What's it all about, Alfie?

[Art Matthews, MA LPC DCC]

I had a conversation with a fellow counselor that I met while working with an "advising site" offering everything from psychic readings to distance therapy. My friend -- who continues to work with the site -- and I traded observations about the clients that seem to be drawn to those kinds of sites and wondered if clients on a more traditionally focused counseling/therapy site would be similar.

We noticed that the typical "advising" site clients were more likely to be clock watchers. These sites usually set up on a "by-the-minute" fee and include a timer in the chat window. This may suggest why these clients seem to place more emphasis on getting to the heart of the matter quickly. Exploring the history sometimes lead to a disgruntled client and sometimes a quick "click away." Anecdotally, I recall some that seemed not to want to engage in actual therapeutic exchange but wanted either 1. confirmation they were in the "right" in a dispute with another person, or 2. wanted a brief and easy action plan to correct their situations ("Dear Abby....").

We both noted that in order to save the client time, we could feel pressure to respond before the client stopped typing. We both reported typing while the client was still engaged. We noted that clients were sometimes prone to using "Text Speak" 2 abbr wrds & indic8 :-) or :-(

I'm familiar with Text Speak because I've worked with college age clients for the past several years, but for a non-tech savvy counselor in her 60s, my friend was not sure if her computer was on the fritz or if these clients might be having some symptoms of a severe mental illness (what would "word salad" look like in text?).

I told my friend that in working with "advising site" clients, I would do a couple of things to understand where I was headed:

1. I asked up front for the client's expectations of the session. On many of these sites, clients "doctor shop" or "doctor hop" from counselor to counselor based on who is there when they log in. I rarely had a repeat customer and even when I did, they didn't set up appointments; they looked for me when they were on and expected immediate service. Asking up front for their expectations, I knew whether or not I was likely to see them again and gave me direction on where to get and how fast to get there.

2. I asked about their comfort level with using abbreviations, text speak and emoticons in order to know what to expect and how I could respond. I "Googled" to find some common text speak and printed those out for quick reference. I refrained from emoticons (you know, those smiley faces like ;-) or :-P) unless I saw the client use them to avoid the suggestion I was not taking the client seriously or was even making fun of them. Some clients cared a great deal about spelling ("shows you're a professional or not") and others were bothered because I was taking too much time spelling out longer words. The chat programs used by some "advise sites" allow the client and counselor to see what the other is typing in real time so you know if they are correcting as they type or not. I often gave the client permission not to worry about typing. I would ask if I was confused.

Using microphones and web cams offer their own challenges too. Audio cuts out, video stalls and connections get cut. My friend and I were chatting on Skype but because I was on a campus with an overloaded server, my audio would sometime cut out. Then we resorted to staring at the tops of each other's heads as we typed out our responses while on a video conference call. The video stalling lead to a funny moment when my friend thought I was asleep because my video on her screen showed my eyes were closed for over a minute and a half. Lesson there: having the visual aspect in distance therapy is good, but it isn't always congruent.

Certainly there are complications from both the technical and human perspectives when switching over to distance therapy. My approach has been to try to be as transparent as possible in clarifying the client's expectations and understandings while sharing my own.

I'm continuing to utilize distance therapy with my university students out on rotations and clinicals, but they have all had a relationship of some sort with me before heading out. The therapy I do with them is more traditional in focus, so I am hopeful that (once I get a private practice site up) the clients I attract will be more interested in a real process than getting a response to an advice column letter.