Insights into text-based therapy

It’s Severe ME Awareness Week now, in early August, and sharing this article seems particularly relevant. People who are most severely affected may find it hardest of all to access counselling and emotional support, and yet also face some of the hardest struggles.

How might text-based therapy be useful?

Text based counselling may offer a way for people with the most severe types of chronic illness to access therapy. This can assist with coping and dealing with the emotional impact of being ill.

What type of text-based counselling have you used?

I trained in-house at a mental health organisation I’ve worked with. Since then I have adapted the techniques and used them to support people living with chronic illness. The training was quite broad and covered etiquette for counselling (eg; not using emojis), partly about counselling for ‘one session’ counselling, partly about online counselling. I have adapted it for my work with chronically ill people as it can make it possible to support people who are housebound and unable to use video calls.

‘Messaging’ is where both counsellor and client are both online and transmitting messages to each other in real time, that is, exchanging messages. However, most of what is described applies equally well to texting via phone or email or other text based communication.

Everything I describe here was either included in my training for this type of work, or cropped up during my work with clients. It is important for maintaining a good working relationship and maintaining a good quality of counselling.

Avoiding misunderstandings through clear communication

The first and perhaps simplest rule is do not use emoji’s (smilies). These are not suitable for counselling. Your client may use them, but you, as counsellor, should not. If your client uses one and you are not sure what it is meant to mean you might want to question what they mean by it.

Often a written word can be misunderstood. If you have any doubt about what something means, ask the client. Don’t make assumptions. This can cause all sorts of problems. With written material there is no tone of voice or facial expression to assist in understanding. If the meaning of a statement is not entirely clear ask for clarification.

Disinhibition

As with video work, the dis-inhibition effect can operate. Take care if you think your client is revealing more than they might be comfortable with in a face-to-face situation. Make sure they want to continue the discussion.

Sometimes a client will present a fantasy. Either a false self, or a false narrative. Be aware that this is a possibility. This can be to play out a sick game with you, the counsellor. It is rather like a dirty phone call. If you suspect this it is best not to go along with it, refuse to play.

Can it work as well as in-person or video therapy?

Messaging can be equally rewarding as other forms of therapy. You can build excellent relationships with clients and experience good work with them. For some people it provides a necessary alternative to other types of contact.

What are sessions like?

Sessions are just like ordinary counselling sessions. Set times to meet on a particular platform in real time. The difference is it is done by exchanging written messages.

The same protocol applies for risk, crime and terrorism as for other forms of therapy. If you have concerns you should apply the same approaches.

Who might it be particularly suitable for?

I think it can be useful where speech is tiring for someone with severe ME. But bear in mind that typing may be tiring too. What I have been describing is ‘Messaging’ which takes place in real time so if typing is tiring email may be more suitable. You can save an email and write it in stages, rather than replying in ‘real time’.

For people with severe ME messaging may be suitable but with very severe ME, email counselling may be better suited where a client can type at their own speed in their own time. This would be an asynchronous form of messaging. With email counselling there would be a set day for the client to send their email and for the counsellor to send their response and a fixed limit on number of words, so boundaries still exist, and etiquette would be similar to messaging and protocols would still apply.

Photo at top of page by Nubelson Fernandes on Unsplash