Now that virtual therapy seems to be becoming a common practice among therapists, there appears to be a question of establishing and maintaining a trusting relationship with patients.
It is much easier to establish trust and create a sense of intimacy during a face-to-face conversation than online. Nuances in body language, eye contact, and facial expressions can be easily missed or misinterpreted when communicating via a screen.
Moreover, you do not have the advantage of creating the right environment for sharing, e.g., using nice lighting, candles, or cushions for comfortable sitting.
It is much harder to create a comfortable environment when providing online therapy, but there are ways to do it successfully.
In this article, you will find some tips and tools that may help you create a peaceful atmosphere and develop trusting relationships with your patients. Hopefully, our guidelines will help you provide effective online counseling!
Creating a Truly Confidential Online Environment
Confidentiality is essential for the creation of a therapeutic alliance. Therefore, to establish trust, you should pay special attention to creating a safe environment in which the client knows that their privacy will be protected.
Platform Choice and End-to-End Encryption
The first thing to consider when choosing the platform for providing online therapy is the issue of the platform’s compliance with HIPAA.
Luckily, today there are many HIPAA-compliant teletherapy platforms that can help you with the provision of online therapy. Such platforms as Doxy.me, Zoom for Healthcare, and SimplePractice use end-to-end encryption that provides security.
Discussing the platform and its advantages and features can help you to create a safe environment.
Authenticated Access
Two-factor authentication (2FA) for the teletherapy account may be a very useful tool for improving the privacy of online therapy.
This method requires the user to complete an additional step of authorization (e.g., entering a verification code). Thus, even if the password was somehow stolen, the account will not be available to any third parties.
Privacy Tools to Protect Client Data
Along with the usage of a HIPAA-compliant platform, one more step that you may take to protect client data and create a confidential environment is the use of additional privacy tools.
If you conduct online therapy or receive any sensitive information on the computer, using a VPN service for PC can be helpful for protecting your internet connection from any interceptions.
Using general privacy tools can be an additional measure that will help you to create a more protected online environment.
Therapeutic Alliance: Tips for Creating Rapport Online
The success of therapy is often dependent on the therapeutic alliance that a therapist creates with his or her patient. Moreover, in order to create such an alliance, therapists spend a lot of time.
In the era of virtual therapy, when more than half of sessions are conducted remotely (either online or over the phone), creating a rapport without meeting patients face-to-face takes even more effort.
So, what may be helpful in such cases?
Being Verbal and Listening Actively
Every therapist knows that active listening is essential for the process of therapy. However, in-person interaction gives us the opportunity to read the client’s nonverbal signs and react to them. In the case of virtual therapy, these nuances can be missed.
Thus, being verbal and listening actively becomes more important in the case of virtual therapy. Tone, pauses, and choice of words become more significant in the process of communication. The demonstration of your engagement also becomes more important.
The repetition of the client’s words or the summarization of what he or she said can be very helpful in demonstrating that you are really paying attention to him or her.
Such words as “I hear you” or “that makes sense” can also be very useful in the case of virtual therapy to help the client realize that he or she is understood.
Nonverbal Communication
Establishing eye contact is another important thing to build trust with the client, but it becomes harder in the case of virtual therapy. Nevertheless, there are some things you can try.
For instance, positioning your camera at eye level can help you in the process of communication, as well as being visually present and engaging.
Not every client can feel comfortable being on camera, and it should be respected, but, nevertheless, video and audio can help in the process of creating rapport.
Some platforms, such as Zoom, have the “hide self view” option so that the client does not see himself or herself but still sees you. At the same time, you can still see him or her.
In the case of virtual therapy, the more expressive you are, the better. Some subtle cues cannot be easily understood by clients during the process of virtual therapy; thus, being more engaged and expressive, and using some nonverbal cues such as hand gestures can be very useful.
Setting Expectations and Boundaries
Talking about boundaries, the duration of the session, and the expected response time can be helpful in creating the right environment. In addition, it is important to discuss the confidentiality of the communication and protection of the client’s personal data.
It may also be helpful to have a simple backup plan so that you both know what to do in case of any problems with the connection or platform.
Conclusion
Providing therapy online definitely changes the way of building trust but makes it no less possible. It is just necessary to be more thoughtful and purposeful in the way you are communicating and creating a safe environment for your client.
Even small things become more important in the virtual environment. How you listen, how you react, how present you look, and how clearly you handle the issue of confidentiality all influence the feeling of your client about the safety of the environment.
About the author
Kerem Okumus is an Outreach Executive at Intseo Media, where he focuses on SEO outreach, publisher communication, and digital content partnerships. He has experience working with content covering technology, online privacy, cybersecurity, and other digital topics.
Please also review AIHCP’s Grief Counselor Certification program and CE courses see if it meets your academic and professional goals. These programs are online and independent study and open to qualified professionals seeking a four year certification
When clients experience stress, grief or loss, sometimes meaning is critical to understand. The emotions and feelings need to find meaning in relation to the issue. Counselors need to have the helping skills to aid the client in finding meaning again. This is essential especially in Grief Counseling. In grief and loss, the individual needs to find meaning in the loss and be able to connect the past with the present to move forward to the future. New meanings in relationship to the loss help the person connect the dots and knit together the chapters of life into a logical story. When meaning is not found and emotions rage without direction, then the stressor or loss can lead to grief pathologies of depression or prolonged grief. Hence it is important for the counselor to be able to navigate the person through the emotion and find meaning. This is more than understanding the process of grief and loss, or dealing with stress, but also being able to help the client find meaning through good counseling techniques that help the client find meaning.
In previous blogs, we discussed the importance of meaning re-construction, as well as Cognitive Behavioral Therapy or CBT, as key ways to help clients tie together pass loss or trauma to the present to move forward. In this blog we will focus more on the micro skills and probing that is necessary to help clients find meaning via interaction, reframing and interpretation skills, and how to relate to the client. Obviously, many of the other micro skills of attending the client, observation, focusing, responding, challenging and confronting are all implied within this blog and found in other previous blogs.
Please also review AIHCP’s multiple counseling blogs as well as certification programs in Grief Counseling, Stress Management, Crisis Intervention or Christian and Spiritual Counseling.
The Importance of Meaning
Finding meaning is critical to life. When bad things happen, counselors can help clients discover meaning
Meaning is essential to human existence. This is why it is so important for individuals suffering from trauma, or abuse, or loss, or any situation to find meaning in their situation. Sometimes it involves regaining it because it has been taken away, other times, it is discovering it for the first time.
Logotherapy is a type psychotherapy that helps individuals find meaning. It is based off Victor Frankl, the famous Holocaust survivor, who utilized meaning in life, even in its darkest hours, as a prisoner in a Nazi camp, to find hope. Frankly administered to many of his fellow prisoners and helped them find also meaning despite the evil and trauma and abuse that surrounded them under Nazi rule.
Frankly believed everyone had a will to meaning. This meaning is what pushes all in will and action and even helps one endure suffering and pain. These beliefs persist in the value and uniqueness of each human person. It also is a platform for a person to move forward in life. This has numerous applications in counseling and helping others. It involves understanding purpose in life despite pain, but the importance to define and push forward. It involves understanding that life is far from fair but one can still find meaning through it. Purpose is beyond bad things (Waters, E., 2019).
Frankly summarized his philosophy in six basic tenets. Humanity is comprised of mind, body and soul but it is through the soul that we experience and find meaning. He continued that life has meaning in all circumstances, good or bad. He stated as well that humans have a will to meaning that pushes them. He also listed humans also have freedom to access this meaning no matter the situation. He stated in addition that true meaning is not merely an statement but something concrete that correlates with life and one’s values and beliefs. Finally, he emphasized that all human beings are unique (Waters, E., 2019).
From Frankl and his classic work, “Man’s Search for Meaning”, counselors, but especially grief counselors have an excellent way to help reconstruct meaning to clients and cultivate true change in a client’s life.
Obviously, much of the work associated with David Neimeyer and meaning reconstruction are found from the ideas of Frankl.. Meaning helps tie together past, present and future into something that matters to the individual. It helps make sense of the loss and allows the chapters of one’s life, even the bad ones, to have meaning to the overall story and book. Obviously, counselors play a key role in helping clients evolve the story told initially into telling the right story that correlates with reality. This involves intense counseling and sorting out feelings, but eventually these feelings can lead to a true meaning. Reflecting and reframing are keys in achieving this for a client.
Reflection
When individuals are discussing feelings and emotions, it is essential eventually, not initially, to guide them to meaning. In the very beginning, it is important to allow raw emotion to be expressed, felt and processed, but it needs to eventually find meaning within the grieving process. Counselors can help clients reflect on the emotion. Ivey refers to the term “reflection on meaning” as a way to help clients find deeper understanding regarding issues, purpose, feelings and behaviors (2018, p. 258). Ivey also points to the importance of interpreting and reframing these feelings. Interpretation helps the clients understand their feelings and add meaning to them through a variety of perspectives or multicultural or psychodynamic ways. The client is able to find new meaning, while the counselor provides the necessary reframing to explore new interpretations (2018, p. 258).
The counselor through reframing, can with empathy begin to offer different interpretations of the event itself, One skill a counselor can utilize is linking. Linking helps the client tie together two or more things that enables them to find new insight (Ivey, 2018, P. 265). A counselor can tie family history, values and talents to the client in relationship to the issue, or tie the event to psychodynamic issues that exist within the client. The linking helps the client find new perspectives on the issue at hand.
Counselors can help clients link and find self discovery through a variety of approaches. Some counselors may utilize decisional theory that presents outcomes and alternatives for action. Decisions need to be understood and made with the client understanding outcomes (Ivey, 2018, p. 268). Another approach is person centered. Linking is utilized to tie the problem together with the person’s strengths. CBT is another way to help individuals review old ways of thinking, acting and behaviors and re-interpret them. Reframing and linking can also be utilized with psycho-dynamic theories that help the person understand the person’s deeper subconscious past. Finally, multicultural therapy can help a person link to and also reframe an issue with ones’ own ethnic and cultural backgrounds
Reframing
A counselor’s response is key in helping one reframe and interpret meaning. In previous blogs, we discussed first attending the client, with basic responses, such as paraphrasing or summaries. How one reflects how one feels helps open new dialogue and understanding. Other ways to help discuss emotions and help build meaning and cultivation to change involves disclosures, feedback and consequences.
Counselors can help clients reframe and reinterpret events and emotions and help them find new meanings moving forward
Disclosures are excellent ways to involve oneself by sharing an appropriate story of one’s own life, but usually it involves oneself utilizing the phrase ” I think or I feel” in relationship to one’s issue or feeling or intended action. Feedback is also critical in cultivating change. It can be confirmatory or corrective. When corrective, it looks to help align a person back on track. It involves empathy and nonjudgment when being applied but helps the client again find the proper perspective and route. Remember, the client remains in charge and review how the client responds. Empathetic confrontational approaches should be utilized. Finally, logical consequences can be employed to help a client. It summarizes the possible positive and negative consequences of a particular action. The common phase includes “If you do…then…will possible result” (Ivey, 2018. p. 302).
Employing psychoeducation and instruction is also a key way to help push individuals to change and reframing. By making the client understand the science and philosophy of their feelings, one can better take ownership to change.
Whatever link the counselor can utilize through whichever therapy, or phrasing is good. Each individual is different. The key is to help the person find a new perspective on the emotion, situation, stressor or loss. This enables the person to form a new meaning which can help them tie the past with the present and into the future.
Fostering Resiliency
Through any change and new discovery, counselors need to foster resiliency. This helps the person emotionally and physically push forward into the new change and maintain the new meaning he/she has found. This can be accomplished through a multitude of stress management techniques that involves multicultural approaches, psychoeducation, social skill training, assertiveness training, conflict resolution, bio or neurofeedback, positive reframing, CBT, time management, relaxation management and active planning techniques (Ivey, 2018, p. 288). Ivey also lists the importance of Seven Therapeutic Lifestyle Changes. He includes exercise, nutrition, sleep, social relations, cognitive challenges, meditation and cultural health. Within these, he also lists the importance of prayer, hobbies, positive thinking, social outreach and avoidance of negative substances (2019, p. 288).
Egan, emphasizes that in cultivating change, counselors need to help client discover their own resilience. Egan points out the difference between process resilience and outcome resilience. In counseling, the counselor should be able to encourage clients to change in face of challenges, but also note outcomes. With outcome resilience, the counselor comments on the change and how one has returned to one’s own self (Egan, 2019, p. 263). Like a coach, the counselor hence cheers the person’s progress and ability to overcome. Counselors need to also help clients identify resources for resiliency, within family, friends or other social support systems. A counselor should help a client find ways to make better connections with families and friends as well. In pushing forward, a counselor can help a person reframe issues, such as challenges or crisis as ways to grow and to understand that change is part of life (Egan, 2019, p. 265). A client must continue, especially after loss, or trauma, to continue to keep things in perspective, maintain a healthy outlook, find new ways for self discovery and maintain care of oneself (Egan, 2019, p.265). A counselor can help a person maintain this progress.
Recall also, the previous blog which discusses the change scale in clients and how it is essential that the counselor discovers the level of acknowledgement and commitment to change a client may possess, as well as helping the client implement first order or second order changes depending on their situation. The counselor can help the client with goals to implement the change and also be aware of possible setbacks and pitfalls.
Conclusion
Please also review AIHCP’s multiple mental health certifications, including AIHCP’s Grief Counseling Certification
In helping clients change, reflection and reframing are key in helping the client link and find meaning in the trauma or loss. As time progresses, the client will be able to find meaning and connect the incident into one’s life narrative. Counselors can help this transition through a variety of skills mentioned in this blog and throughout other blogs written for AIHCP. These skills help the client understand the emotion and find linking to it. This helps them discover new meaning and ways to reinterpret the event. Furthermore the counselor helps the client move forward by fostering resiliency and helping the client continue to move forward.
Please also review AIHCP’s various mental health certifications. These certifications are granted to professionals in the health care field and human service field. Some may be licensed professionals while others may be pastoral in nature. Obviously such licensures or lack of, grant or prohibit the extent of certain counseling therapies and techniques.
AIHCP’s programs include Grief Counseling, Crisis Counseling, Stress Management Consulting, Anger Management Consulting and also Christian Counseling and Spiritual Counseling. The programs are online and independent study.
References
Egan, G. & Reese. R. (2019).”The Skilled Helper: A Problem Management and Opportunity-Development Approach to Helping” (11th Ed). Cengage
Ivey, A. et, al. “Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society” (9th Ed( (2018). Cengage.
Additional Resources
Morin, A. (2023). “How Cognitive Reframing Works”. Very Well Mind. Access here
Caraballo, J. (2018). “Reframing is Therapy’s Most Effective Tool, Here’s Why”. TalkSpace. Access here
Ackerman, C. (2018). “Cognitive Restructuring Techniques for Reframing Thoughts”. Positive Psychology. Access here
Waters, E. (2019). “Logotherapy: How to Find More Meaning in Your Life”. PsychCentral. Access here
