TILT Magazine Issue 20

Page 1

volume 5, Issue ONE FALL 2014

Online Social Gaming Why Should We Be Worried?



Behavioural Pressure In Cyberspace Building Internal Resources & Resilience in Young People PAGE 42

The CAM Coach

How Technology Supports Complementary & Alternative Practice


Cybersupervision, Marketing Toolbox, Student Spotlight and much, much more!

TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a publication published four times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 5, Issue 1, FALL 2014 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Distribution Coordinator Sophia Zollman Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Thomas Tsakounis Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Sarah Lawton Resident cartoonist Christine Korol

Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute. If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture). If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.

TILT is about envisioning therapeutic interventions in a new way. While Kate was visiting DeeAnna on the Jersey Shore, they took a late afternoon boat ride and a display of sail boats tilting against the sunset came within view. It reminded them how, as helping professionals, we should always be willing to tilt our heads a bit to be able to envision which innovations – however seemingly unconventional – may fit our clients’ needs. Our clients are experiencing issues in new ways in light of the presence of technology in their lives. As helping professionals, so are we. TILT and the Online Therapy Institute is about embracing the changes technology brings to the profession, keeping you informed and aware of those developments, and entertaining you along the way.

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Features 15 Behavioural Pressure in Cyberspace

Building Internal Resources & Resilience in Young People

24 Online Social Gaming

Why Should We Be Worried?

42 The CAM Coach

How Technology Supports Complementary & Alternative Practice

Issue in e v e r y


News from the CyberStreet

10 Research Review 22 Wired to Worry 32 Views From the Front Line 38 Student Spotlight 50 CyberSupervision 54 New Innovations 56 Marketing Toolbox

60 For the Love of Books

A Note from the Managing Editors… Welcome (or welcome back!) to Therapeutic Innovations in Light of Technology. We are so pleased to bring you the first issue in Volume Five – our 20th issue, funded by you our readers through our Kickstarter campaign! Our main feature article in this issue is a topic dear to Kate’s heart – how social gaming has implications for the world of therapy and why we kate anthony & deeanna merz nagel with the should be worried about it. We spend a lot of our online therapy institute in second life business days immersed in how technology can help us and our clients function better and work towards improved mental health, and our features show you these innovations in issue after issue – but what do we need to know about the “fun” side of our client’s lives? Are their leisure pursuits something that gives them joy in life, or are there more sinister machinations at work? Kate teamed up with Professor Mark Griffiths to unpick the seemingly innocent world of gaming on social media, to discuss how online social gaming has implications for our clients by tapping into a behavioural reward system that often leads to addictive behaviour, the closest cousin being harmful gambling. We also welcome Catherine Knibbs, a UK specialist in CyberHarm and Young People. She examines the links between adolescent development and the peer pressure young people experience in cyberspace, often leading to negative behaviour or, in turn, negative results. Cath also highlights the importance of what we can do as adults – moving away from shielding young people from the darker side of the Internet and towards ensuring their resilience in facing them. By understanding the motivation behind online interaction, our young people of the future will find a happier way of living with the outcomes. Finally, Mark Shields – the CAM Coach – talks us through how his business embraces many different technologies to make a success of it, and gives us his insight into some of the tools needed in running a thriving clinic online. Mark’s book is featured in our Love of Books section, so make sure you check that out as well! As always, our regular columnists are here, and we say a very fond farewell to Anne Stokes for her final CyberSupervision column. Anne has been with TILT since Issue One, and it is hard to lose such a stalwart member of the team! Our best wishes go to her as she frees up her time to work on other projects, and her insights into Online Supervision will be sorely missed. Her shoes will be filled by Cedric Speyer in the future, who has a challenging role to take on! Also, Thomas Tsakounis joins us as the new columnist for our New Innovations column. He will help us stretch our CAM muscles each issue! Best wishes to all our readers for the holiday period and happy reading!

Managing Editors

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NEWS CyberStreet TILT – Therapeutic Innovations in Light of Technology

from the


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We also offer the required coursework toward: Approved Clinical Supervisor Board Certified Coach Florida Certified E-Therapist Be sure to check out the details here:

INSTITUTE NEWS Certified Cyber Therapist/Certified Cyber Coach To meet the needs of those needing an introduction to Online Therapy or Coaching, we offer a 15 hour online course as a taster to our larger trainings (cost deductible!)


In other online training news Need Coach Courses? ICF and BCC Approved!

Certified Cyber Therapist Certified Cyber Coach

Certified Cyber Facilitator/Specialist Certificate in Cyberculture We now offer a Certified Cyber Facilitator (CCF) Credential (choosing 1 of the 5 concentration areas as your focus) at 60 hours of training OR the Specialist Certificate in Cyberculture at 30 hours of training.

• • • • •

Online Therapy Online Coaching Online Supervision Avatar Identities Complementary & Alternative Medicine

More Certification Courses Certified Professional Coach (CPC) Certified Intuitive Practitioner (CIP) Certified Aroma Coach (CAC) Certified Kybernetes Reiki Master (CKRM)

If you are seeking coach training that is ICF approved we always refer folks to our partners at The Institute for Life Coach Training (ILCT). ILCT is an ICF and BCC approved school and our selfdirected courses here at OTI (also BCC approved) are offered through ICLT. Our partnership with ILCT continues to grow and that means great opportunities and savings for you! In their latest email newsletter these courses and discounts are mentioned. Take a look- good stuff for BCC credentialed coaches!

Where are we facilitating workshops live? Be sure to check out our Facebook Pages for a full listing of events! Online Therapy Institute~ Events Online Aromatherapy Institute~ Events

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TILT – Therapeutic Innovations in Light of Technology

Stay in the Know with our Blogs! Online Therapy Institute’s Blog - Keep up to date with new posts! Recent posts for Kate’s Blog include: Trolls .v. Abusers Coaching in the Digital Age On Being a Columnist No, YOU hang up! Recent posts for DeeAnna’s Blog include: AromaTherapy on the Go! What is Psychotherapeutic Reiki? The Desire Map Licensing Program

For all the places you can find us See our Community page: http://onlinetherapyinstitute.com/community/


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Like TILT Magazine? Support our efforts and purchase a subscription! Your purchase will go a long way in ensuring we can continue to give you this quality resource! http://onlinetherapyinstitute.com/tilt-subscription/

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TILT – Therapeutic Innovations in Light of Technology

Research rev

UK Secondar Online Comm and their Fu In this edition we focus on a single study by Jeanette Hennigan, doctoral candidate at the Metanoia Institute in London.


review of my (JH) UK Secondary School psychotherapy service in 2011 indicated significant pupil demand for online support as an adjunct to the faceto-face (f2f ) provision.

Research suggests this may increase access (Fenichel et al., 2002; Barnett, 2005) for young people by reducing stigma (Lange et al., 2001); a primary reason for not seeking f2f therapy in schools (National CAMHS review, 2008). A critical evaluation into UK Schoolbased Counselling (Cooper, 2013, p.18) suggests that it would be “very useful to evaluate whether the effectiveness and/or cost-effectiveness of school-based counselling could be enhanced through specific adaptations…. or through supporting face-to-face counselling with online counselling delivery”.


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Research into online therapy as an adjunct to f2f is promising (Yager, 2001 & 2003; Maheu, 2003; Tate & Zabinski, 2004; Murdoch & ConnorGreene, 2000), but as yet, limited. Online therapy’s evidence base has rapidly expanded over recent decades (Cohen & Kerr, 1998; Grohol, 1998; Barak, 1999; Anthony, 2000; Rochlen et al., 2004) and significantly in recent years (Barak et al., 2008; Reynolds et al., 2012) with a forthcoming symposium in the British Journal of Guidance and Counselling (Goss & Hooley, in press). Although scepticism about online therapy exists (Allerman, 2002; Wells et al., 2007; Mora et al., 2008), there is increasing evidence of demand from clients generally (Goss & Anthony, 2003) and from young people specifically (King et al, 2006; Hanley 2007), but as yet little research specific to UK schools. I (JH) surveyed UK secondary schools’ therapists in March 2014, asking; • “To what extent are UK School Therapists engaging in online communication with their clients currently?” • “What might be the main motivators and

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by Jeanette Hennigan and Stephen Goss

ry School Therapists’ munication with Pupils uture Intentions barriers to those who want to work in this way in the future?” • “In terms of development, what training or research may be useful to you?” Key findings Responses from 246 schools (of 3753 invited to participate) present a varied landscape from resistance: “Young people already spend enough time plugged onto devices of all sorts. It is good to be able to provide them with the experience of good old-fashioned face-to-face direct communication” to active engagement and enthusiasm: “I work in a geographically spread area of the country: Face-time [the videolink app] facilitates availability and provides greater access for children”. Almost half (45%) said they had no online communication with their clients but only 16% said ‘nothing’ would motivate them to consider working in this way. 52% were already using various forms of online communication with their clients though largely for administrative purposes only. This is similar to a previous report

(Othman, 2000), suggesting that many school counsellors were not ready, nor prepared to use the Internet for therapy as such. 9% suggested that they used texting as well as email for administration purposes with their clients and also for counselling support (especially during school holidays). Almost 70% of respondents considered both ‘evidence of reaching pupils that have psychological barriers to accessing face to face help’ and ‘evidence from pupils that it would make accessing the service easier for them’ as major motivators in favour of working online. This was particularly interesting to me (JH) as requests from my pupil survey in 2011 had been the very reason that I had embarked upon research into this area in the first instance. The main deterrents to working therapeutically online were the potential impact upon the therapeutic relationship (61%) and issues around confidentiality (44%). Research and training needs fell into three broad categories:

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TILT – Therapeutic Innovations in Light of Technology

Research review 1. ‘School therapists’ specific needs’, which included evidence of demand from pupils, applicable working school models and the applicability to Special Educational Needs (SEN). 2. ‘Practical needs’ included specific training and support for this group, practical management, cost and equipment (including data security). 3. ‘Online therapy in general’ needs included more information sought re ethics (including suitability of this medium for therapy at all), impact upon the relationship without f2f cues, evidence of efficacy, and concerns over safety and confidentiality for both client & counsellor. These findings were in accordance with Glasheen and Campbell’s Australian schools’ research in this area (2009 & 2012) which reported mixed feelings about providing counselling for young people online from school therapists. It is notable that a number of the issues highlighted as barriers to providing online services have been the subject of an increasing body of literature, suggesting, perhaps, that training and education for practitioners is the key to unlocking the potential for increasing online provision. Thus although there is currently a wealth of information in various aspects of working therapeutically online generally, the research base for this client population is small and the information that is available may not


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co n t inu e d

Please send reports of research studies, planned, in progress or completed, to the TILT Editor at info@onlinetherapyinstitute.com

be reaching a significant enough majority. However, “although we need to advance with care, with a good research base, to do nothing is to avoid a potentially useful tool. Young people are already accessing the Internet, changing the ways that they communicate, so school counsellors need to change with them. The new technologies are providing exciting possibilities to complement face-to-face counselling to provide more options for helping young people.” (Campbell, 2004, p.138) This study suggests that further development of online provision in schools is likely to be well received by a significant proportion of practitioners but that practical assistance and training to lead those new to the possibilities offered by working online will be required. Further research is planned. n Stephen Goss, PhD, is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK. He is also Co-Editor (Counselling) of the British Journal of Guidance and Counselling (BJGC) (http://about.me/stephengoss).

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references Allerman, J. (2002) Online counselling: The Internet and mental health treatment, Psychotherapy, 39, 199-209. Anthony, K (2000). Counselling in Cyberspace. Counselling Journal, 11(10), 625-627 Barak. A. (1999). Psychological applications on the internet: a discipline on the threshold of a new millennium. Applied and Preventive Psychology, 8, 231-246. Barak. A., Hen, L., Boniel-Nissim, M., & Shapira, N. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 2 (2/4), 110-160. Barak, A. (2008). Psychological aspects of cyberspace. Theory, research and applications. New York: Cambridge University Press. Barnett, J.E. (2005). Online counselling: New entity, new challenges. The Counselling Psychologist 33 (6), 872-880. Campbell, M.A. (2004). “What it the place of innovative ICT uses in school counselling?” Issues in Informing Science and Information Technology 1, 0133-0140. Campbell, M.A., & Glasheen, K.J (2012). The provision of online counselling for young people. In B.I Popoola & O.F Adebowale (Eds.), Online Guidance and Counselling: Toward effectively applying technology (pp.1-13). PA: IGA Cohen, G.E., & Kerr, A.B. (1998). Computer-mediated counselling: An empirical study of a new mental health treatment. Computers in Human Services, 15(4), 13-27. Cooper, M. (2013): School-based Counselling in UK Secondary Schools: A review and critical evaluation. University of Strathclyde, Glasgow. Fenichel, M., Suler, J., Barak, A., Zelvie, E., Jones, G., Murok et al (2002). Myths and realities of online clinical work. Cyberpsychology and Behaviour, 5, 481-497. Foresight Mental Capital and Wellbeing Project (2008). Final Project Report, Mental Capital and Wellbeing: Making the most of ourselves in the 21st Century. The Government Office for Science, London. Glasheen, K.J., & Campbell, M.A. (2009a). School Counselling launches into cyberspace: An action research study of a school based online counselling service. Paper presented at the Australian Association of Research in Education. Brisbane, Australia. Glasheen, K.J., & Campbell, M.A. (2009b). The use of online counselling within an Australian secondary school setting: A practitioner’s viewpoint. Counselling Psychology Review, 24(2), 42-51. Goss S, Anthony K (Eds.), (2003). Technology in Counselling and Psychotherapy. Palgrave, Macmillan. Goss, S. & Hooley, T., in press (expected 2015). Online practice in Guidance and Counselling. British Journal of Guidance and Counselling. 43(1) Whole issue.

Grohol, J.M. (1998). Future clinical directions: professional development, pathology and psychotherapy on-line. In J. Gackenbach (Ed.), Psychology and the Internet, intrapersonal, interpersonal and transpersonal implications (pp. 111-140). San Diego, California: Academic Press. Hanley, T (2007). R u still there? Therapy Today, 18(4), 37-38. King, R., Bambling, M., Reid, W., & Thomas, I. (2006a). Telephone and online counselling for young people: A naturalistic comparison of session outcome, session impact and therapeutic alliance. Counselling & Psychotherapy Research, 6, 175-181. King, R., Bambling, M., Lloyd, C., Gomuura, Smith. R., S., Reid, W., (2006b). Online Counselling. The motives and experiences of Young People who choose the internet instead of face-to-face or telephone counselling. Counselling and Psychology Research 6 (3), 103-108. Lange, A., van de Ven, J., Schreiken, B. & Emmelkamp, P.M. (2001). Interapy: Treatment of Posttraumatic Stress through the Internet. A controlled trial. Journal of Behaviour Therapy and Experimental Psychiatry, 32, 73-90 Maheu, M.M (2003). The Online Clinical Practice Management Model. Psychotherapy: Theory, Research, Practice, Training, 40 (1/2), 20-32. Mora, L., Nevid, J., & Chaplin, W. (2008). Psychological treatment recommendations for internet-based therapeutic interventions. Computers in Human Behaviour, 24, 3052-3062. Murdoch, J.W., & Connor-Greene, P.A., (2000). Enhancing therapeutic impact and therapeutic alliance through electronic mail homework assignments (2000). Journal of Psychotherapy Practice and Research, 9, 232-237. Reynolds, D., Hanley, T., & Woolfe, M. (2012). Reaching out across the virtual divide: An empirical review of text-based therapeutic online relationships. In Popoola, B., & Adebowale, O. (Eds.), Online Guidance and Counselling: Toward Effectively Applying Technology. Hershey, PA: IGI Global. Rochlen, A.B., Zack, J.S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates and current empirical support. Journal of Clinical Psychology 60(3), 269-283. Tate, D.F., & Zabinski, M.F. (2004). Computer and internet applications for psychological treatment: Update for Clinicians. Journal of Clinical Psychology: In session, 60 (2), 209-220. Wells, m., Mitchell, K.J., Finkelhor, D., & Becker-Blease, K.A.(2007). Online mental health treatment: Concerns and considerations. CyberPsychology and Behaviour, 10, 453-459. Yager, J., (2001). Email as a therapeutic adjunct in the outpatient treatment of anorexia nervosa: Illustrative case material and discussion of the issue. International Journal of Eating Disorders, 29, 125-138. Yager, J. (2003). Monitoring patients with Eating Disorders by using email as an adjunct to clinical activities. Psychiatric Services, 54 (12), 1586-1588.

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Young People, Cyberspace & Trauma THIS IS MUCH MORE THAN E-SAFTEY!!

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Behavioural Pressure in Cyberspace Building Internal Resources and Resilience in Young People

by Catherine Knibbs

TILT – Therapeutic Innovations in Light of Technology

Young people using cyberspace via any device that enables them to communicate with others digitally, and in particular the internet to access websites and social media, are under a considerable amount of peer pressure and what seems to be trickery and/or good (although sneaky) marketing techniques employed by app/game/sales developers. Underdeveloped cognitive systems, such as decision making, attention, memory recall and negative behaviour choices (known as executive processes) are due mainly to chronological age and are developmentally inhibited during adolescence. Due to this, young people often miss the ulterior message or motive hidden in ‘online activities’, whether these are passive or active interactions.

trolling, addiction to gaming and gambling sites, pornography and forums that promote self harm/eating disorders/suicide ideation and so on?

Beginning with a look at peer pressure, this is usually thought of in an extremely simplistic format: as being both the visible and invisible force that “makes teens bully/drink alcohol/ smoke/take drugs” etcetera. However, how does this play out for young people on the internet? In short, the visible form of peer pressure - for example an invitation to an illegal party and subsequent further invitations and reminders - is one that can generally be easily spotted (quite often it is in print on social media or via text message) and can then be challenged/ confronted and changed/prevented quite quickly.

Lets start with a silly Facebook game; “What’s your superhero name?”

But what of the invisible form of peer pressure, which for the sake of this article will also include the marketing techniques that result in negative behaviours such as cyberbullying, 16

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In order to understand how difficult it can be for a young person to spot peer pressure or other methods of misdirection, I would like to highlight two of these methods that you as an adult may have unwittingly fallen prey to.

1. Take your pets first name and last two digits of the year you were born and match them to this picture. 2. “Digory Do-Good” you say? Ha ha ha... pass it on to your friends – it’s only a bit of fun! Or perhaps “What are your top 10 favourite novels/ films?” So you write your list, possibly attempting to name books like Shakespeare rather than Enid Blyton (would you be under peer pressure here to fit into societal norms or to appear well versed and read?) and again pass on the game by nominating friends. Would the outcome of the first game have been more obvious if it asked you to name your first

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pet, mother’s maiden name, favourite food or any other security question that might be used by the banks, energy suppliers or credit card companies? The second games outcome may not have such a direct impact on you, until you realise that every time you log into Facebook (for this example), you are inundated with adverts that suggest you visit Amazon, WH Smith, Waterstones or suggest Cinema showings and the latest DVD’s? I’m hoping right now you have just had what Psychologists call the ‘aha’ phenomenon. Do you feel in any way foolish, conned or tricked into giving some form of personal information which could be used in an attempt to steal your identity

by a game on Facebook? Or, as in the second game, did not know that ‘online’ marketing tricks are used to monitor your interaction and “smartshop” you (a technique employed to show you adverts whilst you browse the internet based on products you have looked at or bought recently)? If so, you would not be the first, nor the last, to have joined in these types of games without realising they could have an ulterior and misdirected outcome. This is not to say that these games have been designed by corrupt or criminal people - however, what if they were? Would you have noticed the underlying message? In order to understand the nature of deception and peer pressure, I would have to write a very T I LT M AG A Z I N E FA L L 2 0 1 4


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Peer pressure then can be seen to be the force, which when added to this ‘missing ingredient’ can cause some young people to fall foul of its hidden intentions by an inability to understand exactly what interaction it is they are involved in.

different article. However, for now I will discuss a simplistic form of these theories so you can understand why young people make the choices they do and why the internet can sometimes be a dangerous place for young developing minds. The ability to read another person’s facial/non verbal cues when they speak to us is a skill that we develop from the very moment we are born. We are innately wired to communicate with others in order to get our needs met and to survive in the world. However, it takes us some years to begin to work out when we are being conned, tricked and pressured into doing something that ordinarily we would not do. For example, before the object constancy period (where infants are able to hold an object in mind such as mummy is still alive when she goes out of the room and has not disappeared forever) means it is possible for us to trick, bring surprise and joy again and again to very young children when we play games such as peek-a-boo and “where did the ball go under the cup”? Children learn to spot when they are being tricked in these games once they develop the ability to remember what happens next, where the games direction usually goes and as time develops the ability to predict the outcome with certain people. However, often they are unable to generalise to


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other situations and games of a similar nature or with other people. We develop this skill once we are able to think using theory of mind and to use abstract concepts. It is also a skill that needs practice. However the very important skill we use implicitly is involved in face to face interaction and involves an interpretation of cues that are only available when we see another person’s face. This is the missing ‘ingredient’ in online communications which makes it difficult for some young people to notice the intentions of A.N. Other. Peer pressure then can be seen to be the force, which when added to this ‘missing ingredient’ can cause some young people to fall foul of its hidden intentions by an inability to understand exactly what interaction it is they are involved in. Whether that is playing a game, accepting cheats and hacks which turn out to be trojans/viruses, adding comments to a thread that involves the demoralisation and mocking of another person (cyberbullying, trolling, or “banter” as its also known), kicking people from games (purposive exclusion) or setting up groups that they are rejected/omitted from, or designing pages and websites devoted to the intentional hurt and harassment of someone else. In order to help young people, in particular adolescents, build a repertoire of resources to enable them to spot these subtle pressures we are stuck with a dilemma. Realistically we would need to build their knowledge of such deceptions by teaching them about these (this could take a very long time indeed!) and this scaremongers and makes the internet a place that becomes very frightening and dangerous to them. This is not helpful. If however on the contrary we do not teach young people about the dangers of deception and peer pressure in cyber space we would be doing them a great disservice and not

preparing them for what could happen, nor how to spot it and disengage. This brings me neatly onto the adolescent brain and why this can be such a difficult task. Firstly (according to many parents, some teachers and some forms of the media) many adolescents “know it all’, i.e. can we teach them about the dangers and probability of negative things happening when they are primed for hyperrational thinking? Can we teach them when they are going through a normal developmental phase of ‘empathy switch off’ and as such would not be able to use the Pre Frontal Cortex to integrate information and process another person’s point of view (also known as theory of mind)? Can we

...teaching children and young people mindfulness skills would enable them to develop a thinking pattern that responds to a situation rather than reacts, and would therefore result in a more thoughtful, diligent and mature way of behaving when under peer pressure... help support them through moments of peer pressure when their brains are developing and it is normal for them to value peer opinions much more than parents and teachers? And secondly how do we combat the dopamine rush that is in its highest sensitivity period during adolescence T I LT M AG A Z I N E FA L L 2 0 1 4


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and contributes to much of the developmental risk taking and addictive behaviours that we so often see in young people? I believe we can, if we educate teachers and teens together about how their brains work. Young people would like to know that they are developing in a very complicated way and are not ‘abnormal’ as they so often feel throughout puberty and adolescence. However, most importantly, this would need to be underpinned by play, starting with infancy, including teaching parents how to play with their babies and children, followed on by early childhood and primary school. The mechanism of play enables children to learn how to attune to another through sharing and co-operative games. Furthermore, learning about when things go wrong enables a child to learn about empathy and theory of mind and this enables them to learn social development skills and enables the social part of their brains to build in strength. Play is also a way in which young people can learn about cheating and trickery in a safe and manageable way, which in turn can help them develop the skills I eluded to that are missing in the online marketing and peer pressures. Children can learn to build resilience and how to recover from mistakes and social mishaps and again this builds towards an integrated brain needed for the adolescent period. I also personally think that teaching children and young people mindfulness skills would enable them to develop a thinking pattern that responds to a situation rather than reacts, and would therefore result in a more thoughtful, diligent and mature way of behaving when under peer pressure and would enable children to build their internal resources and resilience towards negative outcomes and behaviours when using the internet and everything it has to offer. n 20


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About the author Cath is a psychotherapeutic counsellor (MBACP registered, awaiting accreditation) and supervisor, working with children and adults. She has a PG Diploma in integrative child psychotherapy and is currently studying for an MSc related to providing therapy for victims of cybertrauma. She owns PEER Support Yorkshire CIC and is a consultant in cybertrauma, running workshops on cybertrauma for professionals and parents.

The Use of Technology in Mental Health Applications, Ethics and Practice Edited by

Kate Anthony, MSc, FBACP

Online Therapy Institute

DeeAnna Merz Nagel, LPC, DCC

Online Therapy Institute

Stephen Goss, PH.D., MBACP

Independent Consultant in Counselling, Research, Supervision and Technology in Mental Health 2010, 354 pp., 7 x 10, 6 il., 5 tables • (hard) ISBN 978-0-398-07953-6 • (paper) ISBN 978-0-398-07954-3 • (eBook) ISBN 978-0-398-08447-9

Technology is revolutionizing the delivery of mental health services. In this book, the reader is introduced to the broadest possible sampling of technologies used by mental health professionals today. It contains 30 chapters on different aspects of technological innovation in mental health care from 43 expert contributors from all over the globe, appropriate for a subject that holds such promise for a worldwide clientele and that applies to professionals in every country. A wide range of styles is offered, from the individual practitioner exploring a new technology and writing anecdotally about their personal experience, to some of the world’s most experienced practitioners writing a thorough overview of a technology and its uses in the profession. In each chapter, you will find introductions to the technology and discussion of its application to the therapeutic intervention being discussed, in each case brought to life through vivid case material that shows its use in practice. Each chapter also contains an examination of the ethical implications – and cautions – of the possibilities these technologies offer, now and in the future. Technological terms are explained in each chapter for those not already familiar with the field, while the content should stimulate even the most seasoned and technologically minded practitioner. Psychotherapists, counsellors, psychiatrists, life coaches, social workers, nurses – in fact, every professional in the field of mental health care – can make use of the exciting opportunities technology presents. Whether you have been a therapist for a long time, are a student or are simply new to the field, The Use of Technology in Mental Health will be an important tool for better understanding the psychological struggles of your clients and the impact that technology will have on your practice. Further information on ethics, training and practical exploration of online therapy can be found at: www.onlinetherapyinstitute.com, whose work extends and deepens the resources made available in this volume.

Order Online at:


TILT – Therapeutic Innovations in Light of Technology


Surviving Social Media Shame How to Cope When Your Worst Moments Go Viral The experience of shame and humiliation online is different than offline. There is no way to wrap your mind around where the humiliation ends — there are no borders. ~Monica Lewinsky

Christine Korol


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We are long past shaming people in the stockade - we now do that much more efficiently on social media. Rania Walker, founder of Sparq Street Communications, points out that, “The unfortunate circumstance of online communications and global outreach, is instant uncensored feedback. Currently there is little that can be done to protect people from damning judgement at

best, and vicious, incessant ‘trolls’ at worst.” Although Europe’s “right to be forgotten” is criticized as being overly restrictive, Google is now complying with the legislation by removing embarrassing links upon request. While I agree that we should be allowed to move on once we have made restitution, I do not believe that this is accomplished by erasing the past. Some things are not forgotten at all or quickly enough. Online reputation management companies can eventually improve your profile by increasing the number of positive stories in order to bury the old news. However, these

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strategies do not help if the consequences to the public humiliation are swift. This happened recently when a video went viral of a dad pushing his son down a skateboard ramp. The case was investigated, the father remorseful, and no charges were laid. However, the consequences were severe, as the father lost his job and the family had to move so they could start over in a new community. Monica Lewinsky is leading the charge towards creating a more compassionate

society given that she knows firsthand what it feels like to be vilified. Therapists can help their clients recover from online humiliation by showing them how to make effective apologies. This is accomplished by acknowledging the mistake, making amends, and describing a plan that will ensure that it never happens again. Most importantly we can remind clients that each of us has the right to be forgiven and how to deal assertively with those who continue to criticize. n

ABOUT THE AUTHOR/ ILLUSTRATOR: Christine Korol, Ph.D. is a cartoonist, psychologist in private practice in Calgary, Canada and the host/ producer of a podcast on WiredToWorry.com that provides free online anxiety and stress reduction education videos.

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Kate Anthony & Mark D. Griffiths

TILT – Therapeutic Innovations in Light of Technology

ocial media platforms have undoubtedly impacted on many areas of our lives. Even if we have no use for computer or smartphone communication, we are bombarded by the ubiquitous blue thumbs-up or the Twitter bird in our TV advertising or high street browsing. At the extreme end in the social media we hear of cyberbullying on Facebook and criminal prosecution for hate crime via tweeting, or of the teenagers who innocently send explicit photos to their partners only to find wide distribution of the material further down the line. These forms of abuse do exist on the Web, but they are simply public manifestations of human behaviour that would exist without the Internet in some form – from misogyny in the workplace to playground battles. Scaremongering does little to protect us from abusive online behaviour, and we need new strategies to build resilience against it, particularly for our young people. But there is one area of online behaviour that only occasionally hits the national broadsheet headlines, and that


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is the new forms of gambling or traditional forms of gambling behaviour that have been given new life through social media. Research has shown that gambling is a form of leisure that is enjoyed without problems by most of the population who partake in it. However, there remain a small minority of gamblers who experience harm (Responsible Gambling Trust, 2012) and as a result suffer the usual life issues that most addictions can bring including loss of relationships, loss of jobs, health problems, debt, and resulting homelessness (Griffiths, 2004). Criminal implications of losing money through gambling affect the prison population, and there are aspects of gambling, such as frustration with machines in amusement arcades, that can result in violence (Parke & Griffiths, 2005). When we see the inviting environment of the World Wide Web, and away from the media, we rarely think of these negative aspects of its existence. In a leisure pursuit capacity, we see tweets and ‘likes’ and candy

and clouds. Social media has changed our language – we are ‘friended’ and ‘instagrammed’, ‘tweeted’ or ‘pinged’. The red notification icon on Facebook itself can affect our mood – has our status been liked, or our recent selfie? In the world of teenagers, a photo without enough likes can be a damning comment on their actual identity (for instance, a recent research presentation by Alison Preston of OfCom at the Parentzone Digital Families conference in London put the “acceptable” number of likes on a selfie at 30-40 within 4 minutes [OfCom, 2014]). We don’t seek to add to the media frenzy around negative online behaviour in general. However, there is a growing element online that has implications for treatment of addiction that runs the risk of being lost in the inviting glow of crushing candies and buying cartoon cows for our virtual farms – and that is the issue of addictive social gaming. We seek to bring this to the attention of practitioners. Addiction has many forms, and social gaming runs the

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risk of being lost as somehow glib or less important, mostly because gaming is fun – right? Over the last couple of years, there have been an increasing number of media reports about the potentially exploitative and/or addictive nature of various types of social game that can either be played via social networking sites or be played after downloading apps from online commercial enterprises such as iTunes. Most social games are easy to learn and communication between other players is often (but not always) a feature of the game, and they typically have highly accessible user interfaces that can be played on a wide variety of different devices (e.g., smartphones, tablets, PCs, laptops, etc.). There are arguably four main concerns relating to social gaming. Firstly, there are concerns about the way games companies are making money from players by making them pay for in-game assets, ingame currency, and/or access to other levels within the game.

Secondly, there are concerns about how engrossing the games can be that have led to various news reports claiming that a small minority of people appear to be “addicted” to them. Thirdly, there have been concerns that some types of social games are a gateway to other potentially problematic leisure activities – most notably gambling. Finally, social gaming can be seen as a trigger to those already in recovery, igniting the very stimuli they seek to avoid by using them as a means to replace gambling.

Almost anyone that has engaged in social gaming will have played ‘freemium’ products. Freemium social games give free access to the game being played, but players must pay for so-called ‘premium’ services. In games like Candy Crush Saga (CCS), players are not charged to

advance through the first 35 levels but after that, it costs 69p for another 20 levels. Players can avoid paying money by asking their friends on Facebook to send them extra lives. Players on CCS are encouraged to buy ‘boosters’ such as virtual ‘candy hammers’ for around £1.25. Although this does not appear to be much money, the buying of in-game assets and items can soon mount up. Last year, many news outlets covered the story of how two boys (aged just six and eight years of age) spent £3200 on their father’s iPhone buying virtual farm animals and virtual farm food with real money at £70 a time. Another case involved a ten-year-old boy who ran up a £3,000 bill on the game Arcane Empire on iTunes. Games played via social networking sites that are ‘freemium’ games are psychological ‘foot-in-thedoor’ techniques that lead a small minority of people to pay for games and/or game accessories that they may never have originally planned to buy

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before playing the game (akin to ‘impulse buying’ in other commercial environments). It is arguable that many of the games played on social network sites share similarities with gambling, especially as they both involve in-game spending of money. Although in our view social gaming operators need to be more socially responsible in how they market their games and how they stimulate ingame purchasing, parents themselves also need to take responsibility when letting their children play social games or allowing them to download gaming apps. Simple measures that can help stopping children unwittingly buy in-game items for real money include: • Not giving children access to online store passwords; • Personally overseeing any app that they download; • Using parental controls on phones and tablets; • Unlinking debit/credit card cards from online store accounts (i.e., not storing payment details with online stores); and


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• Talking with children themselves about the buying of in-game extras.

Games like CCS are genderneutral games that have a ‘moreish’ quality (a bit like eating chocolate). Social games like CCS and Farmville take up the entire player’s cognitive ability because anyone playing on it has to totally concentrate on it. By being totally absorbed players can forget about everything else while engaging in the activity. These are some of the psychological consequences of other more mainstream chemical addictions (e.g., alcoholism) and behavioural addictions (e.g., gambling addiction). At their heart, social games are deceptively simple and fun but can be highly rewarding on many different levels (e.g., psychological, social, physiological, and financial). Social games like CCS and Farmville may not seem to have much connection to gambling,

but the psychology used by the games developers is very similar. People cannot become addicted to something unless they are being constantly rewarded for engaging in the activity. Like gambling and video game playing more generally, the playing of social games provides constant rewards (i.e., behavioural and psychological reinforcement) that in a small number of instances could result in a person becoming ‘addicted’ to the game they are playing. Even when games do not involve money, most social games introduce players to the principles and excitement of gambling. Small unpredictable rewards lead to highly engaged, repetitive behaviour. In a minority, this may lead to addiction. Basically, people keep responding in the absence of reinforcement hoping that another reward is just around the corner – a psychological principle rooted in operant conditioning and called the partial reinforcement extinction effect – something that is used to great effect in both slot machines and most

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video games (Sparkman, 1979). At present there is little empirical evidence that social gaming is causing addiction-like problems on the scale of more traditional online games (e.g., World of Warcraft, League of Legends, etc.), although researchers are only just beginning to research into the social gaming area, particularly in light of the recent DSM-5 inclusion of it as a diagnosable disorder (see Petry et al, 2014, for a discussion).

One social networking activity that has only recently come into focus is gambling via social networking sites. Although the playing of gambling games for points (e.g., poker) have been popular for a number of years, a number of gaming operators are now using Facebook as a platform in which to offer gambling for real money following the introduction of Bingo Friendzy in August 2012. Social gaming companies have been accused of leveraging the mechanics of gambling

to build their gaming empire. One of the key psychological ingredients in both gambling (such as playing a slot machine) and social gaming is the use of operant conditioning and random reinforcement schedules. Basically, random reinforcement schedules in games relate to the unpredictability of winning and/or getting other types of intermittent rewards (Skinner, 1938). The psychosocial impact of this new leisure activity has only just begun to be investigated by academic researchers in the gaming field. Social networking sites have the potential to normalise gambling behaviours as part of the consumption patterns of a non-gambling leisure activity, and may change social understandings of the role of gambling among young people. There is no money changing hands but teenagers are learning the mechanics of gambling and there are serious questions about whether gambling with virtual

money encourages positive attitudes towards gambling in people (and young people particularly). For instance, does gambling with virtual money lead to an increased prevalence of actual gambling? Research has demonstrated that one of the risk factors for problem gambling among adolescents is the playing of the ‘play for free’ gambling games on the internet (games that are widespread on Facebook and other social networking sites). Based on the available empirical literature, it has been argued that it may be important to distinguish between the different types of money-free gambling being made available – namely social networking modes (on social networking sites) and ‘demo’ or ‘free play’ modes (on internet gambling websites). Initial considerations suggest that these may be different both in nature and in impact. For example, some researchers have argued players gambling in social networking modes may experience a different type

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TILT – Therapeutic Innovations in Light of Technology

and level of reinforcement than those gambling in ‘demo’ mode on an internet gambling site. On some social networking sites, the accumulation of ‘play money’ or ‘points’ may have implications for buying virtual goods or services or being eligible for certain privileges. This may increase the value and meaning of the gambling event to the individual. Additionally, when considering the ‘flow’ and intention of individuals accessing such sites, it could be argued that individuals accessing money free gambling through social networking sites may be more likely to be induced or persuaded to play given that these website visitors’ primary intention may have been social interaction (i.e., the primary function of the website) as opposed to those playing in ‘demo’ mode where gambling is the primary function of the website. Other features, such as stylish and appealing characters and graphics, and (what some might deem to be) aggressive viral marketing tactics, also appear to play an important part in the


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acquisition, development, and maintenance of social gaming behaviour.

Much like the recovering alcoholic will turn to alcoholfree beer to aid recovery, gamblers (and other addicts) may turn to replacement activities to help them through the gaps in their lives that used to be filled by their potentially damaging behaviour. There are two dangers in this – the first is that a whole new addictive behaviour is gained: that of social gaming addiction. The second is that playing on social casinos online for free is detrimental to recovery as it generates strong urges to engage in real money gaming. Anecdotal qualitative research shows that people in recovery report that: • The feeling of gaming on social casinos is almost identical to real money gaming as it generates a

dissociative state leading to a substantial loss in terms of time and it also provides them with an “escape from reality”. • The guilt felt by problem gamblers who have engaged in no money gaming is of a similar strength to the guilt and remorse they would feel had they played for money. Furthermore, some clients have reported in groups that: • They began gaming on social casinos before moving onto real money gaming which eventually became a problem. • They wanted to replicate the “big money wins” experienced during social casino gaming that they would have had if they had been playing for money. In addition to taking clues from traditional theories around addictive behaviour for treatment planning, there are important nuances in how we need to treat addiction in the digital future. As we can

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see above, those in the treatment field are citing more and more cases of the use of social gaming to replace gambling addiction by those in recovery, only to find that the games are addictive as the gambling play or are triggering the need to gamble real money. As one client in a text-based gambling recovery forum put it: “Its the same rush, the same waste of time, the same futile effort. The same hangover.... Whats ‘free’ about that?”

References Griffiths, M.D. (2004). Betting your life on it: Problem gambling has clear health related consequences. British Medical Journal, 329, p.1055-1056. OfCom (2014). Children’s online behaviour: Issues of risk and trust. Available at http://stakeholders.ofcom.org.uk/market-dataresearch/other/research-publications/childrens/online-behaviour/ (accessed 8th November 2014) Petry, N.M., Rehbein, F., Gentile, D.A., Lemmens, J.S., Rumpf, J., Mößle, T., Bischof, G., Tao, R., Fung, D.S.S., Borges, G. Auriacombe, M., Ibáñez, A.G.,Tam, P. & O’Brien, C.P. An international consensus for assessing internet gaming disorder using the new DSM-5 approach. Addiction, 109, p.1399–1406. Parke, A. & Griffiths, M.D. (2005). Aggressive behaviour in adult slot machine gamblers: A qualitative observational study. International Journal of Mental Health and Addiction, 2, 50-58.

New types of social gaming and gambling-like experiences that people of all ages are now being exposed to raise various moral, ethical, legal and social issues. Given that most of the issues highlighted here are somewhat anecdotal, more empirical research is needed in these new online activities as the line between social gaming, non-financial forms of gaming, and gambling are beginning to blur.

Responsible Gambling Trust (2012). Strategy 2013-14 to 201516. Available Online at http://www. responsiblegamblingtrust.org.uk/ (accessed 8th November 2014) Skinner, B. F. (1938). The Behavior of Organisms: An Experimental Analysis. New York: Appleton-Century. Sparkman, R.B. (1979). The Art of Manipulation. Doubleday Publishing. p. 34

Dr Kate Anthony, FBACP, is co-Founder of the Online Therapy Institute, co-Managing Editor of TILT Magazine, and a member of the Responsible Gambling Strategy Board (RGSB) in the UK (kate@ onlinetherapyinstitute.com). Kate’s opinions are her own. Dr Mark Griffiths is Professor of Gambling Studies and Director of the International Gaming Research Unit at Nottingham Trent University, Nottingham, UK (mark. griffiths@ntu.ac.uk). The authors would like to thank Jane Fahy of GamblingTherapy.org for additional discussion, and Sidonie Thorne for additional remote research.

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TILT – Therapeutic Innovations in Light of Technology

Views From The

FRONT LINE An industry perspective


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Dennis Reichards and Mark Wallin represent SilverCloud Health in the UK and US respectively. As leaders in their field, producing and promoting engaging online health and wellness solutions, their roles require them to stay abreast of industry relevant matters. However, their geographic localities each present different issues and priorities, and occasionally divergent perspectives.

A View from the US Mark Wallin, SVP, SilverCloud Health Inc. Mark has U.S. and international experience with corporate healthcare and eHealth organizations, such as Aetna, WebMD and ICW AG. Driven by a passion for quality health outcomes, Mark has successfully operated or engaged in multiple entrepreneurial start-up and turnaround opportunities in healthcare technology. Behavioural health can be an afterthought In the United States, Behavioral Health has sometimes, and in some healthcare circles, been an afterthought. Even as we begin the evolutionary process of shifting from fee-for-service reimbursement to an outcome or value-based reimbursement model, healthcare providers remain focused on the most commonly measured clinical values to demonstrate quality. While this is an important step forward, the state of a person’s mental wellness is not easily demonstrated in some of the more commonly used clinical measures. The PHQ9 or GAD7 measures, which are found in the more traditional behavioral health provider setting, are not typically found in the primary care setting, where most people first seek professional help to address their condition(s). Guided psychological therapy as first-step intervention is efficacious Often patients’ mild complaints of general malaise, just feeling off, unmotivated, or “feeling bad” are addressed with a pharma-based solution. This scenario may represent the biggest opportunity to truly help people. Patients are approaching clinicians essentially with a basic request for help. While a pharmabased approach should be considered as part of an overall strategy, early intervention with a psychological element seems to offer the best first “step”. Getting at the root-cause can T I LT M AG A Z I N E FA L L 2 0 1 4


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uncover “issues”, and guided psychological therapy can provide coping mechanisms and support development of life-skills to help a patient become a stronger and more effective self-manager of their condition(s). If a pharma-based approach is used as a first step, it may actually prevent the improvement of a patient’s condition by masking realities, leaving root-causes undiscovered, and allowing the condition to linger and perhaps even create a dependence on a pharmaceutical solution or solutions. As previously stated, this is not to say that medication does not have a role to play in delivery of optimum care for some patients. It is suggested, however, that a first step approach, especially in the primary care setting, should strongly consider the tremendous potential of psychological screening for the most efficacious care for a patient’s mental wellness. Indeed patients often express a preference for psychological interventions over pharmacological interventions. Removing barriers to therapy In addition to the challenges of addressing behavioral health in the primary care setting, the opportunity to access support for those who struggle with depression, anxiety and stress is as much a geographical barrier as any other perceived societal barrier. In some of the less densely populated states in America, the nearest psychiatrist or psychologist might be a three or four hour car ride from home for many people. The stepped approach to delivering support to those suffering from a mental health condition is not foreign in the United States, but delivering such a therapeutic approach via an online solution is foreign for many professionals in the country. This is not a critique on professionals; rather, it is a comment on the barriers to innovation. Growing evidence including academic, clinical and peer reviewed studies from the EU and Australia support the efficacy of online delivered therapies, such as the programs offered by SilverCloud Health.


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A view from the UK & IrelanD Derek Richards, Clinical Research Director Derek Richards was responsible for pioneering the first online mental health community for students in conjunction with the Centre for Research in IT in Education (CRITE). Now, as Director of Clinical Research & Innovation at SilverCloud Health, Derek is very interested in the development, implementation and clinical research of technology delivered interventions for mental health problems, in particular interventions for high prevalence disorders such as depression and anxiety. Easing the burden of demand Care pathways in mental and behavioral health services are generally overburdened and consequently access to and provision of services can be limited. This is not ideal, especially with the creation of waiting times that run contrary to the benefits of early intervention. Mental and behavioral health services are continually seeking new ways to innovate and overcome the barriers that they face with increased demand on services and limited changes in capacity and human resources. However, online delivered interventions for behavioral and mental health, and indeed for the management of physical conditions and co morbid psychological distress, can make a significant contribution to optimizing the care pathways of service provision and help ease the burden of demand while at the same time offering the possibility of early intervention. Online delivered interventions can achieve this in a number of salient ways: 1. Online delivered interventions do not demand the same human resource capacity as traditional face-to-face interventions; this means that a greater number of people can be offered services without any changes in the human resource capacity to support them. In our research we have demonstrated that approximately 6-7 clients can be supported per hour using the SilverCloud platform and its evidence-based programmes. 2. Programmes delivered through the SilverCloud platform are entirely evidence based and predominately use a cognitive and behavioral based approach to the treatment of mental health difficulties. Cognitive and behavioral therapy has the greatest empirical support as a group of interventions for the treatment of a broad range of mental health difficulties.

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3. Online interventions have the flexibility to be integrated into the care pathways at different points: a. As a standalone treatment intervention with support from psychological wellbeing practitioners, b. Online interventions can be used at a preventative level where delivering evidencebased principles and practices can equip people with the necessary skills and abilities to manage stress and crisis and progress with their lives. c. Online interventions can be used as an adjunct to high intensity interventions. These solutions can, for instance, be used on alternative weeks in conjunction with face-to-face treatment. d. Online interventions can be used as a waiting list management intervention, supported and monitored so that if some people need to be stepped up, that possibility exists. e. Post high-intensity therapy, online interventions can be a valuable source of continued education and learning for people as they progress with their lives. 4. A growing body of research has demonstrated the utility of online delivered interventions as part of natural care pathways within a variety of mental and behavioral services. Technology such as SilverCloud is available and is successful in delivering online evidence based interventions while also recognizing the value of the clinician/ supporter to maximize outcomes.

Marketing for Counsellors Build your own WordPress website course Make a Facebook business page workshop Small online groups -­ CPD hours -­ www.marketingcounsellors.nl 36

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HIPAA-compliant secure web-based email since 1999 Use coupon code THERAPY

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STUDENT Spotlight On Becoming a Certified Aroma Coach Mieke Haveman

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n the summer of this year I started working with essential oils, and in particular Young Living essential oils (YLEO). I had been interested in oils for a long time and bought and tried several in the past. Yet this summer everything seemed to come together and I was ready to seriously commit to them.

Even though most of us are all doing this from home and in different parts of the world, I can always ask questions. There are closed groups on Facebook and a large knowledge base about the use of oils. All the people in this group are committed to learning how to use and share the oils properly.

I saw DeeAnna Nagel post on Facebook a lot about how the oils were supporting her health. That really got me interested. You hear about “miracle cures� all the time, but usually not from people you know and trust. Reading how well the YLEO oils supported her wellness goals, I wanted to try it myself, so I signed up to become a distributor under DeeAnna.

As a foundation, DeeAnna offers the Certified Aroma Coach course at the Online Aromatherapy Institute. The course offers introductory information and resources about the use of oils, but moreso, business models such as: network marketing; heart-centered sharing; and social entrepreneurism, and all with an eye on cybercommunity as paramount to doing the work.

I became a distributor for two reasons. First I get the oils at a cheaper price myself, and second I was looking for a new income stream which was something to tie in with my online counselling business. The last year I had been focusing mostly on tutoring and my marketing business that involves a lot of coaching - I had not done too much counselling. And suddenly I felt that I wanted to include other things in my practice not only counselling but advising people on how to use oils to make their life a little easier. I work a lot with clients in pain, so using oils would be ideal. Doing this online I can reach a far greater group of people than I ever could working inperson.

I also want to help other people get started as oil distributors, especially in Europe and my own country (the Netherlands). Therefore I have started to translate some of the brochures into Dutch. It is great to make a business out of something that you truly believe in and love to share. And of course I use the oils myself. I think I use them every day. It is lovely to have some oils in a diffuser while you work. And I am gaining more knowledge - only last week I attended a workshop on how to work safely with oils, which is more knowledge I can use myself and share with others. n

The support I get from DeeAnna and our larger Essentially Powerful team has been so great.

Visit Mieke’s website for more info on YL essential oils at http://havenoils.younglivingconnect.com/, or email her with any questions at mhaveman@gmail.com. Online Aromatherapy Institute is a division of Online Therapy Institute.

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TILT – Therapeutic Innovations in Light of Technology

Liability Insurance for Coaches and Energy Medicine Practitioners

The perfect fit for your Practice Do I need to have Liability Insurance for my Energy Medicine Practice? This is a question you need to be asking yourself if you are seeing clients as a student, practitioner, instructor or a volunteer. Even when you do your absolute best work, there’s always some risk that someone with whom you interact will be dissatisfied. Professional Liability Insurance protects you against covered claims arising from real or alleged claims in your work.

Professional and General Liability Insurance available through www.OnlineTherapyInstitute.com


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Your Options Explained!

Deciding which Online Therapy, Coaching, Supervision, Avatar or Intuitive training is right for you!

You may have seen that Online Therapy Institute now offers an academic route to training through our collaboration with the Metanoia Institute. You may also be wondering what the differences are between that and our Certified Cyber Facilitator credential. The simple answer – the difference is what you require at the end of your training! If you are looking for Continual Professional Development or Continuing Education Credits, then our Certified Cyber Facilitator (CCF) course may be enough for you. You can read all about this course at http://onlinetherapyinstitute.com/ certified-cyber-facilitator/ and get in touch with us at info@onlinetherapyinstitute.com to discuss it if you need more information. However, if you would like to train as a potential starting point to a Post Graduate Diploma (PGDip) or Masters (MSc), then you will want to consider taking our option with the Metanoia Institute, which includes the CCF plus a final case study module to help you formulate your thinking in implementing a work-based solution to your future clients’ needs. The PGCert in Cyberculture for Therapeutic Purposes is the initial step towards your academic training, and awards 60 Credits at Level 7 (M). You can read all about this course at www.metanoia.ac.uk/cyberculture

Download the information booklet, or get in touch with Kate direct at kate.anthony@metanoia.ac.uk if you need more information or to discuss what your work-based project might look like!


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CAM Coach How Technology Supports Complementary and Alternative Practice Mark Shields In 2012, The CAM Coach book was launched in the U.K. This book has become known as the “Business Bible� for all Complementary and Alternative Medicine practitioners as it helps them to understand the fundamental action required to set up or run a success business. My co-author Simon Martin and I had realised a need for this sort of toolkit for therapists, practitioners, Life Coaches and Psychologists, as many of them were leaving university or college with their qualifications which they knew inside out but when it came to their business knowledge this seemed limited if at all present. T I LT M AG A Z I N E FA L L 2 0 1 4


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The Law of (Technological) Attraction I write for many publications, and was looking to contribute for an internationally based publication. The Law of Attraction came into play when I was approached by the TILT Editors through Twitter and asked to write an article for them. Once again technology had a part to play in this new exciting path as it does with many of the projects we find ourselves involve in. I would like to share with you how technology directly supports our company with the work we do, as well as how our clients can utilise it within their own practices and clinic businesses to be successful. Social media is something I consistently promote at my seminars to practitioners and coaches as it is one of the fundamental key tools to use when getting yourself out there and known in your marketplace. It is a great way of gaining a local audience for your services; helps you to keep up to date with industry news and events; and may lead you to making important business connections and relationships that may lead to fruitful ventures down the line. 44

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The Economic Benefits I only learnt to use a computer in my late thirties which was well into my career at the time, and even today I do rely heavily on my business partner to help me with technical matters within our business. However, I recognise the importance of embracing technology as it is fundamental in running a clinic and helps to keep running costs to a minimum. Examples of this are: • We use time saving accounting and booking software to take care of the monthly cycle of invoicing and booking appointments. • We have become our own marketers by learning and utilising social media platforms such as Twitter, blogs, You Tube, and Facebook. We can pinpoint exactly who our target market is and send them the marketing messages about our services that fit into their demographic at any time, all at the touch of a button. Furthermore, we do not need to be sat in our office to do this. • A large part of our business is conducted over the internet via teleconferencing using

Skype. We keep in touch with our Associate team across the UK this way, in order to save time and money travelling. We also have various international appointments set up in this way with clients. • We run our “Success in Business” webinars which are a great way to offer CPD to therapists and practitioners worldwide and in an easy to use format.

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workshops to order to develop and enhance their creativity to write poetry. The issues that these young people face today is being translated into poetry as a tool for other young people to relate to and increase their awareness and understanding that they are not isolated in their own experiences or feelings. This project will be using a software program called “Blurb” which allows the user to produce and publish their book. No longer is it necessary to wait for a publisher like Random House to accept your idea.

• Monthly newsletters are created using Constant Contact, a template designed software whereby we can design our own branded newsletter and send it to our email database weekly, monthly or quarterly. The newsletter facility also includes use of You Tube so we can include videos within our newsletter as well, which offers the viewer variety. Furthermore, you can send

a link of the newsletter to your social media followers, connections and friends via Twitter, LinkedIn and Facebook as well. This software also offers a facility to send surveys to our demographic so we can create conversation and interact directly with them. • We are currently working within a local secondary school on a project where we are using mindfulness

• Finally, we also use apps for clients with smart phones to monitor their progress in nutrition and exercise which offer additional support to help them achieve their weight loss goals.

Embracing Technology For Success Technology allows us to keep in touch with our audience in a variety of ways, anytime, and anywhere, which enables us to give a super-fast response time when we have been contacted for an appointment. T I LT M AG A Z I N E FA L L 2 0 1 4


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This prevents the enquirer from going to the competition. For all of you who have read The CAM Coach we offer an international Mentoring Program and there are several key areas that we look at when we mentor new mentees. Below are the first four areas from The CAM Book where technology plays a fundamental key role in running a clinic:


Website set-up, structure and on-site SEO

A website is your window to the world 24/7. Think of it as your online business card or brochure where you can tell your potential client base everything they need to know about you and your services, giving them an insight into your offering before they meet you. Add testimonials from any previous clients as a great way of building your credibility, as well as displaying the logos of the Professional Bodies you belong to. Remember customers buy YOU first, then your product and then the company. So, always advertise a landline telephone number and not a mobile. It makes the client feel that you have a static base and adds credibility. 46

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You can use a website to sell products online such as webinars, supplements, books, podcasts, and videos. Your audience can download a FREE web-brochure in a pdf format which is a cost effective way to get your message out there in detail and can be updated and changed limitlessly. From a website you can collect a database of contacts which you can target for future promotions, workshop announcements, discounted products, health tips etc. There are a variety of ways in which you can develop a website to suit all budgets, from creating your own through software like Wordpress, using an online company such as, www.Webhealer.com or hiring a Web Developer. If using the latter here are some points to remember: • Ask for a quote first • Provide the developer with a good complete and detailed brief • A good web-developer will look at your needs, look at your content (text, images etc.), and consider your potential audience. Only then should there be any design work. This is in fact the part that (should) take

the most time if it’s done properly. • You can help your webdeveloper by looking at other websites and make a note of those that you like and those that you don’t like to give them an idea of your taste. • Ensure you make it clear to your designer or host that you want to be able to make changes to the website whenever you choose. This will enable you to freely make the changes you need to make whenever you want without waiting for and paying someone else to do it. A Web developer can charge anything from £300 to £1000 depending on what features you require. If you are just starting your business Webhealer are a great website company who will set up and host your website from as little as £15.00 per month.


Pay per click/Digital Advertising on Google

Once your website is completed and registered on Google, it can take many weeks and months before it reaches the front page of Google, so if you are about to qualify it is a good idea to start

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building the website as soon as possible. Teach yourself how to get your website onto page 1 of Google, let’s face it how many of us really check pages 2 and 3? You can do this by searching for free information on the internet using terms such as “Google Adwords webinars”. So, what are Google Adwords? Google Adwords are based on Pay per Click system (PPC) – you only pay money to Google when someone clicks on your ad, so you should have a much higher chance of selling something to the people who click through on your ad than you would from a normal ad. Google Adwords are a very popular means of getting immediate traffic to your website. They are the advertisements that you see on the right hand column of the page when you do a search on Google or at the very top of the page in a different colour. You have the ability to run multiple ads targeted with one or more search keywords and Google’s step-by-step demos walk you through the process of creating a successful ad campaign. The nice thing about an Adwords campaign is that you can have it up and running in 48

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minutes, and you can let it run for as long (or as short) as you want. So to Summarise: • You are in Complete Control of how much you spend • You can start and stop a campaign at any time • You can set a max daily spend • You choose the words you want to sponsor • You Design your Google Advert


• You can run as many adverts as you want at any one time • You only pay when someone visits your website • You get statistical support to help you improve your campaign • You can choose the best time of day to advertise EG Weekends


Social Media Marketing

Quite often our mentees call themselves “technophobes”. Technology design for consumers has come a long way since the day of the BBC microcomputer. These days it is consumer friendly and designed for even the youngest

of users to understand. There really is no excuse to be given for not having a go. All the Social Media platforms offer step by step tutorials, as well as, help and search boxes where you can type anything you are looking for and it will offer that subject matter. The only frustration about Social Media is time, as it does require that to learn the platform. Once you have the basics most of your learning is done through using the platform, plus any mistakes you make can always be deleted. As a business owner in today’s modern world we are so blessed to have such a tool at our disposal, mainly, because it is FREE! We can now tell the world about our product or service not just our local town or village. Our reach is far greater and with it we can create more opportunities than ever before. Social Media is here to stay and it adds volumes to your business. Twitter and Facebook are great ways to build a client base in your local area. You Tube, Instagram and Pinterest can offer free information in the way of videos of techniques to use at home, cooking demos, photo recipes and educational snippets. Finally, for those of

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you wishing to enter into the corporate market, LinkedIn is a great way to pinpoint the large corporates in your area.

• Client letters, reports, notes, Communications, flags and alerts Diary for everything


• Event/Appointment Diary

All successful practitioners need a robust system to manage all facets of their business from appointment making to invoicing to record keeping. This is often done manually to keep costs down.

• SMS Client appointment reminders

Practice Management Software & Organisation

It is common however these days to have a software management system in place to take care of all of your business needs within the parameters of one system. Common features and benefits to look for in a system should include: Easy patient / client management • Clients Record Creation and Management

• Online booking

• Billing, reports, letters Quick and Accurate Finance • Invoicing

privateprac ticehub.co.uk/ reviews.php and is known as “Click”. See Visit their website at www.click-hub.com So there you have it, a quick overview of the importance technology has in the successful running of a Private Practice or clinic. It offers cost effective business solutions to target your demographic and run your business in an organised and time effective way. n

• Payment records • Electronic billing • Charging Sorting and tracking Continuing Professional Development • Plans, logs, events • Professional body reports The software we currently recommend and use ourselves is provided by the Private Practice hub - www.

If you would like to know more about The CAM Coach Book please visit our website www.thecamcoach.com where you will find our book shop, further reading and videos and news about our latest CAM Coach courses and webinar series.

ABOUT THE AUTHOR Mark Shields is the Founder of The Life Practice Group (http:// w w w.lifeprac tice.co.uk). He is nationally respected as a successful Life and Business Coach & Trainer, Media Expert, Author and Motivational Speaker, appearing regularly on television and radio. He has worked successfully with clients from CAM, the Financial World, the Entertainment industry, as well as with world champion athletes, senior business leaders, famous musicians and senior government politicians. As the CAM Coach, Mark helps CAM practitioners to achieve success in their respective CAM businesses by sharing models, tips and business advice.

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Cyber Supervision Anne Stokes


t is strange how things come together. When I wrote the column for the last edition, I had no conscious awareness that I was thinking about my ending here, and my decision to make this my final contribution. In fact interestingly I had even temporarily forgotten that this had been the focus of that issue when I was making my decision! Last time I considered whether endings online are really endings, but here I would like to explore why and how we make the decision to end the supervisory relationship, both as a supervisor and as a supervisee. Knowing when to move on is a key aspect of supervision, and ideally in the early stages of the


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relationship there will have been exploration of how each partner would signal that they might want to discuss this. However, I suspect that most of us either don’t do this, or we do it, and then we forget what we’ve said! The ending can be initiated by supervisor or supervisee, but hopefully in a good collaborative relationship both will be involved in the process. It may help the supervisor to be aware of how the supervisee manages endings with their online clients, as this may give indicators of the possibility of a supervisory ending and also the attitude of the supervisee towards endings. Are they a person who needs plenty of time to work towards a final

session, or are they someone who prefers to ‘go’ once the decision is made? Neither is right or wrong, and both have advantages and downsides. Is it our need as supervisor to spend time ‘working it through’ rather than the supervisees, or do we unconsciously feel upset that they are leaving us and so push them out of the nest too soon? Perhaps supervisors need to make sure they take endings to their own supervision of supervision, so that someone is watching out for the blind spots in the process. One reason for ending may be to do with the age and stage of development of an online supervisee. Our first online supervisor will have taken us through the initial stages of

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When Is An Online Ending Really An Ending? Part Two training and working online, but as we become more confident and experienced a supervisor with different strengths may be more appropriate. Perhaps it would be someone who has set up an online practice themselves, or someone with an online specialism that matches our own practice. It could be simply that we have worked with one supervisor for a considerable time and feel that we would benefit from a new perspective or challenge. Much of what I’ve written above applies to f2f as well as online supervision, so what particular aspects need to be considered online? I think there is a greater possibility of a ‘sudden’ ending, and I referred to this in the previous

column. My sense is that this is more likely to happen in text based work, and particularly in email supervision, than in webcam sessions. It may be more important for the online supervisor to support the supervisee in the process of finding a new supervisor, as there are currently fewer supervisors trained to work online than f2f. This leads into the accountability of a supervisor to the online clients of their supervisees. If we accept that there are fewer online supervisors, do we have an ethical responsibility to ensure that our supervisee has indeed a new contract in place elsewhere? What do we do if they haven’t? From the perspective of the online supervisee, what

do they do if they feel that they are not getting the supervision they need from their supervisor? Hopefully the relationship will stand that exploration, but we know that sometimes life is just not like that! A brave supervisee will be upfront about their decision to leave, and while it may still be difficult to do this, it is possibly easier online than f2f. There is much less chance of coming across the supervisor later because they are probably not geographically close to each other. So what are my reasons for leaving here? They are similar to those I would bring to my work as an online supervisor There is nothing sinister about them! Kate and DeeAnna haven’t been brave and told

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me that it’s time to move over. It is partly about the general reduction in my working life, but mainly because I want to stop while I am still enjoying doing this column and have something to say; ‘to end while the going is good’ as the saying goes. There is also the consideration that I have been around in the online world for a very long time (though ‘long’ is of course a relative word in online circles) and someone newer and fresher may bring many different and interesting perspectives. I would also bring these considerations to my work as an online supervisor Thank you for reading these columns (though of course, you may not have!) and to Kate and DeeAnna for the opportunity from the first edition of TILT. I’ve enjoyed being part of the TILT team and wish everyone well for its future.n

Editors Note: It is with sadness that we say goodbye to Anne, who has been with us as our CyberSupervision columnist for 20 issues! We wish her all the best for her future, and it truly has been a pleasure reading her work. From Issue 21, we’ll be welcoming Cedric Speyer as our new CyberSupervision columnist, who has big shoes to fill!

ABOUT THE AUTHOR Anne Stokes is based in Hampshire, UK, and is a well-known online therapist, supervisor and trainer and Director of Online Training ltd. She can be contacted at anne.stokes4@btinternet.com.


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NewInno vations

Stretching the Modalities Toolbox Thomas Tsakounis

Throughout history, every swing of the pendulum has resulted in changes to healthcare. We are in the midst of realizing the most recent swing of that pendulum. Healthcare is changing; the days of solitary practitioners who cling to a single modality are slowly fading into the pages of history. What seems to have remained a constant in this evolution of helping people achieve their health goals is the professional’s desire to be efficacious. The shift however seems to have more to do with appreciating the client’s desire to approach health from a more well-rounded or holistic perspective while remaining safe. To that end, therapists are seeking out a


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variety of modalities and tools to share with their clients. Let’s face it, the more tools in a client’s toolbox, the better chances are for success and isn’t that the goal? Interestingly, the modalities stretch over a broad spectrum. Some therapists start conservatively with mindfulness strategies such as visualization or breathing techniques. Other therapists merge together complementary modalities, for example counseling and coaching or counseling and body work. While yet other therapists actively create holistic hybrids within a modality, for example weaving together a primary training such as mental health counseling with energy

healing (i.e. Reiki), coaching, aromatherapy, flower essences, or other holistic approach. This facilitates the therapist’s access to a cornucopia of modalities to choose from when working with clients. The advantage to both the therapist and the client is very rewarding. When the client comes to an impasse, the therapist can draw on several intervention strategies to keep the process moving. The advantage to the client, who has already built a relationship with the therapist, does not have to seek out another professional, in another location, build another relationship, and spend another fee. While the advantages are abundantly clear, the

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About the Author cautionary notes are equally notable. Adequate training and clinical experience while under some sort of supervision is fundamental in preparing a professional to work with the public and therefore very important. For many helping professionals there is a code of ethics, which clearly outlines general guidelines to which a professional must adhere while working in their professional capacity. It is also important to understand that helping professionals are accountable under that code of ethics and their license despite how they brand themselves. For example, a licensed professional counselor is duty bound by their counseling code of ethics even if they are working with a client as a Reiki healer. In other words, their professional license and code of ethics is in full force despite their activity as a holistic or alternative practitioner. Just as with all things in life, there are good training/ certification programs and there are not so good

programs. You can find both brick-and-mortar and virtual programs. Programs are a dime a dozen and in today’s virtual world programs are cropping up like weeds. A prudent step in identifying a legitimate program may involve seeking out a nationally recognized credentialing agency or organization which may aid in identifying reputable programs although this may not always be the case. When in doubt, don’t hesitate to get on the phone and contact the agency or company offering the training. Ask as many questions as you need to in order to feel completely comfortable. Note bene if you perceive even the least bit of skepticism, take heed and let your intuition be your guide. There is nothing more disappointing then completing a program only to find out that it isn’t recognized by your professional credentialing or licensing organization. Which brings up another worthwhile consideration, continuing education units or CEUs. Ask

Thomas Tsakounis is a Licensed Clinical Professional Counselor and Approved Supervisor in Maryland. He weaves together over 20 years of varied trainings, certifications and modalities in his day-to-day work with clients. If you would like to contact Tom, feel free to email him at therapist@aquietjourney.com

about the availability of CEUs for the program you are considering. If CEUs are offered it may be a good sign that the agency has applied for and been approved to award CEUs which certainly may add a level of confidence. Finally, it is important to remember that a “one size fits all” approach is not good for everyone so if it doesn’t feel right, let your therapist know about your concerns. On the other hand, don’t be so quick to judge a new modality based on what you think you know. Give the new modality a chance, a probation period if you will, if you don’t notice a difference or your not satisfied after two or three sessions it may not be the modality for you and that is perfectly ok! n

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Sarah Lawton

Marketing Toolbox

Mental health practitioners, coaches and healers are well versed in the role of narrative and storytelling in psychotherapy. Essentially an inherently narrative process, psychotherapy also uses stories as inspiration to clients, and in therapeutic and mutual storytelling approaches. This storytelling strategy can be applied equally well within your marketing strategy. Through blogs, online or self-published articles, presentations and word-of-mouth, the power of a good story will quickly draw the attention of new audiences. Stories are personable, inspiring, emotional, motivational and more memorable than advertising copy. Everyone loves a good story and science has demonstrated that a good story is a first-class engagement tool.

Telling tales & remembering stories is in our genes In a world where we are surrounded by vast quantities of information, it is important to use your storytelling skills in order to stand out, be heard and be remembered. A Stanford research study showed that statistics alone have a retention rate of 5-10%, but when coupled with anecdotes, the retention rate rises to 65-70%.


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“Facts and figures and all the rational things that we think are important in the business world actually don’t stick in our minds at all,” says Nick Morgan, author of Power Cues and president and founder of Public Words, a communications consulting firm. Stories create ‘sticky’ memories by attaching emotions to things that happen and storytelling is in our natural make-up. Even those who lack confidence in their current storytelling abilities can rest assured that with a little practice they too can hone the skill. “We are programmed through our evolutionary biology to be both consumers and creators of story. It certainly can be taught and learned,” assures Jonah Sachs, CEO of Free Range Studios in his book Winning the Story Wars. If you tell a great story, you can be sure that your listeners are more likely to repeat it.

Our brains become more active when we tell stories When we are listening to a story, the words we hear quite literally light up our brain when viewed under a functional magnetic resonance imaging (fMRI) scan. Science has demonstrated that not only do stories activate the language centres in our brains, but also any other areas

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STORYTELLING AS A MARKETING STRATEGY that would be used when actually experiencing the events we are currently being told about. “A team of researchers from Emory University reported in Brain & Language that when subjects in their laboratory read a metaphor involving texture, the sensory cortex, responsible for perceiving texture through touch, became active. Metaphors like “The singer had a velvet voice” and “He had leathery hands” roused the sensory cortex, while phrases matched for meaning, like “The singer had a pleasing voice” and “He had strong hands,” did not.” (Extract from Your Brain on Fiction By Annie Murphy Paul, published: March 17, 2012, New York Times Sunday Review)

the woman could plant ideas, thoughts and emotions into the listeners’ brains,” [Hasson et al, Brain-to-brain coupling: a mechanism for creating and sharing a social world, Trends in Cognitive Sciences]

"Personal stories and gossip make up 65% of our conversations.” —Jeremy Hsu

If we are listening to the taste of a delicious meal being described, our sensory cortex lights up. If we are being told about a hike up a mountain, our motor cortex activates. Even more impressive are the results of Uri Hasson from Princeton, who demonstrated that the brains of a storyteller and a listener can synchronise.

This phenomenon, which Hasson calls ‘Brain-tobrain coupling’, where the listener’s brain activity mirrors the speaker’s activity, effectively means that through a good story you can manipulate how a listener feels.

“When the woman spoke English, the volunteers understood her story, and their brains synchronized. When she had activity in her insula, an emotional brain region, the listeners did too. When her frontal cortex lit up, so did theirs. By simply telling a story,

Keep it simple

If broken down into a simple narrative, a story stimulates cause and effect.

The simpler the story, the more easy it is for the listener to immerse themselves in it and the ‘stickier’ it becomes. Simple language and a simple storyline is the best way to activate brain synchronisation.

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A good story should have a structure that helps the listener in the immersion process. This should include: • A framework that relates to your audience

• Use a ‘hook’ –this is the attention-getter, the headline, question or quote that immediately hooks your listener or reader

• Clear purpose –why are you telling this story?

• Avoid giving yourself the starring role

• Personal connection

• Present events in chronological order – this will give your story a natural momentum

• Common reference points • Detailed characters and imagery • Conflict, vulnerability, or achievement the listener can relate to • Pacing—a clear beginning, ending, and segue way back to the topic

Five types of stories When seeking inspiration for a good story to aid in your marketing strategy, there are plenty to choose from including: 1. Educational stories 2. Trending news stories 3. Stories relating to therapy 4. Classic stories, lessons and quotes 5. Your personal stories A good blog, for example, might include a mix of all of these.

Tips for storytellers When it comes to writing stories, there is only one thing you really need to do and that is get started. Do not concern yourself with the production of an epic best-seller but do get ‘pen to paper’ or ‘fingers to keyboard’ and begin writing. The more you practice, the better your stories will be.


• Write for your audience

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• Include specifics that paint a picture and make people want to know what happens next • If you raise a question, make sure you answer it • Reflect and summarise why you’re telling the story and what it might mean to your audience • Keep a log of potential stories to refer to when you need them • Match important messages with stories • Practice telling your stories The best stories create emotional connection and engagement. Powerful stories draw upon sense memory. When your stories resonate with others, they start telling your stories. In addition to being a strong psychotherapy tool, storytelling is a skill you can use to enhance your marketing strategy. n

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Earn your credential and work in the health and wellness industry! ABOUT THE AUTHOR Sarah Lawton is a UK based content marketer and social media expert. With a passion for communication, new technologies and top quality content, Sarah encourages SMEs to make the best use of both traditional and online solutions. For further information or advice, please contact: sarah@ for-content.com and see www. for-content.com

Certified Professional Coach Certified Intuitive Practitioner Certfied Aroma Coach

EARN CE info@onlinetherapyinstitutecom


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TILT – Therapeutic Innovations in Light of Technology

Love For the of


v ith w e s u o h r u o y l l l i l a “F n i , s k o o b f o stacks d n a s e i n the cran oks.” o n e h t l al USS



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The CAM Coach: Reveals the Proficiencies, Practical Steps and the Inspiration you Need to Set Up and Enjoy an Outstanding Practice Mark Shields and Simon Martin The CAM coach brings together the writing partnership of Mark Shields and Simon Martin. Mark is a nationally renowned NLP coach and Trainer and Simon a veteran natural health journalist and editor of CAM, the monthly magazine for practitioners of complementary and alternative medicine. Between them they have come up with a host of proven secrets, strategies and evidenced techniques of how to successfully set up and run a Complementary Health Practice. The CAM coach is based upon Mark Shields Coaching for Practitioners Series in CAM magazine which has been proven to help, coach, inspire and motivate many practitioners over the years. This together with expert contributions from industry leading experts such as Mike Ash, Jayney Goddard, Anthony Haynes and Kate Neil makes the CAM Coach a unique and valuable resource for anyone looking to work successfully in the Complementary and Alternative Medicine industry.


Feeling Present in the Physical World and in Computer-Mediated Environments (Palgrave Studies in Cyberpsychology) John Waterworth and Giuseppe Riva Our experience of the physical world around us, and of the social environments in which we function, is increasingly mediated by information and communication technology, which is itself evolving ever more rapidly and pervasively. This book presents a coherent and detailed account of why we experience feelings of being present in the physical world and in computer-mediated environments, why we often don’t, and why it matters - for design, psychotherapy, tool use and social creativity amongst other practical applications. Since the extent to which presence is experienced in a technology-mediated interactive context can be manipulated by design, and in almost unlimited ways, we can use explorations with mediated presence to provide new insights into the psychology of presence in both the physical and technology-mediated worlds.


Visit the Online Therapy Institute’s Book Store to purchase featured books and more! http://www.onlinetherapyinstitute.com/bookstore/

Online Therapy Institute, Inc. P.O. Box 392 Highlands, NJ 07732 877.773 5591 www.OnlineTherapyMagazine.com Magazine Designed by www.StudioUltimateDesign.com

Stay tuned next issue for... 99 More great articles about online coaching, online therapy and related topics! 99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology! 99 If you are interested in submitting an article, review our author guidelines at www.onlinetherapymagazine.com 99 If you are interested in advertising in TILT magazine, please visit http://onlinetherapyinstitute.com/advertising-options/

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