Virtual counseling sessions seek to ease the strain of the coronavirus pandemic and all the associated changes on interpersonal relationships. — Dreamstime/TNS
Feeling anxious or constantly worried? Having trouble sleeping through the night? Experiencing loss of appetite?
According to the World Health Organisation, adapting to new normal measures such as working from home and practising social distancing – while learning to protect themselves from Covid-19 – can be “challenging” for everyone, leading to its #HealthyAtHome campaign to increase awareness about mental health.
Petaling Jaya-based marriage and family therapist Dr Christina Pillai noted that there was an increase in individuals and couples seeking online counseling sessions during the movement control order (MCO) period, which was first implemented on March 18.
“There is an intense sense of anxiety and stress due to the difficulty of adjusting to the sudden change brought to us by the new normal. People could be feeling a lot of uncertainty on how to restructure their lives and keep up with new routines,” she said to LifestyleTech.
She added that some reasons that could lead people to seek online counselling during this time include emotional distress due to loss of employment, or loneliness due to sudden isolation. For couples with children, they could be facing issues stemming from differences in parenting styles and financial matters.
In light of this, the Department of Social Welfare (DSW) under the Ministry of Women, Family and Community Development began offering free online psychosocial support and counselling services.
The Department of Social Welfare (DSW) under the Ministry of Women, Family and Community Development began offering free online psychosocial support and counselling services during the MCO period. — RAJA FAISAL HISHAN/The Star
DSW director general Zulkifli Ismail said clients in need can request for the service by calling the district or state social welfare departments, or the 24-hour Talian Kasih hotline at 15999.
“Our psychology officers will handle the service using the Crisis Intervention and Psychology Support Guidelines,” he said in a statement to LifestyleTech.
The Malaysian Mental Health Association (MMHA) also introduced online counselling sessions in April in response to difficulties in accessing therapy services during the MCO, along with a Free Emotional Support online initiative where people can sign up for a 30-minute session to determine if they need help with their mental wellbeing.
Zulkifli said that those directly affected by Covid-19 – such as patients, family members and frontliners at quarantine stations – were also offered access to DSW’s online counselling services.
Based on data, he said it was mostly women at quarantine centres who reached out for counselling services with DSW throughout the MCO period.
“They were experiencing symptoms of depression, anxiety and panic attacks. These factors affected their sleep and appetite,” he added.
Dr Andrew said MMHA introduced online counselling services in April during the MCO period. — ROHAIZAT MD DARUS/The Star
MMHA president Datuk Dr Andrew Mohanraj added that uncertainty in aspects of life such as job retention, loss of livelihoods and uncertainty about the duration of the MCO were also some of the reasons people sought counselling.
“Some existing clients were not keen on online sessions initially, but they gave in eventually when they began experiencing deterioration in their mental health,” he said.
“Added stress during MCO could also exacerbate mental health symptoms of pre-existing conditions like clinical depression and anxiety disorders,” he added.
Dr Johnben Loy, a US-licensed marriage and family therapist based in Kuala Lumpur, agreed that there was a need to shift to more tele-therapy or “distance therapy” using online applications like video calls during MCO.
Confidential sessions
According to both Dr Loy and Dr Christina, online therapy sessions are conducted through platforms that are HIPAA-compliant (Health Insurance Portability and Accountability Act of 1996, which was enacted in the US to safeguard medical records and health information that patients provide to doctors or healthcare providers).
“As a marriage and family therapist clinician, I adhere to the guidelines provided by HIPAA to protect the privacy of clients receiving counselling services,” Dr Christina said.
Dr Christina said online counselling takes away the stigma or apprehension that some people may feel about walking into a therapist's office to seek help for their mental wellbeing. — DR CHRISTINA PILLAI
Dr Loy explained that his practice has used a number of different platforms over the years as it changes in terms of HIPAA compliance, adding that sessions can also be arranged for clients who request to use different platforms.
“In such cases, they sign off on an informed consent form that they are aware that their choice of a different platform would not ensure that their privacy and confidentiality can be as well protected as a HIPAA-compliant platform.”
What does it take to conduct an online therapy session? For starters, Dr Loy said both parties – therapist and client – need to be equipped with stable Internet connectivity, a microphone and headphones.
“Sessions are conducted in a private, closed room where no one else can hear or see the conversations. We have a strict policy that sessions cannot be recorded unless both parties have signed an agreement to do so and with good reasons,” he said.
Dr Christina concurred and said that sessions can only be recorded with informed consent from the client: “Without it, the sessions will only be recorded in writing by clinicians.”
Zulkifli concurred, saying that for safety reasons, obtaining the client’s consent is important prior to conducting the session, which can only be recorded based on their agreement: “Any information obtained from the session will be marked as confidential.”
Each 30- to 45-minute tele-psychological support session conducted by DSW’s psychology officers would be on the digital platform of the client’s choosing, “such as WhatsApp, email, phone calls or video calls”, he added.
For sessions where more than one client is involved at a time such as couples, Dr Loy said more care will be taken not to “trigger” any points that could lead to arguments.
“This is important because we are not in the room to safeguard their interactions from becoming harmful.”
Dr Loy shared that he has conducted sessions with couples on different devices in separate rooms, adding that clients can choose to have the counselling sessions on their smartphones or laptop.
“Clients are not restricted in terms of the devices they choose to use,” he explained.
Lost in transmission
Counselling sessions through digital platforms provide convenience and accessibility for more people to seek professional help when it comes to managing their mental wellbeing, experts said.
“It also takes away the stigma or apprehension that some people may feel about walking into a physical office,” Dr Christina said.
However, there are still some challenges, such as how a bad Internet connection can disrupt the flow of therapy.
Dr Loy said online video counselling sessions are strictly not to be recorded unless there is an agreement from both client and therapist and with good reasons. — DR JOHNBEN LOY
“Video conferencing does provide a little more access than emailing or phone conversations. However, it still lacks the essence of capturing body language or vocal signals that is essential to clinicians to assess feelings, thoughts or behaviours.
“Due to the lack of social cues, any form of diagnosing through any online method is deemed inappropriate,” she added.
Dr Loy agreed that distance therapy poses challenges such as “compromised ability to discern non-verbal communication”.
“The quality of transmission is not always perfect due to disruption in Internet connectivity. Staring into a screen is a very different experience from talking to a therapist in person.”
Talking to a therapist online is also not recommended for everyone, as Dr Christina explained that clients with any form of severe or more complex issues are not good candidates for online therapy.
Additionally, some who seek counselling also find it difficult to adapt to online platforms.
During the MCO period, Befrienders Penang asked people in need of counselling sessions to contact them via Skype as volunteers were not allowed to work in the centre. Then on May 15, it suspended the service as the uptake was “not very encouraging”, citing that most were not familiar with the service.
“Our regular callers, including those who are visually impaired, find it hard to reach us via Skype,” Befrienders Penang chairman Damien Lee said.
Once the government lifted some restrictions during the conditional movement control order (CMCO), Befrienders Penang resumed its telephone service.
Zulkifli stated that the practice of tele-psychological support is a needed approach in DSW during the MCO period in Malaysia.
“Our psychology officers and counsellors will use their expertise and try their best to get the clients to express themselves, and also encourage them to share accurate information,” he added.
Help is available online
On June 7, Prime Minister Tan Sri Muhyiddin Yassin declared that Malaysia has entered the recovery movement control order (RMCO) phase, which allows for domestic travel and businesses to resume normal operating hours, to be observed until Aug 31.
Malaysians are still reminded to practise social distancing, while business premises like shopping malls and restaurants are allowed to operate under strict standard operating procedures such as introducing contact tracing measures and limiting the number of visitors inside stores.
Lee said when Befrienders Penang offered counselling service via Skype, the uptake was 'not encouraging'. — CHAN BOON KAI/The Star
Those who have experienced crises like loss of income and deterioration in personal relationships may need a longer time to recover from the effects of MCO, and this is where experts believe online counselling could help with easing into the new normal.
Dr Christina also believes there is a pressing need to help Malaysians overcome their own negative perception about seeking counselling.
“People are curious about what goes on during a therapy session and they want to seek help but are worried about what others might think. Such concerns are natural given our societal beliefs and stigmas attached to counselling.
“Unfortunately, as a result, many would choose not to pursue counselling despite experiencing signs of emotional, physical and mental distress, which could lead to bigger issues down the line,” she said.
Dr Andrew agreed that people who request counselling recognise that they need mental health support after having manifestations of low mood, poor sleeping habits or angry outbursts that affected their relationship with their children or spouse.
He said if there is a plus side to the MCO, it is that it at least got more people to turn to digital avenues to seek information for help with medical and psychological issues.
“This experience has made people more open towards online counselling and psychology sessions despite some initial concerns about digital privacy,” he added.
Zulkifli too believes getting counseling is crucial to helping people feel better as they face their own challenges during the pandemic.
“Those who are experiencing psychological or emotional issues during the Covid-19 pandemic are urged to get counselling from DSW. The online approach is safe and confidential,” he reiterated.
If people are going through challenges such as financial problems or conflict with loved ones or children during the pandemic, Dr Christina wants them to know that they are not alone.
“Counselling through these hard times can be helpful in providing support, stability, clarity, insight and skills to better address these life challenges. It is an important step forward and toward improving your quality of life,” she added.
