Therapy Online

 

Working online is slightly different to working face to face, because online we haven't got the little in-person clues that we all pick up on when we meet with another person face to face, it really is very helpful and in most cases essential to have clarity about certain things. Online counsellors will make explicit to you any information which will help you feel secure and safe within your work together. Below I have included some of mine......

Guidelines for emergency contact

Online counselling cannot provide an emergency service. Emergencies or strong suicidal feelings need urgent attention 

The following are useful contacts :

http://unsuicide.wikispaces.com/Online+Suicide+Help#.WoBCcnCnyaM
https://www.thecalmzone.net
www.samaritans.org     
www.befrienders.org 
https://www.papyrus-uk.org/help-advice/about-hopelineuk
or please contact your local emergency services.

 
  *I am not able to provide online counselling to any person who is under the age of 18*
 

How online counselling can take place 
 
Video
For video counselling the most secure platform is either Zoom for Telehealth or VSee both of which are medical grade, encrypted, HIPAA compliant, and offer a good reception. Other platforms we can use are Signal and FaceTime (also encrypted, but not HIPAA compliant).  Zoom or VSee are recommended for security reassurance. In order to use this type of online counselling, your computer must have a webcam and microphone so we can see and hear each other, or you would download the appropriate app to your phone or tablet. We will agree a mutually convenient appointment time to talk.
 
Voice 
For voice counselling we can use either my own dedicated phone line which will incur no call costs to you, or we can use audio on Signal or  FaceTime. If you prefer audio on Signal or FaceTime your computer must have a microphone so we will be able to hear each other, or you would use the appropriate app on your phone. We will agree a mutually convenient appointment time to talk.
 
Email
Email counselling is carried out by my replying therapeutically to your emails. A pre-arranged time acts as your appointment time and that is normally when my email is scheduled to arrive with you. The most secure email platform is Protonmail, which is a free app or computer download which enables end to end email encryption….you will also use Protonmail which is extremely easy to setup. 
 
Instant message/Webchat
Instant message counselling (also known as IM or Webchat) is carried out at a pre-arranged time using an instant messenger application. The most secure are Zoom for Telehealth or VSee as they are encrypted to medical grade and HIPAA compliant. Signal is also encrypted and secure. Instant Messaging will allow you to receive an instant real time response. We will agree a mutually convenient appointment time to ‘webchat’.
 

Things you need to know
 
There are many reasons people come to counselling…feeling overwhelmed, suffering loss or unexpected change, work pressure, difficult relationships at home or at work, worries about health. Some suffer depression, anxiety, low self esteem, or a traumatic incident, and feel unable to cope with the effects. Unfortunately not all problems can be resolved through online counselling and I will advise you if I consider face-to-face counselling or some other form of support may be more appropriate to your personal needs and presenting issues.  I will also help you as much as is possible to find the most suitable alternative resources. Online counselling is not for everyone but can be very useful to those who have busy lives, or have mobility restrictions, or feel they would prefer contact from the comfort of their own space, or without face to face contact. My experience is that distance does not take away from the effectiveness of therapeutic contact, in fact it can enhance it as the focus is without distraction.
 

** You will need to have your chosen platform installed prior to the first appointment and add me as a contact. **  


Please email me prior to your first appointment, and let me know your choice of online platform and the contact details. My secure email is nashcounselling@protonmail.com 

Specific issues related to counselling using the written word


There may be occasions where I ask questions about what you have written to me. This may be to seek a clearer view of your difficulty or to clarify a misunderstanding in our communication. We can’t see or hear each other, so it’s important we tell each other how we feel and what is going on for us along the way. Also you’ll perhaps be aware already that in email exchanges tone and intent are easily misunderstood….so it’s important we agree to give each other the benefit of the doubt and check things out at the time if this happens. 
 
What happens if  I have computer/connection problems which prevent me keeping the appointment?


Where either of us experiences a technological breakdown, which prevents us meeting online, exchanging emails, or speaking on the telephone, we would discuss via the alternative contact mode you use, how to re-arrange the scheduled appointment. If this is not possible, you will receive a refund for the appointment.


Security

Confidentiality is key to the success of therapy. Practitioners guard it closely and with vigour. The content of our sessions will not be communicated to a third party, except for the purposes of mandatory clinical supervision. As a member of BACP, it is a requirement that I have regular supervision. This is to support me in my work with you and ensure that I work ethically and safely. Counsellors/psychotherapists do not reveal names of their clients in clinical supervision. My supervisor is also bound by the confidentiality requirements of their professional body. 
 
During the course of our contact I will hold your contact information which will be deleted when our contact ends. I am required for good practice to keep very brief records. All personal information about you, clinical notes, and instant messaging transcripts will be stored securely using coded ID, encryption, and passwords. Anything stored offline will be coded and in a locked filing cabinet. All emails with personal information will be deleted as soon as the data has been protected within my secure system. Personal data/records of our sessions will be kept for up to 7 years after our work together has ended. Your personal data/records will be disposed of by wiping the electronic files and shredding any handwritten information. You can also request (in writing) that this data is destroyed : during our contact, once our work together ends, or at any time thereafter. I will not share the content of our sessions with a third party. 
 
Exceptions to the confidentiality rule apply where there is risk of harm to yourself or risk of harm to others. If at all possible I would always discuss a potential breach of confidentiality with you in advance.  

• With regard to online counselling via email, text/message, and video, the police and other authorities can ask for access to an individual’s email account or synchronous messaging account where there is suspicion of illegal or terrorist activities. They can also ask counsellors for access to stored records. Counsellors are not able to guarantee confidentiality in these circumstances. Additionally all counsellors are legally bound to make disclosure to authorities if a client reveals that they are intending to cause risk of harm to others.  

• If at any point during the counselling you were in need of emergency, medical, or additional support, I may ask for your consent to contact your GP or relevant services. I may also recommend alternative avenues of support to online counselling. 


Fees and Payment 

Counselling
All  online counselling  must  be  paid  for  in  advance by direct bank transfer BACS. More information can be found on the FAQ and Fees page of my website www.nashcounselling.co.uk  
(BACS Privacy Policy)

 

Please note that if you have not made payment 72 hours before a session, and have not contacted me, the session will be cancelled.
 
Each online counselling session is 50 minutes. 

  • Instant Messaging  - £70 per session

  • Video Counselling - £70 per session.

  • Voice Counselling - £70 per session.

  • Email Counselling - £70 per email exchange. 

Concessions may be available according to income. Please contact me to discuss if you feel this  could apply to you. 


Cancellation


If you need to cancel an appointment : 


There is a 72  hour cancellation policy. If you have made payment for a session but are unable to meet at the appointed time, please let me know as soon as possible.


The full charge will apply for unattended or cancelled sessions with less than 72 hours notice.
For cancellations with over 72 hours notice the fee will be refunded without delay.
 
If we have experienced a technological breakdown which prevents us meeting online or exchanging emails, we would use the pre-arranged alternative means to continue our session where possible. If that isn’t possible we would re-arrange the scheduled appointment. If that option isn’t open to us, a refund would be made.


Online platforms

​Zoom for Telehealth (https://blog.zoom.us/wordpress/2017/02/15/how-zoom-secures-your-meetings/)
"Security is our highest priority. We have built the most secure network with the most robust security features for our customers. In fact, many of the world’s most-trusted information security companies trust Zoom with their meetings.......Zoom is SOC2 compliant, certified by TRUSTe for privacy, and an active participant of the EU-US Privacy Shield Framework. Zoom also enables HIPAA compliance and we’ll sign a BAA."

VSee (https://vsee.com/security/) "... is a secure application that is fully encrypted to a high standard and is HIPAA compliant, which is an additional protection that is required by law in the US (but not in the UK). This means that it is very difficult for a third party to hack into the communication and all stored data remains fully encrypted."
 
Signal (https://support.signal.org/hc/en-us/articles/212477768-Is-it-private-Can-I-trust-it-)
"Signal uses Curve25519AES-256, and HMAC-SHA256. The security of these algorithms has been tested over many years of use in hundreds of different applications. Signal messages and calls are end-to-end encrypted, which means that they can only be read or heard by your intended recipients. We make it easy for you to verify that you are communicating with the right people and that no man in the middle attack has occurred. The Signal service does not have access to the contents of any messages or calls sent or received by Signal users."
 
FaceTime (https://www.apple.com/uk/privacy/approach-to-privacy/) “We use end-to-end encryption to protect your ... FaceTime conversations across all your devices. With watchOS and iOS, your messages are encrypted on your device so that they can't be accessed without your passcode. ... And we never store the content of FaceTime calls on any servers.”
 
ProtonMail (https://protonmail.com/security-details)is a secure encrypted email platform. ProtonMail's zero access architecture means that your data is encrypted in a way that makes it inaccessible to even Protonmail. Data is encrypted on the user side using an encryption key that they do not have access to. This means they don't have the technical ability to decrypt our messages, and as a result, they are unable to hand our data over to third parties. “With ProtonMail, privacy isn't just a promise, it is mathematically ensured. For this reason, we are also unable to do data recovery. If you forget your password, we cannot recover your data”.

There can never be a 100% guarantee that online counselling is safe, but with awareness, attention, and diligence, the risk that a third party can access the communication or its records, is minimal.

Maintaining the privacy of your online exchange


Please ensure that you secure your computer and emails against unauthorised viewing by third parties. This may include adopting the use of password protection for all personal email accounts and documents etc. It is recommended that you do not engage in online counselling using a public computer where the content of exchanges could be viewed by others in close proximity.