Telehealth Appointments Only

Is Distance Counseling for you?

As you consider the availability and practicality of distance work into your counseling options it is imperative that you to weigh the best fit for each client. Counselors must also be aware of some contraindications for distance counseling use. When distance counseling is selected as the modality, there are precautions that a counselor should exercise with clients.

Distance Counseling is not for everyone. Things to consider to decide if Distance Counceling is the best option.

Best Fit for a Client and Distance Counseling

Distance counseling may provide therapy that is more accessible. The Department of Veterans Affairs (2011) indicated an initiative to reach veterans where they live through virtual service provision. One example is the Veteran’s Suicide Prevention Chat Line. This could provide veteran-specific service to someone who did not have similar service readily accessible in a face-to-face format. Distance counseling could also provide accessibility to clients who were limited in transportation or physical mobility.

A client may prefer distance counseling for convenience. A telephone or computer provides quicker access to the counselor than taking the time, effort, and transportation expense to travel to the counselor’s office. Distance counseling might also be arranged at times that are outside of typical 8 to 5 office hours. This could be a matter of convenience for both client and counselor. Distance counseling can be used as a back-up when a client may have to miss a face to face session because of travel, but could engage in a telephonic or chat session with the counselor.

Often a client may have concerns about maintenance of perceived anonymity with issues carried to a counselor. Distance counseling provides greater opportunity for a client to engage in therapy with anonymity from the local public without the visibility of going to a physical counseling office. This can especially offer benefit to clients and counselors in small towns and rural areas or for clients who are well-known to a local public.

Contraindications for Distance Counseling

The following contraindications are listed by Kramer, Ayers, Mishkind, & Norem (2011) in guidance for tele-mental health practice in the Department of Defense. These are applicable guidelines for counselors in all areas of practice:

• Client is acutely unstable, suicidal, may require emergency care. A client in this state may initially reach out to a counselor or Crisis Line via telephone. It is good practice for all counselors to maintain awareness of protocols as used by Counseling Crisis Lines. A good resource for this is a local community mental health agency.

• Symptom presentation that could worsen with use of telecommunication such as thought insertion or delusions related to technology.

• Client issues that require monitoring at the client site.

• Client with cognitive or sensory deficits that might impair ability to use or interact via technology. Some assistive technology could enhance capacity for distance counseling to benefit the client. The counselor should check for this as needed.

• Cultural issues that would contraindicate use of technology such as discomfort of an elderly client with use of technology.

Precautions with Clients

Counselors should screen potential distance clients for appropriateness of fit for this modality of service. When deemed inappropriate for the potential client, the counselor should either engage in face to face services or refer the client to another appropriate service provider. The screening process should include

• Provision of a detailed written description of the process of distance counseling.

• Precaution taken by both counselor and client to prevent distribution of confidential information to unauthorized individuals.

• Caution to clients about potential hazards of distance communication such as entering private information via shared networks or use of cellular phones for confidential communication.

• Use of a procedure for client identity verification each time service is rendered such as use of a code word.

Kathy Green, M.A., LCPC, has counseled clients from children to senior adults, vetrans and serving military and thier families, as well as those who seek to achieve mental fitness and balance in their lives.  She developed and implemented an online counseling services program at her practice to make mental health services agailable to those who are unable to seek counseling in the more traditional setting.