Blog Post

An interview with Lawrence Murphy - the future of online counselling is now

By: Marco Campana
August 11, 2020

Lawrence Murphy is a pioneer in cyber counselling in Canada. Given the move to sudden remote work for everyone, including human and social services workers, therapists, etc., I wanted to get his insights on where we're at and what things may look like in the future. In particular, what he is seeing now that excites him, what concerns him, what is happening in his own practice, research, and the professional development he does.

As you’ll hear, Lawrence has been busy! He started doing webinar trainings on March 23 and delivered 42 sessions, training over 7000 mental health professionals across the country over two months!

As he did previously, Lawrence recommends a focus on ethics, standards, policies and procedures when getting up and running. Make sure that in your planning there’s an emphasis on privacy, security and confidentiality, both in terms of the technology tools, but also their use. As well, recognize that you may need some new skill development in the space, not just with the tools, but also with the approach to counselling online.

Some themes from our conversation:

  • You need to skill up, not just on the tech, but on technique.
  • You need self-care, and ways to process your client interactions in a different way than you might usually in the office. Create a work routine in your home that separates your work from your personal life. It takes discipline to separate them when you're working from home. Don't work all the time. Especially when you're dealing with difficult topics or situations, it used to be something you could leave at the office. But now "all the pain is in our homes" and we need to recognize that.
  • Setting boundaries and not using personal devices is an important part of that.
  • Ethics - how do you handle situations you see or hear in the background during a client interaction?
  • Policies - what policies do you have in place? Lawrence mentioned some useful documents, they're below.
  • Tech - do you fully understand the privacy, security, and confidentiality settings or deficiencies of the technology you're using?
  • You don't know what you don't know. And it's your responsibility to figure it out to build the best foundation you can, seek out useful resources from any organization or association and to review them and how they can fit into and inform your practice.
  • What does the future look like? This virtual work will carry on. It's that simple. You need to skill up and continue learning. Lawrence's insights will give you some of the key themes you need to continuously be thinking about and building your competencies around.
  • Work on your policies. You're behind and this is an important time to get caught up.
  • It's technology. Whatever can go wrong, will. Be prepared for things to go wrong technically. Discuss that with your clients. Always have a Plan B.
  • Be future focused. Online counselling is not going away.
  • Technology is just another tool in the tool box. You need to stay current. 

Work on your skills, and commit to professional practice. What this looks like comes up consistently in policy documents from regulatory bodies (see examples below):

  • You have demonstrated and documented competence in the technologies you use through appropriate and adequate education, training, and supervised experience.
  • You have necessary digital security measures in place to protect client privacy and confidentiality.
  • The technology applications you use are tailored or matched to unique client concerns and contexts. 
  • You have evidence that supports the efficacy of the technology for the particular purpose identified.
  • If you don’t have evidence, decisions to implement new and emerging technologies that are based on sound & documented judgment and the rationale for their selection
  • You have prepared your clients to use the specific technology-based application, including assessing and providing orientation and training as needed.
  • You have obtained informed consent from clients tailored to the unique features of the technology-based application being used. 
  • It is your responsibility to act in accordance with Code of Ethics and Standards of Practice, and, in particular, to ensure adherence to the principles of confidentiality, informed consent, and safeguarding against harmful effects.

Additional Resources:

Download a repository of useful immigrant and refugee-serving policies, protocols, and guidelines.

Here are some additional useful policy documents:

CCPA:

Alberta College of Physicians and Surgeons:

Consent for digital services:

Machine-Generated Transcript

What follows is an AI-generated transcript using Otter.ai. The transcript may contain errors and is not a substitute for listening to the audio.

Lawrence Murphy

Hi, folks. My name is Lawrence Murphy. And I run an online clinical practice Research and Training Institute called therapy online. And there are a couple things that are kind of interesting one is that I started doing the work in 1994. So I've been doing online counseling for 26 years, which if you're wondering does make me the first person ever to use the internet to deliver clinic services, which is kind of cool. It means it's a Canadian first. So that's kind of fun. And so that's the beginning. And then the the recent is that since March the 23rd, although this week has been a light week, I have done 40 to half day training webinars for agencies and associations all across the country from BC to Nova Scotia from Northern Saskatchewan to Southern Ontario. And I think I've probably trained about 7000 mental health professionals in that time. So

Lawrence Murphy

that's, that's a little bit about me.

Marco Campana  

Just a little bit different. I knew you were a pioneer. I didn't know you were the pioneer. Yeah, online counseling. So that's, that's incredible. I mean, I think I know when I tell people about how long you've been doing it, there's always a lot of shock because there's been such resistance to online counseling, not just nothing. Well as you know, Not just I know in the sort of therapeutic realm but even in the sort of less regulated or paraprofessional, like the work that I do is mainly with settlement workers. So they're not necessarily social workers. They can really span from employment counselors to mental health practitioners to you name a kind of thing. And so they're, they're even in a different realm of sort of slight skepticism and things like that. And so when I tell them that there's been someone who's been doing it for this long, they sort of kind of tweaked their head a little bit and wonder, Well, okay, maybe there is something to this and not just doing it but doing it in therapeutic counseling, which is a more regulated, you know, more rigid, more more sort of, yeah, regulated kind of space. And they start to realize that it's not only possible, but it's possible within the confines of regulatory provisions and things like that. Absolutely. So yeah, so we've we've spoken a bit about your your work before and some of your pioneering what I really was interested in when I reached out is sort of Okay, so I wonder where it's We're at for you Now, given the sudden move to remote work in our sector, everyone's pivoted to online simply because they had to. And and what we're finding we did a little survey of the sector is that a lot of people are actually finding it easier than they thought. But there are still lots of questions around technique around policies around practices around security. And just really, the learning curve is still pretty steep, even though we've been out of for a couple of months now. So so so I wanted to kind of get a snapshot from you, and that's a really good 142 training 7000 people, where where things are at and where you think they might be going. So maybe we can speak a little bit about what happened since March 23. What was it that suddenly brought people to your door in such droves?

Lawrence Murphy

Yeah, well, I mean, the the pandemic, right, everybody went from doing in person counseling and, and maybe wondering about someday to everybody got thrown in the deep end, you know, and there kind of wasn't any choice. I mean, people were just Doing phone based stuff. But as more and more people realize that this zoom teams jitsi, pack, sip whatever was being used, they started thinking, Well, what do I do? And how do I do it? So I've been telling people that, you know, I went from being the sort of the, the peculiar little kid in the corner of the classroom, sort of mumbling about the effectiveness of online counseling to being Justin Bieber. You know, the Ontario Association of Social Workers hosted a workshop with me about a month ago, and it was pay pay per view. We had 675 people on the call.

Marco Campana  

And that's a month into people going suddenly remote. So clearly, they still hadn't figured it out.

Lawrence Murphy

Oh, no, oh, no, in fact, there, there are all sorts of people right now who are doing the work who really don't know what they're doing. And I think mean it you know, it's that old saw but you don't know what you don't know. Right so people turn off they think oh I'll do video counseling because you know they can they can I can I get all the non verbals? Like I can commute I can connect with the person and I can see what's going on for them and No you can't. You see feed me from about here up for example, you know, you start asking me a line of questioning right line of questions. What am I doing with my hands? Right? You don't know. I'm bringing them because you're making me really uncomfortable. I really don't like this line. Can we please stop? I don't like talking about my parents. Can we please stop that you have no idea if I can control my facial features? If I can control my tone, you have no idea how discomforted I am. You know, if I'm on the phone, I'm not going to do this. Hey, how's it going? I'm going to be here. You get me from here up. Yeah. If the lighting is not good, you can't even tell if my face is flushed or you know if I'm feeling confused. But the Don't think about that, because they don't know, you know, the one piece of feedback. I mean, I get lots of you know, thank yous and whatever. But the main piece of feedback I get from the webinars at the end is I had no idea. I had no idea there was so much to consider. So

Lawrence Murphy

yeah,

Marco Campana  

that's what where we are. So what are some of the things that that you're helping people consider that they had no idea. But then what or even just high level? I mean, I took a look at your webinar and the two webinars, the workshops you run in there, they cover such such a great amount of ground, including, like you're saying compensating for nonverbals and telephone compensating the effectiveness of video, just as you described, what are some of those high level pieces that people don't know? They don't know, even though they're moving into this.

Lawrence Murphy

So for example, one of the one of the things that people are unaware of is a construct called dis inhibition. It's a it's a concept that was proposed by john solar an American colleague of ours who's an online therapist, and disinhibition is we know it as people say in Do things online that they wouldn't normally do in person. And if you and I started generating a list of things that would be all sorts of kind of ignorant and offensive and rude stuff, right, but the flip side is that for clients, clients are more likely to disclose, be more open, get to the point more quickly, which is a real benefit. The downside is that as therapists There are all sorts of cues, whether in the words people use in the tone they use in their nonverbals that say to us, I'm ready to go deeper, I'm prepared to talk more about this, I will, I will go down this path with you. And that might be true. Or it might simply be an artifact of the environment, it might be a consequence of the environment. So So you are doing what you normally do in person, which is to you know, attend very closely to the individual and follow their lead. And then all of a sudden, they they realize they've been talking about stuff they didn't want to hmm and so you know, In the best case scenario, they feel a bit like that guy who at the party last night who had the lampshade on his head, worst case scenario, they're embarrassed, mortified. They never want to talk to you again, they blame you. Maybe they just close shut stuff down, they turn it off. So there is a huge clinical implication of doing this online work, which is you have to slow down. You have to check in with clients more regularly. You have to how are you feeling about this? You have to be more transparent. You know, if Marco, if you and I continue this conversation where we're going right now, here's where it's going to lead. This is the kind of stuff we're going to start talking about. I want to make sure that you understand that and you're prepared to go, you have to be completely transparent because all those cues that you would normally accept as on face value in person. They might just be an artifact of the environment. And you you might you project ticularly for clients who the compensate, who dissociate, you could end up doing actual damage. Right? People have no idea, they have no clue. They think, Oh gosh, we have to go online, let's get a video going and I'll start working with my clients.

Marco Campana  

I haven't thought it through. So there's a huge onus on the practitioner to understand a lot of this a lot of that that part of the implications of using technology that that a client or it themselves are not going to have any any sense of for example, so it's so there's there's a lot of pre work that's that, you know that that sounds like it needs to be done for someone who's going to take on video counseling in this case, for example. And what I hear from a lot of people is that they're concerned is the technology learning curve, just just figuring out the right buttons to press and, and the security of some of them over others. I mean, zoom is a great example, right of something that's gone from like people really insecure and in 90 days, theoretically encrypted, you know, potentially HIPAA compliant if you buy the right version and stuff, so they're they're struggling just with The tools like what's the right tool? Do I? Do I WhatsApp message them? Do I, you know, signal them is email, okay, can should I use jitsi or zoom or teams or Skype or you know, you name that kind of thing. But the work that needs to be done outside of the technology sounds like it's, it's even more important around technique and around around just learning the, the, how to use the medium effectively.

Lawrence Murphy

Absolutely. There's there, again, people don't know what they don't know. So, I mean, I spend three and a half hours talking about practical, ethical and clinical implications of doing the work online. And, and, and, you know, I talked about some, you know, kind of the structure of the internet and some general ethical principles, and then a fair bit about self care. So, okay, for example, let's say you and I are doing a session, and at the end of the session, you know, you're my therapist, and you say, okay, Lauren, take care of yourself. Goodbye. Now normally, I'd walk out of your office. I'd walk down the hallway I go into the bathroom, I throw some water on my face, I kind of shake it off, right? And then I go and sit in the park for half an hour just kind of just kind of process for maybe I get in the car, but I drive around the block. When you and I are finished our session. I opened that door over there. I'm in my living room. I'm already at home, right? There's no Laurens. Maybe you want to kind of walk around the block before you go, I walk out that door and my wife's there immediately. Mm hmm. People aren't integrating that into their process in their, into their clinical work there. They're not changing things. If you know if normally with me, you you knew that kind of sort of about five minutes before the end of the session. You know, well Lawrence, we need to wrap up and how you doing and check you know, and kind of put some closure on things. You might need 1015 minutes at the end of the session because I'm walking right back out into my family there. I don't have any time to Sit in the park and cross but people aren't thinking about now. As soon as I say it, everybody on the on the podcast is going Oh, obviously. But did you think about that? 10 minutes ago? No. Right? No. You know, so there's a Yeah, there's there's a, and those are clinical things. There's, there's ethical stuff, too. What do we do if if my dad walks in the room drunk and says, Listen, you know, I'm trying to watch Netflix and hits me and walks out. Or what if we hear what sounds like somebody's hitting somebody? And you say, what was that Lawrence? And I say, Oh, that was a movie. And you say, gosh, it sure sounded like an adult hitting a child and threatening their life. And I say no, no, no, no, no, it's one of those new Bruce Bruce Willis films.

Lawrence Murphy

And your policy is what? Huh? What's your what's your policy?

Lawrence Murphy

What's the policy of universities for using this LockDown Browser and video technology to monitor students when they're writing exams. If you're if you because because Okay, so I'm at the at Wilfrid Laurier. And I teach undergrads and so we had exams at the end of last semester. And this is the technology we use. And then what happens is that different videos get flagged as being issues or problems. And so then the requirement is on me to review them and see what the issues were. So what am I supposed to do five days later, if I witness a parent having come in and yelled and humiliated, a young man or a young woman and walked out? Or like, does the University have a policy? I can tell you right now, the universities typically typically don't have policies.

Marco Campana  

I imagine most practitioners wouldn't either for this type of thing because they have policies if it's an immediate disclosure during a session, I assume.

Lawrence Murphy

Yeah, of course they do. somebody walks in the room and says, My dad's beating up my little sister, we all know what to do. Right? And we know what to do if we witness something and people deny it, but we witness it. Mm hmm. What do you do if somebody says no, no, no, that's one of those new Bruce Willis films. And that this is this is one, I mean, three hours, three and a half hours. Right. So there are dozens and dozens and dozens of things that people haven't thought through because,

Lawrence Murphy

you know, or experience Yeah,

Lawrence Murphy

how could you How could you know, if you haven't had the experience, you know, sure. I'm not being dismissive of the the clinicians or judgmental of that. It makes perfect sense. They wouldn't know but the fact of the matter is, they don't know.

Marco Campana  

So now that we sort of know, I know that there are examples like the in the United States the National Alliance of Social Work a few years ago redid their their ethical guidelines around technology use in social work, for example. And it's a huge long document really, really useful stuff for folks who aren't in a, in a social work setting, for example, to borrow from and perhaps use in organizational policies. But that seems like it's the tip of the iceberg. That's the, what we put on paper and what we should know. But then what I've seen is like educators struggling with how do you incorporate those into learning and then practitioner struggling with? How do I incorporate those into my practice, individually or even as an organization or as you say, as a huge institution? And that's been for about three years now, I think that that's been happening. So all of a sudden, there's a massive acceleration. Are there examples? And when you're walking through people through this, are there even examples that they can borrow from to sort of, you know, other than your session, for example, to kind of look at and go, Okay, here are the massive things that you need to think about. But here are also some resources that other people have been able to start putting together as models for some of this stuff.

Lawrence Murphy

Oh, for sure. So the, the British Columbia, Social Work society, I can't remember what the acronym is. They produce some great materials down terrorists Association, social workers. The CRP, oh, the Canadian counseling psychotherapy Association, the ccpa. That's my association. We've had a set of guidelines in place for a couple of years now that that outline, you know, appropriate practice when, you know, in terms of ethical and, and practical issues. There's a, the Canadian Mental Health Association has has some, some good materials there, there is a lot of stuff out there. And there's new stuff happening all the time. For example, about a month ago, the CRP o came out with a checklist, just a simple little thing, but it's really, it's really nice. It's really succinct. You know, what are considerations for your device for the clients device. Issues of note for for for video counseling or text based work, records, retention, all these kinds of things, right. Um, I did some work with a group in Calgary and so was looking, you know, to Try to find out what was there. And there are actually some really good guidelines produced by the Alberta College of Physicians and Surgeons, because they are continuing to do consultations and so on, but right, wing them online. I mean, they're not doing operations online, but they're doing a lot of their work online. Oh, it sounds like you have this and you should get, I'll write you a prescription for antibiotics. You know, it sounds like strep throat or whatever. And so they have some really, really great guidelines around for example, verbal consent. How do we do how do we do written consent right now between you and I like, right, how does that even work? I'm sorry, I don't have the money. Marco to own a printer and a scanner and a fax and to death. You know, I'm on my phone, let's say and I, you know, the best I can do is Wi Fi. So I can't do it. So so they have some really excellent guidelines around Okay, so what is verbal consent look like? And what do you write in the patient's file? So of course, we're not physicians. And surgeons, but it's good. They're good guidelines. Right. Right. So there's, there's lots of stuff out there. And I mean, at the end of the day, Google is your friend. There's lots of stuff out there.

Marco Campana  

No, but that's great. There's, I mean, my my experience of the the American standards is that in a few cases, the Canadian Association simply kind of reuse them. So it's great to hear that there's some Canadian stuff happening as well that we can, because again, in our sector, it's, they're not members of these associations. But if that informations out there, they can make use of it and replicated in their own practices.

Lawrence Murphy

This is what I've been saying to people, you know, so when I'm doing a workshop, let's say in Ontario, then I introduced some stuff from the OS W and the ccpa, and the C RPO. And I say ahead of time, look, you may not be a member of one or a couple of these associations, but it's your professional responsibility. It's your due diligence, to build the best foundation you can to seek out the resources from any organization or Association If they provide thoughtful guidance, and if there are materials out there, it behooves you to review them. So this is why I bring up the Alberta College of Physicians and Surgeons, completely different kind of thing they're doing to what I and my colleagues do. But at the same time, keen insights and, you know, thoughtful work, we should, we should be drawing on everything we can, you know, gone are these days, and oh, this is the box I live in. I'm not looking at any of the other boxes. Like that's, that's got to end.

Marco Campana  

Absolutely. No, it makes sense. I mean, there's so much incredible work being done and that that can be replicated easily or learned from for sure. You mentioned something about devices and I'm curious about one of the lines in the training as considerations and using mobile tools now, that's a huge thing for for for our sector because newcomers tend to be mobile first. They may only have one phone for a family, for example, which has huge privacy and other implications. Hum house house That evolving? I mean, that's a huge change over the last few years. In general, I would say, but perhaps I'm curious how that impacts counseling and just building this relationship, but also the technology issues behind it.

Lawrence Murphy

Yeah. So So I mean, there, there's there are sort of two areas. One is the client using a mobile tool, and the other is a counselor. And so just to focus on the client using the mobile tool, I mean, you brought one of those things up is, is Who else has access to the phone? Right, who else? So so it might be mom's phone, but the family can't afford, you know, to have five phones. So, so mom has a phone but she lets the kids use it, but she's doing counseling on the phone. So you know, you want to be careful, who has access to things what's password protected, all that sort of stuff, which as the counselor means that we have a responsibility to check in with people, you know, who has actually Who has permitted who has non permitted access? A lot of times people particularly use will share their passwords with their BFFs. Now, that's not so much of an issue right now because we're not physically together. But this, this one it, you know, you said you asked at the beginning what the future looks like. And so just in context of mobile tools or mobile tools, I'll say that part of the future is this carrying on. Yeah, we develop a vaccine. We either require it or people realize that they need it, everybody takes it the the pandemic is over. I contact you know, a client contacts me six months from now or a year from now and says, You know, I want to do some work and I say, Well, you know, why don't you come into my office did it? They say, didn't, didn't you do video work during the pandemic? Do I really have to drive into Toronto pay 20 bucks an hour for parking wolf down a McDonald's hamburger find care for the kids. is an hour of work so that I can get mental health support. I'm doing it online from my home. Okay. Yeah. And we're gonna have to say yes, absolutely. Okay. You know, so. So, you know, mobile technology, the phone turns on, I tell you a story. I have a colleague who's in Australia. And we were doing, we're having a call and 8pm in Ontario. 6pm in Ontario is 8am in Melbourne. So, you know, and we're just talking business, so we're just using FaceTime. Anyway, his phone goes on, and I am looking at him over top of his steering wheel.

Lawrence Murphy

And I say, mate, what are you doing? Yeah. And he says, no, maybe it'll be fine. I say no, it will decidedly not be fine.

Lawrence Murphy

I'm like, and he said, Well, you know, what am I gonna I gotta get to work and said, well, but you know, anyway, so we finished the call at work, but So you know what, what, uh, that's that's the sort of thing clients are going to be doing. They're going to be, you know, because they already talked to us when they're driving and I would suggest Don't you know, you ask the right question that suddenly touches that nerve and they burst into tears. Yeah. On the highway in a school zone, I mean, no, no, no. Even texting, you know, texting and driving increases the risk of a crash significantly, texting and walking. There's a website called Safe kids.org, which does research into kind of exactly what it sounds like. They do research into about one in five, just under one in five young people who are hit by a car or almost hit by a car when they're walking. We're texting ish. So, I mean, obviously the worst thing is that the client is is injured. Clearly. That's number one. But still on the list down down the list at number two, but still on the list is what's our liability there? And my guess I'm not a lawyer. My guess is Yeah, we would we would be liable for some portion of the injury. Well, you don't want any of that. But it's in your policies. Right? Right. When the fall when the, you know, six months from now, this is going to keep going, we're going to be hiring new people, some new person comes on and the first thing that happens to them is the camera goes on and they're looking at their client over top of the state. Do they know what to do? Was it in the policy in the binder they had to re before they got working? It's all has to be put in place. Um, you know, five years ago?

Lawrence Murphy

Sorry, I just I can't resist, right? No, I six year yeah. 26 years.

Marco Campana  

So I've been I've been talking about this with my sector for shorter amount of time, but I feel I feel the same. It might only been about 10 years, about talking about like it's inevitable and our clients, we know that all the stats show us their digital, they're more digital than the organization's there when you ask them, would you like us to text or WhatsApp or Facebook? They say yes. Not everyone. Obviously, there's a digital divide. I mean, yeah, all things being equal, they're more they're more interested than not. And what we have seen during the pandemic is that that's, you know, seniors have had a harder time, but most people have been just like you said, I didn't have to take two buses to come to your agency, I still get the service. And what what, what was it an hour interaction became 15? Because we focused on what needed to be focused on sorry, 15 minutes, not 15 hours. Yeah, and it changed. It changed for the good for a lot of people. So I agree. It's, it's it's somewhat inevitable. But this this idea of not knowing is one thing but then not having the policies in place. So you know, that that's something that has become a real issue that managers are struggling with. It's like, Well, what do we need in place to do this kind of stuff, from a policy perspective, let alone a practitioner knowledge perspective,

Lawrence Murphy

or there's a there's an organization

Lawrence Murphy

the tobacco center. And they contracted they contracted with me to do a series of webinars and the very first one that we decided we would deliver was to EDIS managers and supervisors only nice, entirely around. Okay, once we once once I start doing this training for your organization, here are the kinds of questions your staff we're going to have here, the sort of things they're going to come to you with, here are your answers. This is this is the stuff they're going to want to know, this is what's going to make them panic. This is what's going to make them anxious. Here's how to reduce that, here's how to answer those issues. Here are the kinds of things you need to be thinking about now around policy and procedure. So, you know, for example, most of insurance companies now, I mean, are covering online work if they're not, they don't have any customers. Right? Yeah. So they have to, and so some of them, you know, they just are and some of them, you want Uh, you know, everybody should contact their their liability insurance provider and say, Hey, this is what I'm doing. And in some cases, they'll say great, no worries, thanks. Sometimes they'll say, here's a form you have to fill in and tell us, sometimes they'll say, Oh, well, you need to purchase this rider, a rider as a piece of insurance that adds to your basic liability insurance. So most of them are, you know, it's the idea of technologically enhanced services or, or cyber liability or whatever. And what I like to do is I like to hold this up and say, This is my iPhone. Does anybody want to argue with me that this is not a piece of technology? Anyone? Anyone want to say the iPhones not technology? Gosh, Lawrence, are you saying that an insurance company might deny me coverage? If all I was doing was talking to a client on the phone and I didn't have a rider for technologically enhanced services? Yeah, that's exactly what I'm saying. Yeah. What about insurance for counselors who are working from home? Is it different if they're using their own device or a company device? What if they're using their phone but their kid you What if it's it? Call your insurance provider right now is, you know, pause me and Marco, pause us and call your liability insurance right now and say, This is what I'm doing. Am I okay? And they'll tell you, they'll say, here are the rules. Here's what you can and cannot and just, you know, do whatever they tell you to do. follow their rules. But seriously, you know, people are Yeah, so anyway, so that there's an example of something that, you know, everybody got thrown in the deep end, we're all helping professionals. We're trying to do the best. Our clients are desperate, frightened, scared, confused, anxious, as are we. So we're trying to do our best we're trying to do every we're trying to do more than maybe we should sometimes. And, and we're forgetting to look after ourselves, making sure that you have the right answers. It is a way of looking after yourself.

Marco Campana  

It's a good segue to the whole idea of of self care and boundary that's been an issue in our sector for a long time, the more the more personal devices get you or the more mobile devices, there's agencies, for example, that don't have work devices. So people are using their personal devices and and they do it because they feel they have to, but the it just crosses so many ethical boundaries and, and personal boundaries. Where does that come up in the conversation that you're having with practitioners?

Lawrence Murphy

Huge, huge issue. So you know, we're talking about clients, having somebody stormed into the room or even just just, you know, by mistake walking and say, Oh, you know, if you and I were doing counseling, my wife says, oh, Lawrence, I'm sorry, I forgot you had a session and walks out, you know, but, but as a therapist, you know, I had a, I did a call and like one of these these trainings and one of the folks got on and said that she was doing a session with her with a client As she was, she's the therapist. And there was a sudden pounding on the door, and a little voice said, Mommy, why don't you play with me? Don't you love me anymore? Mommy. Now, this clinician was kind of, you know, sophisticated enough that she turned that into a way to connect and join with her clients and her client felt like wow, this is you're actually a human being you're under stress too. And so she made it into a good thing but, but you know, that takes a certain level of a clinical sophistication to be able to turn that around. The The other thing in terms of you know, one of the reasons that companies for years have not wanted people to work from home is because they didn't want their personal lives. getting in the way of the the company's work the work they're supposed to be doing. But it's the opposite. The problem is the opposite company. gets into personal. Okay. People check their email before they have breakfast. Like Is that what you do? Do you get up in the morning shower, go to the office, check your email, then drive home, have breakfast and go back to the office? No, of course you don't. The day has got to start. The workday has to start and it shouldn't start until it starts. And then the workdays got to end. It's 10 o'clock the movie that we picked on Netflix is pretty boring. Maybe I'll just check my email one more time. Maybe I'll just see if there's a notification for the days got it and it's very hard to do. I've been working from home for 20 years. It takes a lot of discipline to have work here and home here and and it's the problem is not that our personal lives get in the way of us getting our work done. The problem is is that we work all the time, weekends, evenings.

Marco Campana  

Absolutely.

Lawrence Murphy

One of the thing that I think is really important is

Lawrence Murphy

six months ago, a counselor would finish their work. And all the pain, the sadness, the suffering, that came out in that day sessions was in the office. And the counselor leaves the office and gets in their car and drives home to their sanctuary. Now, all the pain is in our homes. Right? All the horror, all the sadness is in our homes. And for some of us, like, you know, for somebody like me, I'm very privileged. I have a big house. I'm in a spare room here. My wife is upstairs doing her work, my son's in the basement, doing his stuff. There's lots of space in this house. Not all clients have that experience. Not all counselors have that experience. Lots of people are working from apartments or condos. I've worked with a number of youth organizations. You know, have have a younger staff. And some of those people have been too lonely and and too sad at isolation, they've gone back to their parents home. So they're in their childhood bedroom. Right? You know, the pain, the suffering, the horror is now in that room. So I'll give you an example of one solution. A colleague of mine, you know, I've been talking about this stuff, and then I kind of open up the webinar at the end for comments and questions and so on. And she said that what she has done, she's got a little folding card table. And in the summer, she takes out in the backyard puts a tablecloth on and invites neighbors over and they play cards and have drinks and things in the evening. So what she's been doing is she's been setting up that that that folding table, it's in her kitchen, she just lives in a one bedroom apartment, and she's setting up the folding table in the kitchen, taking a folding camping chair, and that's where she does her work. And at the end of the day, she has this kind of ritual that she goes through where she she you know, she she does I'm not sure what it is but then at the And eventually folds up the table. She folds up the chair, she puts them in the corner. That's where the pain stays. That's the pain and the horror is not in her kitchen. It's in that little group of table and chair over there in the corner. Right? Yeah, those are kinds of things that we have to do we have to compartmentalize. And we have to be thinking about this, right? How, how do we draw the line between the personal and the professional? It's really important, particularly in our profession.

Marco Campana  

Absolutely. I mean, in any caring profession, I would say, include any caring profession. And I know that that's before the pandemic, that was an issue for a lot of workers who were using personal devices, and they would, he would get a call at nine o'clock at night, or they would bring home the work device and not turn it off. And then the the sense is like, well, I should answer it because you never know what the what the situation might be. And one of the things we've talked about it I'm curious to get your input is, is anticipating some of that and helping your clients understand where they can go for help when I'm not available, for example, so I'm available like nine to nine, maybe or nine to five, whatever the hours are. But to be very clear that if you can't reach me, here's Plan B, Plan C, like, here's the phone numbers you can call whether it's, you know, urgent numbers like a 911. Or maybe it's a 211. Or here's another hotline, um, what sort of, again, it comes back to the responsibility of the practitioner to prepare their client for for the 24 seven reality that they're living and the feeling like, Oh, I know your number. So I'm going to call you now. It's different than if I have to call an office, make an appointment come in. There's there's friction in that, right. Whereas if I have your cell phone, there's no friction, I just pick it up and I call you on a whim. So how do we prepare practitioners to prepare their clients and what does that conversation need to look like?

Lawrence Murphy

Yeah, so I know this is not realistic for some folks, but don't share your cell phone number, right. Yeah. Is just don't you know, most agencies that have a phone and what agency doesn't have a phone, you just get one. Have your tech people to read, you know, rework things so that when somebody calls the agency and types in your extension, it goes to your cell. This is not a complicated thing, although it needs somebody with some sophistication to be able to put it in place. And you probably need to contact Bell or Rogers or whoever it is, but it's doable, but it's doable. So that's that's the first thing. And then the second thing is you're absolutely right, you know, bat boundaries. It's what I like to say in the training is it's what our grandmothers taught us, an ounce of prevention equals a pound of cure. It's what our grandmothers taught us, and they were right. So you tell people that look, I'm available at this time. You set your boundaries, even for at the beginning of a session, you're clear, this session ends at this time, right? You let people know when you're available. Yeah, and you and you follow through on those things. And, and you know, you wouldn't if you were you wouldn't stay in the office 24 hours a day, seven days a week. Right? You wouldn't do that. And so again, this is this is going back to this whole thing about self care boundaries or self care having a plan B, actually, even during a session because, you know, although, you know, although this is this is working pretty well, right now. stuff goes wrong with real time communication online, right, of course, you know, the governments in Europe and North America have instructed Netflix and Amazon Prime and the others to reduce the quality of their video streaming so that the internet does not collapse. Yeah. That's the environment we're in. So so not only should you have a plan B for listen after, after we're done here. If it's two in the morning, here's what you do. Just have a plan B for right now.

Marco Campana  

Great advice Absolutely.

Lawrence Murphy

If something goes wrong, so for example, if the video starts glitching or we believe comfortable with turning off our video and just going to voice only. Yeah. Right. And and, you know, clients will will usually say I guess that's okay. Now you as a clinician need to know how to compensate for the absence of non verbals in voice only. Right? And not only for yourself, but for the client as well. Or, you know, if, if if things fall apart, then, you know, well, we'll wait five minutes to get back on and you know, it doesn't really matter. People say what, what's the best plan B doesn't really matter, just that there is a plan B, and that you've communicated it and that you communicated so. So if something were to go wrong here, like if I'm your client, and suddenly something goes wrong, my first reaction is Oh, my God, oh, my God, oh, my God. And then I go, Oh, no, no, no, Marco told me the plan B. The plan B is I wait for a call on myself from an identified ID. That's going to be him I answer it he breaks or right I go back to the email that I received with the notification About the Xoom call, I click on it again. I do to wait a minute, I've got that written down because he told me to write it down.

Marco Campana  

Yeah. So I do. Okay, so I'm going to click right. Always have a plan B. And again, the onus is always on the practitioner to make sure that that's there. And it's been clearly communicated and the clients comfortable with it. Right.

Lawrence Murphy

And and the other thing is, is that is that that is modeling, self care, it's modeling being prepared. I mean, one of the things that many of us talk to our clients about, because many people have clients who just kind of flit from crisis to crisis and chaos to chaos and think ahead, be prepared plan for what comes next that it's great role modeling, to demonstrate to the client that this is not just something you have to do because you know, your life is a mess. This is something we all do and frankly, sometimes my life is a mess. And I don't want it to be a mess. And so what do I do, I plan ahead, I prepare, I cross my T's and.my eyes, you know, all that stuff. It's been rolling modeling, right? We don't really need to do in an office. You know, I actually think there are these fabulous opportunities, because of the environment for doing this for role modeling for demonstrating to people, you know, this is how you do it. And here are some considerations that, you know, there's this great joining opportunity with new clients, you know, are you comfortable with this? It's pretty weird, isn't it? Our whole agency was thrown in the deep end, you know, so that's, I know what I'm doing here. But boy, when we started out, oh, my goodness, so I totally get your anxiety, right? Great opportunity to connect and join at the level of, you know, a human being,

Marco Campana  

I was gonna say, you're describing instant rapport, and humanizing someone who's typically seen as a very authoritative person in power. And instead you're now I'm a guide, and I'm working with you because we're in the same kind of chaos. And there's a huge opportunity there.

Lawrence Murphy

huge opportunity. And the other cool thing that's going to happen is that you're going to get on and you're going to say to somebody, you know, one of your clients and how are you feeling about This, they're gonna say actually I do tech support, so I'm totally cool. More than me see, I was trained in a, in a, in a tradition where you're always looking for what we call a one down is situations in which I know less than the client does, right? Because there's always going to be a power imbalance, somebody whose life is chaotic is coming to me for help. I'm always going to be the authority like there's we can't get around that. But But the way that I was taught was any anything we can do to try to reduce that power imbalance. So one of the reasons I say to clients is, look, you're the expert in your lived experience. That's not something I know. I say it because it's true, but I also say it to try to take a one down I know less than you. So if you're in a situation where you have somebody going yeah, no, no, I've worked for Microsoft for years like wow,

Lawrence Murphy

each mean that

Lawrence Murphy

I mean, I know the words way overused in our disciplines, but that's an opportunity to empower the client. Yeah, it's a fabulous opportunity. I love those those those situations, you know, I think that's great. That's not a moment for embarrassment or, Oh, Jesus, this is a wonderful opportunity to, you know, to, to, to look to the client say, wow, you know more than I do. That's really cool. And tell me a little bit about that. What's this been like for you? And what's the demand?

Marco Campana  

Yeah, it's a totally different way to start the conversation after them. Absolutely. Yeah. Putting people at ease. No, I love that. Yeah, I mean, I've said that, sadly, the pandemic in so many ways, has provided opportunities for that kind of connection, but also the, the alternative uses of of ways for us to serve clients in particular in ways that they want to be served as well, which is always a question we don't tend to ask in our sector. And so that for me, that's a forward looking kind of opportunity for the sector to to figure out you know, the new normal isn't either digital or in person. It's blended right. And it's choice for clients. So I'm curious what excites you, you know, 7000 people have now finally figured out and learn from someone who's been doing it. Okay, theoretically had an opportunity to learn from someone who's been doing this for so long, what excites you about the possibilities of all of these people going back into the field now?

Lawrence Murphy

Yeah, so I mean, they're, they're all sorts of things. So the first thing is that and I have actually said this, what you just said, slightly different words. I've been saying this for years is that this is just another tool in the toolbox. Yeah. Right. This is not some kind of panacea, it's not going to cure world hunger, it's not going to bring about reconciliation in Canada. Like, it's just another tool in the toolbox. And so one of the things that people are are hopefully going to recognize is that is that it's not just it's not one or the other, it's both and, you know, so so if I, if I, I don't know I break my leg skiing you and I don't have to stop seeing each other. I we can continue to do the work. If I'm traveling on business, or if I'm, if I'm a journalist, one of the one of the groups that Has has seen the greatest uptake over the last 10 years. I'm not talking about since the pandemic, I'm talking about years before, of online services, his journalists, they're constantly traveling, you know, I have a drinking problem and you expect me to come to a session once a week in Toronto, like, that's not going to happen. You know, I'm in Johannesburg for a week and then I'm in in Brussels for four days. I'm coming back to Toronto, then I'm down in Atlanta at the CDC for four days. I'm over. So, so that's part of it. Right and and thinking about how can it be leveraged? How can we use it as as a service, as you say, for what clients want, but also what they need? You know, people, people don't always know what they need. And so so for example, you know, one of the things that I say to clinicians when I'm doing the training is that we know that there are all sorts of clients who not for love nor money. Are they walking into your office, looking you in the eye telling you what they did, or what was done to them. They're not they're not stupid. They're not they know that it would be valuable to them, they understand that sharing the burden would be good for them, but they're just not doing it. Hmm. So starting out with text based communication, gaining trust, building a bond demonstrating to them that you are a person who's trustworthy and has their best interests at heart could be a starting point to them coming in for counseling. You have in in, you know, a detox center or a treatment center for addictions and you know, typically what's the best we do we say, Oh, well here's the here's the the times and locations of five a meetings in Thunder Bay Best of luck, right? create an online account for them. You know, I come in I come into the the, you know, the, the the institution during the last week of group and I say Hi, my name is Lawrence Murphy. I'm the online counselor. Once you leave here Going to you're going to be setting up an account with me and I'm going to follow up with you over the course of the next three months. And, you know, there are lots of different ways that we can use this and add it on to improve our services to enhance a client's experience and and to to ensure that when the counseling ends in person, there's still some measure of follow up. You know, I for private practitioners, it's another source of revenue. It's another opportunity to you know, if somebody says, Look, I don't want to keep driving in you don't have to abandon them which feels awful. You also don't have to lose the opportunity to continue to have a client paying for your services. You could say let's set you off online. Yeah, you know, no reason for you to come in anymore Marco. But let's let's keep going. Do you feel done and you say I don't feel done but I just I just can't do the whole commute and crap. I it just, I arrived at your office Lawrence and I am so stressed. It takes me I'm paying for 20 minutes of decompressing from the stress of driving to your office. I don't I don't want to do that anymore. Yeah, there's no reason you should have to Marco let's get you set up online. There's lots of possibilities people need to people need to clinicians need to be an agencies and institutions need to be thinking about this as another tool in the toolbox right now. It's the only tool we've got. But six months a year from now, whenever it is, it's another thing to add in, like group or like family work, like, you know,

Marco Campana  

yeah, but the essential thing is now to do the groundwork to make it work well, not only now but also in the future as a tool, just like any tool they need to become proficient in, they need to keep learning they need to stay up on top of the research, the evidence, the new tools, the new technologies, right. So it becomes part of how they, how they their own professional development.

Lawrence Murphy

Yeah, exactly. So like, like, you know, I remember this old that I remember when we actually started talking about Instead of having a six month waitlist, let's offer groups so that people can get in and do something. And the number of clinicians who are like group work. That's appalling groups. What What a waste of time? Oh, the only thing that has any value is individual work. This is the only thing that anybody can do groups are absurd. They won't. It's that you know, and, and, thankfully, there was enough impetus and that we did it but, but it was different. And so, a lot of the tools and techniques one uses individually one continues to use in a group. And there are other things you need to know and there discoveries you make along the way. And I guess this is this is one of the things that's key for me is, is you know, you're talking about being up to date and learning and staying, you know, and knowing how things work and what the new discoveries are. This is something we have to be doing together, right. We're being pushed apart physically. We need to be coming together professionally, communities of practice. Do you have a success? Tell your colleagues if something really works, well tell your colleagues, if you have a challenge, but you overcome it, like, we need to share these things, right? Because this is a, this is a, as much as I have been working in this field for 26 years, there's because we're all forced to do it now. And and in person isn't an option. There's all sorts of stuff that we're doing. People are doing now that, you know, we would never have done six months ago, even if we were interested in doing online work. So So sharing those discoveries is really important.

Marco Campana  

I love that I think that's such an important message. I mean, there's so much to be learned from other people who may be one step ahead of you or had something go horribly wrong that you can learn from so you don't do it next time or, you know, started chipping away below the iceberg of policy and process to figure this out in their agencies so you can follow along with them instead of having to feel like you're reinventing the wheel all by yourself, right? Yeah.

Lawrence Murphy

For example, I have a colleague I was talking about about, you know, the challenges of working with children. And, and so, you know, she she again, you know there's time for people to come on the webinar and ask questions and make comments and she said she had had this experience where she was working with a child, rambunctious sort of six year old and trying to get them to sit in a chair. I mean, it's just not going to happen. And so she thought to herself, she thought, What do I do in person? What I do in person is I get down on the ground. I get down at eye level with the five year old. And so she said to the parents, who were who were in the background who were helping out, she said, Can you put the laptop on the ground?

Lawrence Murphy

And the kid loved it. The kids I

Lawrence Murphy

loved it. It was amazing. And all of a sudden there was just like, wow, you're right here and, and the kid was still rambunctious, but they were focused now. The computers on the ground. That never happened. It was brilliant. Yeah. Yeah. That wasn't part of the webinar. Now it's part of the webinar. I talked about, of course love it, that's great. But but the, you know, the 20 webinars before that I never crossed my mind, she made this discovery and it works so well. So, you know, stuff like that. Right. It's exciting. And, and, and, and here's a kid who's enthusiastic about the experience of being with the clinician, like, what else do we want from a five year old?

Marco Campana  

You know, it's a brilliant story. Yeah, absolutely. So being creative is so important. I mean, once you get past the intimidation of the technology, go back to what you know, which is how to connect with people, right?

Lawrence Murphy

That's right. That's right. And so that's one of the things that I've been saying to people is, you know, you're gonna have all sorts of questions and here's your first strategy for figuring out what you should do. Take a breath.

Lawrence Murphy

Take a step back and ask yourself, what do we do in person

Lawrence Murphy

so Lawrence, the camera goes on my client is drunk. What do I do? Well, step back, you're walking down the hallway, you go into the waiting room, your client stands up, they are clearly inebriated. What do you do? Do you kind of do a mini assessment, see how drunk they are and then decide they're not that drunk and decide to work with them? Do you make sure that they're safe, talk to them about policy and put them in a cabin, send them home. I mean, you basically take exactly the same PMP tweak it a little because you're online. You're doing you're doing the same thing. Yeah, a lot of cases. The The, the, the anxiety is not warranted. I understand it, but it's not warranted because really, your your procedure, your the way you're going to do what you do is, you know, tweak it slightly. People say what do I do if the client is really anxious about Being on video. Well, what would you do if they were really anxious about being in a group? Well, I'd asked them why I'd help them process their anxiety and their worry. I talked to them about the advantages. Same process tweaks let you do exactly the same thing, where you know, just because we're on in this technology doesn't mean that all your skills and abilities and knowledge that you had two months ago has gone out the window, you you are still the same capable, competent, ethical, knowledgeable professional, you are still capable of reframing, giving voice to people's fear, resolving conflict, empathy, none of that's changed. Yeah, none of that's changed. It feels like it has because the environments so different, but none of that has changed. You're still the same professional. So what I say to people is lean into that. We in into that, that's still who you are.

Marco Campana  

That's so essential I my advice to people is don't don't forget everything you already know just because you go online, there's, you're still that incredibly competent professional, it's it gets passed. That's why you got to learn the tool. So you can get past the intimidation, but then it's like, I'm still connecting with a person here, you know? Exactly, exactly. Awesome. I love it. Well, that sounds like great advice to end on any final thoughts about where, where this is all going, I'm gonna link through people through to your webinar to your training, because I think it's so good. I've taken your introduction to cyber counseling through the U of T, a few years ago, and I just found that such a good foundational kind of lesson in a lot of these a lot of the things you talked about, and and in our last conversation, we really walked through the text based counseling approach. So I'm gonna you know, people should listen to that conversation as well, because today we sort of focused on newer technologies, but there's still again, don't forget everything that already worked before. Right? We don't have to go to the newest and the coolest when some of the old tech Or the just the existing tech works just as well with obviously plenty of training and modifications to your approach sometimes. But again, you teach such a really interesting approach to text based communications that I think it works just in human conversation, let alone therapeutic counseling, you know, being able to express ourselves better, you know, but yeah, any final thoughts that you want to leave people with around, you know, six months from now we're back, maybe in our offices, we're doing this blended thing. You know, we've all we're all doing more of this online stuff.

Lawrence Murphy

Yeah. So one of the things that is really interesting, after people have done like the training you're talking about, or people begin to do online work, we're talking, you know, six months, a year ago, before the pre pandemic, yeah. And then they went back into their offices, you know, the day the next day to do some in person work. And it really impacts and changes the kind of work that we do. Hmm. It makes us this, this is going to make clinicians much more aware of how much they take for granted. How and I know we're not supposed to assume because it makes an ass of you and me haha. But we assume all sorts of stuff and we accept at face value all sorts of things that clients tell us and and and and so one of the things that happens when you go online is you realize you got to slow things down you got to check in more you got to ask questions more. And so this is this is one of the consequences that I've seen in the past and I predict for the future is it's going to change people's in person work sometimes in in noticeable way, sometimes in very subtle ways. But that's, that's one of the really cool things. Just as doing family work alters the kinds of questions and the way that you interact with clients on their own now knowing and understanding and having seen revealed to you some of the dynamics of families within the counseling office. So to will that happen here, people are going to change their process. And I'm excited about that, that that, that that will that will make really significant positive changes to people's in person work in the future.

Marco Campana  

That's great. That's a great note to end on. Thank you so much again for taking the time and I like I like last time, I feel like we could go on for hours but there's so much there's so much great stuff to talk about. But I really appreciate you kind of spending less time distilling some of your experience and knowledge and here's to another 7000 people getting trained in your in your

Lawrence Murphy

say, I'm liking the break, to be perfectly honest. I'm kind of like, at the beginning I thought oh, I hope this never ends. And after I had done like 35 of them I thought Please stop. Don't actually okay. Although if people want to call me I'm, you know,

Marco Campana  

it's really nice to have something more sustainable over a longer period of time. But the idea though, right, like this is just the beginning of the learning right? You know that down the line that that's something again, people can come back and say, Okay, give me a level two, give me a level three, give me the organ I went in as an individual. But now I'd like to bring you into my organization. And you mentioned that earlier, for example, that that notion of like, talking differently to managers and supervisors than to frontline and, and again, that that there's so much more that people can still learn. You know, this is this is a great tip of the iceberg, though. So thank you so much.

Lawrence Murphy

Oh, my pleasure. Thanks, Marco.

Leave a Reply

Your email address will not be published.

arrow-circle-upmagnifier