The coronavirus pandemic forced the world to shift from in-person connections to virtual and clinical social work is no exception. Deborah Sharp, LCSW-S, CGP, offers guidelines, tips and tricks for a successful online clinical practice.
- Setting up the space
It’s best to work from a desktop computer with a camera; cell-phones’ small screens negatively affect the ability to pick up cues from facial expressions. If possible, use headphones to improve the quality of the audio, block out background noise and increase confidentiality.
Light your face by facing a window or using a lamp; avoid having the only light above you or behind you. Ask your clients to have their faces well lit so you can see their expressions.
Think about self-disclosure when it comes to your background. You may use a simple white background or a green screen for a Zoom virtual background; the latter may be used to convey mood and can be a fun way of communicating with clients.
Plan ahead for your kids’ or pets’ needs to avoid disturbing your session. Practice self-compassion and give compassion to your family members if things don’t go as planned. If your session is interrupted, excuse yourself, attend to the immediate need, apologize to the client, and give them an opportunity to process by asking what that was like for them. If there is an emergency, end the session and call the client later to discuss what happened and reach an agreement as to whether you’ll charge for that session or reschedule.
- Running groups on Zoom
You may see more expressions of strong emotions in your group during this time because people are under a lot of stress and the group format allows an additional layer of insulation. This may have the reverse effect, especially for a newer group. For a short-term group, it may be hard to achieve cohesion because of the mediating effect of the platform.
Ask members to identify who they are talking to when they’re speaking. Be aware that Zoom groups make it easier for members to dissociate and watch other members on screen as in a TV show. You may want to have a facilitator or someone to monitor participants and manage the chat.
- Making eye contact with clients
You can’t make complete eye contact through Zoom. You may want to turn off your self-view to avoid distraction. Remember to tell people when you’re looking at them. In individual sessions, you can reassure your client that you see them and pay close attention by saying things like “I’m looking at your face, I see tears.”
- Telecounseling styles
Put into words things that you would normally indicate through eye contact, body language or nonverbal communication.
Telecounseling has been especially interesting when working with couples. Some couples I work with had breakthroughs after sessions where they were in separate rooms on different computers.
- Suicidality or high-risk clients
Be sure to ask and write down the address of where the client is. Confirm where they are at that address each time you talk to them.
If domestic violence is a possibility, you may suggest that the client go for a walk and talk by phone. If possible, set up a safety word for the client to use when in danger or unable to speak safely.
During lockdown, cliens in abusive situations are at very high risk. Some clinicians are choosing to call for intervention when they might not have done so in the past.
- Telehealth agreement
See three samples of the general guidelines:
- Internet special interest group (iSIG) of the American Group Psychotherapy Association
- Telehealth agreement for my private practice groups
- Telehealth agreement and instructions for my Conflict Management in Dispute Resolutions Office at UT
- Answering clients’ questions about your own personal health
I answer briefly and accurately, as in, “I’m well, thank you for asking.” I think it would be more dysregulated to pretend that the pandemic is not real.
- Dealing with fatigue
It’s reasonable that in these extraordinary times we are not operating at 100%. Be kind to yourself, take breaks, allow yourself some space and rest.
Try to walk away from your computer throughout the day. Staring at a screen all day fatigues your eyes and your brain; you’re managing emotions and technology. In addition, staring into white light all day is very stimulating for your brain and may impact your sleep.
- What happens after COVID-19
If you hate virtual counseling, you can always fall back on telephone sessions until shutdown ends. If you love it, this cultural change might be really good news for you.
I’ve personally found that I love not fighting traffic and not adding to air pollution and that I particularly like some things about this medium when working with groups and couples.
This material was originally presented as a webinar for the Steve Hicks School of Social Work’s Office of Professional Development on April 17, 2020.
Posted by Montinique Monroe on Sept. 1, 2020.