Certificate in Online & Telephone Counselling
Get expert training from the Counselling Tutor team on how to transfer face-to-face skills to work safely and ethically online and via telephone
Learn how to assess and manage risk in online therapy, including how to handle high-risk presentations, use appropriate screening tools, and ensure client safety with ethical contracting and emergency planning. Continue reading to strengthen your online counselling competence.
Working to professional standards when practising online and telephone counselling is just as vital as it is in face-to-face therapy.
The BACP competences point out that understanding risk assessment for online therapy means we must work within our competence, but one of the challenges of online therapy is that you do not get as full a picture of the client as you would if you were seeing them face-to-face.
Get expert training from the Counselling Tutor team on how to transfer face-to-face skills to work safely and ethically online and via telephone
Clients from certain groups may have behaviours or environments that contribute significantly to a serious risk of harm to self or others.
Traditionally, online and telephone counselling courses do not recommend working with the following client presentations:
It is your responsibility as the therapist – with support, as appropriate, from your clinical supervisor – to think carefully about managing risk.
It is also important – just as in face-to-face work – that your skill set is a suitable match for the client’s issues and for what they wish to get from counselling.
Unlike face-to-face work – where you can negotiate with a client to get some help if they disclose a life-threatening situation – working online poses several challenges.
The most pressing of these is how we get help if the client becomes unwell during a session, expresses suicidal intent or poses a danger to others in the household.
Managing risks in online therapy
A risk-management plan, also known as an ‘intake form’, allows you to identify any risks in advance, and so to help manage any clients who may be in danger.
It is important to have a risk-management plan whether you are working face-to-face or online. This should form part of your online counselling contract.
It is best practice to revisit the risk-management plan regularly (as part of your reviews), but always to keep previous versions too, so as to ensure you have a complete audit trail of your actions. This helps protect both the client and you as a professional.
The information provides the basis of a risk assessment if you need to decide whether or not to break confidentiality.
Areas to ask the client about are:
The questions needed to elicit this information may feel very invasive, and it is therefore important to approach these in the right way, paying attention to your tone, and reminding the client of confidentiality and its limits.
It also helps to explain why you need to collect this information.
Get expert training from the Counselling Tutor team on how to transfer face-to-face skills to work safely and ethically online and via telephone
It can be helpful to use standard mental-health questionnaires.
As well as providing evidence-based information to support your decision-making on whether or not it is safe and ethical to work with a particular client, using a standard tool as part of your assessment for all clients can help reduce the feeling of invasiveness.
As a tool in assessing risk and thus suitability for online therapy, you may wish to use one or more mental-health questionnaires.
These come in various forms, measuring depression (e.g. PHQ-9 and Beck’s Depression Inventory), anxiety (e.g. GAD-7), stress (e.g. PSS) and overall mental wellbeing (e.g. CORE and WEMWBS).
Many of these include questions that relate to suicidality (e.g. in PHQ-9, there is ‘Thoughts that you would be better off dead or of hurting yourself in some way’, assessing suicidal ideation; and in CORE-10, there is ‘I made plans to end my life’, assessing suicidal planning).
There are then specific instruments available to measure suicidality – for example, the Beck Scale for Suicidal Ideation.
These assess how far along the suicidal continuum the client currently is, and so whether it would be more appropriate to see the client face-to-face (if possible) or to refer them to other services (the Samaritans, their GP, acute mental-health services etc.).
As well as providing evidence-based information to support your decision-making on whether or not it is safe and ethical to work with a particular client, using a standard tool as part of your assessment for all clients can help reduce the feeling of invasiveness.
Key to safe and ethical online counselling is the collection of emergency contact details for each client (including their GP practice) before beginning therapy.
Ensure that you then always have the relevant details on hand during every session in case you need to contact the emergency services (for risk of harm, falling over, having a seizure etc.). This is especially useful if you are working with a client abroad.
It is good practice to set your boundaries for information-sharing using the Caldicott Principles.
The BACP (2019: 9) advises:
Care needs to be taken in communicating to clients what assistance can be offered from a distance in situations where the client becomes vulnerable or distressed or requires urgent support outside the scope of the service being offered. It is good practice to have discussed with clients how they might be assisted before such a situation arises.
Managing risks in online therapy