MONIKA SIDHU – Paitra Marsh was in the middle of conducting an online therapy session when she realized she needed to put things on pause. Her client was sharing information that was revealing itself to be traumatic.
Though Marsh has been practicing psychotherapy for over a decade, she is relatively new to the world of online counselling.
“I don’t feel comfortable going into that level of depth through this,” says Marsh. She says traumatic processing is something that she isn’t sure of navigating through an online medium.
“Our nervous system physically has a response and sometimes feels overstimulated and needs to be grounded. Being in the presence of another person can create that sense of grounding and calm the nervous system. I don’t know if that can be done through video,” says Marsh.
This is one of the ways that video counselling is proving to be a complicated topic. With COVID-19 keeping non-essential workers at home for the unforeseeable future, this might be one of those complications that therapists simply have to figure out for the time being.
After practicing psychotherapy for nearly 12 years, Marsh decided to come together with a longtime friend and colleague Kornelia Hawrylewicz to open up their own clinic. In January of 2020, the two women opened up Piece of Mind Counselling in Mississauga which offered in-person counselling at their office.
Marsh and Hawrylewicz had to quickly change their counselling style in mid-March as COVID-19 created the need for physical distancing. Marsh says that clients did not immediately jump at the switch to a virtual platform. Instead, clients were opting to wait for in-person services because she says a lot of information initially put out led many people to believe closures may only last two to three weeks.
“I’m starting to see a slight shift in that because now people are seeing it’s gonna go on longer, so maybe if they weren’t really open to the idea before, they’re kind of opening themselves up to testing it out as opposed to stopping it completely,” says Marsh.
While it is important to continue counselling during the pandemic, Marsh and her business partner have their reservations about using online mediums. Both of them have practiced online counselling before. Marsh did so for existing clients that had moved away, and Hawrylewicz had limited experience with online or phone counselling, only offering the service to her long-term clients if they had any issues getting into the office because of transportation or illness.
Online counselling does come with its own set of nuances.
In a 2014 article, Dr. Rachel Birnbaum and Bryanne Harris reviewed the ethical challenges associated with online counselling. The scope of these challenges was quite broad and included issues such as anonymity, lack of access to technology, absence of non-verbal cues, online security, and potential misunderstanding or misinterpretation between the client and counsellor.
For both Marsh and Hawrylewicz, their hesitancy to open up to online counselling prior to the coronavirus was based on not knowing how successful it would be. Marsh says that she counts on the physical presence she can create for a client.
“The type of work I do myself like addiction and trauma, I use my physical presence and myself as a therapy tool and I find it a little more challenging to do that through a screen. Sometimes just even the way that I move my eyes can connect a person. I can still connect to a certain degree over the screen; it’s just not the same as being face-to-face, so I think I just prided myself in continuing to do face-to-face contact,” says Marsh.
Hawrylewicz says many of her colleagues in the past had encouraged her to pursue online counselling, but she also had her own qualms.
“I struggled with the concept of creating a safe space for someone through the phone or video. A lot of the clients I work with vibe off of my vibe and my behaviours and expressions. I always pictured that as being impossible to replicate from behind a screen. I feared for their ability to speak openly when living in a home with others. I felt genuine concern for their ability to express emotions, be loud, cry, or anything else they wanted to do or be, in their own space,” says Hawrylewicz.
Marsh echoed these feelings of uncertainty surrounding the concept of space. She says it can be hard to conduct a session when a client can be living with the people they need to speak about or if they live with an abuser. At the moment, Marsh says she has been able to find some alternatives for her clients.
“I would look at ways in which we can still conduct [sessions], whether it’s going in your car; whether that’s going on a walk,” says Marsh.
In looking for alternative spaces for these clients, Marsh said the idea of the booster appointment came into play. A booster appointment, as Marsh explains it, is essentially a check-in appointment that allows the client to interact with somebody outside of their day-to-day routine. Marsh says booster appointments are not as long as regular sessions, but “you’re still getting a little bit of your bucket filled as opposed to nothing at all.”
But options are limited right now. Marsh and Hawrylewicz have been the Jane App, which allows for virtual counselling. There are other online platforms available to mental health clinicians such as Doxy and the Ontario Telehealth Network (OTN), a not-for-profit that is funded by the provincial government with a focus on virtual services.
Siham Elkassem, a social worker out of London, Ont., uses both Doxy and OTN for her services that have moved online.
“I see a lot of benefits right now considering social isolation, having somebody to talk to immediately through an online platform, not having to leave your home,” she says.
Elkassem, who works at the Vanier Children’s Services, says she does have a few doubts about the transition into an online medium.
“OTN and doxy are supposed to be encrypted and 100 per cent safe; nothing is 100 per cent safe,” says Elkassem.
Not only does Elkassem see online counselling through a practitioners lens, but she also sees it through an academic lens. She is currently a PhD candidate in social work education from Memorial University with a focus in critical-race. Her concerns with the move to online counselling are stemmed from access to technology—especially for those who come from racialized, immigrant backgrounds. She says she is most worried about these marginalized communities that may also have financial barriers.
“What does that look like for people who don’t have internet access on the regular or even who culturally are not accustomed to having an online conversation with people?”
She says that there is a lack of academia and resources available that deals with the concept of online counselling or e-therapy, as she refers to it. Elkassem says she does expect more research about e-therapy to be conducted, as COVID-19 is confronting the lack of resources.
Marsh also hopes to see more resources soon.
She says she is concerned with how to deal with taking on new clients and the need to verify identification. She is also trying to be mindful of the access that her clients have to technology. Marsh says that some clients had issues accessing newer online platforms or even had issues because of a lack of familiarity with the technology. She says she has noticed this mostly with her older clientele.
For now, she says the transition to online hasn’t been as daunting as she initially thought. After receiving client feedback in the last few days, Marsh says she realized that there was a lot of positive reception regarding the switch; her clients expressed that they still felt heard and validated.
Marsh encourages other clinicians to give online platforms a try. Hawrylewicz, her business partner, is also pleased with how she has learned to adjust to online counselling.
“To be honest, I am glad I was pushed. This experience has taught me that we can replicate this safe space for most of our clients. Moreover, we can actually do it quite well. I have this suspicion that even once we are back in our office, some of my clients will continue requesting online counselling, and at that time I will gladly abide,” says Hawrylewicz.
Though both Hawrylewicz and Marsh say they are starting to see the brighter side of online counselling, some of the complicated issues such as trauma and access have yet to be unpacked. In the meantime, Marsh may still need to take some moments of pause in her practice.
This article was originally published on April 7, 2020 in Telling the Story using Integrated Media.