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Cyber Counseling
Cyber Counseling
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Cyber Counseling
know something about the Internet, to whom do you think I go? Of course, to my 20-something
daughters! While I am still learning how to use my cell phone, they are proficient at text
messaging, IMing, video- and picture phones.
- In many locations qualified clinicians are a rarity: more than 80% of MSWs and 90% of
psychologists and psychiatrists practice in urban areas. More than 60% of rural Americans
reside in federally designated shortage areas for mental health services. The Internet now offers
an inexpensive means of providing qualified clinicians right in the clients town.
- Over time, costs for online services will continue to decrease, and through high-speed
broadband connections, the speed of communication will dramatically increase. Advanced
encryption will further ensure security of information. And the Internet and computer systems
will be readily available to most U.S. citizens.
- It is a non-sexist means of communicating, as 50% of those using the Internet are male,
50% female.
- The array of tools now available to the counselor through the internet is mind-boggling,
from multi- media presentations, video vignettes, flash and static slides, interactive slides, group
and private text messaging, personal homepages to assess issues such as self-esteem,
anxiety, sobriety progress. Personal journaling is not enhanced, as are homework assignments,
and synchronistic and a synchronistic communication (Gross, 2002).
Some of the barriers or issues that the mental health field faces with cyber counseling are:
- What are the qualifications of a cyber counselor? What specialized training is needed in
this new, developing field? In the future, cyber counselors will need to acquire many of the skills
possessed by hearing and sight impaired counselors: how to understand and read non-verbal
cues when the client is shielded by the technological screen of the Internet. Counselors will
need to develop a third ear as blind counselors have done. Further, standards for credentialing
of cyber counselors will be required, even as there is specialty certification for gambling,
prevention, eating disorders, etc.
- How much time and experience online do most counselors have, given the newness of the
technology? It is easy to hang out ones shingle, professing experience in cyber counseling.
However, along with the needed skills addressed above, time online will be required to become
familiar with the technology and techniques of working on the Internet. For example, I am a
technopeasant, as are most individuals in my generation. We will need training and experience
online as well as learning a new vocabulary. This only comes with experience and time.
- What are the appropriate types of interactions for what clients, ranging from chat rooms,
email, video-conferencing, etc? What about the frequency of online visits and the cost and
payment procedures?
- Most importantly, what federal and state laws apply? Whose jurisdiction and insurance
requirements does the online counselor fall under? For example, the client might reside in
Connecticut and the counselor works in California. Do the laws of Connecticut or California
apply? (In the future the counselor might reside in India). These issues were addressed thirty
years ago with hotlines and after-hours Employee Assistance Program (EAP) answering
services, often operating across state lines. Hotlines resolved that the laws to be followed
pertain to the state in which the client resides. What are the different state laws concerning duty
to warn and protect, dependent and child abuse, etc? This requires the counselor to be familiar
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Cyber Counseling
with the various state laws in which their cyber client resides, not a simple task. Most likely, the
same ethical standards that apply to hotlines can be utilized for cyber counseling as well. The
American Counseling Association has recently issues ethical standards for cyber counseling.
JCAHO and CARF are also developing standards for the accreditation of cyber counseling and
accredited the first substance abuse online program, www. egetgoing.com (Hsiung, 2002).
- If relationship and therapeutic alliance is so important in counseling (see The Heart and
Soul of Change by Hubble, Duncan and Miller), how does a counselor establish rapport when
there is reduced interpersonal contact, when there is an absence of physical closeness? When
the counselor cannot see or hear the client? How can the clinician ensure the true identity of
the client? How to avoid avatars? (An avatar is when I get online in a chat room, for example,
and pretend to be twenty years old and with a full head of hair).
- How does the clinician deal with counseling emergencies, especially if the therapy is
offered across state lines, or even national boundaries? Again, hotlines and Employee
Assistance Programs have developed nationwide resource lists to respond in clinical
emergencies. Cyber counseling programs need to tap into these existing lists and networks.
- How does one avoid misuse of the website or online system, such as pornographic
communication, cyber-infidelity (cyber affairs), and most importantly, internet addiction (see
more below)? This is a much larger question that the Federal Communications Commission and
other regulatory bodies will surely address.
- What about privacy and confidentiality? How can the counselor protect against a hacker
getting into the system? Who has access to the information obtained online? This is the most
often raised concern I hear about cyber counseling. Technology, though, has answers for this:
through improved broadband capabilities and firewalls, improved encryption methodologies,
confidentiality can be assured. Voice printing, finger printing before one can log on, and other
tools are emerging that can assure that the person online is in fact the client. People will always
voice concerns about technology and confidentiality, even as I did twenty years ago with fax
machines, answering services, and now the internet. A facetious answer I give when the
question of confidentiality is raised is What makes you think anything you do, even
paper-and-pencil forms and charts, is confidential when seventeen sets of eyes and hands
touch every claim form you send through for third- party reimbursement? How often have you
gone around in a clinic and found charts lying around on desks? This does not release cyber
counseling from concerns about confidentiality. Two wrongs dont make a right. However,
questions about confidentiality hav
e always been relevant and should be raised
regardless of whether the counseling is performed face-to-face or online.
- Is there an inherent issue of classism, where the poor again might not have access to care
and treatment? Are there cultural, ethnic and racial issues unique to the internet?
- How can online systems be tailored to the unique issues of the substance abuse field? For
example, how does a cyber counselor deal with an online client who is obviously intoxicated
when in group counseling? How does a counselor assess if the client is intoxicated? How do
we deal with mandated clients and sign-in procedures when logging onto an online group
session?
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Cyber Counseling
Mental health professionals will need to acquire not only a new vocabulary but also core skills,
such as:
- How to establish rapport with clients over the Internet. This is not a new skill as a hotline
and Employee Assistance Program counselors have been able to do so, often in high-risk
situations;
- How to maintain a professional tone when there might be no verbal communication;
again, this is not a new issue as hearing impaired and blind counselors have been able to see
and hear clients in different and unique ways;
- When the counselor is visible onscreen, issues such as the counselors make-up, nuances
of facial expressions, body language, voice inflection, etc. Although obviously in FTF
communication these issues are relevant as well, the internet and monitor make these issues
more obvious, visible, and important to the client/counselor communication.
- Online group etiquette needs to be taught to counselors and clients (Kraus, et al, 2004).
Preliminary results of internet counseling seems to point to higher percentages of people
completing the treatment program, higher abstinence rates for alcohol and drug abusers, the
vast majority of cyber clients state that it was beneficial. A new term has been coined: virtual
intimacy. It seems, from early research, that people are more comfortable talking online than
FTF. There is something reassuring and safe about the technological shield under which we
can communicate online.
There seems to be more uniform treatment results, more personal attention given to clients
through the use of personal homepages, and other tools. There is greater client involvement
and interaction in online treatment than in traditional FTF counseling.
So where do you go if you are interested in cyber counseling? First, contact the reputable firms
who have pioneered the use of the Internet in counseling, such as www.egetgoing.com,
www.webMD, and others. Second, contact your trade association (ACA, NAADAC, APA,
NASW) concerning training programs available and the ethical standards that apply. Finally,
contact CARF and JCAHO concerning programs they have reviewed and accredited to see the
standards being used and what programs are viewed positively. Conclusion
The Internet is a reality in our lives. By getting into the net early, the alcohol and drug abuse
professional can play an important role in defining the standards for e-therapy. Resources
and Bibliography
For additional resources concerning the Internet, the reader is referred to:
- www.virtual-addiction.com
- www.netaddiction.com
- http://mentalhelp.net/check
- www.mytherapynet.com
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Cyber Counseling
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