EXAMPLE ANSWERS: Q13

Q13. Research the GHR Code of Ethics in relation to remote and online therapy and other relevant materials and consider and discuss the potential issues a therapist must consider before working online.

1. Learning outcomes: 1.3

Student answer The GHR code of ethics contains guidance for conducting sessions online. There are many advantages of conducting a session in this way, including the reduction of geographic limitations and the ability to be more flexible in appointments. Online or sykpe sessions are a recent advancement in therapy and one which requires some additional steps and considerations at each stage of the therapeutic journey: Pre session The therapist must have specific professional insurance to conduct online sessions. The therapist and client must have had contact in which the following factors can be established/agreed- preferably in a written signed format: Client relevant medical history Assurance as far as is possible that the client is who they say they are and they are presenting a true identity and location What to do in the case of technological failure – exchange phone numbers so that this can be addressed and the session completed or appropriately finished in the case of technical failure. Obtain friend/family member phone number so that if an emergency situation arises you as the therapist are able to call for assistance. This includes the address of the client and their GP details with consent to call them. Assess your own location. This is especially important if conducting a session not in your usual therapy room e.g. in your own home. What can be seen in the background? Is this something you are happy to share? What are you wearing – video or web cams don’t always respond well to certain patterns like stripes Lighting – experiment and ensure that you can be seen Check your skype settings – can someone try to call when you are already on a call? Provision of payment for the session. This could take place at the start of the session but it may be ill advised not to have it set up before the session is completed. Start of session Check there will be no interruptions and agree what you will both do in case of unexpected ones. Take some time to ensure that the webcam is set up in such a way that you can see more than just the client’s face. Ideally you need to be able to see their hands and if possible upper body. It may be useful to get an idea of the room. Are others in there? What is the environment like? Agree if either of you will record the session and what will be done with the recording if this is the case Make an assessment of state- do they appear sober and ready to engage Develop rapport – this is especially hard in a remote session. It is likely that there will need to be more time spent on this area as you are physically apart During session If possible ask the client to play relaxing music in their own location rather than you playing it over the signal – this is likely to be distracting and poor quality Take note of subtle signals and extra care to check for physical reactions Ensure that the relaxing place is firmly established– this is even more important as in the case of an abreaction this may essential Use visual or audio anchors as you can’t use physical ones such as touch End of session Be confident that everything is ok before ending the session. Agree to end the call Ensure you disconnect from skype and aren’t still together in cyber space! This reinforces boundaries and prevents any embarrassing moments Store any recordings safely e.g. password protected on your computer Delete if recorded after an appropriate agreed time period. Be offline at times when you are not in session to avoid unexpected call-backs (LO 1.3 Sophisticated thinking, within the bounds of law and ethics, but beyond the confines of unnecessarily dogmatic rules sometimes asserted in training, supervision and reading)

Tutor feedback (DO NOT delete/edit feedback. Write amendments, additional information & thoughts underneath this table) Correct. A comprehensive and detailed answer bringing up some very good points and alerting the therapist to the potential issues which may arise in these circumstances. A well thought out approach, thank you.

(Further student work goes here if requested through feedback)

Further Student Example Answer:  Over and above the standard procedures and practises of the GHR Code of Ethics for therapists those that chose to work on-line or remotely must comply with the following best practise to provide the best for their clients and their practise.

The therapist must ensure they understand the difference between face-to-face treatment and on-line working; this includes the reduced feedback from the client during both the assessment phase and the actual treatment session itself.

The therapist must be confident the client is who they say they are and the contact details are correct. The therapist should be confident as to the true nature of client’s issues prior to commencing any sessions. They must have already agreed the standard personal contract and paid the appropriate fees.

They must be sure the client is not suffering from any relevant medical conditions which could impact on the session and that they have provided their GP's details and phone number with authorisation in case the therapist feels it necessary to make contact with the GP for the wellbeing of the client, their family or the public.

The therapist must be insured to work remotely or on-line, the therapist and the client must have a suitable working environment a safe and distraction free room, the therapist must be made aware of any other persons present with the client and will have previously agreed if the sessions are to be recorded in any way by the client.

The client must also be aware and happy to work remotely or on-line, including what to do in the case of technology failure issues, the therapist must have a quality back up plan including a landline/secondary phone number and if possible a third party emergency contact number.

Ensure all electronic transactions, emails, contract and fee scales etc. are available to the client.

The therapist must ensure the privacy and integrity of any material on their computer systems prior to linking to any clients system and deleting unnecessary material as soon as the clients contracted work is completed.