9 Observations About the Practice and Process of Online Therapy, Page 4

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Drawing on an evidence base of over 700,000 words of email-based counselling and therapy, this exploration highlights 9 simple observations about the practice and process of online therapy. This paper is available here as a series of brief web pages, or separately as a single PDF download.

Email-Based Counselling in Practice

Peak to Mean Ratio and Realistic Response Times

Replying to client emails naturally takes time, and more often than not, one or more are awaiting my attention. Comparing the maximum amount of email that is ever waiting to be answered at a given time to the average amount of email that is outstanding over all times gives the peak to mean ratio. (In communications engineering contexts, the peak to mean ratio represents the ‘burstiness’ of data being transmitted across a channel.)

In my practice, the peak to mean ratio is over 15: sometimes my outstanding workload balloons to 15 times what it is on an average day.

Awareness of this basic quantity — whether by ‘feel’ or via explicit measurement — is crucial for avoiding breakdowns in quality of service. For example, the ratio helps me determine how to link my advertised response time to the size of a client’s email — so that I can be assured of providing a quality response to all my clients, without everything falling to pieces when luck has it that a dozen clients all decide to write several thousand words over the weekend, their messages peeking out from my inbox first thing Monday morning.

Failing to specify any link at all between response time and email size would be analogous to guaranteeing that any client contacting a f2f counselling service would be seen by a counsellor within a given period of time and for any duration desired: maintaining such a guarantee would be impossible, and offering one unethical.

I learned this lesson very early in online practice with the help of Cassandra, a trainee nurse working on anxiety and relationship issues. Her training schedule made it convenient for her to spend several hours replying to my messages immediately upon receiving them. Shortly after exchanging 13,000 words of emails in just four days, I recognized the obvious: I cannot commit to replying fully to all emails within 48 hours. In retrospect, the questionable ethics of a blanket ‘guarantee’ seem blazingly obvious, but nonetheless I only came to learn this practicality through experience.

Exactly such ‘guarantees’ are advertised at most of the online therapists’ websites I have visited.

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