A Bereavement Counsellor’s Whimsical View of

“The Move from f2f to OLC”

The Move to Bereavement Counselling On-Line

• My name is John – I work as an unpaid counsellor dealing with Complex Bereavement situations

• I am planning to move to On-Line working to reach a wider audience whilst I am travelling the world.

• I am Eclectic in my Counselling and will use anything and everything in Counselling for and on behalf of my clients to release them from their prison of GRIEF.

• This presentation is a whimsical but relevant spotlight on how this might be tackled.

How will I, as a f2f counsellor, do that?Well,…

• I will use a systematic and iterative process adopting elements from several models of grief, just as I do in f2f (face to face) counselling

• The models I use are:– Elizabeth Kübler–Ross (1995) 5 stage model of

the grief process– J.W.Wordon (1991) Complicated Mourning

model– I.Pollin(1995) Medical Crisis Counselling 8

stage model– Egan G. (2004) on a systematic approach to

counselling• For the purposes of this presentation I shall use

the first wherever needed.

The Therapeutic Alliance• They all start with the counsellor developing a

therapeutic alliance with the client.So that is where I shall start too.

• Petruska Clarkson (1995), in her book “The Therapeutic Relationship defines this as follows:

“The Therapeutic Alliance is the powerful joining of forces which energises and supports the long, difficult and frequently painful, work of life changing therapy”

• It is the naturally empathic nature of good OLC work, that can aid the creation of a powerful therapeutic alliance quicker than f2f.

Developing a Therapeutic Relationship

• Ideally the counsellor tries to be, in Roger’s (1980) unforgettable words:

- walking in the clients shoes -

• To do this, s/he, the counsellor tries to establish a relationship with the client, in which the client will divulge their deepest secrets, their strongest and most stressful thoughts and emotions, for the counsellor.

• This, in the understanding that the counsellor can and will work with them, in confidence, to create a better, more comfortable and more stable emotional life, as a result.

Steps towards a Therapeutic Alliance in On-Line Counselling• By providing a confidential, safe space with ‘a professional’

whose codes of conduct include strict boundaries, impersonal, emotional and physical, skills in helping their emotionally troubled client (BACP Ethical Framework & others)

• Using Roger’s (1980) core conditions of:Congruence, Empathy & Unconditional Positive Regard

• & the counsellor’s multi faceted toolkit which includes:- Active Listening - Reflecting clients words - Summarising- Paraphrasing & Reflecting Feelings- Feedback - Focusing - Clarification - Exploring with open questions - Challenge - Advanced Empathy - Immediacy & Self Disclosure etc

The counsellor’s task is to:• Manage an active listening space by:

– Encouraging the client to tell the story of their bereavement in their own words, with all the emotions that are inherent in bereavement stories and expose them on the table as it were.

– Encouraging the client to allow their emotions to surface and take physical form and so relieve the stress from whatever thoughts accompany them.

– Learning what it means to be ‘inside the skin’ of the client and thereby; create the conditions necessary for a therapeutic alliance, where the client and counsellor are joined, feeling and in some senses, thinking , as one; the being that is the client.

So how do we do it on-line?• The tools are the same, the

method of delivery is different and the responses of the client need careful interpretation.

• So what is the difficulty,or is it an opportunity?

Working on lineCharacteristics and special features

• On-line work is characterised by its technology and a) its synchronous and /or b) it’s a-synchronous character.

• I shall deal with b), its a-synchronous character, in this presentation.

• A-synchronous in this context, means that it provides a pause (for thought) between communications.

• This gives the two participants time to think carefully about what they are writing and, because previous communications can and/or have preserved, what has been written before by either of them.

Characteristics and special features cont.

• A-synchronicity also has the advantage that emotional outbursts can be made by the client without being embarrassed by the presence of anyone else and ….it is easier to be calm and careful when thinking about why the outburst occurred because of the time lag between emails and …..because of the availability of all the emails sent in either direction.

• A-synchronous working on the Internet can be by email and/or by message board. The email system is perhaps the easiest to set up but the message board system, where messages are written to a pass-worded “board” for each to read, can be just as efficacious, it is very much up to the individual to choose.

Characteristics and special features cont

• In both these cases there is an added bonus of anonymity.

• This anonymity can provide a powerful release from normal social mores for the client so that the work may well progress very quickly.

• John Suler (2005) said “When people have the opportunity to separate their actions from their real world and identity, they feel less vulnerable about opening up”

• This dis-inhibiting factor, as it is termed, can contribute greatly to the powerful nature of On Line Counselling.

Professional Standards for OnLine Working

• It is just as important to work ethically OnLine as it is in Face to Face.

• BACP have produced guidelines to cover OnLine work and ACTO, the Association for Counselling and Therapy OnLine has been formed as the source of Professional Conduct and Code of Ethics in OnLine Counselling. These are ignored at ones peril.

How might the alliance be created on-line without the visual clues of f2f?

• In a sense, it is very much like f2f. However, that said, the techniques of fulfilling Roger’s (1980) core conditions are somewhat different.

• Whereas in f2f work the counsellor can see and acknowledge communications from their client. The on-line counsellor must look for clues as to how the client is feeling from what and how it has been written.

• In return the counsellor must find a way to convey their thoughts & feelings to the client inwords, or by some other means.

• So, the task is to express the visual clues of f2fto and from one another, in words, or the look of the words.

How then might it be done?• This presentation is limited in scope by the time

available, but I shall try to give you a flavour by looking at some samples, there are many others in the various “on-line” guides and training books I have studied and are referenced here.

• In f2f, the counselling process starts immediately the client enters the room. The counsellor starts to appraise and make observations about how the client is, at that point.

• After the introduction phase and the setting out of the ‘rules’, the counsellor will invite the client to tell them what issues have brought him to meet with a counsellor.

• In OLC, counsellors will start in the same way, however they will have to assess from what is written, just what sort of person they are dealing with.

• When the clients tell their story, they will be looking for clues from the words used, about what the client might be thinking and feeling.

• They will want to prompt & expose more of what is going on for the client… “I am wondering how you were feeling when you watched the coffin lowered into the ground, can you tell me a bit more about that please?”. A more tentative & empathic approach altogethercompared with f2f.

• The objective here is to encourage the client to relive the trauma, reaffirm the reality of the loss.

• The client may regret not having said goodbye to the lost one and the counsellor might use a Gestalt technique and write:

‘I know that you feel really bad about not saying goodbye and I wondered if you might like to write your goodbyes down and send them to me? Do you think you could do that?’

• The client might not be able to, but if they can, the relief of actually saying goodbye in this way, can often provide great solace and reinforce the reality of the loss.

• The counsellor might invite the client at the end of their narrative: “From the way that you took longer than you expected, to write your story, I felt that you may be having real difficulty telling me at all. I am wondering how you are feeling now, having set it down in writing?” The client is likely to agree and accept that it was very difficult but that: “I feel so much better having gone through it again with you.”

• You can again see that the counsellor is verytentative in their queries, much more so than in a f2f dialogue perhaps.

• A simplistic statement might be that whatever is possible in f2f, there is a similar thing that can be done in OLC. The difference is, that because there is a delay between messages and because each message, once transmitted, is there for ever,both client and counsellor can examine in detail, every word written by each other and look for meaning.

• For the counsellor. This enables him to get into the clients shoes much quicker than in f2f, and also means that the counsellor can respond to every small part of the client’s message in order to delve deeply into the clients persona. This is valuable and aids the counsellor in

being truly client centred.

• From the client’s point of view it is likely that they will feel really heard if the counsellor takes this opportunity and diligently responds to every point the client has written and responds to it, from the client’s perspective

What am I saying in all this?• First and foremost, creating

a therapeutic alliance is ofprime importance whichever medium the counsellor uses.

• Secondly, ftf models of bereavement counselling can be transferred to OLC but…

• The mode of listening, and looking for clues in ftf is performed much more tentatively and gently, more empathically by nature.

What am I saying in all this? cont.• Thirdly, OLC can be more powerful and work

quicker than ftf because it gives an opportunity for the counsellor to be more client centred in the detail, due to the permanent availability of all that has been written in prior exchanges.

• Lastly, the timing in OLC could be quicker to reach a conclusion than in f2f, as the client is confronted every time they open the email trail, by what they have written previously between them.

What has not been done:• None of the suggestions have been in any way proven

here and have only been lightly touched upon in this presentation.

• I make no apology for this, the task is enormous and there is a book waiting to be written on this subject.

• The techniques and skills of on-line and face to face counselling have both been glossed over and need to be studied in depth and learnt through experience.

• I recommend the reader study the above through the medium of the

bibliography I offer below.

Assessment & Contract• I am aware that I have not discussed assessment and

contracting of clients in the on-line context.• After reading the ISMHO paper on assessment

(www.ismho.org/therapy_suitability_assessment.asp), in the first week of the course : I realised that this would be an enormous subject to include in this presentation.

• Similarly I looked at the contract ideas in Jones & Stokes (2009) & in several of the other works in my bibliography and decided that the contract was another subject which would elongate my presentation too far.

• So I read them, and incorporated some of the thinking into my own contract/assessment document for role-play. For completeness, I have made that document available as an Appendix to my presentation critique.

• References• Kübler-Ross E 1995 - On Death and Dying “Five stages of Grief” Ch 3 - Routledge KP London• Wordon JW 1991 – Grief Counselling & Therapy Ch 4 - Brunner-Routledge Hove UK• Pollin I 1995 – Medical Crisis Counselling - Short Term Therapy for Long Term Illness Ch 4 – The

eight stages of chronic illness – WWNorton &Co New York • Egan G. 2004–– The Skilled Helper 7th Edition - Pacific Grove CA -• Sanders P 2006 – The Person Centred Counselling Primer Ch9 - PCCS Books Ltd Ross-on-Wye –• Geldard K & D 2003 - Counselling Skills in Everyday life Ch 3,4,5 - Palgrave Macmillan

Basingstoke • Suler J (2005) - The Psychology of Cyberspace last updated in 2005) - Sn 7 Para 3 - accessed

19.7.10• usr.rider.edu/~suler/psycyber/disinhibit.html - • www.office.microsoft.com/clipart accessed 19.7.10 & many other times• www.ismho.org/therapy_suitability_assessment.asp: accessed 18.4.10

• Bibliography• Adlington J 2009 – on line therapy – reading between the lines MX Publishing - London• Jones G & Stokes 2009 - Online Counselling – A handbook for Counsellors - Palgrave Macmillan • Evans J 2009 - Online Counselling and guidance skills - Sage Publications Ltd London • Clarkson P 1995 - The Therapeutic Relationship Whurr Publishers Ltd - London • Sutton J. & Stewert W. 2002 Learning to Counsel 2nd Ed. - How to Books Ltd - Oxford • Mearns D & Thorne B 1999 Person Centred Counselling in Action - How to Books Ltd - Oxford • Feltham C & Horton I 2000 Handbook of Counselling & Psychotherapy - Sage Publishing - London • Rogers, C. 1980 - Way of Being - : Houghton Mifflin - Boston • Rogers, C. 2005 - The Carl Rogers Reader edited by Kirschenbaum & Henderson Countable & Robertson -

London• BACP 2010 – BACP Ethical Framework - bacp.co.uk/ethical_framework/ accessed 2/8/2010• ACTO – Professional Standards and code of ethics for online counselling. - acto-uk.org/

End of PresentationCompiled by

John KnottJuly 2010