in the aftermath of an earthquake, flood or hurricane. They found ‘no significant increase in suicide rates’ in the years after. However, these forms of natural disaster don’t include an element of social isolation, which Matthew Nock, a psychology professor at Harvard has said, is related to suicide.
Where the empirical evidence is stronger however, is in the connection between declining mental health and an economic downturn. The New York Times reported that the increase in suicide rates in the U.S. doubled during the 2008 economic crisis. A study in the International Journal of Social Psychiatry noted a correlation between economic crises and suicide. It seems intuitive really, that job losses, which come with financial stress, loss of social standing and potential eviction and displacement would have negative mental repercussions.
“Many adaptations have been made in the wake of the virus. The way we shop, the way we socialise, the way we exercise. Maybe counselling need not be any different.”
And Ireland is facing an economic crisis, at least if you listen to the prominent economic commentators. Unemployment is still at 26.1% due to job losses connected to Covid-19. Andrew Webb, chief economist at Grant Thornton, told the Irish Times this week that ‘there is a growing sense that we are heading for a deep and damaging downturn, with a longer climb back to economic strength than originally hoped’. If indeed this is the case, counselling in whatever form it may come, might be more important than ever.
Despite this, almost all the counsellors I spoke with had registered a reduction in clients. Joe Heffernan noted a significant drop in his private clients.
“Off the top of my head I’d say about 40% of my clients have opted for the online form of counselling. With the other 60% saying ‘No Joe, we’ll meet up when the face to face counselling is back’”.
What was interesting however, was the contrast with Joe’s HSE clients – people in Direct Provision – of which about 90% have opted for online counselling. Perhaps due to the scandalous lack of services those in Direct Provision receive from the government, they’ll take whatever services or help they are offered. Maybe there is something to this pragmatism. Maybe we too, as a whole society need all the help we can get right now. It’s a trying time. There’s been a loss of life, loss of jobs and there’s fear over paying rent. We can’t rely on the usual community supports. We can’t even rely on our friends and family to the same degree. Perhaps it’s time to put pre-conceived notions about the way counselling should be conducted to bed. Ian O’Grady noted that counselling may not even return to the way it was previously, until at least such a time that we have a vaccine.
“You may have to sit very far from your counsellor. You may have a mask on, your counsellor may have a mask on. There also might be increased stress in relation to being in a location that many people have been in, regardless of how well it’s sanitised.”
Many adaptations have been made in the wake of the virus. The way we shop, the way we socialise, the way we exercise. Maybe counselling need not be any different. Particularly at a time when mental health could be at such a precarious juncture. Further, mental health services in this country are already notoriously underfunded, and it may get worse. With inevitable budget cuts coming in the next months, mental health services will be hit and likely, will be one of the first to be hit. Perhaps a further reason to avail of whatever services are available.
Of course, people needn’t avail of counselling, in whatever form it comes, if they choose not to. But if there are people suffering in silence, all the counsellors I spoke to encouraged people to try the online version. All counsellors have noted the satisfaction of the vast majority of clients using the service, with almost everyone who did move over, sticking with it. It seems to me that as long as we can remove our very own ‘Mary’s’ from the room, if even for an hour, online counselling is a very viable option.
With special thanks to Joe Heffernan, Brian Holohan, Ray Henry and Ian O’Grady for their input.
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