volume 2, Issue ONE September 2011
Coaching and Counselling‌
Is There a Merge of the Disciplines on the Horizon? PAGE 24
PAGE 9
The Rewarding Journey of Self-Publishing PAGE 40
Public Mental Health Care in Canada PAGE 53
Social Presence in Technology-Assisted Counseling
PLUS...
Legal Briefs, Cybersupervision, Marketing Toolbox and much, much more...
TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a free publication published six times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 2, Issue 1, september 2011 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Production Coordinator Agnes Ikotun Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Mark Goldenson Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Susan Giurleo Associate Editor for Film and Culture Jean-Anne Sutherland Associate Editor for Coaching Lyle Labardee Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute. If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture). If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.
TILT is about envisioning therapeutic interventions in a new way. While Kate was visiting DeeAnna on the Jersey Shore, they took a late afternoon boat ride and a display of sail boats tilting against the sunset came within view. It reminded them how, as helping professionals, we should always be willing to tilt our heads a bit to be able to envision which innovations – however seemingly unconventional – may fit our clients’ needs. Our clients are experiencing issues in new ways in light of the presence of technology in their lives. As helping professionals, so are we. TILT and the Online Therapy Institute is about embracing the changes technology brings to the profession, keeping you informed and aware of those developments, and entertaining you along the way.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Features
9 The Rewarding Journey of Self-Publishing A new option for therapists and coaches
24 Coaching and Counseling‌ Is There a Merge of the Disciplines on the Horizon?
40 Public Mental Health Care in Canada
53 Social Presence in
Technology-Assisted Counseling
Issue in e v e r y
6 News from the CyberStreet 14 Research Review 19 Ethical Dilemma 22 What Would You Do?! 23 Wounded Genius 31 Reel Culture 34 Legal Briefs 36 Technology Enhanced Coaching 46 A Day in the Life: Therapist 50 A Day in the Life: Coach 60 CyberSupervision 64 New Innovations 66 Marketing Toolbox 68 OTI Open Office Hours 69 Get Verified! 70 For the Love of Books 72 Advertiser’s CyberMarket
A Note From the Managing Editors… Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology. We are very pleased to reach our first birthday issue and the first in Volume Two! Features this month include a discussion paper by us, the editors, on the legal view of the differences and similarities of coaching and counselling, offering our view of what those look like and what implications separation of the two professions mean. This is particularly relevant to online work where practicing across state and international lines is very possible. Courtney Holmes offers a summary of her research into the use of social presence in technology assisted counselling. Her results support the author’s views in previous editions of TILT regarding presence. She found no significant difference between online and face-to-face counseling clients regarding social presence. This supports the notion that clients, regardless of counseling modality, were aware of their counselor within the relationship and felt a similar level of presence. Courtney Armstrong gives an account of just how easy it is to self-publish e-books and hard copies of it, and how a simple blog gradually transformed into a saleable product, publicizing one’s work and experience beyond the four walls of a consulting room. Brett Goldenberg discusses the state of play of health care in Canada, and explains how the use of technology is increasing to meet the demands of services. We are pleased also to welcome Margaret Adams to the fold to cover a break in Susan’s Guirleo’s usual marketing slot. Margaret asks if your website is holding you back, and what points to consider when designing or revising website content. She points out that used correctly your website is an important business asset, and that used without care it’s a cost, and maybe a liability. Our aim continues, issue by issue, to keep you up-to-date with developments in innovations in service delivery; publish interesting articles; provide resources; and feature members and friends of the Online Therapy Institute and the Online Coach Institute. All our other regular columnists are here, with useful and entertaining comment on online supervision; coaching; research; legalities; film culture; and new innovations. We also have our member’s responses to our last Ethical Dilemma, and a new one for you to consider and to post responses at our social network forums for publication in the second issue of Volume 2 (Issue 8). Our featured “Day in Life” therapist and coach are Brenda Bryan and Juliet Austin respectively – we hope you find it as interesting to hear about their work as we do. Also, our resident cartoonist, Wounded Genius, has given us another brilliant birthday take on therapy to make you laugh along the way. We hope you enjoy our birthday issue, whatever professional world you inhabit. We look forward to our next issue in November! J
Managing Editors
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
TILT – Therapeutic Innovations in Light of Technology
NEWS from the
CyberStreet The Cyberstreet is here to keep you informed of news even if you haven’t found time to visit the Online Therapy Institute Website or Social Network!
And remember, even if you are not on Twitter, you can still read member tweets at the homepage of www.onlinetherapysocialnetwork.com!
6
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
Blog and forum News… Here is a glimpse of what is going on...get a taster and then head to www.onlinetherapyinstituteblog.com, www.onlinecoachinstitute.com/blog, the member blogs at www.onlinetherapysocialnetwork.com, and the OTI forums on the homepage of the Social Network! At the OTI and OCI blog…. DeeAnna gives two excellent examples of informed consent and intake questionnaires for coaches, and poses the question “what modifications should be considered for online coaching services?” You can also download our new article published in The CAPA quarterly – more information below! Kate also follows up her previous post at the OCI blog by providing a link to her presentation on Online Coaching at the BACP website. At the member blogs, John Wilson continues to keep us up to date with his workshops at http://www. onlinevents.co.uk/, Laura Dessauer gives her seven best practice tips for introverts, Brian Dear tells us about iCouch CBT, Jodie Anne Harper blogs about efficacy of online counselling and reflects on the ethical online behaviour of a Psychologist.
Member news… As mentioned at the blog, DeeAnna and Kate published a new article on Avatar Therapy in The CAPA Quarterly – the Journal of the Counsellors and Psychotherapists Association of New South Wales in Australia. The article offers sub-topics on what Avatar Therapy is, how and where it is being used, what skills are required and what future work with Avatars may look like. Download the full article from the blog! Stephanie Adams has a book coming out in the next few months, called The Beginning Counselor's Survival Guide: The New Counselor's Plan for Success from Practicum to Licensure. Details are at her book blog, stephanieannadams.com.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
7
TILT – Therapeutic Innovations in Light of Technology
Stephen Goss and Kate Anthony will be presenting at the BACP Coaching Division Network Event in Elgin, Scotland in September, which will also be livestreamed by John Wilson’s team – the topic is Telephone and Online Therapy - click here for more details. Marina London is presenting "Top 10 Web Secrets for the Next Decade" at the Employee Assistance Professionals Association 2011 World EAP Conference in Denver Colorado, October 26 29, 2011. For more information, visit http://www. eapassn.org/i4a/pages/index.cfm?pageid=3391 for more details. Kathy Morelli has been supporting mothers throughout the childbearing years and their developing families for 15 years. She is re-releasing her book, originally written in 2000, BirthTouch®, Mind-body Therapies for Expectant Moms. The latest edition includes current research about the relationship among touch therapies, mindfulness practices and women's moods. The BirthTouch® e-book will be out in September on her websites, www.KathyMorelli.com and www.BirthTouch. com and will be available on Amazon. She will be speaking at the Postpartum Support International annual conference on September 16 in Seattle Washington about BirthTouch®.
the article voted best in Division 42's Independent Practitioner Quarterly. The article citation is Kolmes, K. (2010). Developing my private practice social media policy. Independent Practitioner, Summer 2010, 30 (3), pp. 140-143. Steve Walfish, the editor of the IP, gave her the award and said, "Dr. Kolmes has revolutionized how practitioners view social media." DeeAnna Nagel, Kate Anthony, and Daniel Moshel will be presenting at the 3CVV online conference on Login 2 Life - A New Documentary about the Positive Uses of Second Life. More information is available at http:// sl.counseloreducation.org/3vcc/index.html
FOLLOW ONLINE COACH Facebook INSTITUTE on & Twitter
Keeley Kolmes was awarded "Best of the IP" for APA’s Division 42. This is a yearly award that goes to
TILT Magazine is published bi-monthly by The Online Therapy Institute. Each issue is filled with articles, news, business tips, reader comments, and much more.
Subscribe Today! 8
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
The Rewarding Journey Of SELF-PUBLISHING A new option for therapists and coaches
Do you have ideas and insights that you would like to share with the world? Would you like to develop multiple streams of income for your practice and reach more people than you could reach in one-on-one therapy or coaching sessions? Have you thought about writing a book but haven’t the faintest idea how to get anyone in the publishing industry to talk to you?
Courtney Armstrong
Self-publishing is a wonderful way to get your message out to the world and now there are plentiful resources to help therapists and coaches do this. I first embarked on the journey of self-publishing last fall and was surprised at how easy and incredibly rewarding it can be.
It Began With a Blog The call to write began to beckon me several years ago while I was learning new methods for treating trauma and grief that were getting phenomenal results for my clients. I couldn’t wait to tell people and started leading workshops to teach these new approaches to mental health professionals. Many of the workshop participants suggested I write a book. They wanted a reference and as much information as I could give them. Although I had childhood fantasies about writing a book, I seriously did not think I had the time, talent, or connections to get published. So, I created a blog where I could share my thoughts and keep the conversation going. T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
9
TILT – Therapeutic Innovations in Light of Technology
As the blog grew, several clients and colleagues continued to ask me to write a book, and I just laughed it off. Finally, one of my mentors, Bill O’Hanlon, threw the gauntlet, stating, “You have good material and I would like to pass your name to larger organizations who hire professional speakers, but you need to have a book if you want to be taken seriously.” I told Bill, “I’d love to have a book, but I heard that a literary agent won’t even speak to a writer, unless she already has a few publications under her belt and/or a following of thousands of people who would commit to buying the book before it was even written.” Bill disagreed and said it was perfectly acceptable for me to start with a self-published e-book. Self-publishing is no longer considered “vanity” publishing and is gaining credibility among consumers, especially as the demand for e-books increases. In fact, e-book sales have tripled in the last two years according to the Association of American Publishers and are actually predicted to reach 20-25% of total book sales by 2012. It Evolved Into An E-book The thought of writing an e-book seemed much more manageable and I learned that e-books are very easy to produce. They can be short and narrowly focused. You can type your manuscript into a Word document, then convert it into a PDF document, and make it available immediately through your website where people could download it to read on their computers. If you want to make your e-book available for e-readers such as Nook, Sony Reader, and the iPad, there are several companies who help you with this process. One such company is Smashwords, Inc. created by author, Mark Coker. With Smashwords, writers can upload their manuscript in Word document format to the Smashwords site, free of charge. Then, Smashwords’“meatgrinder” program will convert the Word document into PDF, e-pub, and other formats that can be read on e-readers. 10
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
You can create a sales page for your book and make it available through the Smashwords catalog where people can easily purchase the book and download it in their preferred e-reader format. Smashwords gives the writer 80% of the royalties from the sale of their e-book, which is much higher than a writer would receive through traditional publishing houses. Smashwords can also list your book in its “premium” catalog, which makes your e-book available for direct download through iBookstore, Barnes & Noble, and several other e-book distributors. The royalties for sales through these channels are about 60%, but that is still a higher percentage than you would get publishing the book through other channels. In addition to Smashwords, Inc. a writer could publish an e-book through other self-publishing companies such as Scribd.com, Lulu, or FastPencil who yield about 70% royalties. Amazon.com also has an option for self-published authors to submit Kindle formatted manuscripts and will pay 70% royalties to Kindle authors. Although some people can whip up an e-book in a weekend, I wanted my book to be more substantial. My book was presenting some new, slightly controversial concepts and I wanted to include research that supported these interventions. I began my research and interviews for the book in September and put the outline for the chapters
w w w . on l in e t h e r a p y instit u t e . c o m
of the book together in October. By November I committed to writing at least one hour per day on the manuscript and had the first draft completed by January. Even though I could have published the manuscript as an e-book at that point, I decided to hire a professional editor to review the manuscript before I released it into cyberspace. Hiring my editor, Cindy Barrilleaux, was one of the smartest things I did. Because Cindy worked for years as an editor for the Psychotherapy Networker, she specializes in coaching therapists who want to write articles and books. She helped me clarify my ideas, find my voice, and refine my writing style. Cindy also showed me how to blend the research in the manuscript with personal stories to help it read more like a compelling narrative and less like a dry dissertation. As I was polishing up the manuscript, I also created a cover image for my e-book using a beautiful photo of a sunlit horizon that I purchased from iStockphoto.com and free e-book cover creator software I found on the Internet. You could also hire a freelance graphic designer to create an e-cover relatively inexpensively through sources like Craigslist, E-Lance, Fiverr. Many of these freelancers can format the interior of your book with special text boxes and graphics too. With my editor’s coaching, feedback, and support, I had the final version of my manuscript completed in April. I uploaded the manuscript
to Smashwords and it was available for purchase and download within two days. One month after announcing the book’s availability to my e-mail and social networking contacts, my book actually made the Smashwords bestseller list in the selfimprovement category. Unsolicited e-mails began to arrive from people who wanted to tell me the book had comforted and inspired them. Many asked when a print version of the book would be available, noting they still enjoyed holding a three-dimensional bound book in their hands, complete with the scent of fresh paper and ink. Appreciating their desire for a tangible book, I set out exploring self-publishing print options. It Peaked With Print-On-Demand Fortunately, with the advent of Print-On-Demand (POD) technology, you do not have to sign on with a major publisher or commit to print thousands of copies of your book that sit in your garage and gather dust. You can sign up with companies like Lulu, CreateSpace, FastPencil, and others who will put your manuscript into ready-to-read format and only print books as they are ordered. I used CreateSpace for my project because they are affiliated with Amazon.com and can have your book available in the Amazon catalog fairly quickly. CreateSpace provided a package called Total Design Freedom (TDF) that cost $758. The TDF package included services to create a professionally designed book cover and format the interior of my book with attractive headings, special fonts, selected photos, and nice-looking text boxes. Lulu has a similar package that runs at $629, while FastPencil has a package that runs at $999, and includes an editorial review of your work up to 25k words. From start to finish, the process to create the print version of the book took about eight weeks. First, I had to reformat the Word document from the style Smashwords required, into the
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
11
TILT – Therapeutic Innovations in Light of Technology
style that CreateSpace required. After receiving the reformatted manuscript, the people at CreateSpace did an extensive interview with me to get a clear sense of what the book was about and how to reflect its essence in the cover and interior. Then, I had to look at various fonts and styles for formatting the interior of the book. CreateSpace mocked up samples of several pages and e-mailed them to me for review until we had a style with which I was happy. A few weeks later, CreateSpace had the first online proof ready for me to review. The font for the main text did not read as well as I thought it should, so we decided to change the font and make some other formatting adjustments. Online proofs were exchanged again over the next week and then CreateSpace resubmitted my book for print. In mid-June, Create Space shipped the first physical proof of the book to me. Holding the physical book in my hands was simultaneously exciting and surreal. My excitement waned, however, as I flipped through the pages and caught a few more grammatical mistakes and formatting issues. CreateSpace assured me that finding such mistakes is “normal,” as minor errors that tiptoe quietly through an online document unnoticed, jump out quite glaringly on the printed page. In fact, CreateSpace routinely allows up to 20 editing changes free of charge after an author reviews the physical proof because this is so common. By early-July, the print version of the book was complete and ready to be published. I received my first order in time for a workshop that I was giving and sold copies to almost all 65 attendees. In mid-July, the book was listed in the Amazon.com store and by September, it should be available for purchase through Barnes and Noble and other literary outlets. Although writing and self-publishing a book required a substantial investment of my time and money, it has been well worth the effort. Some 12
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
very surprising things have happened for me since my book has been published. Not only have I been invited to do more speaking engagements, but I have also been asked to write for some online magazines and contribute a chapter to a professional book being released by a major publisher next year. My practice has grown substantially, and I have created some audio products and another e-book that people are purchasing from my website. The most rewarding surprise, however, came from a former client who said my book inspired her to start a foundation to help people get therapy who could not otherwise afford it. I think I am more excited about this foundation than I was about my book! Bill O’Hanlon told me that publishing a book would open amazing doors for me, but I had no idea it would happen this quickly and I certainly didn’t believe a self-published book would yield such exhilarating opportunities. This book is just the beginning for me, and I plan to write more. If you have thought about writing and creating products based on your skills and expertise, I encourage you to start. You too may be pleasantly surprised to find all kinds of possibilities emerge when you are willing to share your voice, compassion, and wisdom beyond the confines of managed care and the four walls of your office.
ABOUT THE AUTHOR Courtney Armstrong, is Licensed Professional Counselor and the author of Transforming Traumatic Grief: Six Steps to Move from Grief to Peace. In practice for 15 years, Courtney owns a counseling center in Chattanooga, Tennessee and has trained hundreds of mental health clinicians nationwide in creative ways of promoting resilience after trauma. She can be found on the web at www.courtneyarmstronglpc.com
w w w . on l in e t h e r a p y instit u t e . c o m
Online Therapy Institute is proud to announce
Introduction to ONline Coaching Methods, Ethics and Responsible Social Networking
5 clock hours of instruction Online and self-paced An Introduction to Coaching Online: Considerations and Definitions Conducting and Enhancing your Online Coaching Client Relationship The Ethical Side of Online Coaching Maintaining a Responsible Online Presence Telephone, VoIP and Coaching via Videoconference
REGISTER OR GET MORE INFORMATION
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
13
TILT – Therapeutic Innovations in Light of Technology
Research Review
Can Virtual Rea Changes in Self by Agata Pasikowska Virtual environments allow us create multiple alter-egos. We can climb into the skin of a “night elf” avatar in World of Warcraft or become a famous designer in Second Life. During many hours spent in game communities as a psychologist, Agata Pasikowska, a researcher in Poland, worked on the hypothesis that online 3D gaming in virtual environments can support personal awareness, learning and psychological growth. Virtual worlds enable computer-mediated immersion and interactions encompassing multimodal communication channels including audio, video, and text. These are enriched by avatar-mediated body language and physical manipulation of the environment. Virtual reality possesses many qualities that give it rehabilitative potential for people with intellectual disabilities, both as an intervention and an assessment. It can provide a safe setting in which to practice skills that might carry too many risks in the real world. Unlike human
14
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
tutors, computers are infinitely patient and consistent. Virtual worlds can be manipulated in ways the real world cannot be and can convey concepts without the use of language or other symbol systems. This study (Pasikowska, 2009) examined the impact of playing the online multiplayer game World of Warcraft on the player’s selfimage. It was predicted that creating avatars whose status represents success in a game will alter disproportions between the player’s online self (alter ego) and their real self. It was further expected that these changes in the discrepancy between online and real self would be dependent on several initial qualities of the person – self-esteem discrepancies, stability of self and received social support. Gamers were asked a battery of questions about World of Warcraft (WoW) regarding their character, their self-esteem, social support and motivations in playing it (Yee, 2007). Moreover participants rated how similar each personality characteristic was to their real and online self using an adjective rating method. Participants were initially self-selected through WoW gaming forums with a second survey sent
w w w . on l in e t h e r a p y instit u t e . c o m
S t e p h e n G oss
ality change people? f while Playing Online Game.
via e-mail to assess change. Forty participants completed both parts of the study. Results supported the hypotheses with a noticeable impact of playing online multiplayer games on self-image being recorded. In particular, players’ self-esteem towards their real self (as differentiated from their in-game
persona) increased significantly over time. The difference between players’ self-esteem towards their real self and towards their ingame persona also changed, depending in part on their initial levels of self-esteem particularly for those who reported low self-esteem and high stability of self-image. continued next page
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
15
Table 1 Changes in self in 1st part of study
Table 2 Changes in self in the 2nd part of study
A decrease in discrepancies between players’ online self and real self explains strong identification of gamers with their avatars, which are created likeness – or at least representations – of their ideal self. Players with low and unstable self-esteem tended to identify strongly with their virtual selves. Bessiere (2007) found that WoW players tend to create their main in-game character to be closer to their ideal self than their real self. That is, avatars may have traits the player yearns for or that are held in check in their off-line life.
16
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
“
“
TILT – Therapeutic Innovations in Light of Technology
“increased social support while playing the game had a positive impact for players and decreased discrepancies between their online self and real self ”
Growth of discrepancies between online self and real self in people with high and stable selfesteem seemed in this study to exist because of weak identification with avatar. In other words, they explore a possible alternative self in their gaming, but do not get serious about it, but rather simply play with a new alter ego. The game world allows players the freedom to create successful online selves. Fenichel (2004) pointed out that the Internet enables free association, transference and projection and that there are many places on the net where people can express themselves. This study also showed that increased social support while playing the game had a positive impact for players and decreased discrepancies between their online self and real self. Those who received high social support while playing in their online persona also showed an increase in their offline self-esteem. McKenna (2002) suggested that the secure protective environment found on the Internet is likely to have a positive effect on relationships,
w w w . on l in e t h e r a p y instit u t e . c o m
for example through being able to express a ‘real me’ version of the self that the person believes is the truth, but that they find difficulty in expressing in their offline life much as clients might after successful therapy, when they manage to become more truly themselves. This study hints at the significance virtual reality can have for people with social difficulties. For some, the virtual reality may become their preferred social environment where they can express what they feel is their ‘real’ self. Perhaps in the future virtual reality games might even request a personality profile of the user and shape the environment in accordance with their answers. Already, it seems, virtual worlds can become significant tools in our lives quite capable of enhancing our well-being. n
ABOUT THE AUTHORS Agata Pasikowska is a psychologist of new technology and communication and a PhD student in Psychology at the Warsaw School of Social Science and Humanities, Poland. She is interested in identities in cyberspace, Human Computer Interaction and the psychology of self. Her PhD project examines elements of dialogical self and dialogue between them using virtual reality environments. Stephen Goss, Ph.D. is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK (http:// about.me/stephengoss).
References Bessiere, K. (2007). The Ideal Elf: Identity Exploration in World of Warcraft. Journal of CyberPsychology and Behavior, 10, 530-535. Fenichel, M. A. (2004). Online behavior, communication and experience. In R. Kraus, J. Zack and G. Sticker (Eds.). Online counseling (pp. 3-18). Oxford: Elsevier. Lawless-Reljic, S. (2010). The Effects of Instructor-Avatar Immediacy in Second Life, an Immersive and Interactive 3D Virtual Environment. San Diego: University of San Diego and San Siego State University. McKenna, K. Y. A., Green, A. S. and Gleason, M. J. (2002). Relationship formation on the Internet: what’s the big attraction? Journal of Social Issues. 58, 9-32. Yee, N. (2007). Motivations of Play in Online Games. Journal of CyberPsychology and Behavior, 9, 772-775. Pasikowska, A.(2009). Changes in self during playing online game. 1st prize for masterthesis poster presentation session during Conference of Psycho-Technology, New Technology in Psychology. Warsaw School of Social Science and Humanities, May 2011, Warsaw, Poland.
Please send reports of research studies, planned, in progress or completed, to editor@onlinetherapymagazine.com, Subject line: Research Review.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
17
TILT – Therapeutic Innovations in Light of Technology
Research Call Ralph Wilson has proposed a research study on the improvements in emotions and mental health that accompany treatments that change the acupuncture meridian energies. Participants will track changes in emotions and mental health of their clients using questionnaire and correlate with skin resistance alterations measured by AcuGraph technology. Initial proposal has been accepted, first steps underway. Seeking interest in participation as well as assistance in writing final questionnaire as part of the IRB. Information: http://www.naturalconnectionshealthcare.com/ research_preparation.php/ Enquiries: Dr.Wilson.WashingtonDC@gmail.com
Kylie Coulter, an Australian honours student, is looking for participants for her online study into how emotion is conveyed through text communication, online. All data collected is anonymous and anyone can participate as long as they can speak English. The survey takes roughly 25 minutes and you will be asked a series of questions about your mood and level of empathy. You will also fill out information in regards to 9 emails that you will be presented with. The study is aimed at finding out just how effectively we can convey emotion through text. This research is aimed at aiding life coaches, online therapists, and anyone who uses text communication to improve their online communication skills. Click the link below to participate: http://unebcss.qualtrics.com/ SE/?SID=SV_0MKCvw3QbvBaoni
18
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Check Out the Online Coach Institute! Resources for Coaches and Helping Professionals!
w w w . on l in e t h e r a p y instit u t e . c o m
Reader Responses
Ethical Dilemma IN THE LAST ISSUE WE ASKED:
Your client tells you that he often goes into Second Life to destress after a long day at work. He says he can "be himself"- a self that he cannot present to the real world. He asks you to join him in Second Life to meet his Avatar.... What Would You Do?!
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
19
TILT – Therapeutic Innovations in Light of Technology
1) I would explore what it meant to him/her to change the venue. It seems unlikely that I would change venues, given that I wouldn't likely go to someone's home, if we started therapy in my office, etc, though I'm not as sure I can articulate why. I do believe that I would meet his avatar, however. 2) I would explore why he/she felt they couldn't be "themselves" in the physical world, and what the SL avatar meant to that person.
Reply by
Debbie Quackenbush
I would definitely take this request seriously, for me a good outcome in therapy can often be correlated to as many 'parts' of the client feeling met and heard. There would also need to be caution here, could the request be similar to meeting the client at Starbucks for a coffee and the beginning of a friendship? That would clearly not be within the bounds of an ethical therapeutic relationship. However I have met my therapist for a number of sessions where we will walk together for half the time and then sit in the office in the traditional way for the other half, something that I have found personally very helpful. Any contact like this out of the office needs to be clearly thought out with the client and happen within clear therapeutic boundaries. I think this is also true for a meeting outside the face to face counselling office in Second Life, contact within clearly negotiated therapeutic boundaries could facilitate a helpful therapeutic process. Something else to consider is how familiar the environment we meet our clients is to ourselves, if it would be our first visit to Second Life and the experience would be completely alien to us as therapist, how well would we be able to offer solid therapeutic relating and support to our client? To offer contact in in Second Life we need to have some familiarity and preferably even training in meeting clients in this environment.
Reply by
John WILSON 20
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
I would do several things: 1. explore why he/she wished to change venues.
With some preparatory discussion, I would be very likely to agree.
2. what he/she likes about SL and how it helps him/her.
This is meeting the client on their own ground, where they are able to be the part of themselves that they clearly want to bring to the therapy.
3. explore why he/she wishes me to meet the avi and what is important about the avi that is not present in RL. 4. would discuss boundary issues, rules and risks 5. would invite client to login to SL during the therapy hour and show me his/her avi IN therapy and thru the context of therapy. Inviting client to show me his/ her world thru the Avi. 6. Given the ethical issues pertaining to privacy and security of SL (e.g. it is not a secure site), I would not meet client there with my avi, nor would I engage in therapeutic discussion with him/her using one of my avi's. I would let client show me his/her avi in therapy just as I invite teens to bring his/her music that is often representative of the teen's self. 7. I would also be open to client printing logs and bringing in dialogues that could be of concern to him/her.
I would, first, want to discuss why and what the change would mean. It does alter the therapeutic 'space' and I would want our frame to remain safe and securely in place. I would also discuss some ground rules, ensure we had secure, encrypted communication (not reliant on SL, therefore, but a parallel channel), the boundaries of mutual online privacy and several other issues - and process it in our sessions thereafter, whether they happen partly in SL or anywhere else, to keep in touch with as many parts of my client as possible with a view to integrating what are clearly divergent self-configurations for them. Reply by
Stephen Goss Reply by
Dr. Vicki Van Cleave, PsyD
Longer (unedited) replies and further discussion are available at http://onlinetherapyinstitute. ning.com/forum/topics/coaches-and-therapistsethical thanks to everyone for their contributions!
T I L T MAGAZ I N E S e p t e m b e r 2 0 1 1
21
TILT – Therapeutic Innovations in Light of Technology
Hi Eve ry o n e!
In each issue of TILT we shall be presenting an ethical dilemma about a Web 2.0 experience and other ethical topics related to mental health and technology, and inviting readers to comment at the Online Therapy Institute’s social network. In the following issue of TILT, we shall publish a selection of comments about what YOU would do when faced with the dilemma, as well as our own considerations about what the issues are.
What Would You Do? dilemma Chris, one of your online supervisees has sent you an email describing the client Jo, and has told you previously that there is “something that I wasn’t quite ‘getting’”. The Supervisee is receiving information from the client that she feels is a different story to the one she was giving on the intake form. For example, the client’s alcohol intake appears to be much higher than stated, and she also makes statements that indicate she is underage and not 19 as the Supervisee was told. The Supervisee is unsure whether to challenge the client or wait for more information… You are her Supervisor and she needs advice…**
What would you do?! Weigh in at the OTI Social Network’s Discussion Forum! http:// onlinetherapyinstitute.ning.com/forum/topics/ ethical-dilemma-what-would-you-do-selectedreader-comments-to-be**A longer version of this issue’s Ethical Dilemma, with responses, will appear in the November issue as the CyberSupervision Column with Anne Stokes.
22
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Wounded Genius Welcome to our Resident Cartoonist, Wounded Genius. We discovered WG through Facebook, when our colleague and friend Audrey Jung posted a cartoon on Facebook, and within half an hour we were chuckling away, following on Twitter, and were commenting on the main blog at http://talesoftherapy.wordpress.com/ - make sure you check out the archive of cartoons, written from the perspective of a client. We are thrilled to have WG on board, both for TILT and as a member of the OTI social network.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
23
TILT – Therapeutic Innovations in Light of Technology
… g n i k a e p s y l t Stric
Coaching and CounselLi Is there a merge of the disciplines on the horizon?
24
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
Ling‌
By DeeAnna Merz Nagel and Kate Anthony
Can a licensed mental health practitioner practice coaching across state and international lines? Over the years, we have been approached with this question too many times to count. Many psychologists, counselors and therapists assume that if they want to practice across state lines or across international boundaries, they can simply call themselves a coach, separate their mental health business from their coaching business, hang their virtual shingle and call it a day.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
25
TILT – Therapeutic Innovations in Light of Technology
Legally, it depends on who is defining counseling vs coaching. Theoretically there are differences- but from a risk management perspective for licensed practitioners the concern is that the practitioner truly knows how to extract purest coaching from the broadest definition of counseling: “…the provision of assistance and guidance in resolving personal, social, or psychological problems and difficulties, esp. by a trained person on a professional basis…” It is this broader definition (gleaned from a wide ranging Internet search of definitions held widely) that someone would be called to answer to should a complaint go before a licensing board or a therapist winds up in court. Additionally, what seems to be developing is two different opinions- the first is that coaching and counseling are two separate and distinct disciplines. The other emerging opinion both in the United States and the United Kingdom is the idea that coaching is in fact, a sub-specialty of counseling. Whether that was the intent- that is what is coming to pass. Now that the Center for Credentialing and Education (CCE), an affiliate
of the National Board of Certified Counselors (NBCC), is offering the Board Certified Coach Credential and with the development of the new Coaching Division of the British Association for Counselling and Psychotherapy (BACP), the fields of counseling and coaching seem to have further blurred the areas of separate and distinct fields of practice. Professionals in both the coaching and counseling disciplines are wrangling with this blur and the lines of demarcation are becoming less and less obvious. Therapists who are licensed might choose to use coaching techniques and tools, or even gain a coaching credential, but still identify as a counselor. The concern is that there is a misconception that a licensed mental health practitioner can simply call themselves a coach by gaining a coach credential and practice coaching across state lines. As a licensed practitioner, this would be very risky because of the very loose definition of counseling referred to above.
If, as a counselor, you accept the idea that you should be properly trained as a coach because to do otherwise suggests you would be working outside your scope of practice, then you already buy into the concept that your license and your profession as a mental health practitioner is The concern is that there is a your guidepost. However, these misconception that a licensed mental issues may be more legal than ethical in nature. Ethically we can health practitioner can simply call certainly separate coaching and themselves a coach by gaining a coach counseling into two professions and create different contracts and credential and practice coaching recommend different websites for coaching and counseling services. across state lines. But when we think in terms of verbatim material, it becomes clear
26
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Online Therapy Institute is proud to announce
w w w . on l in e t h e r a p y instit u t e . c o m
online workshop modules! We offer several modules comprising 5-10 clock hours of learning on many topics! Introduction to Cyberspace: A Primer for Helping Professionals Relationships in Cyberspace: An Introduction for Helping Professionals The Online Therapeutic Relationship: Theoretical Considerations Ethical Considerations of Online Therapy Working Therapeutically Using Asynchronous Email Working Therapeutically Using Synchronous Chat Working Therapeutically Using Telephone and Audio Using Video Conferencing to Conduct Online Therapy E-Therapy: Asynchronous Email/Web Board Therapy, Cyber-culture, Ethics
More Information
We have also launched a new Certificate in the Therapeutic Use of Technology. This is the first in our Certificate Programme series. This Certificate is a 40 clock hour facilitated course and truly prepares the mental health practitioner in the delivery of online therapy.
More Information
REGISTER TODAY!
C E / C P D h ou r s a r e a v a i l a b lT eI L T MAGAZ I N E s e p t e m b e r 2 0 1 1
27
TILT – Therapeutic Innovations in Light of Technology
that a therapist who is also a coach must keep the purest methods of coaching in mind so that the verbatim transcript is evidence of coaching and not counseling. It doesn’t matter how different the language is during a coaching session- if it is positive psychology, it is still embedded in psychological interventions- if it is motivational in nature, it is still rooted in psychological interventions- and if the goal is to help, aid, guide someone to a different outcome, then by the very general definition previously offered, and by even more stringent definitions of counseling, it will be regarded as counseling in the event ANY complaint is filed and goes forward. We have no case law in the United States regarding a licensed mental health practitioner who practices coaching via technology
28
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
across state lines, just as we have no case law with online therapists who cross state lines- but we think we border on being irresponsible as trainers of online coaching and online therapy if we simply tell licensed counselors that if they separate their businesses- coaching here and therapy over there- or even for the licensed individual who wants to solely conduct coaching- that they can safely conduct coaching across state lines or international borders. It is more likely that a coach who is licensed as a mental health practitioner will be held to the standard of care of their licensewhich represents a regulated profession. If you are a counselor, and you want to conduct counseling or coaching across state or international borders, we recommend the following steps:
w w w . on l in e t h e r a p y instit u t e . c o m
1. Consult with your regulatory board 2. Consult the regulatory board where your potential client resides 3. Consult with your professional association 4. Consult with your malpractice insurance 5. Consult with a lawyer If you are advised that you can proceed, document your consultations as proof of due diligence in determining your professional responsibilities. These consultations indicate good practice management and allow you to assess your risk. Some may see this as strictly an issue in the United States- the battle of the regulated vs non-regulated helping professions- and yet, the more global picture is perhaps the beginning of the merge between the two disciplines. Lack of regulation of both therapists and coaches in the UK may make it seem that this topic is less relevant to those practicing outside of the US, but it is important to consider that complaints procedures are extremely relevant. The emergence of the BACP Coaching Division has brought to light much speculation on social networking sites as to whether this predicts the changing of the main professional organisation’s name to the British Association for Counselling, Coaching and Psychotherapy (or
similar), and also whether there would be a new membership grade for coaches. Statements from BACP during these discussions indicate that this is not on the cards. However, it is clear that there is a blurring of boundaries with the introduction of this special interest group. The Professional Ethics and Quality Standards Committee of BACP has agreed to admit coaching training into CPD endorsement, but on the proviso that it isn’t used to evidence professional development criteria for Counsellor/psychotherapy accreditation applications. This indicates a strong separation of the two types of intervention, but it is still the case that one has to qualify for BACP membership to join the Division, which indicates it is a subspecialist group of therapists. It is clear that these discussions need to continue to gain clarity. We, the editors of TILT and the co-founders of Online Therapy Institute and Online Coach Institute, are pointing out the varied sides of this issue. But whether you are a therapist utilizing coaching techniques in your practice or as a stand-alone service or a coach who offers coaching services using solid principles of positive psychology and other counseling or psychology principles, the goal of the Online Coach Institute is to help you learn how to engage in ethical online work.
ABOUT THE AUTHORS
DeeAnna Merz Nagel and Kate Anthony are co-founders of the Online Therapy Institute and Managing Editors of TILT Magazine – Therapeutic Innovations in Light of Technology.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
29
TILT – Therapeutic Innovations in Light of Technology
Expand your practice Improve client access Reduce No‐Shows Connect to clients via web based HIPAA‐compliant video, email & chat No expensive equipment or software to buy Collect payments online and submit claims Private label your practice For information or a free demo call 616‐805‐9452 or email sales@breakthrough.com
30
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
REEL CULTURE
Jean-Anne Sutherland
The Collective Experience of Harry Potter At 10:20 PM, on July 11th of this year, I finished my second reading of Harry Potter and the Deathly Hallows. By 11:00 PM, my partner, my daughter and I were headed out the door, to the midnight premier of this last Harry Potter film. The Cineplex was crawling with young people (and a smattering of “old folk,” aka, over 40’s), dressed in robes as Harry, Hermoine, Ron, or Draco. There were several Luna Lovegood’s; various red-headed Weasleys; Professors Trelawney and McGonagall; a few Moaning Myrtles and; even one hilarious Dobby the house-elf. One fella, sans costume, simply had a sign around his neck that read, “Muggle.” The energy of the theatre (inside and outside) felt creative, witty and festival-like. More than anything, it seemed as if most people had received the same memo: get into the spirit of things and dress accordingly. Movies ARE social experiences. We mostly see them with others; talk about them with others – in general, experience them with others. Numerous movies achieve “cult film” status because they satisfy a group of fairly like-minded folk. Films reach this status for
a variety of reasons. Perhaps the film-going itself is such fun (e.g., Rocky Horror Picture Show). Or this cult status can result from the film being painfully inaccurate (e.g., Reefer Madness); really, truly awful (Plan 9 from Outer Space) or; in excessively poor taste (Pink Flamingos). There are films that induce audience participation such as wearing costumes to the theatre (again, Rocky Horror Picture Show) or mass sing-alongs (e.g., The Sound of Music). Quotes from cult films are repeated and shared as inside jokes (e.g., “No wire hangers, ever!” from Mommie Dearest). This kind of shared experience of a movie can certainly be said of the Harry Potter series; the dressing up, the shared emotions among fans, the plethora of social networks websites centered on Potterism. At the same time, the Potter movies are far more than (soon to be) cult classics. According to University of Oregon student, Joanna Wendel, through the book series and films, J.K. Rowling, “defined a generation” (see her blog: http:// nextgenjournal.com/2011/07/harry-potter-and-thelessons-he-taught-me/). When my daughter was about 5 years old, I began reading (excerpts!) from The Goblets of Fire (I was a late Potter-bloomer, not caught up until Book IV or V). By the time the last book was released, she was 9 years old and I read the entire book aloud to her. In the following years she went back and read the books herself and saw each of the movies approximately 62.5 times. Each. By the evening of July 11, 2011 (she’s now 12 years old), we were a relative mess with emotions about going to see what would be the final movie of the series. We absolutely could not wait for T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
31
TILT – Therapeutic Innovations in Light of Technology
the film. At the same time, we kept commenting how the Harry Potter books and films had always been there – a piece of pop-culture that spanned her childhood. Indeed, Rowling did define a generation. From the 1997 release of Harry Potter and the Philosopher’s Stone (later re-named Sorcerer’s stone when it hit the U.S. – apparently we in the U.S. might mistake “philosopher” as something academic and not see the film), to the 2011 release of Deathly Hallows Part II, Rowling offered an entire generation a storehouse of memories. As many have noted, the popularity of the books meant that children read, in mass numbers. As a generation of kids were tuned into visual media, at the same time, mass numbers of them began lining up at bookstores for the next release. And these are not slight little children’s books - we’re talking 700-800 pages! They, like my daughter, had Harry Potter birthday parties, Harry Potter posters on the wall, Harry Potter video and board games, Harry Potter t-shirts. This generation did not simply consume Harry Potter - they shared and experienced Harry Potter. The Potter series offered a collective experience to a generation and this detail should not go unnoticed. Hundreds of social media sights have popped up allowing for a cultural discourse about the series. Granted many of the websites appear trivial: Harry Potter trivia quiz; who is your Harry Potter love-match?; into which Hogwarts house would the Sorting Hat place you?* Hundreds of MA theses and dissertations have considered elements of the Potter series. College courses examine the spirituality of the Potter books. There has been 10+ years of debate as to childhood socialization and
the Potter books (e.g., leading kids down the road to Satan or, offering a lovely moral lesson on the power of love and friendship and over-coming obstacles?). Irrespective of the religious and political debates concerning Harry Potter, collective, shared experiences are good for us on many levels. They offer us a sense of community – a connection to something beyond our immediate lives. They can serve as a kind of reference group and a source for identity development. Shared experiences make us feel like we fit in and those feelings of connection, as the research on the importance of social support has shown, can be good for us psychologically, emotionally and even physically. While technology has brought so many different kinds of people together, as we know, it also holds the power to isolate us. As kids spend increasing amounts of time with technology, it was fun to see those crowds of kids at the bookstore. I don’t think that the art of reading will expire with the finality of the series. I do hope that other books will continue to entice kids (and, hopefully, ones that parents will equally enjoy). One of the delights of pop culture has been the collective experience of it (from the baby boomers to now). Let’s hope that it continues to unite us and thrill us in ways that Harry Potter did. *By the way, I took the sorting hat quiz (a few times on various sites) and, I kept ending up in either Ravenclaw or Hufflepuff. Apparently I am not brave enough for Griffindor nor mean enough for Slytherin. Here’s a fun one, not so disguised as a personality test: http://www.personalitylab.org/tests/ccq_hogwarts. htm.
Jean-Anne Sutherland, Ph.D. is assistant professor of sociology at University of North Carolina Wilmington, USA with one of her research focuses being sociology through film.
32
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
33
TILT – Therapeutic Innovations in Light of Technology
BY Bruce Hillowe
Financial and Legal Issues in Telephone Psychotherapy Private insurers generally do not reimburse for telephone psychotherapy. No CPT code for psychotherapy can be used for telephone therapy because it’s not a face-to-face service. Because it can be considered misleading, patients treated telephonically should not be billed for "individual psychotherapy," nor should their services be coded as 90806 or any other CPT code. Rather, in billing use the description "telephone psychotherapy" without any accompanying CPT code. Some insurers will, however, allow use of such CPT coding for and reimbursement of episodic telephone sessions such as when an established patient is away on vacation or home ill. But as far as I know, none allow these for regularly planned or frequent telephone therapy. Exceptions may be
34
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
granted; you, the patient, or both of you may make a case to insurers that one is warranted, but prior full disclosure to the insurers would be required. There are standard of care issues as well. Can you provide psychotherapeutic treatment that meets customary standards for safety and efficacy by means of planned regular use of the telephone as a primary means of
wwwwww. .on onllin ineetthheerraappyyinstit instituuttee. .ccoomm
Whether a healthcare practitioner is permitted to provide telephonic professional services to a client in a state where the practitioner is unlicensed is unresolved. Public policy of states and risk management policy of practitioners would seem to militate against it. States wish to have jurisdiction by means of licensure over healthcare practitioners who provide services to their residents. Although it has not occurred to my knowledge, there is the possibility that a practitioner might be accused of unlicensed practice by the state in which the client resides (and in which the practitioner is unlicensed); unlicensed practice is a crime. Additionally, there is the possibility that, should the practitioner be sued for malpractice, insurance coverage might be questioned by the practitioner’s malpractice carrier for services rendered out-of-state on the basis of the practitioner having engaged in unauthorized practice.
LEGAL BRIEFS
communication? Presumably, you will be lacking information that you might otherwise glean from face-to-face encounters with patients. Resolution of these questions require recourse to professional research and ethical and community standards. You might address them additionally in an informed consent document, in which you label as experimental the telephonic aspect of treatment, and if possible, offer patients alternative non-telephonic referrals if and when exigent circumstances arise.
purposes the site of delivery of all services shall be considered New York State and subject exclusively to the laws of this State might provide a technical solution to these issues, but is as yet untested also. Having initial and then some ongoing regular contact in New York State, i.e., an in-person intake and occasional face-to-face sessions, would bolster a position that New York is properly considered the situs of the services. Out-of-state telephonic "coaching" presents significantly less exposure than telephone therapy because coaching usually does not require a license, is not necessarily a professional activity, and has standards of care that are looser and vaguer.
Bruce Hillowe practices law in the state of New York, USA , Emphasizing Mental Healthcare Law, Healthcare Law and Mediation and has served his Community for 29 Years. This article is a reprint from his quarterly newsletter in which he offers a Health Law Supplement in each issue. Visit his website at: www.BruceHillowe.com
Having an out-of-state patient sign an agreement that for all
TTI ILLTT MAGAZ MAGAZI INNEE Sseepptteemmbbeerr 22001111
35 35
TILT – Therapeutic Innovations in Light of Technology
Ly l e L a b a r d e e
TECHNOLOGY ENHANCED D The Coaches Console Many people just getting started in the field of coaching are unsure about where to start with respect to organizing, managing and promoting your coaching business. Even if you have been coaching for some time now, you may know there must be a better way to manage all of the paper work, but you just haven’t had the time to look into best solutions. Perhaps you’ve already looked into all this and you’re beginning to find that launching a coaching website, administering e-newsletter services, processing payments, and providing secure online messaging can add up to thousands of dollars and lost opportunity to make a living doing what you love to do: coach. Kate Steinbacher, PCC and Melinda Cohan, founders of The Coaches Console, have developed a user-friendly web application for as little as $49 per month. More than a robust online web application, Kate and Melinda see their Coaches Console as a system designed to provide coaches with all of the tools and resources they need to not only support their clients, but equally importantly, grow their business and learn from emerging leaders in the field. According to Kate, The Coaches Console “gives coaches confidence” where they need it most,
36
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
in running their coaching b u s i n e s s . Whether it’s getting the most out of a website, attracting new clients, supporting clients in a secure way online, efficiently setting appointments, or processing payments, The Coaches Console frees the coach up to do the work they love to do: helping their clients pursue and achieve what’s most important to them. Written in PHP, a widely used, general purpose scripting language, The Coaches Console is finely tuned to the day-to-day needs of running a coaching business and providing coaching services. Deployed via a software as a service (SaaS) model, Coaches Console’s licensed users receive ongoing updates to the web application. Coaches and clients access their unique web pages via secure usernames and passwords similar to the way in which one might access their bank account or cell phone account. Shaped and developed through over 7 years of deployment and more than 2000 users, The Coaches Console is now a colorful, feature-rich, secure web application that includes just about everything a coach needs to market, manage and
w w w . on l in e t h e r a p y instit u t e . c o m
ENHANCED D COACHING grow their coaching business. It provides users with a crisp, clear and efficient user experience and, not surprisingly, integrates with the Mac operating system. The coach’s dashboard features tutorials to help coaches get the most out of the application, system updates, upcoming appointments and to-dos.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
37
TILT – Therapeutic Innovations in Light of Technology
With respect to service delivery, shared calendaring provides coaches and clients with a feature that is itself worth the price of admission in that it allows the coach to make their availability visible to their clients who in turn can select and schedule the appointment time that works best for them.
As the coach’s calendar begins to fill with new clients, prompts appear in the coach’s login screen alerting the coach to upcoming sessions. By drilling down into “Active Clients“ and the associated menu, the coach can complete and view a session prep form which can be referenced online even during the coaching session to support the coach’s efforts to fully attend to the client.
38
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
The Coaches Console also provides web-enabled forms that support the client’s coaching experience and enables the client to effortlessly share outcomes with their coach.
The Coaches Console reinforces the coach’s efforts to provide ongoing, customized support to clients by providing a webbased log. The log entries reflect the coach’s personal notes on how the coaching is progressing and how best to prepare for upcoming sessions.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
39
TILT – Therapeutic Innovations in Light of Technology
With respect to marketing, The Coaches Console enables coaches to launch their own integrated custom website. This website becomes the “front door” for prospective clients. It’s the web equivalent of turning the lights on and opening up for business. Users will find a nice balance here between controls that allow for a range of custom branding and design while keeping the process point and click simple. The Coaches Console offers 20 website templates to choose from and support to assist users in getting started. Beyond simply a web presence, The Coaches Console provide users with the resources and tools necessary to route traffic the coach’s site, such as the ability to integrate key words to maximize search engine optimization, and a simple eNewsletter registration form. Once a visitor obtains a username and password and logs in through this site they will have access to The Coaches Console and client side features. All in all, I feel The Coaches Console is a robust, secure, web application that provides coaches with a near turn-key system for adding value and efficiency to their coaching business. As for areas in need of improvement, while Kate and Melinda have pretty well covered the bases including industry standard data encryption, they may be well advised to take the next step and ensure that coaches and clients alike have access to a privacy policy, similar to what’s posted on The Coaches Console website which outlines how personal information is collected, stored and managed. Readers of my TEC column will recall that my last column was on privacy policies, and there’s no question that personal information is being shared and stored via The Coaches Console. At the time this article went to press, Kate contacted me to let me know that they were already pulling their team together to address the use of a privacy policy link on the web pages accessed by coaches and clients. In summary, The Coaches Console and its 700 active users put up some pretty impressive stats insofar as its objective to equip coaches with a complete system for building a coaching business. Surveys conducted show that within the first 3 months of using The Coaches Console over 50% gained between 1 and 5 new clients, and nearly a third said they gained between 5-10 clients in 12 months. And the revenues follow. Within the first 6 months of using The Coaches Console over 50% surveyed said they increased revenues 15-25%. 40
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
The Coaches Console is certainly worth a very close look, it may well be the system that takes your coaching business to the next level. To learn more about The Coaches Console navigate to http://www.coachesconsole.com/index2.html Lyle Labardee, LPC, DCC, is a distance counseling credentialed, Licensed Professional Counselor specializing in web-enabled coaching. He is co-founder and CEO of LifeOptions Group, Inc., and is based in Michigan, USA.
Are you an online therapist or coach?
We would love to hear from you! Contribute to our "Day in the Life" columns with 500-1000 words! Submit your article to editor@onlinetherapymagazine.com
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
41
Brett Goldenberg
Public Mental Health Care in Canada
w w w . on l in e t h e r a p y instit u t e . c o m
The Crisis The current health-care system is failing many Canadians. The most vulnerable groups are children, the elderly, and the population in rural areas as well as those who suffer from mental illness. The system is challenged in delivering services to these populations - especially mental health care services. For those hoping to see a mental health professional in a hospital, public clinic or even at school, the waiting times begin anywhere from a couple of weeks all the way up to two years if they are not considered to be in crisis. That is, of course, if they do not want to lay out a hundred dollars or more per hour to see someone in a private practice. Private insurance would cover most private practice sessions but many Canadians do not have plans that will cover sessions. Many do not have any sort of plan at all. The wait times do not exist because of a shortage of mental health workers in Canada: the shortage only exists in the public system. They are there because professionals are forced into the private system. The wages are very low and professionals are overworked. They can make more than five times the amount when working in the private system, work their own hours and choose their own patients. The system is not getting any better. Wait lists are growing and there are less and less mental health professionals staying in the public system. There are risks that mental care may disappear from the public system altogether. People wait until they are in crisis to go to the emergency rooms
because no one will see them in a timely manner before that. This clogs up the system further and puts people at great risk.
The Solutions What can be done to alleviate the burden on the public system for mental health services? How can people who need care get it with reasonable wait times? There are no easy answers to these questions. The gap needs to be closed between public and private wages which is easier said than done. With higher wages, mental health workers will be less pressed to move to the lucrative private space. With the health care system already under such burden, there are little funds left for changes for mental services. If the wages cannot be increased because of limited government money there are still other ways to solve the problem. Pro bono works, sliding scales and technology are all tools to mend the problem.
Pro Bono Hours There is no doubt that many mental health workers want to give their time to the public system but it is difficult for them to turn down the opportunity of private practice. Most of them feel that people in the public system are the ones who need mental health services the most. There is an internal moral struggle when mental
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
43
TILT – Therapeutic Innovations in Light of Technology
health workers leave the public space for private practice. It is an obvious decision when there is such a wage and working condition discrepancy. Some mental health professionals split their time between hospital work and taking on private clients. Usually once they get sufficient clients, they will cut ties with the public system and go fully private. Another option is to give pro bono time to those who cannot afford their rates or the wait times in a hospital or clinic. Pro bono work is sometimes difficult to manage. It is tough deciding who to give the free sessions to and for how long the sessions should continue. An easier way for fairness would be a sliding scale for clients. Sliding Scale Sliding scale is a common way for professionals to offer fair rates to clients who otherwise could not afford the full amount. They adjust their rates according to their client’s income. While sliding scale is offered by some therapists in Canada, it is far less popular than in the United States. This is because many private practice mental health
44
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
workers feel like there is no need because of the public system.
Technology Technology will definitely aid solving problems with inadequate services in rural areas. In some remote hospitals in Canada there are less than three mental health professionals for well over a hundred thousand of people in the region. With telehealth initiatives and remote counselling, the rural areas of Canada can see more mental health services available to them. Working conditions will improve for rural workers as they will not have to either commute or relocate to remote areas which could lead to decreases in the loss to the private sector. Remote sessions also can increase the amounts of pro bono work that a mental health worker is willing to take on. If counselling can happen over the telephone or online, professionals can provide the free services right from the comfort of their homes. There would be no need to use up valuable and often costly office time for pro bono work. There are potential road blocks, such as disadvantaged people who need counselling may not have access to an Internet connection or a telephone to receive the pro bono work. With non-profit cooperation and awareness the equipment can be bought and the services offered as long as there are enough mental health workers willing to give their time to those who need it most.
w w w . on l in e t h e r a p y instit u t e . c o m
The health care system in Canada is not perfect but it does give equal access to almost everyone. Unfortunately, mental health still does not garner the attention it deserves whether it is in the public eye or for the funds in a hospital or clinic. With some mental health professionals spending nine years in post graduate studies, putting off family life among other things, it is no doubt that the majority open up private practices. Salaries are often five times more, work conditions are far superior and the hours are flexible. There is not much sign of wage increases for public workers. The Quebec government did just increase wages due to pressure from psychologists; however, it was only raised by $1.67 per hour. With more sliding scale rates and more pro bono hours form private practice workers coupled with an increase
in telecounseling in the public and private sectors there can be significant increases to the wait times for patients. Less wait times mean less people in crisis in the emergency rooms, lower suicide rates and better working conditions for public mental health workers.
ABOUT THE AUTHOR Brett Goldenberg is the founder of the online telehealth platform, Salubri (http://salubri.com). He is also co-founder of a new non-profit initiative aimed at providing free mental health consultations for those who need it most, Change Mental Health (http://changementalhealth.org). He is based in Montreal, Canada.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
45
TILT – Therapeutic Innovations in Light of Technology
an Online Therapist
A Day in the Life of
I am a Virtual World Counselor. I provide counseling services to adolescents and young adults in secure and confidential Virtual World environments. Online therapy provides accessibility to counseling resources across time zones and regardless of the geographical location of professional staff and the participating consumers. As a therapist, I am able to experience flexibility where I can also provide those services from many locations.
Brenda Bryan
46
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
I frequently start my day by logging in to our counseling grids to make sure things are flowing smoothly for clients to be able to access their services. I review my schedule to familiarize myself with individual sessions I have scheduled, orientation sessions for new clients, and group therapy. If materials or posters are needed for sessions or groups that day, I upload the content necessary and set those things up. One of the unique experiences as a therapist providing services in this context is that I get to create the things I need in the environment as I need them. For example, family communication might be an issue someone needs to work on that day so I could go in our virtual space and create a roundtable discussion setting where clients can practice healthier communication, or maybe we are having a group on anger management, so I set up the chairs around a volcano we have constructed as a visual aid. We are able to create multiple environments to meet immediate needs without worrying about expenses or construction time. Orientation to the program is a common duty as a therapist. Orientation for new clients happens in face-to-face individual sessions. We want to help them learn to use the program so they feel comfortable operating their own avatar to engage in services in a virtual world environment. I teach basic skills associated with virtual world environments including how to chat and interact with other avatars in the virtual world, how to edit appearance, how to navigate the virtual space and get from one location to another, as well as many other tasks necessary to engage in their treatment services. This is also a perfect opportunity to build the therapeutic alliance with the client and help
establish that sense of trust we know is vital to help them stay engaged, as we don’t often see them in a face-to-face context from this point on. Throughout the day, I conduct individual and group therapy sessions. These occur in the virtual world setting where I am logged in from a location and the client(s) are logged in typically from their homes or near their home communities. We engage in sessions as we would in the face-to-face settings - each person present is represented by an avatar, which is controlled by their human counterpart. Sessions occur as in the real world, only we are typing out in text chat our communications, or using voice if it is available to all participants. The online sessions provide for flexibility around activities and other things going on in their lives and mine. Since we are performing online services, it provides for the opportunity for them to engage in their regularly scheduled sessions and receive crisis support at any time. In addition to our virtual encounters, clients can also phone staff, or visit one of our offices if desired. The idea to utilize technology to aid clients from “tech-savvy” generations is one of the most innovative ideas I, as a therapist, have experienced and one I thoroughly enjoy. It is great to be able to let them experience services in a setting that utilizes technology that they experience on a regular basis including text chat and interaction in online settings through social media outlets and allow these experiences to become healthy and fruitful ones. A major benefit of online therapy is that it provides flexibility around other activities they are involved in. Treatment time is not extended by travel time. Other benefits of online therapy are the ability to receive services from home or anywhere that there is internet accessibility, clients don’t have to miss
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
47
TILT – Therapeutic Innovations in Light of Technology
appointments due to being ill, missing sessions when there is inclement weather, or waiting to get a face-to-face appointment. Also clients have the opportunity to be as open as they choose as they are represented by an avatar and their true identity is protected from other participants, although staff know who they are. And as mentioned, traditional resources are readily accessible if desired, and always in the event of a crisis situation. As for a normal day in the life of an online therapist, my clients are represented by avatars, who are controlled by human counterparts who have their own thoughts, feelings, opinions, and ideas. Those are things we experience in face-toface settings. Realizing that technology provides for many opportunities to meet client needs in part of my day as an online therapist!
48
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
About the authoR: Brenda Bryan has been employed by Preferred Family Healthcare for over 15 years. She has been serving in the capacity of Virtual World Counselor for approximately 3 years. She has extensive experience in working with adolescents and young adults who suffer with drug and alcohol issues and mental health issues.
P.O. Box 19265 Springfield, IL 62794-9265
B OOK S AVINGS (on separate titles only)*
• Bryan, Willie V.—THE PROFESSIONAL HELPER: The Fundamentals of Being a Helping Professional. '09, 220 pp. (7 x 10), $51.95, hard, $31.95, paper.
Save 10% on 1 Book ! • Save 15% on 2 Books ! Save 20% on 3 Books !
• Correia, Kevin M.—A HANDBOOK FOR CORRECTIONAL PSYCHOLOGISTS: Guidance for the Prison Practitioner. (2nd Ed.) '09, 202 pp. (7 x 10), 3 tables, $54.95, hard, $34.95, paper.
COMING SOON! • Douglass, Donna—SELF-ESTEEM, RECOVERY AND THE PERFORMING ARTS: A Textbook and Guide for Mental Health Practitioners, Educators and Students. '11, 232 pp. (7 x 10), 6 il., 5 tables.
• Kocsis, Richard N.—APPLIED CRIMINAL PSYCHOLOGY: A Guide to Forensic Behavioral Sciences. '09, 306 pp. (7 x 10), 4 il., 2 tables, $65.95, hard, $45.95, paper.
• Goodman, Karen D.—MUSIC THERAPY EDUCATION AND TRAINING: From Theory to Practice. '11, 296 pp. (7 x 10), 3 tables. • Bernet, William—PARENTAL ALIENATION, DSM-5, AND ICD-11. '10, 264 pp. (7 x 10), 15 il., 4 tables, $63.95, hard, $43.95, paper.
• McNiff, Shaun—INTEGRATING THE ARTS IN THERAPY: History, Theory, and Practice. '09, 280 pp. (7 x 10), 60 il., $59.95, hard, $39.95, paper.
• Ensminger, John J.—SERVICE AND THERAPY DOGS IN AMERICAN SOCIETY: Science, Law and the Evolution of Canine Caregivers. '10, 340 pp. (7 x 10), 25 il., 1 table, $69.95, hard, $47.95, paper.
• Richard, Michael A., William G. Emener, & William S. Hutchison, Jr.— EMPLOYEE ASSISTANCE PROG R A M S : Wellness/Enhancement Programming. (4th Ed.) '09, 428 pp. (8 x 10), 8 il., 1 table, $79.95, hard, $57.95, paper. • Thompson, Richard H.— THE HANDBOOK OF CHILD LIFE: A Guide for Pediatric Psychosocial Care. '09, 378 pp. (7 x 10), 5 il., 15 tables, $79.95, hard, $55.95, paper. • Wilkes, Jane K.—THE ROLE OF COMPANION ANIMALS IN COUNSELING AND PSYCHOLOGY: Discovering Their Use in the Therapeutic Process. '09, 168 pp. (7 x 10), 2 tables, $29.95, paper.
NOW AVAILABLE! • Anthony, Kate, DeeAnna Merz Nagel & Stephen Gos s — T HE US E OF TECHNOLOGY IN MENTAL HEALTH: Applications, Ethics and Practice. '10, 354 pp. (7 x 10), 6 il., 5 tables, $74.95, hard, $49.95, paper.
5
• Bellini, James L. & Phillip D. R umri l l , J r.—R E SEARCH IN REHABILITATION COUNSELING: A Guide to Design, Methodology, and Utilization. (2nd Ed.) '09, 320 pp. (7 x 10) 3 il., 5 tables, $66.95, hard, $46.95, paper.
easy ways to order!
PHONE: 1-800-258-8980 or (217) 789-8980
FA X
FAX: (217) 789-9130
EMAIL: books@ccthomas.com
• Marvasti, Jamshid A.— PSYCHO-POLITICAL ASPECTS OF SUICIDE WARRIORS,TERRORI S M A N D M A RT Y RDOM: A Critical View from “Both Sides” in Regard to Cause and Cure. '08, 374 pp. (7 x 10), $73.95, hard, $53.95, paper. • Moon, Bruce L.—INTROD U C T I O N TO A RT THERAPY: Faith in the Product. (2nd Ed.) '08, 226 pp. (7 x 10), 20 il., $53.95, hard, $33.95, paper. • Wiseman, Dennis G.— THE AMERICAN FAMILY: Understanding its Changing Dynamics and Place in Society. '08, 172 pp. (7 x 10), 4 tables, $31.95, paper. • France, Kenneth—CRISIS I N T E RV E N T I O N : A Handbook of Immediate Person-to-Person Help. (5th Ed.) '07, 320 pp. (7 x 10), 3 il., $65.95, hard, $45.95, paper. • Martin, E. Davis, Jr.— PRINCIPLES AND PRACTICES OF CASE MANAGEMENT IN REHABILITATION COUNSELING. (2nd Ed.) '07, 380 pp. (7 x 10), 7 i1., 2 tables, $69.95, hard, $49.95, paper. • Perticone, Eugene X.— T H E A RT O F B E I N G BETTER: An Approach to Personal Growth. '07, 268 pp. (7 x 10), $58.95, hard, $38.95, paper. • Palmo, Artis, J., William J. W e i k e l & D a v i d P. Borsos—FOUNDAT I O N S O F M E N TA L H E A LT H C O U N S E LING. (3rd Ed.) '06, 468 pp. (7 x 10), 5 il., 3 tables, $85.95, hard, $61.95, paper. MAIL:
Charles C Thomas • Publisher, Ltd. P.O. Box 19265 Springfield, IL 62794-9265
Web: www.ccthomas.com Complete catalog available at www.ccthomas.com or email books@ccthomas.com Books sent on approval • Shipping charges: $7.75 min. U.S. / Outside U.S., actual shipping fees will be charged • Prices subject to change without notice *Savings include all titles shown here and on our web site. For a limited time only. When ordering, please refer to promotional code TILT1110 to receive your discount.
TILT – Therapeutic Innovations in Light of Technology
an Online
A Day in the Life of
In 1999 I transitioned from being a therapist to a coach and have never looked back.
50
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
e Coach
Juliet Austin
There were two main reasons for this career change: First, I wanted to more away from working with people who were in emotional pain and instead focus on helping people on a level that was more achievement orientated. Second, I have always had a high need for flexibility in my lifestyle and a strong desire for travel. Providing coaching over the phone and Internet has given me the ability to attain both of these goals. I am fortunate in that I’ve had the opportunity to take my work with me while visiting other parts of the world, including a 6-month stint in Australia.
My focus as a coach is on helping therapists and healing professionals create full private practices. In addition to being a coach, I am a copywriter who writes compelling copy for therapist websites to help them attract more of their ideal
clients. In fact, at this point in my business approximately 50 – 75% of my work is copywriting. Over the years, I have developed a schedule that suits me perfectly. My workday begins between 6:00-7:00 am when I read my favorite news and business-related blogs as well as participate in various social media channels. I like to start the day by knowing what is going on in the world and within my online community.
writing and reviewing client web copy and facilitating tele-classes, workshops or coaching programs that I offer periodically throughout the year. I take several mini breaks during the day, especially in the summer as I have a huge garden on my deck filled with plants that I must tend to. These moments with my plants re-energize me and keep my thinking crisp since I spend so much time involved in the intense process of writing.
At about 8:00 am I take a break and head to my favorite coffee shop across the street. This is an important part of my day since I work at home and therefore really need to experience life beyond the walls of my apartment.
My typical workday ends between 5:00-6:00 pm and I then head out to get some exercise. Depending on the day of the week, time of the year, and the weather, this can consist of going to the gym, attending a yoga class, having a swim, taking a walk or enjoying a bicycle ride.
Upon returning from the coffee shop at approximately 8:30-8:45, I respond to emails. On Mondays and Fridays I tend to focus on my own projects (writing articles, creating and revamping programs, and planning my marketing activities). From Tuesdays to Thursdays I focus more on client work, which includes coaching calls,
Because I work at home, many assume that I can easily do other things during the day while I work – i.e. laundry, errands, chores, etc. While doing these things during the workday may suit some people who have a home office, I prefer to devote my weekdays to my work and allow evenings and weekends for other activities. There are periods,
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
51
TILT – Therapeutic Innovations in Light of Technology
however, when I am developing and launching new programs where I will work in the evenings or on weekends if I need the extra time to meet deadlines.
the end of my day I’m eager to be out in the world interacting with people and therefore eat out a couple of times per week or socialize in other ways.
While I have been very successful with my business and enjoy it immensely, working on the phone and computer all day has its limitations. Many of my friends with jobs are relieved to get to the comforts of their home after being inside at work all day. By contrast, at
My daily schedule has developed over the years into a routine that I am unlikely to change since it works so well. I feel very fortunate that I have had the freedom to create a business that so perfectly suits my personality and lifestyle.
Juliet Austin, M.A., is a marketing coach and copywriter for therapists and healers, based in Vancouver, Canada. Her website is at http://www.julietaustin.com/
52
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
Social Presence
in Technology-Assisted Counseling
You’ve heard the old adage, “only two things in life are certain: death and taxes”.
Change is inevitable and as counselors and mental health professionals we have built our careers on that belief. Those of us working in the mental health arena have seen this play out in our profession over the last several decades. Perhaps Carl Rogers would not have been able to predict the current circumstances regarding technology-assisted counseling, but I’ll bet he would have wanted us to figure out how to proactively work with this change, and find out how to best meet our clients. T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
53
TILT – Therapeutic Innovations in Light of Technology
As we know, counseling and therapy are taking place outside of a therapy room, outside the confines of a traditional face-to-face context. While change is certain, our focus shifts to preserving the unique and foundational aspects of counseling, while figuring out how to utilize these aspects through changing modalities. Over the last few decades of research, the therapeutic relationship is cited as a foundational aspect of counseling that contributes to client change and positive therapeutic outcomes (Duncan et al., 1999; Hubble et al., 2010). The relationship cuts across client population, counseling theory, and micro skills. Above all, counselors aim to provide a warm, genuine, safe therapeutic environment where clients feel accepted and heard – creating and maintaining a therapeutic relationship. This therapeutic relationship translates into a “working alliance,” a piece of the relationship that allows both client and counselor to build mutual trust and buy into the counseling process, the ability to work on agreed upon goals for therapy.
54
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Even though counseling modalities are changing, the foundational aspects of counseling such as the therapeutic relationship and working alliance do not have to be discarded. However, is it naïve to think that our field can hold onto decades of relational focus while the structured, traditional, face-to-face modality becomes only one of myriad ways to facilitate effective counseling? Joy Waddington in TILT [issue 5] reflected on her own perceptions of presence, which were sparked by several authors in TILT [issue 3] who wrote on the issue of presence. This topic keeps coming up over and over again by those providing and receiving technology-assisted counseling, yet a lack of research on the subject makes it difficult to defend. However, from our own experiences we feel the presence of others as we relate to them via technology, both within and outside of the therapy experience. Supporting meaningful connections between people through online communication has become a multi-million dollar industry. Match. com, a successful online dating site, notes that one in five romantic relationships begin online. The majority of people with access to a computer and the Internet communicate daily, or more frequently, with friends, spouses, and strangers
w w w . on l in e t h e r a p y instit u t e . c o m
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
55
TILT – Therapeutic Innovations in Light of Technology
via technology. We supplement face-to-face relationships with those we care about through email, video chat, and text message. Those of us who use technology to communicate with the people in our lives know about the idea of presence – we can feel it and talk about it, and we know that for this reason online counseling can be successful because it maintains the presence felt between people communicating face-to-face. My recent dissertation focused on combining the idea of presence, or social presence, with the working alliance and exploring the relationship between the two in both online and faceto-face counseling. I hypothesized about a missing link that had not yet been deciphered in the literature; our profession believes in the therapeutic relationship, and online counseling has shown to be able to foster the creation and maintenance of such a relationship through technological means. However, as face-to-face and technology-assisted counseling are different, I thought there could be a bridge or connection to allow a therapeutic relationship to be formulated through both types of counseling. This bridge or connection facilitates communication between a client and counselor via online and technology-assisted communication but also could play the same role within face-to-face relationships. I turned to social presence to see if that was related to the therapeutic relationship and, if so, what were the similarities and differences between online and face-to-face counseling. My results support previous writers in TILT, as well as other anecdotal and quantitative evidence. Online counseling clients perceived a significantly stronger working alliance with
56
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
w w w . on l in e t h e r a p y instit u t e . c o m
their counselors than the face-to-face clients. This is not to say that one counseling format is better than others, but my data seem to support previous studies that have also found online counseling to be a modality in which client and counselor can develop a meaningful and functional therapeutic alliance. Additionally, no significant difference was found between online and face-to-face counseling clients regarding social presence. This supports the notion that clients, regardless of counseling modality, were aware of their counselor within the relationship and felt a similar level of presence. Social presence can be conceptualized as a critical factor within all communication mediums, the degree to which a person is perceived as “real” in face-to-face and computerand technology-mediated communication (Gunawardena & Zittle, 1997). My study found no significant difference between the two groups, which indicates that perhaps there is not as much separating the different types of counseling as originally thought. As social presence is defined by, “…the moment-by-moment awareness of the co-presence of another sentient being accompanied by a sense of engagement with the other” (Biocca et al., 2001, p. 2), the current data support the idea that clients who developed relationships with their counselor through computer-mediated communication perceived a similar sense of awareness and engagement of their counselor throughout the working relationship. Moreover, this study highlighted that the working alliance and social presence were significantly positively correlated, indicating that as clients’ perceptions of the strength of the working alliance increased, the perception of the strength T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
57
TILT – Therapeutic Innovations in Light of Technology
REFERENCES Biocca, F., Harms, C. & Gregg, J. The networked minds measure of social presence: Pilot test of factor structure and concurrent validity. Retrieved on September 1, 2010: www.mindlab.org.
the
Duncan, B., Miller, S., Wampold, B., Hubble, B. (2010). The heart and soul of change: Delivering what works in therapy. (2nd ed.) Washington, DC: American Psychological Association. Gunawardena, C. N. (1995) Social presence theory and implications for interaction and collaborative learning in computer conferencing. International Journal of Educational Telecommunicaiton, 1(2-3), 147-166. Gunawardena, C. N., & Zittle, F.J. (1997). Social presence as a predictor of satisfaction within a computer-mediated conferencing environment. The American Journal of Distance Education, 11(3), 8-26. Hubble, M., Duncan, B. & Miller, S. (1999). The Heart and Soul of Change: What works in therapy. Washington, DC: American Psychological Association.
of social presence also increased. This finding underscores the fact that social presence and working alliance have some content in common. As clients were able to feel more aware of and connected to their counselors, the perceptions of the strength of the working alliance increased. In her research on online distance education, Gunawardena (1995) concluded, “in spite of the low social context cues of the medium, student perceptions of the social and human qualities of the medium will depend on the social presence created by the instructors/moderators and the online community” (Gunawardena, 1995, p. 164). This perspective highlights the responsibility that online counseling practitioners have to intentionally develop social presence within their relationships. We can be deliberate in creating social presence within our technology-assisted relationships, perhaps with the words we use or
58
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
the particular words we use to explain ourselves and our ideas. While my research suffered from some methodological limitations such as a small, volunteer-only sample, and relied on a one-time survey design, I began to address the idea of social presence within the literature. Perhaps this may be a tool to foster a better understanding of why a relationship built through computermediated means can feel equally as meaningful and genuine as one facilitated face-to-face. As we continue to discuss how to better serve our clients and how to increase our effectiveness as practitioners in every counseling modality, perhaps the idea of social presence can enhance these discussions. Additionally, social presence may be a way to enhance the training of new counseling students. If we know that a stronger
w w w . on l in e t h e r a p y instit u t e . c o m
sense of social presence is positively correlated with a stronger therapeutic relationship, how can we be intentional when creating a stronger social presence within our counseling sessions, both on- and off-line? What are the practical and concrete techniques online counseling practitioners can use when they are serving clients? If we begin to highlight specific techniques, we can teach them to counselorsin-training who will potentially be utilizing technology-assisted counseling in their future careers. As change is inevitable, we can use this to our advantage in creating tools that help our field gain competency in treating clients in their preferred modality, in meeting them where they are – a past, present and future goal of our profession. n
ABOUT THE AUTHOR Courtney Holmes is a recent graduate from the College of William & Mary in Virginia with her Ph.D. in Counselor Education and Supervision. She is an Assistant Professor at Bowling Green State University in Ohio in the Mental Health and School Counseling program.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
59
TILT – Therapeutic Innovations in Light of Technology
Cyber Supervision Anne Stokes
Recently in a supervision of supervision session, my online supervisee was talking about one of her supervisees (still with me?!) who is from a different cultural background. This led me to think again about the issues in supervising across cultures. I recalled the diagrams that Joyce Thompson and Colin Lago often used when discussing this issue in face-to-face supervision, and how complex it can become. The broad line on the triangle represents the supervisory relationship.
60
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
What do we mean by ‘culture’? Cultural diversity can arise within one country or state, or across national boundaries. Nationality may be the most obvious one, but even where it exists, it is perhaps only the ‘container’ for other differences. There may be a difference in language, with one or more parties working in a second language. Other elements of diversity could be concerned with faith or religion (not always the same thing!), collective belief systems, gender, sexuality and socioeconomic factors, to name but a few. It is also quite possible to argue against making this a topic for consideration, of course, by suggesting that as
Cross Cultural Supervision
w w w . on l in e t h e r a p y instit u t e . c o m
Anne Stokes is based in Hampshire, UK, and is a wellknown online therapist, supervisor and trainer and Director of Online Training ltd.
all of us belong to our own unique, created cultures, all supervision is cross cultural. While there is some realism in that statement, I also think that it can be a way of being complacent. Hopefully all supervisors and counsellors working online will have had some training around issues of culture and diversity, and examined their own beliefs and prejudices. This is necessary whether working face-to-face or online, though it is possible that online work might involve a greater range of differences than face-to-face – I am sitting here examining my own assumptions around that remark and am open to challenge on it!
What does this mean for our online supervision? So what must an online supervisee and supervisor consider when setting up a contract that may cross cultural boundaries? Perhaps the most important thing is a willingness to be open with each other from the outset, and able to discuss what the issues might be, and how they could affect the supervisory relationship. Because we don’t see each other, it is so easy to make assumptions about each other. Questions to ask ‘myself’ and the ‘other’ could be around blind spots, limitations and biases, a willingness to learn from each other, and whether ‘I’ am open to challenge, and review of our supervision arrangement.
In my experience, people can be reticent to ask questions that they feel might be intrusive, rude or prejudiced. Not asking the questions can lead to difficulties later. So how would I feel about asking a South African supervisor or supervisee about their ethnic origin? Do I assume that because a supervisee is from the same country as me that we share ethnicity or first language? And might I make assumptions from whatever the answers are, about other aspects of the person, their counselling approach and their background? And do we as supervisors ever ask our supervisees to tell us more about what meaning they make concerning the cultural differences between them and
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
61
TILT – Therapeutic Innovations in Light of Technology
their clients, or again, do we make assumptions? If we return to the triangles shown above, there are positive and more unhelpful aspects to all of them. In the first one, the supervisee could assume that the supervisor will not understand specific issues that are arising in the counselling. While that could be accurate, it may also be true that the supervisor, who is looking in on the process from outside, could challenge the supervisee to avoid making assumptions simply because s/ he understands the culture of the client. In the second example, the blind spot could be that because the supervisor and supervisee share a cultural similarity, they don’t understand, research or ask about how the client may be affected by his or her culture. The opposite – being very aware of diversity – could have a negative or positive affect. Obviously the positive is to ensure that the client is heard in terms of their own context, while taking it as the only lens
62
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
through which to see the client may mean that they are in fact not truly ‘seen’. Finally, in triangle three, the supervisor could be unconsciously collusive with the unseen client, protecting them from the supposed cultural blindness of the supervisee. While it is right to challenge supervisees, we also need to remember in this scenario, that they may not be blind to differences, and that they are actually the ones engaged with the client, and hopefully have a greater overall awareness of the whole person.
In this triangle, the positive aspects include the supervisor being able to pass on their knowledge and awareness from sharing something in common with the client. The greater possibility of working across cultures and borders is a great strength and opportunity in online work. It is simply necessary to stay mindful and open. In this short article, it is not possible to plumb the depths of cross cultural supervision, its potency and its flaws, so I hope that readers will add their thoughts and experiences by means of letters to the journal or email correspondence with me.
DISTANCE CREDENTIALED COUNSELOR (DCC™) TRAINING E hours BECOME A DCC COUNSELOR
15 C
SIGN UP TODAY FOR A DCC TRAINING WORKSHOP AND EARN 15 CE HOURS UPCOMING 2011 DATES:
9/15 & 9/16 Durham, NC 9/22 & 9/23 Lyndhurst, NJ 10/13 & 10/14 Smyrna, GA 10/25 & 10/26 Denver, CO 11/17 & 11/18 Williamsburg, VA
UPCOMING 2012 DATES: 4/19 & 4/20 Albany, NY 5/3 & 5/4 Boston, MA
FACILITATOR:
DEEANNA MERZ NAGEL, LPC, DCC
WORKSHOP FEE: $595.00 Discounts available if you REGISTER EARLY WHAT PROFESSIONALS ARE SAYING:
“What a comprehensive, informative course! I feel confident that I have the knowledge, the resources, and tools needed to implement online counseling in my own practice. THANK YOU!! Money WELL-spent.” Wanda McCallum, LPC “What a PHENOMENAL Training! DeeAnna Merz Nagel provided invaluable information on using encryption to protect confidentiality, how to maintain appropriate relationship boundaries, and how to screen clients for suitability of receiving these modes of delivery. It was by far the best workshop I’ve ever attended!” Debra D., MSEd, LPC
CONTACT LISA MILLER @ LISA@READYMINDS.COM OR CALL 888.225.8248 FOR MORE INFORMATION
Interested In Getting the Word Out About Your Products & Services? We offer various ways to advertise and "Get Promoted"!
For a pdf download of our Media Kit visit: http://www.onlinetherapymagazine.com/advertising-options
TILT – Therapeutic Innovations in Light of Technology
Ne wInnovations
How to Creat Video Introdu Mark Goldenson When the American Psychological Association identified why more people do not get psychological care, one of the top reasons was the difficulty of finding a wellmatched provider. People seeking care frequently try talking with multiple providers before selecting one. This trial-and-error is time-consuming, expensive, and frustrating. The stigma of seeking care can also prevent people from asking friends and family for recommendations, making the selection process more inefficient. How can this be addressed? An emerging way for potential patients to learn about providers is a video introduction. A video introduction is a short recorded
64
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
video that lets a provider convey his or her strengths, specialties, education, communication style, and other information and intangibles. Video lets providers show who they are instead of just tell and potential patients are increasingly seeking it.
Four Steps to Creating a Video Introduction
1
Write sixty seconds of content
First, outline what you believe clients should most know about you. Highlight your greatest strengths and what you believe most differentiates you. This
can include your education, credentials, specialties, personal skills, any proprietary assets or techniques, and contact information. Sixty seconds is a good length. It is long enough to give a good overview while short enough for easy watching.
2
Setup your video environment
Recording video is simpler than ever. All you need is a computer, Internet access, and webcam or camcorder. Find a professional backdrop - probably your office – and place a light source in front of you. Dress how you would in your daily practice and sit close
w w w . on l in e t h e r a p y instit u t e . c o m
te a uction enough to the camera that your audio is clearly captured. You can enhance this by attaching a simple microphone. You can record your video on Youtube, which also has tools to edit the video and add annotations like a website URL or phone number.
3
Practice and record
You don’t need newscasterquality performance skills; you can practice as many takes as you like! The best delivery will be natural and that may come best by imagining you are talking to someone personally. Instead of reciting your content
Mark Goldenson is CEO of Breakthrough.com, a free virtual office for online counseling.
word-by-word, try just hitting your talking points. Ask a friend or colleague for feedback before selecting your final version.
4
Broadcast your video
offering not only one central place to upload your video, but also analytics on how your video is doing across multiple sites. Video is a great way to expand your practice and find the best clients for you. Happy filming!
Once you are happy with your video, you can broadcast it to many places. You can embed or link to it on your website, therapist directories, YouTube, LinkedIn, Twitter, and other social media sites. TubeMogul is the leading free tool to mass broadcast videos,
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
65
TILT – Therapeutic Innovations in Light of Technology
Marketing Toolbox Margaret Adams
Is Your Website Holding You Back? Is your website doing all it should to help you grow your practice? Margaret Adams asks some challenging questions..... There’s an awful lot written about websites. After all most coaches, counsellors, therapists and other expert professionals have them these days. Yet, many websites aren’t exactly what you might call business assets. In fact, some of them really let their owners down. Does your website fall into that category? Is your website letting you down? Is your website interesting? Take a look at your site. Is it interesting? Is the content written with your visitors and potential clients in mind? If I found your site for the first time today, and took a look around, and then came back next week, would anything
66
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
be different? Would you have uploaded new content, new articles, additional guidance that I might find useful as a potential client, or would the site look just the same? One of the truisms quoted often about websites is that: content is king. Is that true of your site? Will I find your content interesting this week, next week and next month? Is your website engaging? What does your website do to engage with me, to start a dialogue with me, to start to build a relationship with me? Do you invite me to come and meet you on your Facebook page (not your personal profile)? Do you invite me to join you on Twitter? Do you ask me to comment on your blog posts? Do you ask me to take part in surveys or polls? Put simply, does your website suggest that you’re interested in me and my opinions? The social web has made the internet more interactive. It’s encouraged people to converse, to exchange views and to connect in all sorts of ways. You don’t need to share your personal history or your life story with the world, but the days when a website could simply be an online brochure have gone. Have you kept up with these changes?
w w w . on l in e t h e r a p y instit u t e . c o m
What do you want me to do next? Most people focus on two issues when they create their websites. These are the technical issues, which are often a source of stress and frustration, and the content, because every one knows how important a website’s content is. If you stop there, you’ve missed something very important. Your website is part of your marketing mix. Its purpose, in the context of your business, is to get me, the visitor, to take the next step towards becoming your client. Yes, it’s great to get new Twitter followers, and Facebook fans, but is your website doing more for your business? Does every page have a call to action? Does every page tell me what you want me to do next? You might want me to sign up for your newsletter or free e-course, and in doing so give you my email address and permission to contact me when you choose to do so. You might want me to pick up the telephone and call you. You might want me to buy something or to book a place on a course. When I read your website copy, will it be clear to me what you want me to do next?
FOLLOW TILT MAGAZINE on Facebook and Twitter
Finally . . . Used correctly your website is an important business asset. Used without care it’s a cost, and maybe a liability. Take a look at your site. What’s your decision? Is your website helping your business, or is it holding your business back? n
Margaret Adams helps coaches, consultants, counsellors, therapists and other expert professionals to bring in more new business quickly. Find out more about her work at http://www.margaretadams.co.uk/contact/tiltmagazine/
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
67
TILT – Therapeutic Innovations in Light of Technology
Int roducing
Get Verified for Coaches!
Open Office Hours Stay tuned for new interactive ways to ask your questions! we will be livestreamed from Second Life each month!
Upcoming Dates
You can join us in Second Life or simply view the livestream and join us in chat thanks to our partnership with OnlinEvents.co.uk.
Our meetings are held once a month for one hour
Details can be found at
2pm EST
www.therapistsandcoachesopentotechnology.com
> October 6 > November 10 > December 5
68
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
Mon Offic thly e Even Hour ts ar e
Fr
to At ee tend !
w w w . on l in e t h e r a p y instit u t e . c o m
Online Therapy Institute Verification When you see this seal on a website it means Online Therapy Institute has verified this website as compliant with Online Therapy Institute’s Ethical Standards. We will display thumbnails of everyone who has become verified since the last issue.
Look Who's
VERIFIED ECRYPT.ME IS THE EASIEST AND MOST SECURE WAY TO SEND AND RECEIVE EMAILS, AND STORE FILES, ANYWHERE ON THE INTERNET.
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
69
TILT – Therapeutic Innovations in Light of Technology
“The paperback is very interesting but I find it will never replace the hardcover book - it makes a very poor doorstop.” ~Alfred Hitchcock
Love For the
Books of
70
T I L T MAGAZ I N E s e p t e m b e r 2 0 1 1
s
The Cinematic Mirror for Psychology and Life Coaching Mary Banks Gregerson Although many movie guides exist, this volume complements the available literature by adding positive psychology, mental health, and wellness perspectives to the clinical/educational/coaching mix. The serious intent to cull from cinema its underlying psychological value has motivated noted clinicians, life coaches, and cultural critics to offer science-based analysis and intervention strategies. Readers may add their own movie insights and professional expertise to this rich foundation. The volume covers international as well as domestic cinema in a variety of genres, providing a range of film choices relevant to clients’ lives. Beyond this, it expands on universal concepts of strengths, capabilities, and coping methods. Chapters in The Cinematic Mirror: analyze how movies can create and relieve trauma, challenge Hollywood’s portrayal of the American family, overview the use of movies to examine relationships in therapy, explore the acclaimed Up television cinema verite series as studies in personal growth and social change, reinterprets images of disability in terms of positive psychology, examines models, or the lack thereof, for the American adolescent rite of passage, traces the history of mental illness stereotypes in film.
BUY NOW
Cyber Bullying: Bullying in the Digital Age Robin M. Kowalski, Susan P. Limber, Patricia W. Agatston Cyber bullying has become more prevalent through the use of e-mail, instant messages, chat rooms, and other digital messaging systems. It brings with it unique challenges. Cyber Bullying provides the most current and essential information on the nature and prevalence of this epidemic, providing educators, parents, psychologists and policy-makers with critical prevention techniques and strategies for effectively addressing electronic bullying. •
Provides an empirically-based resource with up-to-date information about the nature and prevalence of cyber bullying through the use of email, instant messages, chat rooms, and other digital messaging systems
•
Examines the role of anonymity in electronic bullying
•
Includes feedback from focus groups and individual interviews with students and parents
•
Offers a handy reference with practical strategies for educators, parents, psychologists and policy makers about prevention and intervention of cyber bullying
BUY NOW
Visit the Online Therapy Institute’s Book Store to purchase featured books and more! http://www.onlinetherapyinstitute.com/bookstore/
cybermarket
ONLINE NONCREDIT CERTIFICATE
�
EXCLUSIVELY FO R ADU LTS
Wo rkf o r ce Car eer C o ach Facil itato r
120-hour online program prepares you to help others find jobs and new careers
Satisfies training requirement for Global Career Development Facilitator (GCDF) credential
Students earn up to 15 CEUs
www.tesc.edu/noncredit (888) 442-8372
Expand your practice Improve client access Reduce No‐Shows
Connect to clients via web based HIPAA‐compliant video, email & chat No expensive equipment or software to buy Collect payments online and submit claims Private label your practice For information or a free demo call 616‐805‐9452 or email sales@breakthrough.com
Online Counseling:
A Handbook for Mental Health Professionals, Second Edition Edited By Ron Kraus, George Stricker & Cedric Speyer The fully updated new edition is now available! Order directly at elsevierdirect.com/9780123785961
20110032_A_Online Counseling ad_095-953_1200.indd 1
Interested in advertising in the TILT Magazine CYBERMARKET? $75 single issue For payment and other advertising options please visit us online at http://www.onlinetherapymagazine.com/advertising-options
3/4/11 11:44
cybermarket
cybermarket
THE LAW OFFICES OF BRUCE V. HILLOWE, J.D., Ph.D. A LAW PRACTICE EMPHASIZING MENTAL HEALTHCARE LAW, HEALTHCARE LAW, MEDIATION AND GENERAL CIVIL PRACTICE An attorney with 28 years of experience, Bruce formerly practiced as a psychologist. He represents mental health and healthcare practitioners and agencies for all their legal needs. TELEPHONE CONSULTATIONS AVAILABLE: (516) 877-2016 & (800) 286-0369
190 Willis Avenue, Suite 205, Mineola, New York 11501. For more information visit our website at www.brucehillowe.com
Email eve@applecoaching.com to find out more about how telephone life coaching, business coaching, NLP coaching and EFT coaching can help you and your practice.
www.applecoaching.com
for core confidence in your work, life and relationships
ERE H D A R U YO
ERE H D A UR O Y
ERE H D A R U YO
ERE H D A R U YO
Online Therapy Institute, Inc. P.O. Box 392 Highlands, NJ 07732 877.773 5591 www.OnlineTherapyMagazine.com Magazine Designed by AI Virtual Solutions
Stay tuned next issue for... 99 More great articles about online coaching, online therapy and related topics! 99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology! 99 If you are interested in submitting an article, review our author guidelines at www.onlinetherapymagazine.com 99 If you are interested in advertising in an upcoming issue, email advertise@onlinetherapymagazine.com