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Issue Three 2011 ISSN 1835-937X

Virtual Therapies

Journal of the Counsellors and Psychotherapists Association of NSW Inc


CAPA

Annual General Meeting 10am, Saturday 13 August 2011 Crow’s Nest Centre, 2 Ernest Place, Crow’s Nest

Schedule of events: 10.00am – 12.00pm AGM 12.00pm – 12.30pm Address by Ione Lewis, President, PACFA 12.30pm – 1.00pm

Lunch break

1.00pm – 4.00pm

PD session (see details below)

PD hours: 4

CAPA NSW Professional Development Event: Elizabeth Riley Children Are Born to Be Who They Are, Not Who We Want Them to Be: The Needs of Gender Variant Children and Their Parents Adults with gender variant childhoods have often lived traumatic lives due to the attitudes and limited understanding of the people in their environment while parents of children with gender variant behaviour are forced to contend with societal bias and assumptions that allow their children to be marginalized. Understanding the needs of gender variant children and their parents is a necessary step towards the provision of suitable training and interventions for the support of gender variant children into adulthood. Professionals who work with the transgender community also have a unique

perspective to aid in the understanding of issues and needs of gender variant children and their parents through years of experience with a variety of transgender clients. This presentation focuses in the findings of a recent investigation aiming to identify the needs of gender variant children and their parents. The primary needs for gender variant children were for acceptance recognition, freedom of expression and validation of their feelings. The dominant parents’ needs were related to information and professional guidelines followed by professional support, parenting strategies and peer support.

Elizabeth Riley is a counsellor, supervisor, and educator specialising in sexuality and transgender counselling and a Senior Educator at the Australian College of Applied Psychology. A PhD candidate, she has been part of a team researching the needs of gender variant children and their parents. She is also a counsellor, consultant and trainer for the St James Ethics Centre and works in private practice in Sydney. Elizabeth has presented papers and workshops, both locally and internationally, in the areas of Sexuality, Gender Identity, and Ethics.


Welcome

Editorial

The future is now. ~ Nam June Paik (electronic artist) & countless others

Those of us ‘of a certain age’ remember a childhood where futuristic fiction depicted technologies that have since become not only real but commonplace and have, in fact, become so integral to our lives that a world without them seems almost unthinkable. It’s probably safe to say that in developed countries, all but the poorest people, even children, now have personal mobile phones that they carry with them wherever they go. We are sometimes too ‘reachable’, losing a portion of our privacy in the interest of instant contact—and who among us, especially professionals, does not use e-mail as a primary mode of communication? Social networking sites such as Facebook and Twitter have become not only the way most children stay in touch and interact, but they are common communication tools for many adults as well. These sites have even entered the business mainstream as communications and marketing tools for nearly every imaginable sort of enterprise. Personal websites and blogs also abound. Our youth have never known a world where cybertechnologies are not the norm. Babies seem almost to emerge from the womb already wired for quickly learning how to use computers. Not to be left behind, even many seniors have plugged into cyber systems. My ninety-year-old aunt, for example, loves her e-mail and Google, though she’s not game to expand her techie skills beyond that. The topic of these communications technologies—their reach, and the psychological effects and implications of them— is far too vast a topic to cover adequately in a journal, but we can offer here a few insights. Naturally, the availability of modern communications technologies affects the way counsellors and therapists do business and interact with clients and potential clients, expanding the range of possibilities, easily vaulting over hurdles of time and distance. While social concerns are often raised about people, especially the young, spending too much time on line and not enough interacting with others in the real world, and about the very real dangers posed by anonymity and cyber-predation, researchers have revealed that there are also distinct social and psychological benefits to such distancing and the availability of anonymity or masked identity, though there are cautions to be observed. Our lead feature this quarter addresses the use of avatars— images chosen by users to represent themselves—in the delivery of therapeutic services in the cyberworld through programs such as Second Life, where virtual worlds manipulable by users facilitate uninhibited interactions between counsellor and client. We present reviews and analyses of the important and valuable online counselling resources available through e-hub Self Help Services at the Australian National University’s Mental Health Research Centre and, especially for children and youth, the Kids HelpLine run by the Queensland-based social services organisation, Boystown. August 2011

Our regular columnist offers an expanded presentation about the use of technology in private practice: the recommended and the not recommended. In an interview by your Editor, an anonymous client offers a valuable perspective by sharing her experience of therapy through the medium of Skype, and an experienced supervisor offers her perspectives and those of a sampling of her supervisees on conducting and receiving supervision through Skype and phone vis-à-vis face to face. Our next issue, November 2011, is devoted to the topic of Addictions, and in addition to coverage of those most familiar, we have an article that could have been in this issue, looking at the multiple varieties of internet addictions and their therapies. Stay tuned! Clare Mann is stepping down as our columnist due to new and exciting enterprises she has taken up, so her contribution to this issue will be her last column. We are appreciative of and grateful for the insights she has provided to our readers over the years and wish her well in her new ventures. I am entertaining proposals for a replacement columnist (see Page 5). We have received the sad news that valued CAPA member Lucia Brooks passed away in April after a brief bout with cancer (see Page 5). We also received a complaint that one of our authors last year had failed to adequately acknowledge in his referencing the work of the complainant, and the author has offered his apology for that oversight (see Page 34). There has been a change in the post-AGM PD presentation, and new details are presented on the facing page. Please note The CAPA Quarterly blog has been taken down, and the information previously found there will be moved to the main CAPA website, www.capa.asn.au. In the interim, that information can be obtained from office@capa.asn.au, editor@ capa.asn.au or advertising@capa.asn.au, depending on the nature of your enquiry. We apologise for any inconvenience this time off line may cause. As always, this journal is for you, our valued members, and I enthusiastically encourage your active participation in the professional dialogue and sharing that this journal provides. Please have a look at the upcoming themes announced on Page 36 of this issue and have your say on the topics that interest you. Journal articles are, by the nature of page space, limited, and early contact with me improves the chances of your contribution being included. Dialogue is welcome and encouraged. If you’d like to contribute to future issues, please contact me at editor@capa.asn.au. Laura Daniel Editor Laura Daniel, BA, JD, is a Sydney publishing professional with more than forty years’ experience in the industry, both in Australia and overseas (http://www.editorsnsw.com/esd/ae1445523.htm). In addition to editing, she also designs, writes, mentors, composes, paints, sculpts, photographs, sings, dances, walks, rides horses, does yoga and appears in minor film roles and commercials.

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CAPA NSW Executive and Staff President Maxine Rosenfield president@capa.asn.au Vice-President Linda Magson vicepresident@capa.asn.au Secretary Jennifer Heward secretary@capa.asn.au Treasurer Campbell Forsyth treasurer@capa.asn.au Ethics Chair Jeni Marin ethics@capa.asn.au PD Coordinator Juliana Triml capa.pd@hotmail.com Membership Chair Beate Zanner membership@capa.asn.au

Contents Welcome 1

Editorial

CAPA News 3 4 5

From the Vice-President and Membership Chair Rural and Regional Report ~ Sharon Ellam CAPA Update

Features 6

Avatar Therapy ~ DeeAnna Merz Nagel and Kate Anthony

In Review 10 Helping Clients to Help Themselves: e-hub Self Help Services ~ Kathleen M Griffiths, Helen Christensen, Kylie Bennett, and Julia Reynolds 16 Counselling Kids On Line: The Tech-Savvy Generation ~ John Dalgleish and John Hartshorn Practice Tips

Regional and Rural Liaison Chair Phil Hough regional@capa.asn.au

20 Lost in Translation: How Communications Technologies Can Help or Hinder the Therapeutic Process ~ Clare Mann

Administrative Assistant Christine Rivers office@capa.asn.au

Conversations

The CAPA Quarterly Editor Laura Daniel editor@capa.asn.au Advertising Coordinator Jennie Maxwell advertising@capa.asn.au

24 The Face on My Computer Screen: A Client’s Experience of Therapy via Skype ~ Laura Daniel First Person 26  Supervising Through Cyberspace: A Personal Reflection ~ Eveline Crotty Professional Development 30 Suffering Loss and the Search for Identity ~ Review by Juliana Triml 31 Professional Development Events Member Profile 32 Tessa Marshall Noticeboard 35 Classifieds 36 Calls for Contributions & Ad Rates Back Cover Conference Calendar

Cover art by Jim Frazier/Stock Illustration Source Design by Sarah Marsden for Unik Printing The CAPA Quarterly respectfully acknowledges the Gadigal people of the Eora Nation, the traditional owners and custodians of the land on which the CAPA NSW office is located; and the traditional owners of all the lands through which this journal may pass.

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Š CAPA NSW 2011. Copyright is held with CAPA NSW and individual authors. Please direct permission requests to the editor. Opinions expressed in The CAPA Quarterly do not necessarily represent those of the editor or of CAPA NSW. While all reasonable care has been taken in the preparation of this publication, no liability is assumed for any errors or omissions. Liability howsoever as a result of use or reliance upon advice, representation, statement or opinion expressed in The CAPA Quarterly is expressly disclaimed by CAPA NSW and all persons involved in the preparation of this publication. The appearance of an advertisement in The CAPA Quarterly does not imply endorsement of the service or approval of professional development hours from the service. Advertisers are advised that all advertising is their responsibility under the Trade Practices Act.

The Capa Quarterly


CAPA News

From the Vice-President & Membership Chair Our formal role as the two co-opted members with specific roles on the Executive Committee lasts until the AGM elections this year, and we are grateful for the learning and personal stretch that serving on a committee can provide. In addition to the elected roles, there can be up to three coopted members and two external members with expertise in areas such as law, ethics, marketing, and human resources. We encourage other CAPA members to step up as leaders in the next exciting new phase of CAPA NSW. We are pleased to provide an update of activities since the last quarterly issue of our CAPA journal. It has been a busy time, setting strategic directions for CAPA NSW and establishing a shared vision—assuring standards of excellence in counselling and psychotherapy from our member practitioners in NSW. To this effect, there has been much work done on articulating governance standards and policies to guide the work of all volunteers and employees and to establish more of a leadership role for the incoming Executive after this AGM. The CAPA office is the coalface of CAPA operations. We have employed a temporary administration assistant, Innas Almazide, to help Christine in the office and have added the role of an Office Coordinator to look after the core business of members and implement the decisions and directions of the Executive Committee. Membership renewals occur between mid-May and midAugust, so we are now at the tail end of the process. This year we formed assessment teams to process the 800 or so applications for renewal and regrading. We would like to thank the people involved who came primarily from the Executive and Membership Committees. Next year, this role will be assumed by the Office Coordinator. Preparations have been under way for a new website for CAPA, maintaining the existing logo and light blue colour we associate with CAPA NSW and adding a new, contemporary, professional look, increased user-friendliness, clearer content and helpful features for members. A new database is also being developed to better support the work of the administration in meeting members’ needs for timely and efficient service. Our new-look CAPA journal has been introduced by our new Editor, Laura Daniel, who brings her expertise as an international publishing professional. The much-awaited PACFA Register external audit took place on 28 April and the auditor determined that the register

met all of Medibank Private’s criteria. On 24 May PACFA advised that they have been successful in their application to Medibank Private for recognition of PACFA Registrants as Medibank Private Providers. By the time this journal is published we expect that eligible CAPA members will have received their provider numbers. Other CAPA members are still finalising RPL requirements to make this possible. PACFA will continue their advocacy role and following up other Private Health Funds to request the provision of similar benefits to PACFA Registrants. Future challenges for the Executive Committee will be to support PACFA with its federal lobbying and to lobby state governments to recognise registered counsellors and psychotherapists as a valued resource in early intervention for mental health and for addressing the shortage in supply in this area. The Executive Committee would like to thank Maxine Rosenfield for her tireless work as President of CAPA NSW (2009-2011) and to acknowledge her vision and energy, and the amount of time and effort she has given the organisation in this role and to her work for CAPA in general. Her achievements are most notably the representation of CAPA in the broader counselling and psychotherapy profession and the myriad tasks she has undertaken in pursuit of streamlining procedures and furthering the reputation and public standing of CAPA members. With Crystal Lockard, she successfully negotiated the acceptance of clinical CAPA members by WorkCover NSW in their revised regulatory framework, and strengthened CAPA’s standing with PACFA to get provider numbers for our eligible clinical members. She has continued to support the need to lobby NSW government agencies for their support for counselling and psychotherapy, and the CAPA working party that involved interested members and provided you with lobbying material for the NSW election earlier this year was one outcome of her passion in this area. Developing CAPA’s Regional and Rural Committee and supporting the implementation of PD events for rural and regional members has been a priority. Maxine has built on the foundations of past Executive Committees by strengthening and formalising the infrastructure and streamlining processes. We hope this message finds you well, and remember that to do good work with your clients you need to look after yourself and always reach out for support when required.

Warmest wishes,

Linda Magson Vice-President August 2011

Beate Zanner Membership Chair 3


CAPA News

Rural and Regional Report The Port Macquarie PDE in May was a great weekend! Nineteen participants travelled from Sydney and the Blue Mountains, from as far north as Lismore, and as far west as Brewarrina—coverage from roughly a third of NSW. Planning began during the Queensland floods, coinciding with two youth suicides in Port Macquarie. We aimed to focus on connections, support and information sharing for regional counsellors who were possibly affected and feeling isolated. Kristal Morris & Uncle Bill, an Elder of the Biripai Tribe, spoke about Domestic Violence in Aboriginal Communities. They showed an educational video on domestic violence, alcoholism and culture, called Respect. The outcome of a community project in 2009, also illustrating the role of Elders, this video is shown in the community often, identifying respect to elders, self, culture, and women. A strong traditional culture of support provides a sense of ‘belonging’ to guide those affected by alcoholism towards help and rehabilitation. ‘Building Belonging’ is a feature of local change with various groups formed for elders, men, youth and women. Sacred Men’s Initiation Ceremonies were re-introduced after being stopped in 1937, resulting in improvements as they ‘tackle the young ones’ to break the cycle of apathy. They described fourth and fifth generation unemployment as a major difficulty in raising motivation. Also introduced was a program called ‘Rainbow Readers’ with preschoolers. Kristal can be contacted at Kristal.Morris1@tafensw.edu. au to purchase a copy of Respect. Funds are being sought to make another video to educate communities about the role of women. Coralie Reeve a CAPA Clinical Member gave a comprehensive overview on caring for carers of people with a mental illness. Representing ARAFMI-Hunter, an organisation supporting family and friends of the mentally ill, Coralie began with a quote from a carer:

Kids–Hunter, he described SIDS as a ‘diagnosis of exclusion’ in a baby less than 12 months old. The SIDS and Kids ‘Safe Sleeping’ Risk Reduction Program aims to reduce death by suffocation and choking, resulting in an 85% reduction in SIDS. The incidence of SIDS is highest at 3–6 months of age, and 14 times higher when parents smoke a packet of cigarettes per day. Phil presented some startling statistics. In 2007, in NSW one in five pregnancies resulted in a perinatal death (death between 20 weeks of pregnancy and 28 days after birth). He shared emotive descriptions of Grief Counselling, which he described as ‘bringing their child into the room’. ‘Sitting with them and re-visiting their child’ is the focus of counselling those who grieve. Being empathic is about ‘walking with some people to a pretty tough place’. He said it was ‘humbling’ to consider what it is like for people to come and tell their story. Contact SIDS and Kids on www. sidsandkids.org or Phil on supporthunter@sidsandkids.org. Youth Suicide and Cyberspace was a dynamic and highly emotive presentation by Lee-Ann Foord. Young people in regional areas use the internet or social media for a range of reasons including connection, information, to belong, to combat isolation, and empowerment. A Cyber-Bullying Instrument, developed by Boystown and shown on the Kids Helpline website (see related article on Page 16), identified the methods of cyber-bullying in Australian respondents in 2009 (percentages don’t add up to 100 due to multiple responses): 1. E-mail 51% 2. Chat room 38% 3. Social network site 36% 4. Mobile phone 30% 5. Other (not specified) 17% 6. Other websites 13% 7. Other texting, e.g. Twitter 6%

Carers are always in uncharted waters, no one knows what is going to come up in the future. You have periods of calm and turbulent waters. In the beginning you don’t have a clue what you’re in for...

Lee-Ann’s main message was to teach kids to STOP – BLOCK – TELL to defeat cyber-bullying. She also shared latest ABS statistics showing 19% of all 15–19-year-old male deaths in Australia were attributed to suicide. In 2010, Kids Helpline took 7000 phone calls where suicide was discussed. In response to the youth suicides in Port Macquarie earlier this year (Facebook was raised as a negative factor by some community members; however, Lee-Ann said that both young people involved received only positive messages of support on their walls beforehand) a Facebook page has been started to connect, educate, support and inform local youth about mental health issues (called Hastings Youthspace). She recommends Living Works

Self-care is an important factor in keeping carers caring. Educating carers is a strong focus, building resilience and recognising burnout. In discussing boundaries, Coralie described ‘honouring our right and obligation to control what is us or ours’. In working with carers she asks ‘What is you and yours?’ and ‘What is them and theirs?’ Visit ARAFMI-Hunter at www.arafmihunter.org for more information or to join a program. Phil Hough gave a challenging talk about the Sudden Unexpected Death of a Child. Representing SIDS and 4

The Capa Quarterly


Programs such as ‘safeTALK’ and ‘ASIST’. Information can be found at www.livingworks.org.au or email Lee-Ann on lifematters@lifelitnemidcoast.org.au. Access further information relating to the information given on CyberBullying at www.kidshelp.com.au/upload/22817.pdf.

Both days were rounded off with a relaxation session by Christine Strong. On Saturday night several participants met for dinner. With a PDE cost price of $30 for members, many participants remarked on the value of attending (“to do it so inexpensively was fabulous”). Feedback was (continued on Page 34)

Code of Conduct for Unregistered Health Practitioners As counsellors and psychotherapists, we are legally required to display two documents in our practice(s): •  the NSW Code of Conduct for Unregistered Health Practitioners •  information on how clients can make formal complaints to the Health Care Complaints Commission. Both are available online in the members area of the CAPA NSW website: www.capa.asn.au The Code of Conduct is also available in several community languages on the Health Care Complaints Commission website: www.hccc.nsw.gov.au These legal requirements are set out in the ‘Public Health (General) Amendment Regulation 2008’ under the NSW Public Health Act (1991), and came into effect on 01/08/2008. Ethics Checkout the CAPA NSW website for information on: • Ethics and Counselling • Problem Solving Steps •  Client Confidentiality and Privacy and Relevant NSW and Commonwealth Legislation • Duty of Care • Workplace Bullying and Violence • Mandatory Reporting • Keeping Track of Paperwork •  Information for Counsellors who have been served with Subpoenas • Complaints Form for Submission of Complaints and Grievances by a CAPA Member

Just login to the members area of www.capa.asn.au and click on the “Ethics” button on the left.

August 2011

Membership Total Due to problems with procedures for processing membership applications and renewals, our usual categorised figures are unavailable at the time this issue of the journal goes to press. Combining the numbers for processed and unprocessed memberships at this time produces a total of approximately 800. The next issue will present the regular list of firm numbers in each category. Apologies for any inconvenience.

Do you want to write a column? Our regular columnist has stepped down, and proposals are now being entertained for a new column. This is a firm commitment for each issue, not just for an occasional item. If you are interested in making a regular contribution, please send a description of your concept to the Editor. Describe your background, education, experience, and special interests and the column you propose to write—what you could bring to the journal on a regular basis to enrich the value of it to our members. Please also send a few samples of other things you have written. editor@capa.asn.au

In Memoriam

Lucia Brooks died in April 2011 from cancer, which was diagnosed on Christmas Eve 2010. She was 54. This was a great shock for her colleagues and friends with such little time between diagnosis and passing. Lucia had been a CAPA member since 2004 and worked for a number of years as a Gambling & Financial Counsellor for Lifeline Central West in Bathurst. CAPA extends its sincerest condolences to Lucia’s family and to her friends. 5


Features

Avatar Therapy An ‘avatar’ in the context of computerised virtual realities is a graphical representation of someone, usually a human form. As bandwidth increases and software becomes more sophisticated, what used to be considered a radical and futuristic method of delivering therapeutic services (Goss & Anthony 2002) is now very much a reality. Where faceto-face therapy was considered a traditional method of service delivery, in 2011 even text-based service delivery via email and chat has become more mainstream more quickly than anticipated, and the growth of VoIP (Voice over Internet Protocol) and video services is also apparent. Avatar Therapy is something that professionals may be less aware of, but the body of writing about it is growing and we eagerly anticipate research programmes about it. The Online Therapy Institute (www.onlinetherapyinstitute.com) is already writing courses about how to deliver therapy using virtual environments, ensuring that future and current professionals are aware of the benefits and pitfalls, and how to ensure safe and ethical delivery of therapy using distance methods of technology-assisted therapy. In this article, we hope to demystify the concept of using avatars and virtual environments to assist our clients in their journeys towards better mental health.

What is Avatar Therapy? Virtual Reality offers endless opportunities, limited only by imagination. Originally popular for the gaming community, who meet as avatars in Massively Multiplayer Online (MMO) platform games such as World of Warcraft to battle each other and in-game enemies, it morphed into a social and, increasingly, business community with the surge in popularity of Second Life (http://secondlife.com/), as one example. Daniel (2008) cites an online strategy analysis that predicts up to one billion participants in non-gaming virtual worlds by 2018. Just as we adapted to technological communication methods such as e-mail, chat, texting and videoconferencing, it was only a matter of time before we adapted to communicating virtually. Indeed, the difference between ‘real’ and ‘virtual’ realities is becoming blurred and, increasingly, academics are discussing the perception of the individual of the environment they are in as being the ‘reality’ (Blascovich & Bailenson 2011). Therefore, if a person seated at a laptop is immersed in Second Life, it is the perception of that ‘virtual’ space as real that defines what is actually real to that person at that time. The concepts of virtual reality and avatar therapy have historical overlaps. When virtual environments are used successfully in treating phobias, for example: the client is immersed in an environment s/he fears by wearing headsets/ visors, haptic body gloves and, often, in the case of treating a fear of heights, standing on a vibrating platform that simulates a lift rising. Another good example for treatment of fear of flying is sitting in a vibrating aircraft seat and being immersed in a virtual aeroplane. In these more traditional uses of virtual environments, the representation of the self is experienced first-hand, and from within. 6

DeeAnna Merz Nagel and Kate Anthony

Entire rooms also exist that simulate reality, much like 3D funfair rides or IMAX films (Riva 2010). Another use of virtual representations of the self is through photographic 3D representations, creating a manipulable photograph of the self that can be adjusted to simulate movements and emotional facial contortions. Although these may be considered using or ‘being’ an avatar to represent the self, in the context of this article we are looking at instances where a person creates (or chooses) an avatar which they then control using a keyboard, with no actual physical sensation (although plug-in hardware does exist that can simulate physical experiences, for example sexual stimulation devices). As professional mental health practitioners with a presence in Second Life (offices, a conference centre and therapy rooms), we designed our avatars to be as close representations of ourselves in reality as possible, within the limits of the clothing and style choices that were available to us. Clients who have a presence in Second Life, or other virtual environments, may choose whatever part of their psyche they choose to represent, from aardvarks to muscle-bound sexual warriors. This in itself provides a dynamic way of exploring one’s psyche or that of the client and, with careful management and titrating of emotions, many life scenarios can be explored, such as childhood trauma, creating new visions for the future, and enacting endings of current situations. In the inaugural edition of the Institute’s bi-monthly magazine TILT (Therapeutic Innovations in Light of Technology— www.onlinetherapymagazine.com), we wrote the fictional story of Alice, who uses the virtual environment and her avatar of herself as a young girl to address the sexual abuse she experienced in reality, first as self-help and finally educating and including her face-to-face therapist (Nagel & Anthony 2010). By using her avatar self, Alice was able to create a safe space to explore her feelings around the abuse and reframe it. So what does avatar therapy look like? Taking the virtual environment of Second Life as an example (which is not without its issues of confidentiality due to lack of encryption technology), the client as avatar and the therapist as avatar meet in a virtual location. This could look like anything depending on what the therapist has created—a calming office with mood lighting, a beachside location with lapping waves and seals gently playing, a dynamic play room with beanbags to sit on. There is a concept known as a Skybox ‘inworld’ (the phrase used to describe being in Second Life), which is a more private space held notionally far above the public ground level, so that passers-by do not happen across it on their inworld travels, making it more appropriate for therapeutic work. Once client and therapist are together, they can use the keyboard to type to each other, with the text appearing above their heads or in a chat room-style window on their respective screens. This is not the only option; voice can also be used in virtual environments, creating a cross between a telephone call and an in-person session. Virtual creations—such as vision boards, whiteboards for art therapy, and virtual pebbles The Capa Quarterly


for working on relationships and family dynamics—are also available. Wilson (2010) also points out that multiple avatars could be created to be in the room, to represent subpersonalities or family members, although this level of work is not simple to create, or indeed to manage, technically and emotionally. Using virtual environments to conduct therapy need not be limited to replicating the traditional 50-minute hour in a consulting room, however. Outdoor therapies, such as Wilderness Therapy or Adventure-based Therapy are increasingly popular methods of real-world therapeutic intervention, and such environments are particularly suited to avatar therapy when their virtual replications are so easily created. We will now go on to discuss the specifics of Avatar Therapy, considering how and where it is being used, what skills are necessary for conducting it, and some future innovations that the concept of Avatar Therapy may lead to.

How and where is Avatar Therapy being used? Avatar therapy is already being used successfully, and the more prominent projects will be discussed here. The first is a second pilot program with Dick Dillon leading these pilots at Preferred Family Healthcare, Inc. in Missouri, United States. The first pilot focused on delivering substance abuse counselling to rural adolescents and was funded by a $300,000 grant from the Missouri Foundation for Health. The outcome studies from that project revealed that clients were three times as likely to complete the virtual treatment program as the face-to-face program. Outcomes were ‘as good as or better than’ outcomes in physical (brick and mortar) treatment centres (Korolov 2010). The second project is currently in progress with funding from the Center for Substance Abuse and Mental Health Services Administration (SAMHSA), within the US Department of Health and Human Services totalling $865,000. Their first pilot took place in the virtual world known as Second Life; the second pilot is operated via a private Open Sim

August 2011

grid through ReactionGrid, a company that provides technology and consulting services for organizations who want to conduct virtual services in a more secure and stable environment than Second Life provides. In the case of Preferred Family Healthcare, the client information is held on the organisation’s private server, keeping clinical services compliant with state and federal privacy and security laws. Avatar therapy is also being conducted as part of a project at the Center for BrainHealth at the University of Texas at Dallas, founded by Sandra Bond Chapman. The Center is developing a unique program for adults with autism and Asperger’s using a virtual reality environment designed to facilitate and motivate social change in the individuals. The Center for BrainHealth used Second Life initially, but they are now building their own virtual-world solution to continue the research. This new environment will include avatars with more expressive abilities. Preliminary results indicate significant increase in areas of social perception, prosody, and emotion recognition skills (Bond-Chapman 2011). In an interview with Dr Chapman in 2009, she stated that skills developed within a virtual world are transferable to real-world scenarios (Nagel 2009). This concept appears to be further illustrated by research being conducted at the Virtual Human Interaction Lab at Stanford University headed up by Jeremy Bailenson. Bailenson suggests that distinctions in real and virtual worlds are becoming more blurred and perhaps even interchangeable. His research indicates that behaviours learned in a virtual world carry over to face-to-face interactions, particularly when the avatar closely resembles the person the avatar represents (PBS 2009). Virtual Iraq is another project developed by Albert ‘Skip’ Rizzo, Associate Director for Medical Virtual Reality at the Institute for Creative Technologies, University of Southern California. The program uses sight, sound and smells to evoke and subdue painful memories (Halpern 2008). Dr Rizzo conceptualised Virtual Iraq from Full

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Features

Spectrum Warrior, a popular video game. This intervention involves wearing a set of goggles. While this is different from maneuvering an avatar in a virtual world like Second Life or a game like World of Warcraft, the client is viewing other avatars and landscape in a virtual world setting and this process is facilitated. The US military is leading the way in the use of virtual reality/virtual world interventions with 40 veteran hospitals using virtual reality interventions to treat PTSD. Gaming remains a popular form of entertainment and leisure and more and more therapeutic games are being designed to capture clients’ attention in settings that are ‘fun’ and appealing. Much like Dick Dillon’s project at Preferred Family Health, capturing the attention of teenagers by using a virtual-world setting, therapeutic games offer interventions that are solution-focused and often self-paced. Similar work was developed by Trinity College, Dublin, Ireland by Mark Matthews and David Coyle (2010), using a platform problem-solving, solutionfocused game called Personal Investigator to engage adolescents in therapy. With the popularity of gaming, some helping professionals are even considering offering help within the game itself. People who immerse themselves in virtual worlds for long periods of time, to the extent that real world obligations are neglected and dysfunctional relationships form with others in the game, may benefit from such therapy (Beaumont 2009). Gaming is receiving a more positive attitude with regard to its therapeutic potential, particularly through the work of Mike Langlois at www.gamertherapist.com, who offers an overview (Langlois 2011). More and more virtual world options are becoming available for mental health practitioners who want to work with clients directly within a virtual world setting. Of utmost importance is client confidentiality so working within an environment that is maintained on a practitioner-owned server or a web-based encrypted environment are the two best options. As stated, ReactionGrid (www.reactiongrid.com) offers server-based options while InWorld Solutions (www.inworldsolutions.com) offers a web-based encrypted platform.

Necessary skills for the therapist One of the most important attitudes the helping professional must embrace when working in virtual environments is the concept that relationships can be formed in virtual-world environments and that those relationships are real (Anthony 2001). Understanding cyber-culture means understanding how people interact online and in virtual worlds and realising that just as a therapist’s cultural competency is called to task when working with people from other countries, so it does when working with individuals who are immersed in virtual worlds and live a mixed reality of real-life interactions and virtual-life interactions (Nagel 2010). Using teaching tools such as the documentary, Life 2.0, now available for purchase by universities and colleges, helps to bring experiences within virtual worlds such as Second Life to the forefront. Every day, across all corners of the globe, millions of users log onto Second Life, a virtual online world populated by real-life-like avatars. Life 2.0 follows a group of people whose lives are dramatically consumed by the 8

virtual world of Second Life. They reside in this new reality, where inhabitants assume alternate personas in the form of avatars—with digital alter egos that can be sculpted and manipulated on a whim. More than an examination of a hot new technology, Life 2.0 is an intimate, character-based drama about people who look to a virtual world in search of something they are missing in their real lives. The results are unexpected and often disturbing: reshaping relationships, identities, and ultimately the very notion of reality. (Spingarn-Koff 2010) As we can see from the reality of the impact on lives/ relationships within Second Life from the viewing of Life 2.0, nothing is virtual at all and actually everything is real (Nagel & Anthony 2010). Once the therapist believes that people experience inworld relationships as real, and is able to respond empathically to a virtual world persona, and not only to the person behind the persona, deeper therapeutic relationships can be formed. Along with cyber-culture competency, practitioners working in virtual worlds must have a rudimentary knowledge base about delivering therapy at a distance. Delivering therapy through text-based interventions such as e-mail, forums and chat as well as audio and videoconferencing is important preparatory experience, because work in virtual worlds often includes other forms of conversation as well. Understanding the use of blended technologies and multimedia platforms is vital so that the practitioner can move fluidly between technologies and methods of delivery, according to the needs of the client. Using more than one platform or technology at once may sometimes be advantageous. Once the practitioner has had his or her own experience in a virtual world, the concept of ‘disinhibition’ becomes clear. Suler (2004) states about disinhibition: It’s well known that people say and do things in cyberspace that they wouldn’t ordinarily say or do in the face-to-face world. They loosen up, feel more uninhibited, express themselves more openly. Researchers call this the ‘ disinhibition effect’. It’s a double-edged sword. Sometimes people share very personal things about themselves. They reveal secret emotions, fears, wishes. Or they show unusual acts of kindness and generosity. We may call this benign disinhibition. On the other hand, the disinhibition effect may not be so benign. Out spills rude language and harsh criticisms, anger, hatred, even threats. Or people explore the dark underworld of the internet, places of pornography and violence, places they would never visit in the real world. We might call this toxic disinhibition. On the benign side, the disinhibition indicates an attempt to understand and explore oneself, to work through problems and find new ways of being. And sometimes, in toxic disinhibition, it is simply a blind catharsis, an acting out of unsavoury needs and wishes without any personal growth at all. To some extent, most of us feel less inhibited when interacting online. The disinhibition effect can be experienced at varying levels, and on a continuum. Both the therapist and the client may experience disinhibition, The Capa Quarterly


and since disinhibition can further heighten transference and countertransference, particularly in virtual world settings, a strong foothold on the theory is recommended. We also recommend that practitioners who work within virtual worlds also have studied trauma theory or have a background in working with clients who have experienced trauma, so that basic support and intervention strategies used with survivors of trauma can be used with clients within a virtual world (inworld). Because of this concept of disinhibition and because of the intensity of interactions and transferred behaviours from real world experience to virtualworld experience and back to real-world experience, a 3D environment can trigger past trauma more readily. A trigger that occurs inworld can be handled within the therapeutic milieu and help the client move forward. A trigger may also cause the client retraumatisation, which is why the practitioner must understand how to titrate emotions properly, especially since, due to disinhibition, clients will be more inclined to self-disclose and be opened up to feelings of vulnerability. This idea of titrating emotions is not new to trauma work; the therapist is often guiding the client through traumatic recovery of events and leading the client to a place of resolve, providing containment and closure (Steele & Colrain 1990). Regardless of what the client’s presenting issue may be, depending on historical events in the client’s background, he or she may experience flashbacks or become abreactive within the virtual-world therapy session. Knowing how to pace the client and provide containment is paramount to a successful outcome.

A Look to the Future

We now have the ability to incorporate artificial intelligence into the avatar therapy process. While this is not futuristic, mainstreaming this technology as a cost-effective option for practitioners is not yet a practical reality. Still, it is important to look at the possibilities. Avatars allow people to express identities as literal or metaphorical representations of self; the inner child or the shadow as examples. With advances in technology and artificial intelligence, we now have the ability to simulate scenarios, manipulating outcomes and reframing experiences. Artificially intelligent avatars help a client heal from trauma, create a new ending to a dilemma, or work out unfinished business with a deceased loved one. This psychotherapy approach is known as Innovative Avatar Therapy Simulation (IATS) (Nagel & Anthony 2010). IATS allows reframing, new outcomes and new endings to stories to be simulated by creating new landscapes and using artificially intelligent avatars. Once the simulation is complete, the experience becomes real and the client experiences an imprint that has a healing effect. DeeAnna Merz Nagel, LPC, DCC is a psychotherapist, consultant and international expert regarding online counseling and the impact of technology on mental health. She is co-founder of the Online Therapy Institute and Managing Co-Editor of TILT Magazine~Therapeutic Innovations in Light of Technology. She specializes in text-based counseling and supervision via chat and email. DeeAnna’s expertise extends to assisting individuals and families in understanding the impact of technology in their lives from normalising the use of technology and social media to overcoming internet and cybersex addictions. She has co-authored/edited two textbooks and written several book chapters and articles on topics related to technology and mental health. DeeAnna graduated from the University of Georgia with an MEd in Rehabilitation Counseling and is licensed to practice in New Jersey, New York and Georgia. She is also a Certified Rehabilitation Counselor and a Distance Credentialed Counselor.

August 2011

It is not impossible to imagine a future where technology allows us, through the use of holograms, to ‘be’ with the client remotely but with a full physical presence. In trainings, the present authors tell how we used to joke about the possibility of therapists and clients being face-to-face via hologram technology. We don’t joke about it anymore, we see it as an actual possibility—maybe not in our lifetimes, but a possibility. Technology allows us methods of offering therapeutic services that are really limited only by our imaginations. It’s a very exciting time to be in the profession. References Goss, S and Anthony, K 2002, ‘Virtual Counsellors—Whatever Next?’ Counselling Journal, 13(2):14-15 Daniel, J 2008, ‘The Self Set Free’, in Therapy Today 19(9):5 Blascovitch, J & Bailenson, J 2011, Infinite Reality, William Morrow Publishing, New York Riva, G 2010, ‘Using Virtual Immersion Therapeutically’, in Anthony, K, Nagel, DM & Goss, S (eds) The Use of Technology in Mental Health: applications, ethics and practice, Charles C Thomas Publisher, Springfield, IL Nagel, DM and Anthony, K 2010, ‘Alice in VirtualLand’, Therapeutic Innovations in Light of Technology, 1(1):16-27 Wilson, J 2010, ‘Using Virtual Reality to Conduct a Therapeutic Relationship’, inAnthony, K, Nagel, DM & Goss, S (eds), The Use of Technology in Mental Health: applications, ethics and practice, Charles C Thomas Publisher, Springfield, IL. Korolov, M 2010 ‘Treatment Center gets $865,000 for OpenSim Project’, http://networkedblogs.com/8TBDT Bond-Chapman, S 2011, ‘BrainHealth Researchers Develop Unique Program for Adults with Autism and Aspergers’, http://www.brainhealth.utdallas.edu/index. php/blog/brainhealth-research-studying-autism-and-aspergers Nagel, DM 2009, ‘People with Asperger’s syndrome learn social skills in Second Life’, Telehealth World, Spring, p.1 PBS 2009, Chapter 8 ‘Virtual Experiences Changes Us?’ http://video.pbs.org/ video/1402987791/ Halpern, S 2008, ‘Virtual Iraq’, http://www.newyorker.com/ reporting/2008/05/19/080519fa_fact_halpern?currentPage=all Beaumont, C 2009. ‘Addiction Therapists Signing Up to World of Warcraft’, http://www.telegraph.co.uk/technology/news/5899659/Addiction-therapistssigning-up-to-World-of-Warcraft.html Langlois, M 2011, ‘Saving the Game: The Use of Gaming within Psychotherapy’, Therapeutic Innovations in Light of Technology, 1(5):24-33 Nagel, D 02-09-2010, ‘Cultural competency now stretches beyond the global borders and into cyberspace’, retrieved from Twitter.com, (archived by WebCite® at http://www.webcitation.org/5nggE3nZW) Spingarn-Koff 2010, ‘Life 2.0’, http://www.rocoeducational.com/store/index. php?main_page=product_info&products_id=15 Nagel, DM and Anthony, K 2010, ‘Life 2.0: Virtual World, New Reality’, Therapeutic Innovations in Light of Technology, 1(2):20-25 Suler, J. 2004. ‘The Disinhibition Effects’, http://users.rider.edu/~suler/psycyber/ disinhibit.html Steele, K and Colrain, J 1990, ‘Abreactive Work With Sexual Abuse Survivors: Concepts and Techniques’, in Hunter, MA (ed), The Sexually Abused Male (Vol. 2), Lexington Press, Lexington, MA Nagel, DM and Anthony, K 2010, ‘Conclusion-Innovation and the future of technology in mental health’, in Anthony, K, Nagel, DM & Goss, S (eds), The Use of Technology in Mental Health: applications, ethics and practice, Charles C Thomas Publisher, Springfield, IL Kate Anthony, DPsych, FBACP, is a leading expert on the use of technology in therapy. She qualified as a psychotherapist from the University of Greenwich, London, UK in 2001, with her MSc Thesis on The Nature of the Online Therapeutic Relationship. Kate has trained practitioners and organisations worldwide in online therapy for over ten years. She is co-editor and co-author of three textbooks on the subject, as well as numerous articles, chapters and journals. She is a Fellow of BACP (awarded 2008) and Past-President and Fellow of ISMHO (awarded 2005). She is also Executive Specialist for Online Coaching for the BACP Coaching Division. She is co-founder of the Online Therapy Institute, and Managing Editor of TILT Magazine~Therapeutic Innovations in Light of Technology. Kate’s doctorate was “Developing Counselling and Psychotherapy in the Age of Technology and the Internet” with Middlesex University/ Metanoia Institute

9


In Review

Helping Clients to Help Kathleen M Griffiths§, Helen Christensen, Kylie Bennett, Julia Reynolds

In 1966, Joseph Weizenberg, a computer scientist from MIT, developed the world’s first chatbot, a ‘Rogerian therapist’ called Eliza. It is still possible to find Eliza or her close imitators on websites around the world. Type in, as the first author (KG) did, “I’m feeling really depressed,” and the automated Eliza will respond, “I’m sorry to hear you are feeling depressed”. State that “Every morning I wake up and I think I don’t want to get out of bed I can’t face the day,” and Eliza will ask, “Why don’t you want to get out of bed?’ Eliza elicits further information by punctuating her therapy session with, “I’m not sure I understand fully,” and “Can you elaborate on that?” At the time of the first demonstrations of the program, some psychiatrists heralded Eliza as a promising means for providing psychotherapy, one reportedly speculating that Eliza might offer a solution to the severe therapist shortage since “several hundred patients an hour could be handled by a computer system” (Weizenbaum 1976, p.5). Weizenbaum, however, never intended Eliza as a serious tool for communication or care and was mortified that others thought that it might be. Certainly, it does not take too long to uncover Eliza’s limitations as a therapist. In response to KG’s input: “Well, you know, I feel like life is not living,” Eliza’s response was less than empathic: “We were discussing you not me”. KG countered: “Well I definitely was discussing me not you”. But Eliza remained adamant: “Perhaps in your fantasies we were definitely discussing you.” Eliza never was implemented as a therapeutic tool! Nevertheless, almost 50 years later, internet-based computerised self-help tools are now being used to prevent, treat and manage mental health problems, either with or without therapist input. Some are doing so on a large scale and can, as prophesised in the mid-1960s, deliver services to several hundred consumers in an hour. However, the current tools differ from Eliza in at least two important ways. Firstly, many of

them are evidence-based, having been evaluated and found effective in randomised controlled trials (Griffiths, Farrer et al. 2010). Secondly, current automated applications employ an instructional, skills-training approach rather than natural language processing. In particular, most deliver cognitive behavioural training (CBT), although more recently Andersson and his group from Linköping University in Sweden have implemented and evaluated an internet bibliotherapy version of psychodynamic therapy, and the ANU has developed, and with Dutch psychologist Tara Donker recently evaluated, an interpersonal therapy program. Australia is recognised for its pioneering contributions to internet-based development, delivery and evaluation of mental health programs. In the early 2000s, Richards and Klein of the University of Ballarat and, separately, Kenardy of the University of Queensland, published papers demonstrating the efficacy of their internet-based interventions for panic disorder. Meanwhile, the current authors, Christensen and Griffiths from The Australian National University, published outcome data for the largescale delivery in the community of MoodGYM, a self-help program for depression (Christensen, Griffiths et al. 2002). Now, ten years later, MoodGYM forms one element of e-hub Self Help Services, which provides accessible information, automated therapy and peer-to-peer self help to hundreds of thousands of people around the world annually, including those referred by a health or mental health practitioner. This paper briefly describes e-hub services, its programs, their usage and some of the evidence for their effectiveness. It concludes with suggestions about how these services might be incorporated into counselling and clinical practice.

Figure 1: e-hub Self Help Services 10

The Capa Quarterly


Themselves:

e-hub Self Help Services

Structure and governance e-hub Self Help Services is provided by the Centre for Mental Health Research at The Australian National University. It is currently funded by the Commonwealth government as part of the Council of Australian Governments’ (COAG) Telephone Counselling, SelfHelp and Web-based Support Programmes initiative. The service provides a global self-help service for anxiety and depression to visitors and is free to the end user. Users can contact the service for technical support. However, e-hub does not provide one-to-one therapy, personal advice, or crisis support, but rather directs users to contact other services for such input. The service was designed to comply with the Australian National Standards for Mental Health Services. It also meets Australian national guidelines for the delivery of e-health services. Considerable emphasis has been placed on establishing strong privacy and security protocols, both in the IT domain and in the dayto-day operating of the service. In 2010 the service passed a stringent external security audit. The service is led by two Directors (KG & HC) each of whom is both a researcher and a registered psychologist and one of whom (KG) is also a consumer. The service is overseen by an Executive, which includes the two Directors, a clinical services manager, a development manager, and an Information Technology (IT) manager. The e-hub services team also includes programmers, web developers, a project officer who responds to user technical enquiries and triages other communications for processing by the clinical or IT team, and four part-time consumer moderators who run an online support group (see below). Mental health applications The e-hub service incorporates five main websites or programs: BluePages, MoodGYM, e-couch, BlueBoard and Beacon.

www.moodgym.anu.edu.au

August 2011

BluePages Depression Information (www.bluepages.anu.edu.au) BluePages, which is written at Year 8 reading level, provides evidence-based information about more than forty medical, psychological and alternative (potential) treatments for depression. It incorporates a ‘smiley face’ rating system to convey the level of evidence underpinning a treatment. A frowning face L indicates that according to the evidence the treatment is ineffective; a straight face K that there is no evidence from which to draw any conclusions about its efficacy; and a smiling face J that the evidence suggests the treatment may be effective. A treatment can receive three smiley faces where the evidence is of high quality and strong (as in the case of cognitive behaviour therapy) or one or two smiley faces where the evidence is less strong (for example, the supplement SAMe receives one smiley face). BluePages also provides information about the symptoms and diagnosis and experience of depression as well as relevant resources. BluePages currently receives 6900 unique visitors per month. Although to date much of the discussion about e-mental health programs has been focused on behavioural interventions, information is an important self-care tool. In fact, in a 2004 randomised controlled trial, we found that exposure to BluePages was associated with a significant reduction in depressive symptoms relative to an attention control condition among people with high levels of depressive symptoms (Christensen, Griffiths et al. 2004). It also resulted in a small reduction in stigmatising attitudes and a marked improvement in depression literacy (Griffiths, Christensen et al. 2004). Interested in the unexpected finding that information delivered via the internet was an effective intervention in itself, we subsequently undertook a quantitative review of the effect on symptoms of the delivery by any modality

www.ecouch.anu.edu.au

www.beacon.anu.edu.au

11


In Review

of information about depressive or anxiety disorders. We found that passive information interventions were effective in reducing anxiety or depressive symptoms (Donker, Griffiths et al. 2009).

MoodGYM (www.moodgym.anu.edu.au) MoodGYM is an automated cognitive behaviour therapy program comprising five modules and a workbook containing twenty-nine exercises. It was originally designed to prevent depression in young people, but it has been used successfully as both a preventive and a treatment tool in a broader age group. The MoodGYM modules incorporate training in cognitive restructuring, pleasant events scheduling, applied relaxation, and simple problem solving. Concepts are illustrated throughout the program with the assistance of several characters. The site is quirky and colourful. The latest version of MoodGYM has approximately 450,000 registrants from over 200 nation-states. Figure 2 depicts in white the countries from which MoodGYM has not been visited. Consistent with the level of depression in the community, approximately two-thirds of MoodGYM users are women. Over half are aged between 20 and 49 years. It is often claimed that the internet is a particularly important tool for those with reduced access to conventional face-to-face services. In fact, a substantial 24.2% of MoodGYM users report that they reside in a rural region. Approximately half of the users have completed or are in the process of completing a university degree. A large percentage of visitors to MoodGYM access the program via hyperlinks from other websites and this is the most common means by which Australian users access the

Figure 2: Global reach of MoodGYM. The white sections represent countries from MoodGYM has not been accessed.

program. Worldwide, however, more visitors are referred to MoodGYM by a health practitioner (see Figure 3) than via a hyperlink. Thus, by late 2010, more than one-third of MoodGYM users had been referred to the site by their GP and a further 10% by a therapist. By contrast only 18% of participants accessed the site by referral from a website, the most common referral pathway after practitioner referral. A large number of studies have been undertaken in a range of settings, age groups and countries to evaluate the effectiveness of MoodGYM, either as a preventive intervention or for treatment. The findings indicate that 12

the program is effective. For example, MoodGYM has been shown in randomised controlled trials to reduce depressive symptoms in members of the community (Christensen, Griffiths et al. 2004) and in spontaneous ‘free range’ visitors to MoodGYM (Christensen, Griffiths et al. 2006). The program has been reported to prevent anxiety caseness in a universal sample of Year 8 school students and to prevent depression caseness in Year 8 boys (Calear, Christensen et al. 2009). There is also evidence that in a primary care setting, MoodGYM added to enhanced general practice (GP) care is superior to enhanced GP care alone for depression (Hickie, Davenport et al. 2010). Similarly, an independent study demonstrated that MoodGYM plus face-to-face care from a psychologist was more effective than face-toface treatment alone (Sethi, Campbell et al. 2010). Further studies in a range of settings—including Australia’s Lifeline telecounselling centres, a Norwegian university, and the medical school at Yale University—have been submitted for publication; other papers are in preparation including a recent large-scale randomised controlled study of the effectiveness of MoodGYM for improving the wellbeing of visitors to the United Kingdom’s National Health Service consumer health portal, NHS Choices. Additional trials are underway at The University of York (general practice), and the University of Nottingham (workplace) in the UK and at the University of Otago in New Zealand (community). e-couch (www.ecouch.anu.edu.au) e-couch currently comprises five streams designed to treat depression, generalised anxiety disorder, social anxiety disorder, and to provide support for people suffering from a bereavement or other loss, and separation or divorce. Each stream consists of a mental health literacy component and a choice of several tools. Tools were selected on the basis of two characteristics: (i) established efficacy when delivered face-to-face; and (ii) potential for implementation on the internet. Thus, the depression toolbox comprises CBT, simple problem solving, interpersonal psychotherapy, applied relaxation and physical activity. The generalised anxiety disorder toolbox consists of CBT, relaxation therapy and physical activity. Finally, the social anxiety disorder tools include CBT, exposure therapy, attention practice, social skills training, and relaxation. Like MoodGYM, e-couch is visually attractive (of course we could be biased). It was designed to appeal to a broader demographic than MoodGYM. It is also more focused on treatment than its older counterpart MoodGYM. However, so far the characteristics of visitors to e-couch are broadly similar to those of MoodGYM visitors. Like MoodGYM, two-thirds of the e-couch’s 25,700 registrants are women and 22% are from rural or remote areas. Over half of e-couch’s users are aged between 20 to 39 years, but the program attracts users of all ages. Just over 10% of e-couch users are referred by health practitioners, a substantially lower percentage than for MoodGYM. Spontaneous users of e-couch show a significant The Capa Quarterly


It is evident from comments on the board itself that many participants value the BlueBoard support group and a recent survey undertaken for quality and reporting purposes indicated that the majority of respondents, although not all, were satisfied with the board. Recently we undertook a randomised controlled trial of the effectiveness of an online support group for depressive symptoms modelled on BlueBoard (Griffiths, Crisp et al. 2010). The study is now complete, the findings encouraging, and a journal article is currently in preparation. Figure 3: Percentage of MoodGYM registrants referred by (i) a general practitioner; (ii) a hyperlink from another website; and (iii) a therapist, over an 18 month period.

reduction in symptoms and stigma in pre-post analyses. Randomised controlled trials of the different streams of e-couch are currently under way or have recently been completed; an article reporting the efficacy of e-couch depression is currently in preparation. BlueBoard (blueboard.anu.edu.au) Recently, there has been marked interest in the concept of virtual, connected communities sometimes referred to as the ‘Web 2.0’. e-hub Self Help Services incorporates an asynchronous web-based support group for depression and related disorders. Initially established for the use of people with depression and bipolar disorder or their carers, BlueBoard now incorporates specific forums for generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive-compulsive disorder, and by request of members, borderline personality disorder. BlueBoard is moderated by consumers with experience of depression or an anxiety disorder. Two are located in rural areas of Australia. Each has undergone intensive training and regular training updates. The board has strong safety rules to which all members are required to adhere. For example, some rules are designed to protect the privacy of members (members are not permitted to post identifying information) and others are designed to guard against suicide contagion (members are not permitted to post information about self-harm or suicidal behaviours). The role of the moderators is to ensure that users adhere to these rules. They operate according to detailed e-hub service protocols for the board and an agreed Code of Conduct. The moderators’ role on BlueBoard is primarily to maintain a safe online space where consumers can support each other. Neither the moderators, nor other e-hub services staff, participate directly in Board discussions; rather the focus is on peer-to-peer member support. The training and work of the moderators is overseen by a clinical psychologist (currently the Clinical Services Manager, CSM) who, in turn, is responsible to the e-hub Self Help Service Directors. BlueBoard was first launched in 2003 but was later closed due to lack of resources. It reopened in October 2008 with funding from the Australian Government. Since its relaunch, it has acquired 3,000 registered members who have made over 19,400 posts. Over 91,000 pages were accessed by BlueBoard visitors in November 2010. August 2011

Beacon (www.beacon.anu.edu.au) The programs offered by e-hub Self-Help Services are just some of the many programs and websites currently available to consumers with mental health problems. Over the past decade there has been a rapid growth in internet-based behavioural programs and evaluation trials (Griffiths, Farrer et al. 2010). How does the consumer, or indeed the counsellor or psychologist, know what programs are available and whether they are evidence-based? e-hub’s Beacon website is designed to provide guidance on these matters. (Yes, we resisted the temptation to refer to it as illuminating the path to enlightenment ... well, almost). Beacon aims to provide information about each available internet-based behavioural program, categorised according to the mental health or other health condition it is designed to target (eg, depression, anxiety, eating disorder, diabetes, pain). Beacon provides a brief overview of and link to the target program’s website, together with a smiley-face rating of its effectiveness based on expert review of the scientific evidence about the intervention. The program listing also contains information about its availability and cost, if any. Further, consumers can provide feedback and view other consumers’ feedback and ratings for each program. Currently, approximately 170 programs for 34 conditions have been listed, reviewed and rated on Beacon; more applications are being added. Unfortunately, to date, the listings on Beacon indicate that very few applications are available without cost, and many are not accessible to the general public. Nevertheless, there are programs with demonstrated effectiveness that can be accessed at no cost. Incorporating e-hub services into practice Evidence-based web resources can be used in a number of ways by practitioners. e-hub programs can, for example, be prescribed as an adjunct to treatment, with discussions of progress and issues arising as part of each therapy or counselling session. Progress summaries are available at the end of each MoodGYM module, and these together with a practitioner guide to MoodGYM (Christensen, Griffiths et al. 2004) can facilitate this process. In addition, MoodGYM and e-couch users can also share information with practitioners by printing out material such as their responses to program questionnaires and exercises. In another model of delivery, the web-based program can be employed as the primary treatment, with the counsellor or therapist serving as a coach whose main role is to guide the client through the modules with the 13


In Review

aim of encouraging adherence and engagement with the program. Such a guided self-help approach is particularly suited to the distal delivery of services by telephone or video-conference. For example, it may be useful in delivering MoodGYM to consumers in rural or remote areas or to consumers who for other reasons are unable or would prefer a distal service. In some circumstances, where the demand for services is extremely high and the available therapy resources very limited, this type of guided self help can ensure a client receives an evidencebased treatment while at the same time freeing up the therapist’s time for face-to-face consultation with clients with more complex needs or for whom distal delivery is not appropriate. MoodGYM can also be employed in a guided self-help form in schools. In this context it can be employed as a preventive intervention on a whole-of-class basis. School counsellors are well placed to encourage schools to implement such programs and to oversee their delivery in the classroom, although they can also be implemented by teachers without psychological training. Finally, e-hub services such as MoodGYM are currently used in some traditional service contexts to provide unguided self help for those on a waiting-list to see a clinician. The interested practitioner can learn more about e-hub services and how they may be integrated into existing practice by visiting e-hub Assist (www.ehubassist. anu.edu.au). Developed with feedback from health professionals, e-hub Assist includes detailed information about how e-hub programs can be used together with potentially useful resources. A downloadable PDF of the MoodGYM practitioner manual can be obtained by emailing: ehub@anu.edu.au. Practitioners who wish to know more about peer-to-peer internet support groups and their

incorporation into practice can find a practical guide to this topic in the chapter ‘Online mutual support bulletin boards’ (Griffiths and Reynolds 2010) in the Oxford Guide to Low Intensity Interventions (Bennett-Levy, Richards et al. 2010).

The future ... Some practitioners have embraced e-mental health solutions and have rapidly incorporated them into their practices. Others are wary of these technologies and have adopted a more conservative approach. As with any new development or treatment, a considered approach is appropriate. However, concerns about the potential limitations of any health intervention must be balanced against their potential for benefit and the current evidence suggests that e-mental health applications offer significant benefit. Many of today’s e-health interventions do not markedly differ from evidence-based self-help books, which have long been prescribed by therapists to their clients. With the emergence of mobile phone technologies combined with location and sensing devices, the potential for the use of such tools in clinical practice is increasing. There are those who believe that science will soon deliver the emotionally intelligent robot. One can only speculate on the potential of an emotionally intelligent 21st century version of Eliza, equipped with sensing devices, advanced facial detection, and natural language processing skills. Perhaps instead of responding “We were talking about you not me,” 21st century EmoEliza will first scan her client’s facial and auditory features for distress and respond: “You feel that your life is not living? Let’s talk about that some more. I think I know someone who can help,” and refer the person to a therapist for assessment and evidence-based treatment.

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References Bennett-Levy, J, Richards, D, et al., Eds 2010, Oxford Guide to Low Intensity CBT Interventions, Oxford, Oxford University Press: Oxford, 587pp. Calear, A, Christensen, H, et al. 2009, ‘The YouthMood Project: A cluster randomized controlled trial of an online cognitive-behavioral program with adolescents’, Journal of Consulting and Clinical Psychology, 77(6): 1021–1032 Christensen, H, Griffiths, K, et al. 2004, ‘Delivering interventions for depression by using the internet: Randomised controlled trial’, British Medical Journal 328: 265–270 Christensen, H, Griffiths, K, et al. 2006, ‘Online randomized controlled trial of brief and full cognitive behaviour therapy for depression’, Psychological Medicine 36: 1737–1746 Christensen, H, Griffiths, KM et al. 2002, ‘Web-based Cognitive Behaviour Therapy (CBT): Analysis of Site Usage and Changes in Depression and Anxiety Scores’, Journal of Medical Internet Research 4(1). Christensen, H, Griffiths, KM, et al. 2004, MoodGYM Clinician Manual, Canberra, Centre for Mental Health Research Donker, T., Griffiths, KM, et al. 2009 ‘Psychoeducation for depression, anxiety and psychological distress: A meta-analysis’, BMC Medicine 7: 79 Griffiths, K, Crisp, D, et al. 2010, ‘The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an Internet support group and an automated Internet intervention for depression’, BMC Psychiatry 10(1): 20 Griffiths, KM, Christensen, H, et al. 2004, ‘Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to epression’, Br J Psychiatry 185: 342–349 Griffiths, KM, Farrer, L, et al. 2010, ‘The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials’, MJA 192(11): S4–S11 Griffiths, KM and Reynolds, J 2010, ‘Online mutual support bulletin boards’, The Oxford Guide to low intensity CBT interventions, 1 Hickie, IB, Davenport, TA, et al. 2010, ‘Practitioner-supported delivery of internet-based cognitive behaviour therapy: evaluation of the feasibility of conducting a cluster randomised trial’, Medical Journal of Australia 192(11 Suppl): S31–5 Sethi, S, Campbell, AJ, et al. 2010, ‘The use of computerized self-help packages to treat adolescent depression and anxiety’, Journal of Technology in Human Services 28: 144–160 Weizenbaum, J 1976, Computer Power and Human Reason: From judgment to calculation, WH Freeman and Company, San Francisco. § Corresponding author

The authors are all associated with the Centre for Mental Health Research, The Australian National University, Acton, Canberra, ACT, Australia, 0200

Kathleen M Griffiths, BSc (Hons), PhD, is Director of the Depresion & Anxiety Research Unit at The Australian National University, Co-Director of ehub and ehub services and Deputy Director of the Centre for Mental Health Research at The Australian National University. She is a National Health and Medical Research Council Senior Research Fellow. She is the author of over 150 publications. Her interests are in consumer centred mental health research, use of the internet for the delivery of mental health programs, the measurement and reduction of stigma associated with depression and anxiety, means for promoting help seeking for mental health problems and translational mental health. kathy.griffiths@anu.edu.au Helen Christensen, MPsychol, PhD, is Director of the Centre for Mental Health Research (CMHR) at the Australian National University and a National Health and Medical Research Council (NHMRC) Senior Principal Research Fellow. She is a member of the Australian Academy of Social Sciences. She is the author of over 300 refereed journal articles. Her areas of interest include the evaluation of internet applications/ online programs for the prevention and treatment of mental disorders, the quality of websites, the integration of new technologies into health care, the development of evidence- informed policy and methods to measure impact and dissemination. helen. christensen@anu.edu.au Kylie Bennett, BSc, BA (Hons), is the Development Manager of the e-hub group at TheAustralian National University. She is responsible for the project development and management of e-hub’s online self-help programs, and is experienced in managing all aspects of complex research trials in the fields of e-mental health and intervention research. Kylie facilitates collaborative research projects involving data collected through e-hub’s web programs, and works with research groups around the world to create and implement protocols applicable to online environments. kylie.bennett@anu.edu.au Julia Reynolds, BA (Hons), MPsych (Clin) MAPS, MBPsS, CPsychol, is a registered Clinical Psychologist with extensive experience in face to face clinical practice. She provides clinical support to people using e-hub services and contributes to bestpractice delivery of these services. julia.reynolds@anu.edu.au

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August 2011

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15


In Review

Counselling Kids

The internet has become a critical communication tool that of Queensland. Creative art students from the Queensland keeps young people connected with friends as well as providing University of Technology were engaged to develop the associated information and entertainment. Australian young people have web-based screens. A robust research and evaluation strategy ready access to the internet and are generally ‘net-savvy’. Nine in was implemented to gather evidence about the effectiveness of ten Australian households have an internet connection, and three- this form of counselling as, at that time, the evidential support quarters have broadband (ACMA 2007). Children and young for web-based counselling was undeveloped. The motivation of people aged between 8 and 17 years commit about an hour and the organisation in pioneering this form of counselling was a belief that new segments of the youth a quarter of each day to the internet, population could be provided with with older teens aged between 15 Kids Helpline is Australia’s only national telephone counselling assistance and that the and 17 spending 2.5 hours on these and online counselling service for children and expressed help-seeking preferences of activities (ACMA 2007). Up to 97% young people 25 years and under. It is a service young people should be respected. of young people aged 16 to 17 claim of BoysTown, which is a national youth charity The development of web-based to use at least one social networking dedicated to enabling young people, especially counselling at Kids Helpline also service (ACMA 2009). those without voice, to improve their quality of supports a recent observation by life. Kids Helpline is primarily funded through Young People’s Help-Seeking researchers that innovation is often Preferences BoysTown’s fundraising program, which includes driven by the recipients of counselling the BoysTown Lifestyle Lottery. Within this technologically rich services (Gross & Anthony 2009). environment children and young Before proceeding it is important to In 2010, there were 466,333 attempts by people’s help-seeking behaviour provide a description of email and webchildren and young people to contact Kids Helpline has evolved to encompass ‘the Net’. based counselling. E-mail counselling of which almost 270,000 were answered. Just over Contemporary research indicates involves young people requesting 27,000 of the 62,612 contacts that required a that, after family and friends, the information, support and counselling counselling response, were provided through web internet is most commonly used by through the exchange of e-mails. E-mail sessions and email modalities. young people to acquire information counselling is a time-delayed text- and and assistance for personal concerns image-based form of communication. (Neal, Campbell, Williams, Liu & Nussbaumer 2011). All e-mails are responded to within 24 hours by Kids Helpline Furthermore, there is evidence that acquiring health information counsellors. There may be numerous replies back and forth between is one of the most common reasons for using the internet. The the counsellor and young person, which constitute an e-mail thread. use of online health sites has increased at an even faster rate than E-mail counselling is a 24/7 operation. Web counselling, on the general internet usage (Miller 2009). Consequently, the Net has other hand, is a real-time, interactive, text-based communication become a critical space for the delivery of information support between a young person and a counsellor. Web counselling is and counselling for young people. available daily during designated time periods. Due to the level of staff resources required for web counselling, Kids Helpline is not in The Development of Kids Helpline’s a position to offer this service on a continuous basis.

Online Counselling

Kids Helpline introduced the world’s first publicly accessible web-based counselling service for children and young people in 2000 (Clark 2002). This was an outcome based on young people’s expressed interest and the value of youth empowerment, held strongly by the organisation. E-mail counselling had commenced in 1999. Following feedback received from some young people concerning their preference to undertake help-seeking using internet modalities, an internal working party was established involving IT specialists and experienced counsellors to develop a web counselling model. This work was also informed by specialist researchers in conversational analysis from the University 16

Usage of Online Counselling Since 2005, use of online counselling has increased significantly. The number of e-mail counselling sessions has almost doubled in this time period from 7,605 in 2005 to 13,816 in 2010. The increase in web counselling numbers has increased at a slower pace due to the restricted hours during which the service can be made available to children and young people. Additional funding from the Department of Health and Ageing in 2006 allowed for an increase in web counselling hours, enabling increased ability to respond to demand. The 4,807 web counselling sessions logged in 2005 increased to 6,747 in 2010. The Capa Quarterly


On Line: The Tech-Savvy Generation John Dalgleish and John Hartshorn

Profile of Online Counselling Users The most typical users of Kids Helpline’s online counselling services are young females aged 10-18 years living in metropolitan areas. Interestingly, young people from culturally and linguistically diverse backgrounds are as likely to contact Kids Helpline through e-mail and web modalities as by telephone. Young people who use online counselling are also more likely to be first-time or occasional users of Kids Helpline counselling services. Kids Helpline recognises the limitations of online counselling modalities for ongoing counselling and case management. Counsellors encourage young people who initially make contact through web or e-mail to engage with them by telephone for ongoing counselling or, alternatively, facilitate referrals to local services in the young person’s community. This practice is consistent with current research, which indicates that online counselling, due to its accessibility, increased anonymity and timeliness, is a critical component of a stepped care model. This enables help-seekers who may be resistant initially to seeking face-to-face counselling to become engaged and then, through the use of the established therapeutic alliance, be encouraged to transition to other forms of counselling for longer-term support (Miller 2009, Pelling 2009).

Problem Types

the counselling models and strategies being used. Feedback from counsellors indicates that online modalities are very effective in ‘opening up’ the problem. As previously stated, users of online counselling tend to be more direct about their primary issue of concern, and their feelings in relation to the problem, due to the accessibility and timeliness of online modalities. Online counselling also provides young people with a journaling process such that young people can use the transcripts of the counselling session to reflect on responses to problems if they re-emerge or to validate and confirm their progress. E-mail exchanges between the counsellor and the young person between telephone counselling sessions can also be used to reinforce key messages and strategies and to provide positive feedback to the young person on constructive activities she or he may be undertaking to resolve the troubling situation. However, counsellors find that online counselling takes more time, particularly in relation to the assessment process. They also find that online counselling is more suited to brief or solutionbased counselling approaches. E-mail and web-based counselling are both critical in being able to engage young people about complex issues in a timely way and to facilitate engagement with those young people unable to access or resistant to face-to-face counselling service. For many young people, online counselling is a portal to other counselling experiences via telephone or face-to-face.

Researchers have also contended that the anonymity, accessibility, and timeliness characteristics of online counselling Quality Assurance may also facilitate disclosure, as the users are more likely to Contemporary research in relation to online counselling has capture their immediate feelings at the time they are distressed suggested a number of systemic risks associated with this and also will feel less inhibited about their expression over the modality (Miller 2009, Pelling 2009). Kids Helpline has, over Net (Miller 2009, Pelling 2009, Campos 2009). Presentations its 12 years of delivering online counselling, developed a range of by help-seekers to Kids Helpline’s online counselling services strategies to address these risks. provide some support for this view. Young 19.7% Managing emotions and/or behaviours people are proportionally more likely to 14.2% 16.2% contact counsellors regarding managing Family relationships 16.2% their emotional and behavioural responses 14.4% Mental health issues 12.2% and mental health issues through online 9.9% Relationships with friends & peers 8.6% modalities compared with the telephone. 7.6% Partner relationships 9.6% This is outlined in Figure 1. Similarly, there 5.0% Suicide-related issues (main concern) 5.2% are proportionally more presentations to 4.1% Child abuse online counsellors about self harm (20% of 4.7% 3.2% all counselling sessions) than to telephone Grief & loss 2.4% 3.0% counsellors (16.5% of all telephone Self image 1.3% Phone Online counselling sessions). 2.4% Bullying 3.8%

Delivering Online Counselling As with all counselling, practitioners need to be aware of the strengths and limitations of August 2011

0%

5%

10%

15%

20%

25%

Proportion of counselling sessions

Figure 1: Top 10 online counselling concerns 17


In Review

Kids Helpline places the highest importance on ensuring the quality of counselling services delivered to children and young people. Unlike many Australian Helplines, which rely on volunteers, Kids Helpline employs counsellors with accredited qualifications in psychology, social work and counselling. Counsellors are supported by shift supervisors, experienced practitioners who are immediately available for case and duty-ofcare consultations, debriefing, and other professional supervision issues. Furthermore, BoysTown employs a significant number of clinical practitioners who monitor and develop the practice, knowledge and skills of counselling staff. Kids Helpline requires that e-mail and web counsellors are experienced telephone counsellors. At the time of employment, all counselling staff undertake extensive training in telephone counselling. Only after counsellors have practiced telephone counselling for a significant time period is consideration given to broadening their practice to e-mail and web counselling. Counsellors chosen for web and e-mail counselling participate in specialist training in relation to each of these modalities. New web and e-mail counsellors are then subject to intensive monitoring and performance review of their practice for a designated probationary period. Work in response to high-risk online counselling presentations is always undertaken conjointly with a shift supervisor. Counselling transcripts are internally reviewed ongoingly by clinical practitioners to ensure quality service standards are maintained. BoysTown has also been an active partner in research with tertiary educational institutions to develop an evidence base concerning online counselling. Research has been undertaken with Robert King, Clinical Psychologist and Professor of

18

Psychology in the School of Psychology and Counselling, Queensland University of Technology, into the effectiveness of online counselling and the motives and experiences of young people who choose to use it (King, Bambling, Lloyd, Gomurra, Smith, Reid & Wegner 2006; King, Bambling, Reid & Thomas 2006). Overall, this research has demonstrated that online counselling is effective in reducing the distress of young people (King, Bambling, Reid & Thomas 2006). The outcomes from this research have been incorporated into the management and delivery of online counselling within our agency.

The Tech-Savvy Trend Young people are increasingly turning to the internet to seek information, support and assistance, particularly in relation to health issues. Online counselling is an effective form of practice that has the potential of reaching those young people who would otherwise be resistant or unable to access face-to-face services. Due to the systemic risks involved in online counselling, service providers need to have an extensive infrastructure to support this modality including accredited counsellors, a specialised training strategy, ongoing professional supervision and monitoring of practice, as well as a research strategy that informs its ongoing development. References

Australian Communications and Media Authority (ACMA) 2009, ‘Click and connect: young Australian’s use of online’, Media: 2: Quantitative Research Report, Canberra, Australia, p. 7 Australian Communications and Media Authority (ACMA) 2007, Media and Communications in Australian Families: Report of the Media and Society Research Project, Canberra, Australia, p. 2 Campos, B 2009, ‘Telepsychology & Telehealth: Counselling conducted in a technology environment’, Counselling, Psychotherapy, and Health, 5(1):26-59

The Capa Quarterly


Clark, J 2002, ‘More than lip service: Putting supervision into practice at Kids Help Line’, in M. McMahon & W. Patton, Supervision in the Helping Professions, Frenchs Forest: Pearson Education, Australia, p. 287 Gross, S & Anthony, K 2009, ‘Developments in the use of technology in counselling and psychotherapy’, British Journal of Guidance and Counselling, 37(3):223-230 King, R, Bambling, M, Lloyd, C, Gomurra, R, Smith, S, Reid, W & Wegner K 2006, ‘Online counselling: the motives and experiences of young people who choose the internet instead of face to face or telephone counselling’, Counselling and Psychotherapy Research, 6(3): 169-174 King, R, Bambling, M, Reid, W & Thomas, I 2006, ‘Telephone and online counselling for young people: A naturalistic comparison of session outcome, session impact and therapeutic alliance’, Counselling and Psychotherapy Research, 6(3): 175-181 Miller, K 2009, ‘The potential role of the internet in suicide prevention’, Counselling, Psychotherapy, and Health, 5(1): 109-130 Neal, DM, Campbell, AJ, Williams, LY, Liu, Y & Nussbaumer, D 2011, ‘‘I did not realize so many options are available’: cognitive authority, emerging adults, and e-mental health’, Library and Information Science Research, 33: 25-33 Pelling, N 2009, ‘The use of email and the internet in counselling and psychological service: what practitioners need to know’, Counselling, Psychotherapy, and Health, 5(1): 1-25 John Dalgleish, BSocWk, MBA, manages the Strategy and Research Team at BoysTown. He has extensive experience in youth issues, including child protection, juvenile justice, disability and community development services. His research interest includes the use of contemporary mobile and web applications to provide psychological support to children and young people. In 2010 John was co-author of published peer-reviewed works in relation to the impact of cyber bullying on young Australians. John has also authored a number of submissions to Federal and State government inquiries in relation to bullying, cyber bullying, indigenous issues, youth suicide, youth offending and other matters. John is a peer-reviewer for Educational Research Journal, the journal of the National Foundation for Educational Research (NFER) in the United Kingdom. John Hartshorn, BPsycSc (Hons), BA (IT)(Japanese), works as a Research Officer in the Strategy and Research Team at BoysTown. His interest in youth issues includes young people’s use of information and communication technologies, culturally diverse youth and self image issues. John has worked as a researcher in a number of areas including ageing, child speech pathology and driver distraction.

The Neridah Practice CHATSWOOD CBD Come and join a professional, friendly group of counsellors, therapists and psychologists in a peaceful, custom designed practice. With beautifully appointed, fully furnished and sound proofed consulting rooms, you and your clients will be assured of privacy, comfortable facilities and professional surroundings. The Neridah Practice has a waiting room, is fully air conditioned, has access to wireless broadband connection, kitchen facilities, and building security; every consulting room enjoys natural light. The practice is situated in the beautifully peaceful and discrete Chatswood Village, very close to trains, buses and parking. 24 hour and weekend access. Extremely reasonable half/full day or multi-day rates. Sally Brooks 0433 676 253 info@neridahpractice.com.au. www.neridahpractice.com.au (for photos)

August 2011

19


Practice Tips

Lost in Translation

How Communications Technologies Can

Technology offers therapists a wonderful opportunity to expand their practices both geographically and practically. It has impacted on every aspect of our lives and, as therapists, it has implications for how we conduct our relationships with clients. Traditionally, the only contact clients had with us was in person, in writing or over the phone. The phone was usually used only to convey information about meeting times or directions to our consultation rooms. Today this has changed. Technology has expanded options of how we conduct sessions, communicate with clients outside of sessions, and how we make our services known to clients—the marketing of our services. Whilst these opportunities have been embraced by many clients and therapists, many others are sceptical and believe that changes to traditional practice somehow minimise or trivialise the craft of therapy and counselling. As a psychologist and psychotherapist, I have learnt to embrace technology and the opportunities I believe it offers for therapeutic practice and development of ‘the business of running a practice’. I encourage counsellors to keep an open mind when embracing technology because it can enhance the work we do and reach an audience that hitherto has been unable to benefit from our services. Most therapists understand and use e-mail. This is a valuable means of quickly and effectively communicating with clients. However, it is important to ensure that all e-mails you send are carefully re-reread before sending to avoid information being miscommunicated. In my experience, it is preferable to limit e-mail communication to conveying factual information e.g. meeting times, directions or attaching a promised exercise or reference to a book or website. Care must be taken to avoid e-mail being used as a quasi-therapeutic exchange due to the lapse of time between sending and receiving information. Other forms of technology, explored in more depth in this article, provide a richer medium within which to connect with clients and conduct valuable therapy. By providing some real-life examples from my own experience, it can be seen that technology, embraced wisely, can be an enormously valuable tool for therapists. Not only can our sessions be conducted using phone, Skype or online chat, we can use technology to market our services and provide solutions for clients who may never attend face-to-face sessions. Let’s consider the options available for the therapeutic relationship, both inside and outside of sessions. 20

 Skype: An internet-based communications software which enables free calls computer to computer. It can be conducted using voice only or in conjunction with video. Skype software also allows for several people to be online at once from different locations, with or without video.  Online chat: A computer-to-computer text communication which enables a user to type words that the person connected on line can see appearing on their computer screen as they are typed. It can be used in conjunction alone or with Skype. It can also be one to one or one to a group.  Telephone: A medium we are well used to; however, today this medium has been extended to mobile phones and VOIP (Voice Over Internet Protocol). Mobile phones and VOIP allow greater freedom regarding where we can be when making contact.  Text Messaging: A mobile phone/computer to mobile phone message system limited to text only which can be created directly from your phone or via computer. Each of these methods expands how we see the therapeutic exchange. Therapeutic sessions can be conducted using Skype, online chat (alone or in conjunction with Skype) or telephone. Text messaging is increasingly used by therapists and clients to communicate quickly regarding directions, changes to session times or requests for information.

E x ample 1: The Travelling Client Marilyn is a consultant who came to see me face to face in my practice. She was burnt out, disillusioned, and wanted to make changes to her life. The additional challenge of having to come to regularly weekly sessions at my office represented more pressure, since her job required her to travel for more than 60% of the time. Telephone sessions were possible, but Skype with video offered an additional element to the sessions, since we were able to see each other on computer screens during each session. We were therefore more directly connected, and I was able to evaluate her appearance (in terms of self-care, fatigue, etc) in ways that the phone would have hidden. Additionally, Marilyn was able to call from her computer, avoiding high telephone charges from hotel rooms. The Capa Quarterly


Help or Hinder the Therapeutic Process Clare Mann

What are the benefits and disadvantages of these modern technological advances for therapy?

Benefits of Technology in Therapy • Both client and therapist can conduct therapy in different locations away from a physical practice. Therapy is uninterrupted when client or therapist is travelling or away from home. • Therapists can take clients from a wider geographical area, in the same country or even abroad. • Supervision or group therapy is possible using Skype, allowing supervisees to expand their contacts beyond their immediate group. • House-bound clients can access therapists from the comfort of their own homes. This could equally apply to office-bound executives whom therapists see increasingly for burnout and excessive working! • Flexibility is increased, not only in terms of where therapy is conducted but also in terms of time spent, as travel times are reduced. • Costs can be minimised when room hire or travel becomes unnecessary. • Communication regarding cancellations, a therapist or client ‘running late’ for sessions, or information requested or promised can quickly be conveyed without having to speak or write longer e-mails.

E x ample 2: Supervision Using Skype Rhiannan, one of my supervisees based in another city came to me for help in developing her practice. Audio Skype sessions were chosen because the connection was excellent and calls were free. Rhiannan preferred not to use video function, believing that, for her, the pressure to focus on looking into the camera or screen distracted her from reflecting on her own process of considering her work with clients. Skype’s chat function, though, became a valuable means of quickly typing in a website name or attaching an article or link to a video for use in the session or afterwards. This allowed for rich material to be shared and reflected on in the session while averting the need to look for materials to send separately, after sessions, thus saving time. August 2011

Whilst using technology in therapy can be enormously valuable, many therapists are sceptical or even critical of its impact on the therapeutic process. It is of course the responsibility of each therapist to choose how she wants to use technology and in using it, how she can maintain necessary boundaries to enhance therapeutic change. It appears that Generation Y clients particularly welcome the use of technology, in and out of therapy sessions, so I believe it is important to open our minds to its benefits.

Disadvantages of Technology in Therapy Skype • When video is used in conjunction with Skype, you must consider that your webcam will pick up everything that is behind you as well as your face. Care must be taken to ensure that anything in the background is appropriate for the client to see, as consistency helps create continuity and safety in each session. • It is essential to have a broadband internet connection as a poor or slow connection will greatly inhibit the quality of both audio and video connections. • Interruptions must be avoided, particularly when working from home. Whilst family members may expect to remain quiet in other parts of the house, if they enter the room unexpectedly, they could be seen on the webcam. This would understandably impact on the session and could result in the client questioning confidentiality. Using earphones ensures that the client can only be heard by the therapist. • Connection may be lost periodically, which can inhibit the flow of what a client is saying or distract her or him from a process he or she is in the middle of. • If each participant looks into the eyes of other person on the screen, each must realise that to the other person, they are effectively looking away. The only way to ‘appear’ to be looking into the other person’s eyes is to look directly into the camera. However, this means that reading the nonverbal content of what is said is greatly reduced. • Clients may feel that it is appropriate to interrupt you by Skype chat or phone when they see that you are online. Thus, it is essential to discuss these issues with clients from the outset, to ensure appropriate boundaries are maintained. 21


Practice Tips

Mobile Telephone • Clients may feel they can contact their therapist between sessions. Whilst this was possible before mobile phone usage, young people in particular have become accustomed to quickly contacting people using this method rather than waiting to see people face to face. • The costs of making and receiving calls can be expensive, and when receiving overseas calls from a client, the therapist may also be charged for the call. • Calls can ‘drop out’ due to poor reception, and this can interfere with the sensitive exchange between client and therapist. • Battery life of phones is limited, so for calls of an hour or more, it is wise to ensure that a charger is at hand. • Participants may be distracted during the session by other people, other incoming calls, or situational factors. This understandably interferes with the integrity of the therapeutic exchange.

E x ample 3: Skype Video and Boundary Issues

E x ample 4: Skype Audio/Mobile Phone and Boundary Issues

Maria was a client with whom I worked weekly for over a year. When she moved house, weekly face-to-face meetings became problematic, so Skype audio sessions were held, with face-toface sessions occurring only when she visited her family in the same city as my practice. Possibly because of the longevity of our relationship and a familiarity Maria might have felt with me, on one occasion she beckoned her grandchild to come to the Skype camera and meet me. She did not initiate this, but it resulted when the child entered the room, not realising her grandmother was at the computer.

The use of telephones in therapy can present some challenging conundrums. I recall a session with a client, which had been booked as Skype using audio only, so when the Skype call came in on my computer, I assumed, wrongly as it turned out, that the client was at her computer. She had, in fact, used her mobile phone to access Skype—which wasn’t unusual since this offered her more flexibility. It was not until I heard an announcement in the background of her flight departure that I realised she was calling me from an airport lounge. Clients calling in could, in fact, though, be calling from anywhere. Whether this, in theory, causes a problem is, of course, debatable. In terms of flexibility for the client, it might be valuable, but it raises important ethical and confidentiality concerns. To what extent is the client really available, in practical and attention terms, to benefit from the therapeutic intervention? What are the implications for confidentiality, for input or topics the therapist might raise? These and other questions remind us that, as therapists, we must constantly evaluate the boundaries within which we work. In this instance, the learning that came from this was to set and agree on boundaries and mutual expectations from the outset when working with a client over Skype or telephone.

It would have been unnecessary and possibly damaging to refuse to meet the eight-year-old child, but the issue was discussed after the child left. This event certainly raised boundary issues, since the client might feel that a friendship was possible as I got to know her family and they could have talked about me differently, having met me on Skype. As friendship is a reciprocal relationship, therapy is certainly not friendship as it would require the therapist to divulge personal information about his or herself. The key thing is that in this example, the event was processed to explore my client’s feelings and offered an opportunity for us to re-evaluate how we work together.

Online Chat • C  ommunication is more likely to be impersonal and prone to misinterpretation, since information is often abbreviated and lacks clarity regarding emotion or intention. • Privacy may be violated in that the history of the chat is often saved on each person’s computer. This awareness might inhibit a therapist truly responding in the way she would in a face-to-face session, since she might believe a response could be misinterpreted or watered down in meaning. • The role of therapy in developing a client’s interpersonal sensitivity and relationship-building skills is inhibited in the use of online chat, probably being almost impossible. 22

Text Messaging • Keying in messages on a mobile phone can be slow, prone to errors and, where people abbreviate words, meanings may be misconstrued or interpreted negatively. • Focusing on texting can inhibit conveying real meaning or intention such as is normally conveyed directly and which facilitates trust in the relationship. • Texting may be difficult on a small screen, frustrating and distracting the user. The Capa Quarterly


E x ample 5: Distress Caused by Client’s Misinterpretation of a Text Message Laura came to see me following the death of both her parents within a three-month period. She was struggling to cope with grief, and since she had moved house to nurse her parents three months prior to their deaths, she had also left her community and job in a different city. She felt so immobilised by her parents’ deaths that she couldn’t face moving again back to her own home. As a result, she had little social support except on the phone with friends and, having to take a temporary work assignment, she missed the continuity and direction her old job gave her. Her symptoms were post-traumatic in nature, giving rise to a paranoia about how her friends might be behaving cruelly or dispassionately towards her. She reported receiving mixed messages from friends, as they were supportive on the phone and then sent text messages that were inconsistent and strangely worded. On one occasion, I quickly texted her to confirm an appointment because it had changed from our normal time. Because the mobile phone screen is so small, I mistakenly mis-typed the message. A curt response was received from Laura, and upon learning of my mistake, I imagined this was due to terror that her fears were being realised and now her therapist as well as her friends were behaving in an inconsistent and dispassionate way with her. I corrected the message, but ensured that I questioned her in our next session about her response to the message. As expected, she had become fearful and even considered discontinuing the sessions. Luckily, there was sufficient trust in our relationship for her to challenge me on this, and to learn the reality of it having been a simple mistake. This enabled her to re-frame the potential intention and meaning of how mis-typed text messages can be due to the ergonomic limitations of a small screen. However, this example, reminds us that everything that happens in our interactions with clients must be processed and is part of the therapeutic relationship. The use of technology in therapy must be considered wisely. There are clearly enormous benefits to embracing technology in terms of reaching a wider range of clients, creating opportunities for therapy that previously didn’t exist, flexibility, reduced costs and increased work/life balance as therapists have greater control over when and where to work. However, the limitations and disadvantages must be considered carefully and any negative effects controlled and minimised. The criteria therapists must use when deciding on the extent to which technology can assist their practices, is to remind themselves of what therapy is really all about. Counselling and psychotherapy form a relationship and

context in which profound change is possible, predominantly for the client but usually the therapist as well. As long as boundaries are enforced, professional standards upheld, and integrity, sincerity and clarity maintained, then I believe we can all benefit from embracing technology in the therapeutic exchange. Clare Mann is a psychologist, author and professional speaker who helps psychologists and counsellors run successful and sustainable private practices. Through her teaching, workshops and writing, she ensures therapists attract the clients they love to work with. For a free CD or MP3 ‘7 Secrets of Attracting Therapy visit www.besttherapypractice.com or phone +61 2 9006 3336.

Peer Reviewed Articles  elevating the quality and authority of your work expanding your Higher Education Research Data Collection (HERDC) publication count  enhancing the academic rigour of The CAPA Quarterly Articles submitted for peer review will be sent to 2–3 independent reviewers. The CAPA Quarterly uses a double-blind review process, where the identities of both author(s) and reviewers remain anonymous. Guidelines for your submissions with a request for peer review are available at http://thecapaquarterly.blogspot.com/p/contribute.html or you may contact editor@capa.asn.au

August 2011

23


Conversations

The Face on My Computer A Client’s Experience of Therapy via Skype

Laura Daniel The CAPA Quarterly’s Editor conducted an interview with a client who is actively engaged in therapy using Skype as the means of connection and interaction. The client’s and therapist’s names are omitted in the interest of their privacy.

CQ : What brought you to therapy?

Client: I had a diagnosis of ovarian cancer. My diagnosis was in March and my treatments finished six months later. After three lots of chemotherapy, surgery, and three more lots of chemo, I had a fear of the cancer returning and also felt motivated to revisit some places within myself.

CQ : Had you any previous experience of therapy?

Client: As a client, only briefly, a long time ago. Before my diagnosis, I was myself working as a therapist specialising in helping people deal with cancer issues, helping them to process their journeys with cancer—so I had a lot of awareness around therapy, as a provider rather than as a consumer.

CQ : Were you previously acquainted with the person who

became your therapist?

Client: No, I had never met her. She was recommended to me by a colleague in the organisation where I had been working, who, as a friend, had helped me somewhat in talking through the fear and issues that were coming up for me; but we thought it best that I get regular therapy with someone else. I live in the country, and did not know how that could work out, as the therapist was in the city. When I phoned the therapist to explore the possibilities of my working with her, she suggested working via Skype. I was hesitant, but she gave me the confidence to try it out.

Q

C : Did you meet first in person, to establish a connection between the two of you? Client: No. My therapy started out on Skype. The first time I ever saw her was on my computer screen.

CQ : Had you used Skype before?

Client: Only a few times, a couple of years earlier, when my daughter was overseas. We had a few video calls that way, but it was strange and unreal. It was so new and different that I felt a little overwhelmed and distanced by it … not quite fully there.

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CQ :

Were you comfortable undertaking therapy through that medium? Client: No, not at all. I had a lot of judgement around it. I didn’t think the immediacy of being in the physical presence of someone could be duplicated, simulated, approximated or even approached using a computerised video connection, but the counsellor encouraged me to try it, so I was willing to see what it was like.

CQ : And what was it like? Did it take some getting used to?

Client: The first session felt strange because of my unfamiliarity with both the person and the technology, but she was so warm and caring that I began to feel comfortable, and after a while I hardly noticed the computer screen. This has really shown me how invalid my prior judgement was and has highlighted some of my unconsciously held limiting beliefs.

Q

C : Have all your sessions been via Skype, or have some of your meetings been held face to face? Client: I met with her in person a couple of times when I had doctors appointments in the city, but other than that, it’s been all via Skype.

CQ : When you were active in counselling others, did you do any sessions with your own clients by telephone?

Client: Occasionally, yes, and while it was nowhere near as good as face-to-face, it was still effective, and preferable to missing out on therapy when a face-to-face meeting was not possible.

CQ :How does Skype compare with phone?

Client: Oh, Skype adds a whole other dimension to the interaction, as expressions and gestures and some body language can be seen.

CQ : How reliable is the technology? Do sessions ‘ drop out’? Is the transmission quality good?

Client: Most of the time, the quality is good. I am on broadband, so it’s usually not a problem, though I know people who’ve had the line drop out during Skype calls. It’s funny, really, that the only time it ever happened with my sessions was immediately after the therapist had explained to me that it could happen and we had agreed that if it did, I would immediately call her back. It was like a demonstration! It has never happened again, though there have been times The Capa Quarterly


Screen when the screen freezes momentarily—which doesn’t affect the audio at all—or there’s sometimes a slight delay in speech transmission. When that happens and I don’t understand what she said, I just ask her to repeat. Those minor problems seem to resolve themselves very quickly. The whole thing feels remarkably natural.

CQ : Are you as easily able to express emotion by Skype as you

would be if you and the therapist were face to face? How does that aspect of your relating differ, if it does? Client: That has not been a problem at all for me.

CQ : Are there issues you prefer not to share by Skype that you would face to face?

Client: Actually, no. That might happen for some people, but I’ve been completely comfortable with the technological link-up. I haven’t felt challenged at all.

CQ : Do you have security concerns, like cybersnooping?

Client: Not really. I thought about it, and perhaps I’m naïve, but I just figure that no one would be interested enough in my conversations to go to that trouble, and if they are, I really have nothing to hide, so they can go ahead!

CQ : What difference do you perceive between meeting with

the therapist in person and interacting with the same person via computer screen? Client: Surprisingly little. Of course I felt her presence more strongly when actually in her presence, but it is amazing how strongly I can feel her through the screen. When emotions come up for me during Skype sessions, I actually feel held by her. Once our relationship was built, her energetic field comes through the screen. As soon as I see her face, I am in that safe place. Who she is and what she brings are not diminished by the physical distance.

CQ : How long and how often do you meet via Skype?

Client: Our sessions are for fifty-five minutes. When we have an appointment, I call in, she answers, and we talk as if we were in the same room. At first, I had sessions weekly, then I dropped back to fortnightly, and now we connect only once a month.

home is, of course, a safe space for me—my space—so I’m comfortable here; but the face of my therapist on the screen feels like a welcome visit, not an intrusion at all.

CQ :Do you always use the same room?

Client: No. I use a laptop and wireless, so I can go anywhere in the house. Sometimes I feel like being downstairs, sometimes upstairs—I could even go out in the garden. My children are grown and gone, and my husband, though retired, is not always home. He’s very supportive of me in this process, so when he is here, he gives me whatever space I need. There was one time, early in my therapy, when right at the beginning of a session, I saw a person on the computer screen behind the therapist, a quick movement of someone passing an open doorway. She didn’t see it, but she saw my attention shift, and looked around. She got up immediately and closed that door, and she was very apologetic. It has never happened again.

CQ : Do you determine in advance the issue to be discussed at each session?

Client: Sometimes we do, sometimes we just talk, and the issues unfold as one thing leads to another. As my healing has moved forward, my issues are not so in-my-face, so the sessions are more free-flowing. I now trust the process, the counsellor, and the technology.

CQ : So how would you summarise or evaluate your experience of participating in therapy in this way?

Client: It has been a really good experience. I would not hesitate to recommend it to people in need of counselling whose location or time constraints make regular in-person therapy sessions difficult or impossible.

CQ : Do you have any tips for people thinking of trying out this medium?

Client: I set myself up with a glass of water or a cup of tea beside the computer, and certainly a box of tissues. I also keep a pen and paper to hand to take notes, both during the session and immediately after when my recollections are still fresh. And of course I take the phone off hook and put my mobile on silent or turn it off.

CQ : What is it like sharing your home or room with your therapist? CQ : Based on your own positive experience as a client, would Client: I think it’s great. I don’t have to dress up or make any other preparations for going out. I can just come into the house from the garden and sit right down to my session. My

August 2011

you consider using this technology in your own practice with future clients? Client: Given the right circumstances, yes, I would. 25


First Person

Supervising Through Cyberspace A Personal Ref lection

Eveline Crotty

Supervision interrupts practice. It wakes us up to what we are doing. When we are alive to what we are doing, we wake up to what is, instead of falling asleep in the comfort stories of our clinical routines and daily practice ... the supervisory voice acts as an irritator interrupting repetitive stories (comfort stories) and facilitating the creation of new stories. ~ Sheila Ryan (2004)

Supervision is a consultative process between two or more people known as ‘supervisor’ and ‘supervisee/s’. Each has a distinctive role and, in the process, the supervisor and supervisee work together to create new energy, insight and/ or ‘new stories’ for the supervisee to use in the workplace. Sessions usually take place in regular, facilitated face-toface meetings. This has many advantages for both supervisor and supervisee. They can work with the material being presented in a variety of ways that the supervisor may wish to use to enable both to reflect on the supervisee’s practice. These face-to-face sessions also give the possibility for both to read verbal, vocal and body language signals which fill out the encounter. There is also the possibility for the supervisor to share resources for learning or to use other modalities that may be the supervisee’s preferred learning style—such as art, sandplay, expressive techniques, or mind mapping—to engage in reflection on the supervisee’s practice. Many practitioners who live and work in rural and regional situations—as well as some who are, for whatever reason, engaged in supervision while interstate or overseas—have only limited access to the traditional faceto-face format for supervised reflection on their practices. Modern developments in communications technologies now enable practitioners virtually anywhere to have a supervisory session. Counsellors, chaplains, social workers and a range of community workers, are now regularly taking advantage of telephone, Skype and e-mail. When a supervisee is unable to meet with me face to face, I regularly accommodate supervisory sessions using a range of technologies: • telephone land line • e-mail – for sending and receiving written material for discussion and reflection • Skype (individual) either using audio only or audio and visual through the use of a webcam • Skype (individual – audio only) via telephone, using Skype credit. 26

• Skype (group) (audio only). I have noted that Skype (visual) as a group is now possible for groups but as yet I have not tried this. • Audio-visual conference calling (if available in an institutional setting to other institutions, e.g. hospitals) Telephone landline About 15 years ago I was conducting a training programme in a country town southwest of Sydney. I would travel to the town to work with a group of trainee hospital chaplains. The face-to-face group work was for four sets of four days over a six-month period. Between the group sessions, I would offer individual supervision sessions to the participants by telephone. I bought a headset with earphones and speaker and attached this to the phone, then we would speak at regular pre-arranged times. With this equipment, I was hands free for the session and so could make notes if I needed to do so. Before the session, the supervisee would e-mail or post any reflections or questions he or she wished to raise etc. This gave me time to reflect on those issues in advance. The advantage of being able to speak by phone regularly was that I had ongoing contact with the participants in the programme between the group sessions. The disadvantage was that I had only an auditory interaction to work with. If there was a silence in the conversation due the supervisee thinking through an issue I had no visual or body language clues. I had to concentrate using just this one sense to be able to read the situation. Another disadvantage at the time was that we were paying STD telephone rates for an hour session and this we would take turns paying. E-mail This has also been a useful medium when a supervisee has been reflecting on an issue and wanted some further feedback. Though it has its limits, e-mail has been useful when other forms of communication were not available. The Capa Quarterly


Skype (individual) audio and webcam I asked a couple of supervisees who experienced using Skype for their supervisory sessions last year for their personal reflection on how this medium worked for them. I asked them the question: What were the advantages and disadvantages of having a supervisory session through the use of Skype, whether by audio only or by webcam? From Mackay, Central Queensland My experiences with supervisory sessions through the use of Skype were not always successful; but because of this, I am able to state emphatically that it was most beneficial for me when both the audio and webcam were operational. In the first instance, I was anxious regarding the supervision experience and found that when it commenced and I could read the supervisor’s facial expressions, I was set at ease. It felt almost as if we were one-on-one in actuality. Then, the connection weakened, and we agreed to use only audio; this was not as effective for me. While her verbal assurances were encouraging and our discussion continued well, I felt a little let down that for both of us, our body language could not be used to enhance the reality of the experience. From my point of view, the advantage that distance can be covered by Skype to ensure that a supervisory session can occur far outweighs the technical difficulties that can sometimes arise. From Bundaberg, Central Queensland The main advantage with Skype for me was that I like to be able to see the person with whom I am speaking. In that way I can see facial expressions and pick up a whole lot more than on an ordinary phone call. Likewise I believe the supervisor has that same opportunity. Skype fills the need when a supervisor can’t travel to an area. This could be due to floods, cyclones, air strikes or financial issues. With Skype we don’t miss out on supervision or assistance because of external factors. August 2011

When a supervisor has to be present at a place such as Bundaberg, there is very little scope to reschedule, but with Skype we could reschedule when work/family requirements encroached on a previously set appointment. With Skype there is a wider time frame of availability. With face-to-face, possibilities for times of working together is more limited but if evening is more suitable to both parties then Skype is preferable. Skype helped because we got more supervisory time. I would not like it without the visual. The only disadvantage I can think of is the possibility of the line dropping out or where internet connectivity in country areas is not dependable. From Rockhampton, Central Queensland During the past twelve months, I have undertaken parttime studies. With my course facilitator/supervisor in NSW and me in Queensland, essential face-to-face contact was accomplished through Skype, and we maintain this contact for ongoing projects. There were times of struggle when this technology was a blessing in my ability to receive extra tuition and guidance from my supervisor. I feel confident in saying that the added bonus of Skype sessions enabled me to ‘nut’ out the tough issues, with my supervisor’s support, so that I could successfully complete my studies. I think it is a marvellous communication tool. 27


First Person

Not all supervisees are rural, though. Some are simply located at a distance that makes face-to-face personal meetings unworkable most of the time. From Melbourne I have found the use of Skype in supervision such a bonus in the supervisory experience, both as a supervisee and supervisor. This was brought home to me again in a supervisory session recently, where I normally supervised via Skype, but this time it happened via phone. Somehow the immediacy and presence of the person was diminished to a voice, rather than being able to also observe the person’s face, appearance, body language, mood and surroundings. However, it is primarily the face which embodies the person. I feel more connected, not so isolated. Skype helps immensely when the supervision happens over a distance. My supervisor is interstate, while I have a supervisee in a regional area. I also am planning to offer supervision to others in regional areas, and the potential of Skype means a closer connection and experience. In summary, Skype is a real bonus for interpersonal connection and, for the supervisory relationship, it assists creating trust, a listening space and presence of the other. This presents a perspective from the supervisee’s experience of the use of Skype. To be able to use Skype effectively, broadband is necessary, so for some people this is still not practicable at this time. With the expansion of the National Broadband Network, Skype and other means of using modern communications technologies will become increasingly available. What the supervisees have shared above gives the feel of how this has been of benefit to them in their ongoing work and training.

From my perspective as a supervisor, I think it has been a great advantage to be able to use this medium to offer the service of supervision to people who are restricted by distance and cannot spare the time and expense of travelling long distances to meet with a supervisor to reflect on their practice. Using this technology does not only apply to country, interstate and overseas it can also be used with people in the same city. For example, one volunteer worker on her day off scheduled a supervisory session using Skype. She had two small children and when the children went to have their afternoon nap, the mother/volunteer and I could have our supervisory session. This was an enormous benefit to her as it saved travelling to my office and finding childcare for those couple of hours of travelling plus the session time. Another advantage is that there is no cost involved in using the technology computer to computer using either audio only or audio with webcam. Disadvantages At times the internet connection does drop out particularly if you are using Skype at a time of day particularly heavy with online traffic—e.g. between 5 and 7 pm. Earlier in the day seems to work more easily. This can stop the conversation in the middle of a sentence. At times the picture will freeze. You still have the sound but the picture before you has frozen. Sometimes it returns to normal, at other times you need to close the call and ring again. These are only small disadvantages compared with the overall advantage of having this visual or auditory contact available at almost any time to and from almost any place. I am sure over time, with the technology improving every day that occurrence of these little glitches will diminish or disappear.

Journal ads and PD hours Please note that advertisements in the journal do not necessarily comply with CAPA’s professional development (PD) requirements. As with all workshops/courses/conferences, please check their eligibility using CAPA’s ‘Professional Development Policy 2009/2010’ in the members area of the website

www.capa.asn.au

If you have any queries, please contact CAPA’s Membership Chair on membership@capa.asn.au

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The Capa Quarterly


It has been my experience that people, particularly in country areas, find this medium of great benefit, particularly at times when a crisis has happened in the workplace and they know they can schedule a call to their supervisor for debriefing, etc. When possible, I try to intersperse Skype sessions with a face-to-face session—at least a couple of times a year for people using this technology due to distance. Skype (individual – audio only) ringing a landline, using Skype credit. With Skype you can buy telephone credit. This enables you to ring a landline at very little cost, cheaper than an STD call in many cases, depending on the time of day or telephone plan. This audio call is also very worthwhile when the internet connection is down. Skype (group) audio only Up until now I have only used Skype by audio alone when I am working with a group. I have noted that Skype by webcam for a group has become available, but at this stage I have not yet used it. This will be my next step. The advantage of being able to work through Skype with a group is that the group can work on a group issue together. If you are working on a written document for a supervisory issue this can be transmitted through Skype and each member can have the document before them. This is accomplished by way of what is called a ‘Dropbox’. The article can be placed in the Dropbox and all members of the group who have access to this file can work on the same document together. This can be done while speaking together on the Skype audio or audio-visual session. Group facilitated supervision at a pre-arranged date and time can also take place using this medium. If the person presenting the case study sends an outline to the

group, either through Skype, email or Dropbox, each member of the group then has the advantage of working with the person presenting the case. Conference calling (available in some institution-to-institution settings, e.g. hospitals) This medium I have not used, but I know of workers who belong to a system of hospitals in Central Queensland where this is available and can be used. They have been able to book a time slot and use this medium to have peer supervision or reflection on an issue that has arisen where they would like the opinion of peers in other hospitals. I am sure with the advance of technology we will be able to use other worthwhile media in the future. There may be supervisors already using them. I am also very aware of the confidentiality of the material being discussed while using these media, so I am being very careful before moving into newer technologies that become available. I do not believe that using the technologies will ever replace the advantages of face-to-face contact when working in supervision; but for people restricted by the tyranny of distance, this has been a wonderful advantage, allowing them to avail themselves of a service that enables them to gain accompaniment as they reflect on their practice, get renewed energy, affirmation, challenge and availability to resources that are not always available in country and overseas areas. Reference Ryan, S 2004, Vital Practice, UK: Sea Change Publications Eveline Crotty rsm has worked in the training and supervision of chaplains, pastoral workers and community workers for over 25 years particularly in urban environments. When the work expanded to rural, interstate and overseas the use of technologies to supplement face to face training assisted the learning for participants. Eveline is currently a Supervisor-Trainer member of the Australasian Association of Supervision. A member of the Association of Transforming Practices Inc—a group of qualified professional and pastoral supervisors www.transformingpractices.com.au—and is the co-ordinator of the Urban Ministry Movement–Sydney www.ummsydney.com.au.

You don’t want to write an academic paper? We welcome more informal anecdotes from your practice.

Check out the PACFA website at

www.pacfa.org.au for an update on all the current events

August 2011

Topics could include:  A client who changed my practice (or my life)  The most valuable lesson I learned in the therapy room  Ideas that inform my practice  My most important therapeutic mistake  Some things I wish I knew before becoming a therapist Send your submissions to editor@capa.asn.au

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Professional Development

Suffering Loss and the Search for Identity

Review by Juliana Triml

Alison Strasser, DProf (Psychotherapy & Counselling), MA, BA (Hons)
is Director of the Centre for Existential Practice. Alison has been instrumental in creating the existential curriculum for a variety of counselling and psychotherapy trainings in Australia. She is a practising psychotherapist, coach and supervisor, and former Director, Academic Programs, at the Australian College of Applied Psychology. Alison is co-author of Time-Limited Existential Therapy and founder of the Australasian Existential Society.

“LEARNING IS FOREVER”

“LEARNING IS FOREVER”

On 15 June 2011, Dr Alison Strasser presented a CAPA PDE looking at Identity, Values, and Worldviews, and how we create meaning in our lives. Many of us in this vocational field would know current CEP Director Alison from ACAP, where she held several roles. Those of us who knew her as a lecturer would remember her passion for existentialism, although she is knowledgeable in many other paradigms. Today’s presentation was different yet again. It was not a lecture, but we learned a lot of things about ourselves. How did this come about? There were no handouts, and although I did ask for one and received one, I decided to write this report from my own hermeneutic perspective, as the existential concept of meaning, challenge and other aspects of our worldviews are always subjective. Alison skilfully and vaguely (existential hermeneutics) spoke about some aspects of our identities as we perceive them and then asked a question, inviting us in the audience to share our thoughts with our neighbour in the next chair. I hope

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that other working dyads found these experiential exercises as challenging and insightful as did I and my discussion partner. What follows is what I heard, and the meanings I understood Alison to be expressing. For us in the counselling field, language is a very refined tool of trade. It allows us to hear, understand or misunderstand, and make a meaning, which is about what it is to be human. At the beginning of the presentation we were invited to talk with our neighbour about what Identity means to us. Some said it is the different roles we have in life, or our perception of self within the world or relationships with others, how they perceive us. The PowerPoint slide suggested, among other things, that Identity is a distinguishing characteristic of personality. It is embedded in relationships with others and how they perceive us to be, the self as a process, self as an essence that is altered as we interact with the world. One of characteristics of Identity is its aim to gain some certainty in the uncertain world by fixing most of the ‘uncertains’, thus giving us some safety/security about Self, others and the world. Values impact on all aspects of our being. Alison mentioned that, from her childhood, wanting to be independent impacted on her choice of friends, resulting in her being drawn to strong and independent individuals and pushing away the weak ones. She explained that we create our Worldview in order to create safety and meaning in our lives. Values that are part of this worldview inevitably influence the physical, psychological, social and spiritual dimensions of our Being; and, possibly, incongruence may create an Identity conflict of the self. When our Worldview gets challenged, two things can happen:

Want to explore an Existential approach in your practice? CEP’s Sydney workshops for 2011 include:

Workshops

GroupWorkshops

Phenomenology - To Be or Not to Be

Group Work - the art of co-leadership - sharing the load

- a creative exploration of Being • 1 & 2 October

The Anxious Client - 2-day Workshop • 28 & 29 October

• 22 & 23 September

Working with Teams and Groups - in the Coaching Environment

Advanced Existential Theory & Practice

• 2 & 3 December

- 5-day Workshop • 21 - 25 November

For more information The Centre for Existential Practice admin@cep.net.au www.cep.net.au Telephone: 0431 401 659

The Capa Quarterly


a) we may despair, experiencing a loss, and our Worldview can block us from being psychologically flexible; or b) the situation may open a possibility of revising our Worldview so that it better reflects the present situation. We craft our Worldview to make some sense of a seemingly senseless world and create some security. How do we make a worldview? This happens on different levels during childhood via things that are said to us by our parents or relatives. We interpret them within the framework of experiences we have up to that time and within our understanding at the time, and tend to hold these interpretations of our world as valid in similar situations in our later lives. What happens when these Worldviews are challenged? Often this creates fear. When this fear is experienced, we have choice either to freeze or to choose to be psychologically more flexible. We can choose to embrace the polarity and become open to new possibilities while being in touch with authenticity. Existential philosophy tells us many things, including:

• Freedom consists of choices and responsibility for those choices. Freedom is also aimed at accepting that which is beyond our control. • Quoting Sartre: “Man is condemned to be free.” • Quoting Kierkegaard: “Anxiety is the giddiness of freedom.” Finally, “What happens to your identity when your personal principles are lost? Some people said: “After such a loss our sense of security is lost.” “In Buddhism it is called the suffering.” “Loss or symbolic death created openness to new possibilities.” Alison’s presentation leaves us with more questions than answers, and I believe that this enables us to explore our own Being, which is essential before we can understand the worldview of another Being and then accept him/her unconditionally. Juliana Triml is the CAPA NSW PD Coordinator. If you have any suggestions regarding future professional development events, please contact her at: capa.pd@hotmail.com

CAPA NSW Professional Development Event Acceptance & Commitment Therapy—Six Core Processes Speaker: Mary Sawyer Date: Wednesday 22 November 2011 Time: 7.00 –9.00 pm PD hours: 2 Acceptance and Commitment Therapy (ACT) is a new model of behavioural treatment that emphasises acceptance of internal experience while maintaining a focus on positive behaviour change. This approach is designed to address maladaptive avoidance of internal experiences associated with many problems in functioning while also focusing on making and keeping commitments. ACT uses a variety of verbal, experiential and homework techniques to help patients make experiential contact with previously avoided private events (thoughts, feelings, sensations), without excessive verbal involvement and control—and to make powerful life-enhancing choices. Empirical evidence suggests that ACT techniques that may be broadly useful for intervening with multi-problem patients dealing with issues such as anxiety, depression, epilepsy, substance abuse, pain management, psychotic disorders. In addition to an overview of empirical and research findings on ACT, this event will address some techniques of ACT interventions, including the six core processes of ACT, and the evolution of ACT as the third wave of behaviour therapy and the ACT theory of change. Mary Sawyer RN, BA, MApp Psych, MAPS, MCN has a private psychology practice in Sydney. Before entering private practice, she lectured in psychology and psychosocial care at ACU National in Australia and Hong Kong. One of the foremost ACT therapists in Australia, she has over 150 hours of professional development with expert ACT clinicians and has trained with leading ACT researchers and clinicians in Australia, New Zealand, the UK, the Netherlands and the USA and has presented ACT workshops at International Conferences. She is the first Convener of the Australian Psychological Society (APS) ACT Interest Group and has been actively involved in promoting ACT in Australia since 2003 and facilitates ACT workshops in Sydney and rural areas of New South Wales. Mary uses ACT working with a variety of psychological problems such as; depression and anxiety, grief and loss, post traumatic stress disorder, all addictions including gambling, alcohol and other drug problems, adult survivors of sexual abuse and relationship, separation and divorce issues. She has provided clinical supervision for Alcohol and Other Drug workers in the NSW Department of Corrective services for 10 years and is now a clinical supervisor for St Vincent’s Hospital Sydney Alcohol and Other Drug Service and Homeless Health Outreach Workers, using ACT as the predominant therapy. Bookings: (02) 9235 1500 or office@capa.asn.au Cost: Free for CAPA members. $30 for non-members Venue: Crows Nest Centre, 2 Ernest Place, Crows Nest, Sydney (unless otherwise stated) Please book as soon as possible. Spaces are limited due to Occupational Health and Safety requirements. If you have any suggestions for future PDEs, contact CAPA’s PD Coordinator, Juliana Triml, on capa.pd@hotmail.com. CAPA is also exploring more convenient options for members in rural and regional areas. Please email the Regional and Rural Committee with your suggestions regional@capa.asn.au.

August 2011

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Member Profile

Tessa Marshall Each quarter, no doubt like many of you, I enjoy having a cuppa and reading the latest great insights from my CAPA Quarterly. From getting just the right suggestion at just the right time for a client I am working with, to dog-earring a page that has a great inspiring quote for reflection on my own wellbeing, to reflecting on Clare Mann’s great ideas for how to better build my practice, there are always at least three key takeaways each time. When invited to be profiled for this issue, I was both delighted and excited at the opportunity to give back. That got me thinking: how can I make this interesting and of use to my fellow CAPA members rather than just being a download of what anyone could read about me on LinkedIn or via a résumé? What will be of interest to you? How may my story inspire you? … Well here goes. It is my hope, wish, and desire that the story below spark some thought or insight that you value. I started life as the daughter of a geologist and a nurse, went to ten schools by the age of fifteen in eight different cities and have no doubt that this is what got me started on my fascination with people and relationships. After graduating from Turramurra High (awesome school, home of Shane Gould!!), I studied Economics & Industrial Relations at Uni

then spent the next 15 years falling in and out of Human Resources, Sales, Marketing and HR Consulting roles with McDonalds, British Airways and HJB Group. I managed to also marry, set up house and start a family during that time! Life took a major turn after my two sons were born. Depression set in, marriage difficulties reared their ugly heads, work-life balance whilst running my own recruitment firm proved to be difficult, and I started questioning the meaning of my work and life. After a desperate phone call to Lifeline and some subsequent therapy with an awesome counsellor, Lorna Patten, I sold my business, rebuilt my marriage, simplified my life and went deeply into clarifying my values and life mission. It wasn’t an easy journey but was one that equipped me better than any textbook or course could for the phase ahead. I found counselling so helpful that I decided I wanted to give it a shot myself as a vocation. I hoped I could help others the way Lifeline and my counsellor had helped me. On good advice, I took a stepped approach by keeping a day job coaching and training recruiters whilst training as a Lifeline

Upcoming themes in

Open Forum Issue One 2012

Sex Issue Two 2011

Belief Systems in Therapy Issue Three 2012

Dealing with Dementia Issue Four 2012

Peer reviewed submissions due:

Peer reviewed submissions due:

Peer reviewed submissions due:

Peer reviewed submissions due:

Non-peer reviewed submissions due:

Non-peer reviewed submissions due:

Non-peer reviewed submissions due:

Non-peer reviewed submissions due:

Mailout: February

Mailout: February

Mailout: February

Mailout: February

1 October

1 November

1 October

1 November

1 October

1 November

1 October

1 November

Send expression of interest to editor@capa.asn.au as soon as possible to ensure inclusion. NOTE: Peer reviewed submissions are due four months ahead ahead of the issue month. Non peer reviewed submissions are due three months ahead of the issue month. All submissions are due on or before the 1st day of the month. Contributor guidelines: http://thecapaquarterly.blogspot.com/p/contribute.html or contact editor@capa.asn.au. Advertising enquiries: http://thecapaquarterly.blogspot.com/p/advertise-with-us.html or contact advertising@capa.asn.au

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The Capa Quarterly


telephone counsellor. After a year on the phones, I wanted more and went back to study at Janssen Newman to get my Grad Dip in Counselling and Psych. I then took on face-toface counselling with Lifeline, which was a great way to apply my skills in a supportive agency whilst doing the hard yards to build a private practice. That was all over 14 years ago and I haven’t looked back since! Now I get a great balance. I have had the most amazing paid and volunteer roles with Lifeline from doing personal counselling, gambling and couples work, domestic violence line supervision, running groups for those bereaved by suicide, holding a board position, and learning from an amazing bunch of peers and mentors. I also have a very satisfying and fulfilling private practice where I specialise in career counselling and couples work. These two areas seem to be my calling, and I love getting up each day knowing my work has true meaning. Yet, about eight years ago, I found I was getting restless and was missing corporate life. Private practice can be very intense and isolated, so I set up a corporate arm offering communications skills training, wellbeing at work programs, and executive coaching for organisations—a great contrast to 1:1 clinical intensives and my Lifeline work.

Through it all, I have had my ups and downs. Sometimes I overdo it or don’t get enough supervision, sometimes I spread myself too thin, sometimes my relationships still suffer and/or the work/life balance gets out of whack. But the great thing is that, when it does, I have all the skills/tools and techniques I have learnt as a counsellor to help me bounce back, reconnect with loved ones, rebuild and draw upon the resilience I have gained from this privileged work. My mentor Wendy Carver, supervisor Monica Cable and therapist Kathi Pauncz all have played key parts in keeping me sane so that I can support my clients! So the five key messages I share with you, whether you are just entering your own path as a counsellor or whether you are well advanced on your counselling career path: 1. Love the journey and love yourself. 2. Stay humble and honour that you will make mistakes. 3. Stop and smell the roses as often as you can. 4. Never underestimate the privilege this vocation bestows upon you. 5. Never underestimate just what a difference your work can make to the lives of others. And here is hoping you take away at least three great insights from your CAPA Quarterly this month!

Certificates of attendance with Professional Development Hours available at the following C G Jung Society of Sydney presentations MEETINGS

VENUE Level 2 484 Kent St Sydney TIME 7:00 to 8:30pm COST* M: $10 NM: $25 NMC $20

WORKSHOPS

VENUE The Centre 14 Frances St Randwick TIME 10am to 4pm COST* M: $140 NM: $180

MEETINGS: August 13: The Experience of Evil: Its Archetypal & Sensual Dimensions with Dr David Russell Sept 10: Wisdom of Salt with Peter Dicker, Psychologist Oct 8: The Collective Consciousness & Progressive Evolution with Alexandra Walker, LL.B(Hons1), M Int Law & Rel., BA Nov 12: Jung & the Southern Complex: Sleeping with Medusa with Dr Craig san Roque, Jungian Analyst WORKSHOPS: Aug 21: A Jungian Perspective on Working with Fairy Tales with Sarah Gibson, Jungian Analyst Oct 9: Creative Imaginal Play: Working with Social Dream Artistry & Dream Narratives with Dr Susan Benson Nov 12: Symposium on the Cultural Complex in Australia with Dr Craig san Roque, Dr David Russell, Amanda Dowd et al. *M=Member NM=Non-Member NMC=Non-Member Concession The C G Jung Society FURTHER ENQUIRIES: tel: 9290 1519 email: cgjung@jungdownunder.com PROGRAMME DETAILS: www.jungdownunder.com

August 2011 CAPA_July_2011.indd 1

of Sydney has been promoting the ideas of the Swiss analyst and psychiatrist Carl Gustav Jung (1875-1961) since 1975

33 1/07/2011 2:24:17 PM


CAPA News (continued from Page 4)

encouraging including “Excellent speakers”, “Best CAPA PD meeting I’ve attended”, “professional, warm and relevant”, “lovely atmosphere of acceptance & support”, “well worth my travelling from Sydney to attend the meeting!”, “pleasure meeting up with such a lovely group of people!”, “enjoyed everything ... informative content ... professionalism ... friendly atmosphere ... delicious food” and “what a magic spot Port Macquarie is!”.

Besides being a fun piano teacher, Sharon Ellam is known around Newcastle and the Central Coast for her skills with Childhood Anxiety. Increasingly families are coming to Sharon for help with systemic issues often related to one child who is anxious. With a background in Nursing and Midwifery, Sharon also has expertise in emotional issues during and after pregnancy, and with families affected by an abnormal birth experience, sick or premature newborn. Sharon is passionate and curious about how Counsellors can build a fine film of gossamer across the CAPA space to create a ‘sharing and reaching web’.

Apology from Campiao To the Editor: In November 2010, this journal’s ‘Spirituality and Therapy’ issue carried my article ‘Embodying and Integrating Spirituality: A Vital Role for Psychotherapy’. I intended the article as a description of the ideas and concepts that animate and define my approach to working with spirituality in my psychotherapy practice. I did not intend that any of the concepts described therein be seen as originating with me but, rather, as illustrating the way the ideas and concepts cited had come together in my own mind. It has been pointed out to me, and it now appears clear to me, that I did not adequately express in that article the debt I owe to the ‘participatory studies’ work and literature, including the work of Dr Gregg Lahood and John Heron. This literature and its attendant inquiry practices, including Dr Lahood’s Byron Bay relational inquiry group, and the guidance provided to me by him in its theory and practice, was one of the inspirations for my article and has been suggestive in its application to my psychotherapy practice. In that article, I failed to adequately reference with appropriate citations, in some passages, Dr Lahood’s original research on hybridity and the ethnocentric claims of perennialism in new age spirituality and its highly relevant form of spiritual narcissism. In particular I failed to attribute more strongly Dr Lahood’s thesis that hybridity theory is a powerful hermeneutic tool in understanding the new age. I would like to extend to those sources whom I failed to reference well, but to whom I am indebted—but most especially to Dr  Lahood (www.relationalspirit.com)—my sincere apologies for my inattention to proper acknowledgement. Appropriate attributions and credit where it is due are vitally important in the maintenance of professional integrity in scholarship and on this occasion I unintentionally failed to maintain appropriate academic standards. Yours most sincerely, Pedro Campiao 34

The Capa Quarterly


Noticeboard

Classifieds

A free service for CAPA NSW members, contact advertising@capa.asn.au Rooms for Rent Brookvale New building behind Warringah Mall, suit counsellor, coach, psychologist. Room available most days, half day or full day. Client parking available. Call Peta on (02) 9938 5860 or email jangrant@optusnet.com.au Crows Nest Modern, bright, fully furnished room and large, fully equipped group room available in an established practice on the Pacific Highway. Metered/free parking nearby. Half, full and multiple day rates available. Contact Eve on 0412 011 950 Crows Nest Well presented consulting room in brand new clinic located in the heart of Crows Nest. Excellent parking and public transport. Sessional and permanent rates. Also available: group space for up to 14 people. Fair rates. Please contact Sabina on 0419 980 923 or sabina@wellforlife.net.au Glebe Warm and inviting, well-presented consulting rooms available for reasonable rates on a permanent, weekly or part-time basis. Large, pleasant waiting room, good facilities and great location on Glebe Point Road in the midst of Glebe village. Public transport at the door and ample off-street parking. Contact Lee on 0407 063 300 Glebe Inviting and warm consulting room available for hire on Mondays and Wednesdays; other days negotiable. Spacious and welcoming waiting room. Easy access on St Johns Road, Glebe. Public transport at the door and ample on-street parking. Contact Gay on 0409 986 740 Lane Cove Rooms/room available to rent on a daily basis in a beautifully renovated health care clinic. Ideal for a Professional Health Care Provider. Flexible lease agreement. Unrestricted and ample parking. Please contact Peter on (02) 9427 1785 Lane Cove Rooms/room available to rent on a daily basis in a well established multi-modality Health Care Clinic. Great working environment with unrestricted and ample parking. Flexible lease agreement. Please contact Catherine on 0416 178 517 or email to catherine@lrcc.com.au

Lilyfield Bright, sunny, unfurnished room available at the Lilyfield Psychotherapy Centre, established practice. Very reasonable room rental. Convenient location close to public transport and cafes. August 2011

Contact Jen Fox on (02) 9560 0719 or (02) 9799 3387 Mosman Beautiful practice room at the heart of Mosman, close to public transport and easy parking. Available on a daily basis with good rates. Please contact Eva on 0411 498 468 or eva@ardstrom.com.au Parramatta Four airconditioned and well appointed counselling rooms and a group room are available at hourly casual rates (from $25) or on a permanent basis. Rooms are located in George St, Parramatta and room bookings can be made on our website www.lifexplored.com.au. Contact John Carroll on 0419703410 or john@lifexplored.com.au Sydney CBD Stylish consulting rooms in landmark Macquarie St building, in Sydney’s prestigious medical district. Polished wooden floors, air conditioning, waiting area, kitchen amenities and printer/copier/phone/fax. Bright, leafy outlook and nearby public transport. Opportunities for cross-referral and crosspromotion. Full day, half day and casual sessions. Photos available. Contact Susie on (02) 9221 1155 or beingcounselling@iprimus.com.au Woolloomooloo – CBD Two comfortable, spacious consulting rooms to choose from. One room complete with sandplay tray and figures. Large group/workshop/ training space also available. Close to transport and ample parking. Photos available on our website under Room Rentals. www.gloo.org.au Full day, half-day or weekend rental available for workshop venue. Contact Tanya on 0425240928 or email tanyadawson@iinet.net.au

Supervision

Supervision – Penrith and Richmond Experienced supervisor and adult educator offers supervision for counsellors, group workers, community workers etc. Penrith and Richmond..PACFA Reg. Contact Jewel Jones on 0432 275 468 or email jeweljones@iprimus.com.au Web: www.jewel-jones.com.au Supervision – Disability and Sexuality Individual and group supervision for counsellors, group leaders and those supporting people with a disability or Asperger’s syndrome. Twenty years’ experience working in disability field; seven years in relationships and sexuality counselling and education including working with victims and perpetrators of sexual harassment and assault. CMCAPA. Burwood and Newtown. Contact Liz Dore on 0416 122 634 or lizdore@bigpond.com Web: www.relationshipsandprivatestuff.com

Supervision – Newtown Available for those doing individual, couples and group work. Over twenty years of clinical experience. Accredited in Professional Supervision (Canberra Uni), Registered member PACFA. Contact Vivian Baruch on (02) 9516 4399 or email via www.vivianbaruch.com Supervision – Brookvale and Glebe Experienced supervisor for counsellors and group leaders. Qualified trainer and supervisor, CMCAPA, Registered member PACFA. Call Jan Grant on (02) 99385860 or email jangrant@optusnet.com.au Supervision – Chatswood West Supervision for individual, couple and group work, including counselling, psychotherapy and coaching approaches. Flexibly designed to suit your needs. Over twenty years of clinical experience. Clinical Member CAPA/Reg. PACFA.Contact Gemma Summers on 0417 298 370 or email gemma@goodmind.com.au. Web: www.goodmind.com.au Counsellors/Hypnotherapists Just graduated and looking to go into private practice? Supervision and business coaching available to help you on your way. Also rooms for rent on sessional/permanent basis. Contact Lidy@northernbeachescounselling.com.au or phone (02) 9997 8518 or 0414 971 871 Supervision for working with Adolescents and Parents – Coogee and telephone Individual and group supervision for counsellors, educators, allied health workers, group leaders and parents. Fifteen years in private practice as psychotherapist/counsellor; eighteen years working with pre-teen/teen girls and their parents, addressing developmental issues and popular culture/media’s impact on girls’ body image. Registered clinical member PACFA. Contact Shushann Movsessian on (02) 96654606. Web: www.shushann.com and www.letstalkgrowingup.com.au Supervision Experienced supervisor. Registered member PACFA. Accredited supervisor with Australian Association of Relationship Counsellors (AARC). Available for psychotherapists, counsellors and group leaders. Caringbah. Contact Jan Wernej on (02) 9525 4434 or email janwernej@optusnet.com.au Counselling, Psychotherapy and Supervision For personal and professional development, self-care and mentoring. Thirteen years’ experience in private practice. PACFA Reg.20566. Location: Mosman. Contact Christine Bennett on 0418 226 961 or email christine@caring4couples.com.au Web: www.cb-counselling.com.au and www.caring4couples.com.au 35


Call for Contributions February 2012 – Open Forum Do you have an insight to share about the practice of therapy, but haven’t been able to align it with any of the announced themes for The CAPA Quarterly? Now we have an Open Forum each February so that articles on any aspect of therapeutic practice can be welcomed. Share your knowledge with your peers and open up discussion on topics of importance to you. Peer reviewed papers due by: 1 October Non-peer reviewed due by: 1 November

May 2012 – Sex In our multicultural society and global community, many people have personal and societal challenges around sexuality—sexual attractiveness, sexual performance, sexual orientation, and sexual identity, as well as sexual abuse. Such issues often find their way into the therapist’s rooms as clients search for clarity and resolution, comfort and confidence. Sex can be a tricky subject, but it is fundamental and can arise in many contexts for both children and adults. Sexual issues can also be buried—hidden behind other issues more amenable to revelation and discussion. Clients may suffer anxiety or depression, or may even act out violently in response to unresolved sexual issues of one sort or another. Some therapists specialise in sexual issues; others prefer to avoid them. Does best practice necessarily include dealing with the subject of sex? How does a therapist identify such issues when the client doesn’t voice them? How are the varieties of sexual issues best approached and discussed in therapy? Join the discussion with a contribution to the May 2012 issue of The CAPA Quarterly. Peer reviewed papers due by: 1 January     Non-peer reviewed due by: 1 February

August 2012 – Belief Systems in Therapy It is probable that many of us hold some beliefs that do not serve us well, even some that are contradictory. Every client walks into the therapy room with a set of beliefs that define and drive who he thinks he is and how he fits into the world. Every therapist also has a personal belief system. How does the therapist find ways through these systems or sets of beliefs, and how do those of the therapist and those of the client interact in the therapy room to build trust and a working relationship that can achieve positive results for the client? How do you as a therapist first discover and identify then work with or change those beliefs toward resolution of the issues the client has brought? How do you set aside your own when the need arises? The August 2012 issue of The CAPA Quarterly holds a space for discussion of this tangled web. Peer reviewed papers due by: 1 April Non-peer reviewed due by: 1 May

November 2012 – Dealing with Dementia What is dementia? Where does it come from? How does one cope with growing evidence of its erosion of the person we know—either the self or a loved one? How can the therapist assist someone who has dementia? How can carers cope with the gradual disappearance of the person they have known and loved? What special skills and insights can illuminate such situations in the therapy room? As people live longer and dementia becomes a more common experience, what do therapists need to know to enhance their ability to help in this circumstance? Share your insights and experience with a contribution to the November 2012 issue of The CAPA Quarterly. Peer reviewed papers due by: 1 January Non-peer reviewed due by: 1 February

Deadlines are for articles that have been accepted, not for new ideas.

Please send expressions of interest as soon as possible, to maximise your chance of inclusion. For Contributor Guidelines contact editor@capa.asn.au

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2011

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The Capa Quarterly


Preliminary conference announcement The Australian Centre for Integrative Studies

Allies and Enemies

The role of real and metaphoric siblings in our psychological worlds 23rd to 25th March 2012

Keynote Speaker - William Cornell Historically our theory has been influenced by the interpretations of unconscious processes. As a result our work, theories and methodologies have predominantly explored the vertical transference (parent to child). Whilst this emphasis remains central and significant we also recognise that much of our work still focuses on the individual even when we are working with external systems. This conference therefore wishes to extend our focus and address the impact of siblings and how these relationships translate into horizontal transferences (sibling to sibling). A focus on siblings, and attention to the horizontal transference, encourages us to broaden our lens from the individual to the collective. This conference will address and explore some of the following topics: • The nature of the horizontal transference within our psychological work • The psychological dynamics of sibling and how we can include this more consciously in our therapeutic work • The impact of siblings on both the personal and collective level • The metaphor of “the sibling” within a political context and how this affects our work This is an integrative conference, bringing together different modalities but while being held through the lens of relational theories, philosophies and methodologies. The international keynote speaker William (Bill) Cornell MA, TSTA studied behavioural psychology at Reed College in Portland, Oregon and phenomenological psychology at Duquesne University in Pittsburgh. He is a teaching and supervising Transactional Analyst, Body-centred and Relational analyst.

Bill is a prolific author. He was the editor of the international Transactional Analysis newsletter The Script for 10 years and is the co editor of the Transactional journal. He has written more than 40 journal articles and 10 book chapters. He is the editor of the Healers Bent: Solitude and Dialogue in the Clinical Encounter, a collection of the psychoanalytic writings of James McLaughlin for which Bill wrote the introduction. With Helena Hargaden he is co-editor and author of Transactions to Relations: The emergence of Relational Paradigms in Transactional Analysis published by Haddon Press. He is also the author of Explorations in Transactional Analysis. Bill brings a high level of integration to his thinking, writing and clinical practice. He is passionate in the areas of diversity and inclusivity and is a man who walks the talk. He maintains an independent private practice in psychotherapy, consulting and training in Pittsburgh, PA. He also spends considerable time in Europe leading training groups in psychotherapy. Visit our website to register your interest and receive updates as this profound conference takes shape. Website - www.acissydney.com.au Email - info@acissydney.com.au Conference Convener: Jo Frasca CAPA NSW Past President ACIS Director ATAA President

3 Church St, Waverley, NSW 2024 P: (02) 9386 1600 E: info@acissydney.com.au W: www.acissydney.com.au


PRINT POST PP241613/00114

POSTAGE PAID AUSTRALIA

Journal of the Counsellors and Psychotherapists Association of NSW Inc ABN 50 035 123 804 If undeliverable, please return to: CAPA NSW Suite 134 / Level 13 183 Macquarie Street Sydney NSW 2000 Phone: +61 2 9235 1500 Email: office@capa.asn.au Web: www.capa.asn.au Changed your address? Please notify CAPA NSW

Looking for a Conference? To include your free conference listing, contact editor@capa.asn.au

Some prominent psychology conferences in Australia and elsewhere this year are listed below. For a more comprehensive list of psychology conferences worldwide, visit http://www.conferencealerts.com/psychology.htm

12-13 August 2011 Brisbane

Cult Information and Family Support (CIFS) National Conference ‘Assessment, Diagnosis and Treatment’

www.cifs.org.au/successful.php

24-26 August 2011 Gold Coast

12th International Mental Health Conference ‘Personality Disorders: Out of the Darkness’

www.anzmh.asn.au/conference2011

24-28 August 2011 Sydney

6th World Congress for Psychotherapy: ‘World Dreaming’

www.wcp2011.org

1-3 September 2011 Manchester, UK

Joint Congress of the European Association for Mental Health in Intellectual Disabilities & the IASSID SIRG for Challenging Behaviour & Mental Health

http://www.mhid2011congress.co.uk

7-9 September 2011 Bradford, UK

Beyond Belief: Religion & Belief in Professional Practice

http://www.brad.ac.uk/study/cpd/belief/

12-16 September 2011 Lucca, Tuscany, Italy

Noetic Sciences: Practices for Personal and Collective Transformation

http://italyseminars.com/

15-17 September 2011 Adelaide

The Cutting Edge: Integrating Practices, People & Professions

http://sash.asn.au

19-21 September 2011 Oxford, UK

1st Global Conference: Gender and Love

http://www.inter-disciplinary.net/at-the-interface/genderand-sexuality/gender-and-love/

1-3 October 2011 Cambridge, CA, US

Psychology and the Other

http://www.psychologyandtheother.com

27–29 October 2011 Toronto, Canada

Canadian Grief & Bereavement Conference

http://www.griefconference.org

31 October – 2 November 2011, Prague

2nd Global Conference: Making Sense Of: Suicide

http://www.inter-disciplinary.net/probing-the-boundaries/ making-sense-of/suicide/call-for-papers/

13–16 November 2011 Hobart

Australasian Professional Society on Alcohol and other Drugs 2011 Conference

http://www.apsadconference.com.au/

13–15 April 2012 Syracuse, NY, US

The Empathic Therapy Conference 2012

http://www.empathictherapy.org/Conference.html

CQ 2011-3 Virtual Therapies  

Avatar Therapy ~ DeeAnna Merz Nagel and Kate Anthony Helping Clients to Help Themselves: e-hub Self Help Services~ Kathleen M Griffths, Hele...

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