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Blog CYP

Thinking of using video games therapeutically?

Qualified Counsellor Ellie Finch explores the benefits & key considerations when using video games for working with younger clients.

Perhaps, like me, you’ve experienced the children and young people you work with talk with enthusiasm about games like Minecraft or Fortnite – and could see how much using a video game therapeutically could engage them in counselling?

I’ve been using video games in my private practice with children and young people for the past 2 years and have found it to be a great way to engage children and young people. Sometimes I simply talk about a child’s favourite video game with them; I might ask them what character they like to play, and this can lead to an exploration of their identity. Sometimes I watch a child play and might reflect back to them what I observe. For example, a child with low self-esteem might do something kind for another character in a game and I reflect back to them what I’ve seen of them in the game. Often, I will play the game with the child and together we might play hide and seek, battle monsters, build a castle among many other things.

© Ellie Finch

Games I’ve played with clients include Roblox, Fortnite, Among Us and Animal Crossing. But the game I’ve found most safe, accessible and useful therapeutically is Minecraft.

Before starting to use video games in your practice, there’s a number of important points to consider. I shall map these considerations to the ACTO CYP competences:

ACTO CYP Competency: Psychological Processes relevant to Online Therapy

Ever since I started using Minecraft in my practice I’ve been bombarded with enquiries from parents who can instantly see how it would engage their child in counselling. Often the parents have children who would otherwise not have engaged in counselling if it hadn’t been for Minecraft. However, it’s important to recognise that using a particular video game in sessions might not be suitable for all children. For example, if the child has been struggling with coming off a game to take part in other activities at home, they may struggle with the end of counselling sessions. This can actually be a great opportunity to explore the reasons why they find it hard to come off the game but you may also need to work on setting boundaries around use of games in sessions. In addition, if a client is struggling with not feeling contained in their life, then you will want to consider the landscape of the game you play. For example, Minecraft worlds are enormous and in order to create a more contained space, almost like a sandtray, I provide a physical boundary such as an island or a wall around the space we work in.

© Ellie Finch

I always ask my clients to create a safe place in the game in their first session. This is a place they can come back to at any time if they need to. A safe place can be anything, a cave, a house, a castle…

It also helps to understand the culture of video games and the video game you chose to play itself. For example, terms like ‘griefing’ are useful to know; griefing is a type of online bullying. In Minecraft griefers are players that destroy other players creations. When using Minecraft therapeutically however you can create a private world just for your clients so this can’t happen. In addition, the social side to gaming can be really important to players and the relationships they have through the game are just as significant as their in-person relationships.

ACTO CYP Competency: Assessment of clients for online therapy

Factors to consider when working online using a video game are:

  • Does the place where the child will be having their counselling have good enough internet connection to run the game as well as a video platform such as Zoom?
  • Is the child already playing the game online with other people? If not, you need to work with the parent/carer and child to educate them on online gaming safety, playing on servers with strangers etc. Minecraft Education has an in-built game called ‘Cybersafe: Home Sweet Hmm’ that takes the player through some internet safety challenges and helps the player to come up with strategies to keep safe online: https://education.minecraft.net/en-us/lessons/cybersafe-home-sweet-hmm (This game is available on Minecraft Education and Bedrock editions)

ACTO CYP Competency: Contracting and Boundaries

Having an agreement with the client around the use of a video game (or any digital therapy tool or resource) is essential.

My contract, for example, contains the following:

  • Information about the potential benefits of using Minecraft therapeutically as well as the potential challenges.
  • What they can expect a session using Minecraft to be like.
  • Boundaries such as the way we will communicate, how I will ‘unfriend’ them after each session and that I won’t be inviting anyone else into their private Minecraft world.
  • What we will do if we can’t connect in the game or lose connection.
  • I’m also clear about my level of competency in the game (please don’t feel you need to be an expert player – you need to be familiar with game controls, but most important is that you know how to keep your clients safe in the game).

ACTO CYP Competency: Data Protection

It’s essential to clearly explain any potential data protection risks of each game you play to a client.

I provide a clear, age-appropriate explanation of what ‘data protection’ and ‘GDPR’ mean, along with information about security standards (i.e. does the game have an ISO27001 certificate), where the location data is stored (i.e. outside of the UK, outside of EU, or in the US, for example, where they have different data protection laws).

It’s also important to clearly state how you will take steps to protect your client’s data in relation to the game and the limitations of this.

For example, I save a copy of the world after each session which is saved locally on my computer (and backed up to an external, encrypted hard-drive). My computer is password protected and I have installed anti-virus and firewall. I run updates on my computer regularly to ensure the security measures are up to date.

ACTO CYP Competency: Communication in online therapy

I do not advise using the communication channels within a video game. Instead, I use my usual video platform or the telephone (you may find using the telephone helps with internet connection issues).

I ask my clients not to use the chat function in the game. I also ask my clients to not write anything on signs or boards etc in the game that discloses personal information such as names, locations etc.

You will also need to get used to the idea that if you are embodying a character in a game alongside your client then your movements and body language as that character will be forming part of your communication with your client – much in the same way as our body language in real life forms part of our communication.

ACTO CYP Competency: Creativity in Online Therapy 

Video games provide a great online resource for adapting in-person therapeutic resources.

For example, I use Minecraft much like a sandtray by asking clients to create scenes using items and characters in the game which they can select from a vast inventory (a bit like having rows of miniatures on shelves in your therapy room).

© Ellie Finch

I also have a family tree activity where I ask clients to select different coloured and textured blocks to represent themselves and their family and place them in a tree.

Here are some links to resources and publications about my work:

I have a section in Jessica Stone’s book ‘Digital Play Therapy: A Clinician’s Guide to Comfort and Competence’ on using Minecraft as a sandtray:  https://www.routledge.com/Digital-Play-Therapy-A-Clinicians-Guide-to-Comfort-and-Competence/Stone/p/book/9780367755539

BACP’s Children, Young People and Families Journal featured an article about my work which includes a case study: https://www.bacp.co.uk/bacp-journals/bacp-children-young-people-and-families-journal/december-2021/therapeutic-adventures-in-minecraft/

I have made a 10-minute video for parents introducing them to how I use Minecraft therapeutically by taking them on a journey around my Minecraft island that can be viewed on my website here: https://www.elliefinch.co.uk/counselling-using-minecraft

I have a free webinar also available on my website where I introduce how I use Minecraft therapeutically: https://www.elliefinch.co.uk/events

ACTO CYP Competency: Managing Risk and Safeguarding Issues

Top tip: There are three main editions of Minecraft: Java Edition (available on Mac and Windows), Bedrock/Windows Edition (available of PC, iPhone and iPad, Android, and a range of games consoles including Switch, PlayStation and Xbox) and Education Edition (available on Windows, Mac, iPad, and Chromebook)

Just like working online creates more issues around safeguarding and risk; video games can add a few more to consider. You want to be sure that you are familiar with the video game’s security and privacy settings and have them enabled for yourself and have also advised the client and their parent about how to enable these settings. For example, many video games, including Minecraft (excluding Minecraft Education Edition) are part of social media networks like the Xbox Network. This means that unless you have enabled certain privacy settings your clients may be able to see your friends list, see when you are online, what games you are playing and with who etc. I have written two extensive blog posts for parents about keeping their child safe in Minecraft which is also useful for practitioners using Minecraft Bedrock and Java editions: https://www.elliefinch.co.uk/post/essential-steps-for-keeping-your-child-safe-when-they-are-playing-minecraft-bedrock-edition

Last year Minecraft Education Edition became more widely available to purchase and this is exciting news for therapists as, due to it being designed for use in school settings, it is a lot safer to use with clients than Java and Bedrock Editions. I’ve also written a blog post about the pros and cons of using Minecraft Education Edition: https://www.elliefinch.co.uk/post/why-i-m-using-minecraft-education-from-now-on

Playing video games with clients, can provide a great opportunity to talk about online safety and check in with them about their online life. It is essential you do some training in online safety if you haven’t done so already.

ACTO CYP Competency: Endings and Supervision

Endings in video games can be incredibly poignant and meaningful – whether it be taking a screenshot of your characters together one last time or planting a tree together in the client’s world. I ask permission to take screenshots of the client’s work in the game, you can create a document together and use it to review the work at any time, including in the final sessions. It’s also something they can keep.

I’d advise practitioners looking to start using video games therapeutically to seek consultancy and training before starting to work using video games and connect with professional peers already working in this area.

It’s also important that you have a supervisor that either uses video games in their own practice or is open to learning about using video games alongside you.

Next steps

© Ellie Finch

As you can see, there’s a lot to consider when incorporating video games into your practice. There’s also additional factors to consider that sit outside the ACTO CYP competences such as making sure you are working within the terms and conditions of the video game license terms and conditions.

I’ve been inundated with enquiries from parents telling me their children are actually excited about the idea of counselling using Minecraft. And, seeing the huge amount of interest there is amongst counsellors and other professionals in using video games like Minecraft therapeutically, I have been training other professionals and organisations in how to use video games therapeutically and safely with their clients.

You don’t need to be a gamer to use video games therapeutically, but you do need to have some confidence using technology so that you can troubleshoot any technical issues that arise. My Getting Tech-Savvy in Minecraft webinar can help you get to grips with the technical side of using Minecraft therapeutically: https://www.elliefinch.co.uk/shop

I also provide 1-to-1 and small group consultations, bespoke training to organisations as well as an upcoming training course on using Minecraft therapeutically.


Ellie is also part of the team of ACTO CYP therapists who have just updated the ACTO competences for CYP online therapists which were used throughout this blog post

For further information please email Ellie: ellie@elliefinch.co.uk

Ellie Finch

All images used are taken by the author. Ellie Finch’s services are NOT AN OFFICIAL MINECRAFT PRODUCT. NOT APPROVED BY OR ASSOCIATED WITH MOJANG OR MICROSOFT.

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Blog

Play to your strengths

Two autistic members of ACTO challenge all of us to think differently

This blog post is written by two autistic members of ACTO, with over thirty years of experience between us. We both became therapists before we knew we were autistic, and discovering something so essential about the selves we truly are has proved enlightening in understanding the way we work as therapists. But this post is not about Vauna and Max. On Autism Awareness Day it’s about autistic people in general and autistic counsellors and psychotherapists in particular. 

The watchword of Chris Bonnello, an autistic educator, advocate and author, is “play to your strengths”.

That applies to everyone. Beisser’s Paradoxical Theory of Change says that therapeutic change occurs when one becomes what one is, not when one tries to become what one is not. (1) The more we play to the strengths we actually have, rather than chasing those we haven’t, the more we will thrive and grow.

So it also applies to us as autistic, and to us as autistic therapists.

The traditional view of autism

Autism has traditionally been seen / defined as a collection of deficiencies. The traditional view is this:

“Autism spectrum disorder (ASD) is an early onset neurodevelopmental condition that is associated with diverse social, occupational and educational challenges. ASD is characterised by impairment in qualitative social communication and interaction, alongside rigid, repetitive, routine, ritualistic behaviours and adverse sensory responses to certain stimuli.” (2)

An alternative view of autism

However, there are other ways of seeing it.

For example: autism is a way of being, a way of experiencing the world: not in itself a disorder, simply a difference. Many autistic people regard it as not unlike a culture: we have trouble understanding the non-autistic world because it is not our culture, just as the bloggers, born in England, might have trouble understanding the culture of Japan. And non-autistic people have equal trouble understanding our culture. This has been demonstrated very nicely by Crompton et al in their “diffusion chain” experiment (3), is at the heart of Damian Milton’s Double Empathy theory (4), and underpins the neurodiversity model (5): just as the world is biodiverse – and the more biodiverse the better – so humans are neurodiverse. Autistic people are not in any sense inferior, simply neurodivergent – they diverge from the majority, just as a jumping spider that lives on vegetables might be described as bio divergent. It may be unusual, but it’s the one that will survive in a time of food shortage.

The graphic above is Chris Bonnello’s list of autistic strengths (6). Of course, we do not all have all these strengths to the same degree, and people who are not autistic may also have many of them. But it is a useful corrective to the deficiency model.  

For anyone used to the traditional view of autism it may seem counterintuitive that an autistic person should choose to become a counsellor, and unlikely that we should be effective in that field. However, looking at the list of strengths above, it may seem a little less unlikely.

Autism awareness: a perspective

Many autistic people feel uncomfortable about autism “awareness”. Surely, they say, we deserve better than mere awareness? Acceptance at least, if not appreciation? We certainly appreciate our autistic minds and our autistic senses, even if at times they disable us in a society – a world – that is designed by and for people who are not like us.

However, as therapists we know that awareness is not something superficial. When we talk about something being in awareness we mean a full experiencing of that thing, not just a cognitive understanding of it. So maybe on this World Autism Day, rather than reading a theoretical piece on autism as a disorder, read or listen to an actually autistic person talking about our life, our perception and processing of our world.

Why not start with Naoki Higashida’s “The Reason I Jump”? (7) In the words of that so-called low-functioning Japanese thirteen-year-old you will find one of the clearest depictions of the autistic world. That is his world, and that is our world. Come and meet us.

To finish, just to throw some doubt on the stereotype that autistic people are not creative and have no empathy, here’s a wee poem written by one of us about the inner world of a client. The English is a loose translation of the Gaelic.

Cho trom an t-saoghal.

Tha’ n cù a’ teum le muirn

Tha mi’ n dùil, mi’ n dùil.


So heavy the world.

The dog nips in ecstasy

Oh, I wish, I wish.

Authors: Max Marnau and Vauna Beauvais 

Max is an autistic therapist and clinical supervisor, artist and poet living in the Scottish Borders and working with neurodivergent and neurotypical adults.

Vauna Beauvais is an autistic psychotherapist and clinical supervisor, and a coach for adults with ADHD.

Further information: https://www.un.org/en/observances/autism-day/background

References

1. A. Beisser (1970) The Paradoxical Theory of Change. In: Fagan, J. and Shepherd, I.L., Eds., Gestalt Therapy Now, Harper & Row, New York, 77-80.

2. E. Nicholson, ‘How do you know if your client has autism?’ Healthcare Counselling and Psychotherapy Journal, April 2020

3. C.J Crompton et al, ‘Autistic peer-to-peer information transfer is highly effective’, Autism vol 24 (7), 2020, pp. 1704-1712

4. D. Milton, ‘On the ontological status of autism: the ‘double empathy problem’’, Disability & Society, 27 (6), 2012, pp. 883-887

5. Term probably coined by Judy Singer in her thesis, later published as “Why Can’t You be Normal for Once in Your Life?”in Disability Discourse, Mairian Corker Ed., Open University Press, 1999. A discussion can be found in N. Walker ‘Towards a neuroqueer future, an interview with Nick Walker’, Autism in Adulthood, vol 3 no 1, 2021. See also J. Singer, ‘NeuroDIversity – the Birth of an Idea’ Amazon, 2017

6. See website Autistic Not Weird: https://autisticnotweird.com/

7. N. Higashida, ‘The Reason I Jump’ tr K. A. Yoshida and D. Mitchell, Hodder & Stoughton 2014

Categories
Blog

ACTO is supporting Neurodiversity Celebration Week

ACTO’s CYP team wish to bring awareness to Neurodiversity Celebration Week, which supports changes in attitude and understanding. Sienna Castellon, the founder of Neurodiversity Celebration week www.neurodiversityweek.com and a real innovator, has worked hard since 2018 to change minds and narratives from her own experiences, to ensure that we all move forward in a more enlightened and educated way. ACTO support this.

Here are some links about experiences from different celebrities who challenge stereotypes and help us to create an open forum for support, learning and of course, celebration.

Steve McQueen (3min 47sec):https://www.youtube.com/watch?v=S9Aftu2uZvc

Michael Phelps (2min 53sec):https://www.youtube.com/watch?v=F5OSbrT8OJU

Dr Maggie Aderin-Pocock (3min 55sec):https://www.youtube.com/watch?v=xhJiC-ieXAg

Chris Packham (4min 25sec):https://www.youtube.com/watch?v=5_tn0GFlwwI

Keira Knightley (4min 04sec):https://www.youtube.com/watch?v=OLb6ehPPc4E

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Blog

Talking to children and young people about the invasion of Ukraine

The following links may help CYP, parents and practitioners. We acknowledge that for families who had have to flee other war torn areas, these events may be triggering for them and their children.  We also want to acknowledge that this may feel like another disaster after the last two years of isolation and loss with Covid-19.  

It is important though that if children and young people are asking questions, we answer them as openly and honestly as we can – with a response appropriate to their age. We also recognise the sense of not knowing may impact the overriding feelings of anxiety for both adults and young people.

We therefore feel that finding ways to ground children, young people and ourselves will help to process the emerging information about the invasion of Ukraine.

We hope that you find these resources useful.

Anxiety reduction and calming/grounding strategies

Talking to Teenagers about the invasion in the Ukraine

  • Anna Freud also complied some useful suggestions with BBC Bitesize for parents and carers.

The UK Trauma Council, founded by the Anna Freud Centre has a range of information for families and professionals.  A resource page on how to support refugee and asylum-seeking children from all parts of the world who have experienced trauma. Reports are emerging on lone children crossing borders from Ukraine, this information may be of particularly beneficial for professionals. Here is a list of their support resources to help professionals get started. They also have training available.

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Blog

NHS goals to improve equality within the NHS

ACTO Inclusion & Diversity director Olivia Djouadi gives her views on the NHS’ equality objectives

NHS England and NHS Improvement has six objectives (see in the table below) which seek to improve equality and specifically to ensure that there is a better overall experience for patients and staff alike within the NHS.

In this article, I will explain what each of the goals are – and why they are relevant.

The equality objectives for NHS England and NHS Improvement for 2020/21 addressed our role as an NHS system leader, commissioner and our own role as an employer. The seven overall objectives are:

1. To improve the capability of NHS England’s commissioners, policy staff and others to understand and address the legal obligations under the PSED and duties to reduce health inequalities set out in the Health and Social Care Act 2012.
 
2. To improve disabled staff representation, treatment and experience in the NHS and their employment opportunities within the NHS.
 
3. To improve the experience of Lesbian, Gay, Bisexual and Transgender People (LGBT+) patients and improve LGBT+ staff representation.
 
4. To reduce language barriers experienced by individuals and specific groups of people who engage with the NHS, with specific reference to identifying how to address issues in relation to health inequalities and patient safety.
 
5. To improve the mapping, quality and extent of equality information in order to better facilitate compliance with the PSED in relation to patients, service-users and service delivery.
 
6. To improve the recruitment, retention, progression, development and experience of the people employed by NHS England to enable the organisation to become an inclusive employer of choice.
 
7. To ensure that the equality and health inequality impacts of COVID-19 are fully considered and that clear strategies are developed and implemented for the NHS workforce and patients. To ensure that the proposed NHS People Plan and patient focused strategies reflect this and make an effective contribution to advancing equality for all protected characteristics and to reducing associated health inequalities.
From https://www.england.nhs.uk/about/equality/equality-objectives-for-20-21-and-21-22/

The Public Sector Equality Duty (PSED)

The PSED requires all public authorities including the NHS to consider whether they should take action to meet these needs or reduce the inequalities.

In its assessment, the PSED observed that there were inequalities evident – especially during the pandemic. During this time, most staff in the NHS were overwhelmed by the impact of the health crisis and therefore were focused on trying to provide the best care that they could in the circumstances. Patient care had also shifted in unexpected ways with waiting lists growing exponentially. So, objectives and goals were agreed to attempt to ease some of the discrimination that had been identified.

Review of the Objectives

Objective 1: This aims to help the NHS to gain a better view of the current situation and areas that need improvement. This would enable staff to reduce inequalities and understand their legal duties.

Objective 2: The second goal concerns staff with disabilities and how advancements were possible.  This would mean better treatment and not being passed over when those with disabilities get an equal opportunity to other staff.

Objective 3: This aims to help staff feel more supported at work and improve the LGBTQI+ patient experience. This can also assist to lower the additional barriers that may cause some to shy away from healthcare in the UK and go abroad.

Objective 4: The fourth objective relates to the language barriers that impact on patient safety and health inequality. Interpreters are not always immediately available and family members may not always be able to translate medical or psychological information.

Objective 5: This goal explains the importance of making information about the legal duty for inequality available for everyone. It also needs to be understandable to staff and patients alike, with copies available for those that do not have internet access.

Objective 6: This final objective seeks to improve staff morale and reduce the numbers of people leaving the NHS. Many staff members have left due to exhaustion. Despite the pandemic, the NHS continues through to provide a full schedule of appointments, arguably helped by the high numbers of people vaccinated against COVID-19.

To help to understand what it has been like for staff during the pandemic I recommend reading Life, Death and Biscuits by Anthea Allen published 17 February 2022. Please feel free to get in touch with me with your views on this crucial area.

Olivia Djouadi

Inclusion & Diversity director, ACTO.


Categories
Announcements Blog

Volunteers wanted

We have been listening to you and we would like to give the members more input. Over the next two months the website will be completely overhauled by a professional designer. We want to do this well, so we are forming a small website working group. It will be headed up by me, the webmaster. It will include a few of your directors but we would also like to include some members.

Tasks would include:

Go through the current web content and select what stays and what goes

Help to think of a menu structure to make it easier to find your way around the website

Help setting the parameters for the new improved directories

Help thinking about images and new content for the website

Help thinking of what benefits we can add for members

If that appeals to you (It will involve several meetings with the working group and will take some hours of your time) and you want to help make the ACTO website better please email me at webmaster@acto-org.uk as soon as possible.

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Mind joins ACTO as charity grows its online therapy services

As client & counsellor needs change, the Mind network seeks to develop its digital capacity, accessing ACTO’s ethical framework and standards

ACTO, the Association for Counselling and Online Therapy, is delighted to announce that Mind are one of the organisation’s newest organisational members.

Mind is a federated network across England & Wales made up of over 115 local mental health charities. Many of the local Minds deliver counselling services, either as part of a local offer such as IAPT or independently of statutory services and specialist counselling to equalities groups.

During the pandemic, local organisations within the Mind network reported an increase in need, as well as observing that the requirements of clients and counsellors were changing too. The necessity to deliver counselling remotely, either using telephone counselling or online video therapy sessions, resulted in Mind to evaluate how to increase its digital capacity whilst maintaining and developing standards, working within a clear ethical framework.

Gavin Atkins, Head of Communities for the national MIND network, says: “Many of our local Minds deliver important mental health support, all of which depends on the need of the community they serve. For example, this could include peer support, psychoeducation groups, social prescribing and group activities. 

“The Covid19 pandemic and restrictions meant that we needed to grow our online therapy services, so that our services are more inclusive – for example making sure that our services can better help people from different racial backgrounds – we know therapy is often inaccessible and so there is a need for more culturally appropriate support. What helps people manage their mental health varies from person to person, and we know that online therapy services do not suit everyone; which is why we will continue to offer face-to-face therapy and counselling, especially for people experiencing serious mental health problems (SMI’s).

“Online therapy does bring many benefits, including helping to reduce waiting times and make sure people get the support they need. That is why we decided to join ACTO. ACTO provides us with a nationally respected ethical framework and standards that the local mind network feels are vitally important when delivering a quality service.”

Adrian Rhodes, Chair of ACTO said, “ACTO is proud to welcome Mind into our growing membership. This year has been an incredible challenge for many people – and of course the superb organisations such as Mind who work tirelessly to help people with mental health needs. Almost overnight, counsellors and therapists have had to turn to new ways of supporting their clients, and many have embraced the opportunities offered by working online.

“We look forward to working with members of the Mind federated network, providing them with access to ACTO’s ethical standards and recognised training providers, upskilling their staff and thereby increasing service users confidence.”

EDITOR’S NOTES

ACTO is the Association for Counselling and Therapy Online. Membership is open to qualified professional counsellors, psychotherapists, counselling psychologists and CBT therapists registered with BACP, UKCP, BPS, BABCP or similar organisations.

Photo: Gavin Atkins, Head of Communications, Mind

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Blog

OLT4c joins ACTO as a new Online Training Provider

OLT4C is one of our profession’s longest established online training providers. ACTO is delighted to welcome the organisation as an Online Training Provider.

One of the principal aims of ACTO is to ensure that it fully represents the rich diversity within our growing profession. We are therefore extremely pleased to confirm that OLT4C, widely recognised for the excellence of its provision of professional training in Online Therapeutic practice, is our newest Online Training Provider.

Suzie Mosson and Maria O’Brien are co-directors of OLT4C and describe the values inherent in their organisation:

“At the core of OLT4C is an ethos that ensures all students regardless of experience and/or academic achievement will step into a learning environment which is rooted in the principles of warmth, encouragement and compassion. We strongly believe that these principles are pivotal to empowering students to develop a crucial understanding of the knowledge, skills and awareness required for safe, legal and ethical online practice.

“Along with this, we are a warm and friendly group that values each student and their contributions.”

OLT4C offers an extensive range of CPCAB externally accredited professional training courses starting with, General Certificate in Online Counselling Skills, A Diploma in Online Counselling and a level 6 Diploma in Online Therapeutic Supervision. In addition,

they have various CPD courses, independent study workshops and regularly develop bespoke pieces of training for small, medium and large corporate organisations.

In their joint statement announcing the decision to join ACTO, Suzie and Maria explained how online training can help practitioners to work online safely and confidently:

“One of the challenges we have faced and overcome is the idea that working online means working via video only. We recognise that the increase in this understanding is likely to have been informed by the initial guidance from counselling membership bodies in how to support clients during the early days of the global health crisis. The message then was, where possible therapists could offer to support existing face to face clients online until the therapy ended. In a bid to replicate the face-to-face counselling environment, hence they chose to work via videoconferencing.

“Thankfully, many therapists realise that working online without specific training is outside their limit of competence which raises questions around ethical practice. In a bid to bridge this gap they have sought externally validated training to develop their perception, comprehension, and prowess of this different discipline. OLT4C is well placed to meet these needs and as members of ACTO, we are demonstrating our transparency and responsibility as members of the national register.”

Adrian Rhodes, Chair of ACTO, said:

“ACTO values the contributions from every single individual member – and that includes the work of our Online Training Providers. We know that OLT4C has a very clear understanding and commitment to ensuring that counsellors, therapists and supervisors are trained, skilled and therefore able to treat their clients ethically and respectfully.

“We are grateful and honoured to have OLT4C on board as part of our growing organisation and look forward to the OLT4C team helping us to develop further services that meet the needs of online counsellors and therapists.”

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Maintaining boundaries when working online

As we have all been getting used to working online over the last few months, I have been conscious of a renewed focus that has been needed to create and maintain robust boundaries with our clients.  Particularly given that for most of us this is new way of connecting with our clients.

We tend to take for granted the control we have over the counselling environment.  Whether we work in an office away from our homes, or in a dedicated therapy space at home, we have full choice over what the space looks like, the ‘feel’ we wish to convey to help our clients feel safe, who and when someone enters this space, and when the session is ended.

Whereas, meeting our clients online means conducting sessions in their space, their homes, with no control over the room they choose to be in, and reduced influence over the potential for interruptions.  We have limited control over technological glitches that may interrupt or prematurely end the session, while we do have control over the online communication platform that is used to hold the sessions on.  Meaning we can maintain boundaries regarding the client’s data security and online confidentiality.  

When technological issues arise, it is vital to have clearly set out in your contracting what you will do to try and reconnect, and if this is not possible, what alternative communication you will use to continue the session or rearrange.  Knowing this process, along with your calm response in the moment, will help the client feel confident and safe with you. They will know that you are maintaining the boundaries through the clarity in how you will deal with the situation, and your firmness with time boundaries.  It may be tempting to go over time to compensate for a technological problem that has arisen, while this pushes a boundary and sets a precedent that may be always be possible to repeat in the future.

The importance of remaining firm with your boundaries is further illustrated by the range of possible interruptions that can occur when the client is in their own home.  From a child or partner entering and staying in the room, to a parent wanting to ‘meet’ the counsellor uninvited.  Whatever the client says in terms of them being ok with the child or partner staying in the room, it is important to explain the reason for, and role of, confidentiality.  I have spoken to counsellors who struggled to convey this firmly as the client was in ‘their’ home and so they felt that it is the client’s choice who is in the room.  Explained clearly, the client will understand, and is often relieved at having a professional state on their behalf, what the boundaries are.

When you first entered your counselling room, I would guess that you spent time creating a therapy space that conveys a sense of safety, calm, professionalism, and security.  A space where they can metaphorically leave their stories, traumas, and feelings in when they leave the session.  Thus, creating a safety boundary to support the client to disclose and explore painful experiences and feelings.  I often tell my clients that there is a bottomless pit in the space between us, for everything to go into.  This is a double message; that they can leave behind what they have disclosed and shared in the room, and a self-care message to myself, that I do not expect to be left holding onto all my clients feelings and traumatic experiences.

This self-care message is even more vital now we are all working from home and may be doing so for some time.  You may now be working from a room previously delegated as a social or family space.  So, have been considering how to maintain physical boundaries, of no interruptions; and the emotional boundaries, by working out a process to step out of your counsellor persona into your private one as you walk out of the room.

This heightens the importance of discussing with your client what they will do immediately after the session to create a boundary between their counselling and the rest of their lives. Will they need time to process, and shift their emotions before able to re-join their family?  Is this time available, or will they be expected to end the session and walk straight back into family life?

Working online reveals boundaries considerations for both the client and counsellor that do not arise when working within your own therapy space.  By taking time to consider what they are and discussing them in your contracting will ensure that you both have clarity when responding boundary challenges.  Which will help create a safe, secure space for your clients, and support your self-care when working from home.

Sarah Worley-James

This was first published in the BACP Cyberwork column 

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Counselling Online In A Pandemic World – Emma West

We are proud to present the blog post that won the blog competition.

There’s no doubt that those trained in online counselling were ahead of the curve when we entered the eerie world of Covid-19 lockdown.  

Suddenly face to face counsellors were struggling with the practicalities of working online – “What’s Zoom?”, “How will my clients pay?”, “What’s online disinhibition?”….  

On top of sorting the practicalities they were also having to embrace the possibility that online counselling is actually just as valid, and effective, as face to face work, if not more so for some people.

But there was no time for prolonged smugness on my part because when lockdown kicked in the private online practice I’d been building up took off and I had clients coming at me via ACTO, E-therapy, Psychology Today, and word of mouth too.

Whilst previously I’d always had space for new clients I was now in the new territory of working out how many clients I could feasibly ‘see’ each week.  

It was actually quite a tricky conundrum because initially I found that a lot of people just wanted one session – they wanted to know that it wasn’t just them that was struggling, they wanted to hear that other people were finding things difficult too.  The issues of control, loss of routine, uncertainty, unpredictability abounded, but once their experience had been normalised they were happy to go it alone once more.

Some turned into OAAT [one at a time] clients, with weeks and sometimes months between sessions.  They seemed to appreciate the ability to be able to reach out whenever they needed to.

There were also a number of people who grasped the opportunity of being at home and the flexibility of their working arrangements to give counselling a go – with threats of a mental health ‘epidemic’ hitting the headlines counselling was becoming even more acceptable, and online counselling was their only option.

Many were new to the idea of counselling so initial work was often around managing expectations – what did they think counselling was – advice vs finding their own answers vs a magic wand?!

So how can counsellors adapt in this brave new world?

  1. Decide what platform to use [then stick with it but review periodically]: 

At the start of lockdown there was a LOT of online chat about trying to find the ‘perfect’ online counselling platform.  I found myself getting very caught up in this, with fears of getting it ‘wrong’ and that eternal counsellor bugbear of not being ‘good enough’.  In the end I decided to put all the security I could in place and used Zoom.

  1. Decide how many clients you can work with [then learn to say no]:  

With clients coming at me from all directions I learnt to recognise when I had reached capacity.  It wasn’t easy turning people away but I would try to signpost them.  I knew this would mean I could work effectively with the clients I had, and practice self care too.

  1. Sell yourself:  

When face to face counsellors ‘moved’ online the competition for clients skyrocketed.  I found that when I updated my various profiles to say I had already done specialist online counselling training and had been practising solely as an online counsellor pre-lockdown that the number of enquiries I received increased.  How can you make yourself stand out from the crowd?

  1. Be flexible:   

I realise that many counsellors need to know they have a regular income stream and this usually means seeing clients weekly on the same day at the same time.  

I found that offering one-off, fortnightly, OAAT sessions and not stipulating that I’d need to see clients on the same day/time, enabled me to corner a market in terms of offering a flexible service to those who needed that flexibility.  To be honest it was a bit of a gamble but strangely it works, and I’ve had a steady stream of bookings over the months.

  1. Seek peer supervision [as well as your regular supervision]:  

Coincidently I set up a peer supervision arrangement with another ACTO member at the end of 2019.  Having those monthly meetings together with online peer support through Facebook has been invaluable – it can be a lonely world counselling online.  NB Pick your Facebook groups wisely and unjoin those that leave you feeling stressed and/or unsupported.

  1. Normalise:  

I think it is vital to normalise clients responses to the pandemic.  Feeling anxious or low about potential threats to our health and the ever-changing limitations imposed upon us is perfectly normal.  The big question is how can we effectively support clients to adjust, manage, and move forward?

7. Don’t claim to be Harry Potter.

Emma West

Accredited Counsellor MBACP: 

www.emmawestcounselling.co.uk

www.motabilitylifestyle.co.uk

http://emmabowler.blogspot.co.uk

www.accessibleguide.co.uk

www.bbc.co.uk/ouch/writers/emmabowler.shtml

@FourFootTall