#1 : Counseling during a Pandemic - Establishing tele-psychology facilities

On 11th March, 2020, the World Health Organization declared COVID-19 as a global pandemic. By mid-march 2020, the number of cases of COVID-19 began to sharply increase in India. As a precautionary measure, a national lockdown was also announced by the Government of India on. In line with the precautionary measures, Prerana decided to limit its staff’s field interventions. However, a sudden break in the client (child)  and counselor’s relationship during highly anxious times such as a global pandemic can adversely affect the rapport established between the client and the counselor. Maintaining contact with clients is especially important because the distress they normally experience may be intensified in such times. The client-counselor contact ensures that they remain mentally grounded and safe during these distressing times.  

Measures were undertaken to establish temporary tele-psychology facilities to ensure that contact is maintained with the child. The American Psychological Association defines tele-psychology as provision of psychological services using telecommunication technologies. Telecommunication technologies include but are not limited to telephones, mobile phones, video conferences, email, chat, text and internet (eg. self help websites, blog, and social media). Tele-psychology is a novel and pragmatic method of service delivery in the current time as it can overcome a number of logistical barriers and serve a large number of people in a cost effective and safe manner. Although tele-psychology exhibits great potential yet its implementation may have several challenges. 

One of the key challenges faced while establishing tele-psychology was that the service provided continued to meet the ethical and professional standards of care in spite of the mode of delivery. Thus, prior to conducting any session, the counselor, based on past experiences, had to evaluate whether the client has access to and is comfortable with the technology on which the service is offered. For example, Vrindha (name changed) is a 14 year old girl, who currently  lives with her parents and siblings. Her family owns one cellphone. The counselor on her previous visits, has observed that the cellphone has several technical issues such as the sim-card not working properly, poor battery among others. Moreover, the cellphone is mostly with the mother. Thus, the counselor felt that in these conditions even if tele-counseling was offered to Vrindha, it would not be effective.

Tele-counseling may not be able to offer the same sense of comfort and emotional safety as traditional means of counseling as the counselor cannot see the important non-verbal cues to identify the client’s socio-emotional state. These cues are essential in ensuring that a well rounded discussion takes place to enable healing. In another case, when the counselor was conducting a tele-counseling session with Ritika (name changed), during one part of the session, there was a long period of silence from Ritika’s end. Traditionally the counselor would have used her body language or facial expressions as a way of continuing the conversation. However, since it was not possible in the current situation, the conversation had to be continued using the previous discussion. Thus, the counselor felt that the session dealt with superficial concerns and could not delve deeper. 

In spite of the challenges, tele-counseling and tele-psychology are valuable resources in situations of emergency. These services ensure that basic psychological aid is provided to the client and the client-counselor relationship is maintained. These services can further be strengthened through structured protocols, training and workshops. Although tele-counseling has great utility, it cannot fully replace traditional face to face counseling. It can be seen as a powerful and certain ally to offer support and assistance to traditional counseling in times of need. 

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