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volume 4, Issue one FALL 2013

The Client As Teacher PAGE 15

Experiences of a Writing Coach

PAGE 24

Overcoming Concerns and Fears About Technology PAGE 37

Technology & Intrusive Thoughts PLUS...

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 4, Issue 1, FALL 2013 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 Jay Ostrowski Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Clinton Power Associate Editor for Film and Culture Jean-Anne Sutherland 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 The Client As Teacher

Experiences of a Writing Coach

24 Overcoming Concerns and Fears About Technology

From a Seasoned Psychiatric Clinical Nurse Specialist and Psychotherapist

37 Technology & Intrusive Thoughts

(a work in progress)


Issue in every

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News from the CyberStreet

10 Research Review 14 Research Call 22 Wired to Worry 32 Reel Culture 34 Student Spotlight 44 CyberSupervision 48 New Innovations 50 Marketing Toolbox

54 For the Love of Books


A Note from the Managing Editors… Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology, and the first issue of Volume Four!

kate anthony

& deeanna merz nagel with the

online therapy institute in second life

Developments in our academic world continue in offering the new MSc in Cyberculture with Metanoia Institute and subject to validation by Middlesex University, London UK. The online Master’s degree offers five concentration topics which are part of our Certified Cyber Facilitator (CCF) credential, forming the entry point to this new exciting academic award to be launched in October 2014. If you are yet to complete or start the CCF credential, now is the time to get going to be part of the first cohort!

In this issue, Gay Edelman tells us of her work as a Writing Coach, and how important it is to pay closer attention to what our client does and doesn’t know. By defining what it is that a Writing Coach does, and the different stages of the process within both the client work and the writing itself, Gay is able to learn from the client and help them develop as writers using the new technologies such as blogging, e-books and tweeting, as well as the traditional ways of creating written copy. Martha Ireland tells us her gripping story of her career as psychiatric nurse specialist and psychotherapist, and how she overcame her fear of technology and became able to embrace technology as a valuable tool that supports and enhances her work. Our third feature is from Dave Haniff, who discusses new ways of helping clients deal with negative thoughts that are unwanted using technologies such as Virtual Reality, speech recognition software and the more familiar programmes we may use today that utilise cognitive behavioural theory. Remember, you can help support TILT Magazine with our Pay What You Want model! With subscriptions ranging from $20 to $500, every dollar, pound, euro or yen goes towards maintaining the consistent high quality of TILT and gives you the chance to be part of our mission to produce the magazine each quarter! We will continue to offer the magazine for free of course - our reasons for producing TILT have not changed. One bit. TILT is our pride and joy – we want to offer a quality, easy-toaccess magazine for the helping professions and we do! Our aim continues, issue by issue, to keep you up-to-date with developments in innovations in service delivery. In particular, the Cyberstreet is about what is new and noteworthy at the Institutes as well as with our new graduates, supporters and partners. Our other regular columnists are here, with useful and entertaining comment on research; marketing; legalities, film, innovations and CyberSupervision. In particular this month, we welcome the experiences of Berta Rodrigues, who trained with us to become a Certified Professional Coach (CPC) and at the time of going to press is finishing up her Field Placement. And of course there is a good dose of humour from our resident cartoonist, Christine Korol. We hope you enjoy this issue, whatever professional world you inhabit. J

Managing Editors T I LT M AG A Z I N E FA L L 2 0 1 3


NEWS CyberStreet TILT – Therapeutic Innovations in Light of Technology

from the

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MORE Training NEWS!

News from the Training Room!

Our Certified Professional Coach Training is increasingly popular so if you are looking to become a credentialed coach, we offer an online program and live workshops that qualify toward the Board Certified Coach Credential as well. Here’s where to find out more: http://onlinetherapyinstitute.com/certifiedprofessional-coach/

Certified Cyber Facilitator We now offer a Certified Cyber Facilitator (CCF) Credential (choosing 1 of the 10 concentration areas as your focus). • • • • • • • • • •

Online Therapy Online Coaching Online Supervision Avatar Identities Human Resources Peer Support Children & Youth Cultural Arts Dystopian Studies Intuitive Studies

We are pleased to announce another credential— Certified Intuitive Practitioner (CIP) This credential is already gaining in popularity! Be sure to check out the details here: http://onlinetherapyinstitute.com/certifiedintuitive-practitioner/

MSc in Cyberculture Five concentration areas of our CCF credential form the entry criteria to a second year of study toward a Master’s degree with Metanoia Institute, subject to validation by Middlesex University to commence October 2014. Be sure to sign up for details about the MSc in Cyberculture. We send out emails as details emerge: http://onlinetherapyinstitute.com/earnmasters-degree/

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TILT – Therapeutic Innovations in Light of Technology

Where are we facilitating workshops live? Check out our Upcoming Events! http://onlinetherapyinstitute.com/events/ DeeAnna is facilitating a number of live workshops from small group intensives to full Distance Credentialed Counselor (DCC) trainings. Be sure to check out her full training schedule here: http://www.mentalhealthonthewebblog.com/ workshops-training/

In other INSTITUTE news... Kate presented on The Virtual Self at the Scientific and Medical Network conference "Shifting Consciousness: Mind, Self and Brain in the 21st Century" in August (London, UK), and continued this theme at the Association for Humanistic Psychology conference in September with the title "The Virtual Humanist: Conveying Core Competencies" (London, UK). Also in September, Kate travelled to Kosovo with TILT's Associate Editor for Research Dr Stephen Goss to present and chair the first International Conference On Online Counselling in Kosovo before journeying into the Kosovo mountains for a three day intensive training with our OTI students and the rest of the Foundation Together Kosovo team. Kate will tell you more about this in our Student Spotlight section in the next issue! Talking of our Student Spotlight section - and other TILT contributors - she took the opportunity to meet up with Andrew Jackson of ProReal

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(Issue 14) and also Ran Zilca (Issue 15) who were in town! She was also pleased to spend a day with the Alzeimers Society's Talking Point team, who run a forum for those with and related to issues associated with dementia. DeeAnna has been busy conducting Distance Credentialed Counselor 2-day workshops and has been to Chicago, Washington DC, Orlando and Atlanta! She has also conducted 1-day Online Counseling Ethics workshops through Summit Professional Education. DeeAnna also participated in the Psychotherapy Networker’s Expand Your Practice online series and will be participating in an upcoming Psychotherapy Networker online event as well so stay tuned! Kate and DeeAnna have adapted the International Association for Coaching’s (IAC) Masteries to reflect the use of the masteries in online work. Adapting the Masteries to Best Practices Established in the Delivery of Coaching Services Online: Mastery 1 was recently published in the IAC Voice. As an IAC Masteries Authorized Licensee, we will be incorporating the adaption of the Masteries to online work into courses at OTI.


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Kate, DeeAnna and Stephen Goss have two chapters coming out in the book Psychotherapy 2.0 (scheduled January 2014, Karnac Books), on both the Ethics of Online Therapy and the Virtual Self and Avatars. Kate and Stephen both presented at the UKCP Special Interest Group event in October, taking the opportunity to meet another TILT author face to face - Aaron Balick (Issue 13).

Find out all the ways to join our community by checking out our community page! Our Linkedin group is growing with over 2500 members! http://onlinetherapyinstitute.com/community/

LoriAnn Stretch has joined Kate and DeeAnna in editing a new textbook: The Use of Technology in Clinical Supervision and Training: Mental Health Applications to be published late 2013/ early 2014 by Charles C. Thomas Publishers.

Join our community

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TILT – Therapeutic Innovations in Light of Technology

Research Revie

Technology in is a Mainstrea Longer Only F

I

n this edition I highlight a few papers that have appeared over the last few months in the highly ranked Journal of Affective Disorders, linked only by their common interest in the internet as a subject of importance when considering mental health. That the subject now crops up so frequently in such journals, rather than primarily in specialist publications, is a further indication, if one were needed, that the subject of technology in counselling, psychotherapy, coaching and mental health care is now increasingly mainstream. That they can be culled from a few issues of just one source shows how frequently the issues now arise.

As co-editor of a symposium that will focus on online practice in a special edition of the British Journal of Guidance and Counselling (BJGC - to appear in 2015, issue 43(1), edited by Hooley & Goss), I was impressed by the number (and quality) of abstracts that were

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submitted for consideration - so many, in fact, that just as many good quality papers as were accepted were recommended for publication in standard, non-specialist issues of the journal simply due to a lack of space in a single edition. This will create something of a ‘rolling symposium’ in BJGC on technology in mental health and guidance settings as an entirely normal part of everyday practice for those who do not consider themselves specialists in its use at all. Furthermore, papers on technological innovations have consistently ranked highly among BJGC’s most cited and most read items. This experience stands in contrast to an equivalent symposium in the same journal published just a few years previously (Goss & Anthony, 2009). The subject of technology in mental health care is clearly continuing to shed its image as something that is for specialists. The editors of TILT and the current author have been arguing along these lines


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ew S tep h e n G oss

n Mental Health am Subject, No For Specialists for some time and it is gratifying to see that our predictions of increasing normalisation of the topic are being proven correct. Whether the lessons learned along the way about the need for high quality training and specialist supervision will become similarly embedded in the collective awareness of the professional zeitgeist remains to be seen. Supporting this trend of increasing acceptance of technology in therapy are the following, although such reports are now part of a substantial body of work across numerous titles. Wagner et al (July, 2013) at the University of Leipzig added to previous research showing therapy delivered over the Internet to have positive results by comparing outcomes associated with face to face and online CBT in a high quality randomised controlled trial involving 62 depressed clients. A relatively small number of studies have focused on such direct comparisons with strong positivist-

empirical designs. Improvement indicators included not only change on the widely used psychometric Beck Depression Inventory but also changes in suicidal ideation, hopelessness and anxiety. At the end of treatment, both groups showed significant improvement, approximately equivalent to one another. What is more, three months later, the group who were treated online had sustained their improvements while those in the face to face group had deteriorated significantly. The sample size in this one study is too small to be able to generalise its findings to the extent that we can say that online work is better than face to face therapies – although we can say it clearly was, on average, for these individuals. The findings should give further encouragement to online practitioners and it is to be hoped that the study will attract more and more researchers to apply rigorous experimental designs that include comparative outcomes. If we can have increasing confidence that working online is likely to be helpful, at least

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continued

‘‘

‘‘

Research Review

If we can have increasing confidence that working online is likely to be helpful, at least for some people, how we can predict who it is most likely to be useful for becomes an ever more pressing issue.

for some people, how we can predict who it is most likely to be useful for becomes an ever more pressing issue. A combined team from the Black Dog Institute, the University of New South Wales in Sydney, Australia, and VU University in Amsterdam are one of the increasing number of groups that have been investigating just that point. Reporting in October 2013, a study by Donker et al, which involved an unusually large sample of 1843 people, suggests that online therapy of any of the types they considered were more effective for women, for those less severely affected and those who exhibit lower ‘mastery’. Younger people seemed to prefer computerised interpersonal psychotherapeutic work while older people seemed to show a stronger response to the computerised CBT style intervention used. Everyday uses of the Internet are also increasingly researched and of interest to mental health and coaching practitioners. Smith et al (2013) found

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that a tendency to make social comparisons or to invite negative social evaluations in the Facebook updates of 232 female college students was directly related to increases in bulimic symptomology and body dissatisfaction. The new category of ‘maladaptive updates’ in social networking sites might, therefore, be a useful indicator of risk and, perhaps, of tracking progress when tackling bulimia and similarly socially .d conditions. By extension, seeking to reduce clients’ ‘maladaptive Facebook usage’ could itself, perhaps, be a potential tool in treating them. n

ABOUT THE AUTHOR Stephen Goss, Ph.D. is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK . http://about.me/stephengoss


Online Counselling Software

REFERENCES Wagner, B., Horn, A.B. and Maercker, A. (2103) Internet-based versus face-toface cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders. July 23. doi: 10.1016/j. jad.2013.06.032. Donker, T., Batterham, P.J., Warmerdam, L., Bennett, K., Bennett, A., Cuijpers, P., Griffiths, K.M. and Christensen, H. (2013) Predictors and moderators of response to internet-delivered Interpersonal Psychotherapy and Cognitive Behavior Therapy for depression. Journal of Affective Disorders. 151(1):343-51. Smith, A.R., Hames, J.L. and Joiner, T.E. (2013) Status Update: Maladaptive Facebook usage predicts increases in body dissatisfaction and bulimic symptoms. Journal of Affective Disorders. 149(1), pp. 235-240. Goss, S.P. and Anthony, K. (2009) Developments in the use of technology in counselling and psychotherapy. British Journal of Guidance and Counselling. 37(4), pp. 223-230.

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

Secure and encrypted email, chat, and video! Used by individuals, agencies, and institutions around the world For a demo or more information: Lawrence Murphy: lmurphy@privacemail.com


TILT – Therapeutic Innovations in Light of Technology

Research Call

Catherine Simpson is a final year doctoral student at London Metropolitan University, studying the therapeutic relationship in online therapy. She would like to talk to UK-based therapists who use text-based chat / instant messaging. Taking part would involve an interview of approximately 1 hour to 1 ½ hours. This is a qualitative study which aims to further the understanding of how the therapeutic relationship develops in online therapy. For more information or to participate, contact Catherine: psychresearch@sky.com

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Carole Francis-Smith is conducting research to explore therapists' views and experiences of offering e-mail counselling, and the therapeutic relationship within this medium. She is undertaking this research as a part of her Professional Doctorate in Counselling Psychology at the University of West England. She is looking for accredited face-to-face therapists either new to and/ or training in e-mail counselling. to participate or get more information, email CAROLE: Carole3.Francis-Smith@live.uwe. ac.uk


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Gay Edelman

The Client as Teacher Experiences of a Writing Coach

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Coaching, like life, is both an inside and outside job. We coaches support development of the inner life because that leads to greater joy, sanity and functioning in the client’s world. We support external actions, because all of life is a balance of the inner and outer worlds. We humans, not just coaches, act our way into good thoughts. And we think (feel, heal, meditate, pray, move) our way into good actions. As the Buddhists say, “Before enlightenment, I chopped wood and carried water. After enlightenment I chopped wood and carried water.” All of this came home to me again recently when I found myself caught up in an extended email exchange with a prospective client in my practice as a writing coach. She came to me with a daunting list of possible writing tasks: Pitch a TV producer! Start a blog! Write a series of howto books! Send out press releases! Update her website! During our initial free strategy session by phone, we brainstormed and got her focused and inspired. As is my custom, I followed up with an email recapping her new goals and making recommendations for our future work together. I thought I had been clear. Four rounds of messages later, I realized I was explaining over and over, in a variety of ways, the difference between coaching, editing, writing and all the overlaps and gradations between. She wasn’t getting it, I finally understood, because I was ignorant of the level of her ignorance. And

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while she was the most insistent on getting the details straight about what was what regarding coaching and editing, she certainly was not the first to grill me this way. I could see that people needed definitions. So I hunkered down and added a page of definitions to my website. I emailed her the link. Then I sat back and pondered some more. I’ve been a writing coach for nearly three decades. It’s a role I embraced when I realized how many people there were who wanted to write, but who had no clue how to get started. And, frankly, I took it up because I was weary of the many people asking to pick my brain or send me manuscripts for review, not quite realizing that writing and editing were my profession and they were asking me to perform professional services for free. At this point, I had been on the editorial staffs of Good Housekeeping and Ladies’ Home Journal, had done a lot of freelance writing for dozens of magazines, and had also ghostwritten and edited some books. So I had most answers at the ready. I really should charge for this, I thought after the umpteenth brain picking. I’d never heard of a writing coach, but I decided I’d invent a practice. When I started this work, my clients were all about creative expression and support of personal growth. My first individual client was a young woman with a learning disability who wanted to write novels. We met in person one-on-one weekly and I explained to her the simple basics. One task, one format. She wrote long hand, and her big tech break-though was transferring her tiny tothe-edges-of-the-paper scrawl onto typewritten pages. She went on to publish several novels.


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What Does a Writing Coach Do? When you’re hiring someone to help you with your written work, it’s important to know what you’re contracting for. Some definitions:

Coaching is when the professional guides the client though the process of creating the written work. My coaching can include one-on-one conversations, email contact and in-manuscript notes for guidance (also called developmental editing; see below). Coaching may include as few as one or two sessions, or ongoing weekly, bi-weekly or monthly contact. Coaching can include building time-management skills, discovering what nurtures creativity, brainstorming ideas, and keeping the client accountable for staying on task. Together the client and coach set goals and establish ways to reach them. Copyediting is the final stage before a written work goes live. The copyeditor fixes any last remaining grammar, punctuation and clarity issues. Typically, the changes are not huge, though they will contribute to the overall quality of the work and the reader’s positive response to it. Line editing is more intense. It happens when the manuscript is basically fine but some sentences may need rearranging for clarity and some content may need to be cut or revised to make the work stronger and more focused. With line editing, grammatical problems are corrected. It overlaps with copyediting, but goes deeper into content and is less intensely focused on every last little technical detail.

Rewriting happens when the ideas are sound but the manuscript is not well organized, the language may be seriously confusing or repetitive, and the author may not have thought everything through fully. Half or more of the content may be deleted and/ or replaced. Developmental editing involves looking at the big picture. The editor goes into the manuscript and offers suggestions for changes, in the form of notes within the manuscript. In most cases the editor will also provide a separate overall report on what the manuscript needs. Typically (and for best results and greatest time efficiency) developmental editing happens early in the writing process. There is little or no line editing or copy editing of the work, since much is likely to change. Typically, my writing coaching will include some developmental editing. Ghost writing is when a writer does writing that is then attributed to someone else. Ghost writers may or may not also be “secret.” Ghost writers may do their own research, or the client may provide it, or the client may provide leads and contact information. Writing means that the professional writer creates the work from scratch. As with ghost writing, sometimes she will do the research herself, sometimes the client will provide it. The writer’s will appear with the work.

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And my practice grew. More novelists. Aspiring memoirists. I also ran two writing groups. One generally supported inspiration, creativity and productivity. The other was for incest survivors, which started after a free workshop I did at a public library. A woman came up to me at the end and asked whether I’d consider doing a single-subject workshop. I would, and did. The groups ran for three years and disbanded only when I had other professional priorities and the groups no longer fit in my schedule (the incest survivors group was a closed, by-invitation-only group and members were required to be in therapy for at least a year). In both groups, we did a guided imagery and three rounds of freewrites following writing prompts I provided—one to warm us up, another to take

us deeper, and a third to carry us back up again. After each five to ten minute writing session, participates were offered the chance to read to the group and ask for feedback. Their writing, and their personal growth, advanced. Efficient. Simple.

Enter, Universal Self-Expression But now there are way more possible tasks and those are much more complicated. Also, the writing itself might not be the whole point. The client I currently serve is more likely to be the solo practitioner or small business owner who wants to blog, build out her media platform, flesh out her website, or maybe write a book to self-publish and build a practice as a public speaker. Clients’needs—and therefore their expectations— are much more diverse, and fueled by rapidly developing information technology. In addition to the long-familiar aspiring novelist, a writing coach has citizen journalists who want to make their mark, aspiring bloggers who can’t think of a single subject to write about, and the platformbuilders who need to learn how to frame grab-ya messages in 140 characters. There are those who need permission to indulge in the occasional blog that exceeds the 600 word length current conventional wisdom recommends. And those who need to be nudged to update a blog that’s gone stale, or drop the blog idea altogether (if you are going to do it, do it well!) And all of us are supposed to be branding ourselves. Images are more important than we’ve ever been—and in fact now drive the reader’s interest more even than words—but we still have find the right words.

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Historically, journalistic content has always been a movable feast. Diversity of content and a wide range of different types of outlet were always part of the meal. Writing has always been subject to fads, trends and fashions. Information has always come and gone. This is all still true.

on understand the arc of a counseling session and ways to set boundaries. Coaches and therapists may need to know a broader range of things in a faster-paced world, but the dynamic of learning from the client what he needs is an old one. As is the fact that the best teacher is the best learner.

But there used to be plateaus. No more! Now there is no standing still. We are ice skating on a moving ice floe. This is not going to change. And it requires paying closer attention to what our client does and doesn’t know. To his context when he comes to us.

Another age-old value that’s part of the work I do is what I think of as the soul-connection to authentic self (I change up the language depending on what I sense the client is most likely to be receptive to.) When I coach clients to pitch their products or services to prestigious magazines for possible mention, for example, the first thing I look for is awareness, clarity and respect regarding their own mission. If they haven’t defined their raison d’être, we might need to start there. When I work with a client to build out the content of her website, we first order her professional priorities, starting with who she wants to reach and—most importantly— why.

The protracted email exchange with the prospective client illustrated how much of what we do is influenced not just by what the client knows she needs, but what she doesn’t know she needs. We, as the professionals, have to be sensitive to that and scope it out. We have to constantly up our game.

Some things don’t change Many of the details of how we practice, and what we do to support our clients and our practice, may be changing at the speed of light. But there are some things that don’t. One is how the work is shaped by the connection between coach and client. A coach friend recently shared how she struggled with knowing when a client was getting off-track during a session. Should she let her client ramble on because she needs to be listened to? Or gently guide her back to the expressed purpose of their work together? My friend and I decided that the answer certainly came down to trusting her own intuition and skills, and possibly to buying supervision to work more

Where I see the need, I might encourage a client to commit to forms of self-care that will build mental, emotional, spiritual and physical stamina. Good nutrition, enough sleep, time alone and with family and friends—all as vital now as they’ve ever been. Related to this, I also encourage many clients to non verbal creative work. The fun part of this is you never know where things are going to end up. I thought I was helping someone write the novel that would help her heal a past abusive relationship. She’d been working the novel for 20 years. She knew there was something off about her inability to birth it. She and I talked about time management. We set writing goals and checked in about them. As with every client, I stayed alert

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to issues she might need to explore with a therapist. We strategized and analyzed. We were having fun, but the novel was going nowhere. Then one day she mentioned that she used to create her own greeting cards. Bingo! I encouraged her to resurrect this non-verbal form of creative expression. Next thing I know, she’s branched out to shadow boxes, and is showing her work in a local juried art show. Last I heard, the novel was still gathering dust, but the client was expressing herself full-tilt! The outcome was a good one, just not the one we expected. Ultimately, of course, the work is the work. Whether we’re coaching online, in person, with groups or one-on-one it all comes down to good listening—and good learning on both sides of the desk, phone or computer. n

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About the author Gay Edelman is a writing coach who works with individuals and groups to focus and hone their written materials. She has over 25 years’ experience editing and writing for mass market. Visit Gay's website: www.coachgay.com


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:

www.ccthomas.com


TILT – Therapeutic Innovations in Light of Technology

WIRED TO WORRY

NegativitY in my Newsfeed

Christine Korol

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The other day I was assaulted by a baby elephant. More specifically by multiple people sharing the heartbreaking story of baby elephant who cried after it had been stomped on and rejected by its mother. If you haven’t already seen the story you might want to think twice before you search for it, unless you would enjoy feeling bummed out for the next three or four days. After I recovered from reading this story I can never unread, I started to reflect more on why people share these stories and why I clicked on the link in the first place. Reading the comments section for the story did not offer much up in the way of surprising insights. Most

of the commentators were looking for something or someone to blame. Some had diagnosed the mother with postpartum depression, others suggested that she had gone crazy after being imprisoned at the zoo. Another cluster of people felt that the baby was lucky that the keepers at the sanctuary (not zoo) were there to save the baby. The original news story did not provide enough detail to sort out the cause, but that did not stop anyone from speculating and blaming in an attempt to make sense of this sad story. I find this sort of online behaviour fascinating why certain memes or stories go viral, how we


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respond to them, and what it says about how our minds work. Many people criticize the news industry for being too focused on the negative or politicians for using negative ad campaigns - but they are simply giving us what we want (or at least what our brains seem to want). The brain’s negativity bias is well-documented in the research literature with various studies finding that negative stimuli results in increased attention, better recall and increased

arousal than neutral or positive stimuli. Given that it is unlikely that people are going to stop sharing these depressing stories anytime soon, it seems that my only course of action is to override my own negativity bias and stop clicking those links. For those times when I inadvertently read something I don’t need to read, I am glad I have a mediation practice that allows me to accept that we live in an imperfect

world. The more I meditate, the more I can practice acceptance and shake off the things that I can’t change.

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. T I LT M AG A Z I N E FA L L 2 0 1 3

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Fr o m a S e a s o n e d P s y c h i a t r i c C l i n i c a l

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Nurse Specialist and Psychotherapist

David Tinker


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I have been using secure HIPAA and HITECH compliant video teleconferencing, telephone and encrypted emailing for about 4 years. I am a seasoned Psychiatric Clinical Nurse Specialist and Psychotherapist who has been working in the field for over 25 years. The idea of using this type of technology was totally foreign to me as recently as 5 years ago. I would not call myself technology savvy, and in fact I was one of the last hold outs for the use of emails. I remember telling my children “why would I use email when I can just call you on the telephone?� Oh how my world has changed - emails, texting, video teleconferencing, blogging, tweeting, etc. Let me give you a little bit of my personal history, just to assure the readers that I did not come out of the womb

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with a computer in my hand! I am a grandmother with 6 grandchildren and did not live near my family. I saw my grandchildren a few times a year, and of course I could not make it to the weekend sporting events or school plays. I had a very busy and established traditional psychiatric clinical nurse specialist counseling practice in Delaware. My kids wanted me to move to Virginia to be near them, but the only way to do this, I thought, was to retire and close my practice. The problem with this scenario was that I was not ready to retire; not only did I love my work, but I also was not in the financial position to retire at age 58. So my dilemma, how could I continue working in the field I loved, yet still move near my family? My son-in-law works in the IT security industry, and off handedly suggested the possibility of using video teleconferencing to see my existing patients in Delaware, while living in Virginia. My first reaction was excitement about the possibility of being

able to move and not abandon my patients/practice. But on the other hand I had many concerns. Was the format viable with clinical efficacy? Was this type of therapy ethical? How can you effectively work if you cannot touch (nursing skills) or observe (nursing and psychotherapy skills) a patient if they are not in the same room with you? I eventually had a paradigm shift that allowed me to embrace the potential pros and cons of face to face psychotherapy .vs. distance psychotherapy, and realise that they are not mutually exclusive. I was also scared of the technology itself. I had and still occasionally have a reputation for tangling up technology. I was once working in an intensive care unit that required all patient data entry be put into the computer. My charge nurse had to call the IT department more times for me than any other nurse on the unit. To this day, I am not sure we know how I managed to challenge the hospital computer programs or cause the computer to lock up, but


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I had more new starts and new passwords then I care to remember. However, the truth is that just as Sherry Turkle, an Abby Rockefeller MauzĂŠ Professor of the Social Studies of Science and Technology at MIT states, “technology is here to stay", and she strongly suggests that we use the technology intelligently. So I did have to face my fears and meet this new friend called technology, both in my personal and my professional life. As I began pondering the use of technology in my own practice, I reflected back on my past experience as an intensive care nurse. I remember when I first walked into the intensive care unit, how overwhelming all the

equipment, monitors, alarms, etc. were as a new nurse. It did not take long for me to realize that the equipment was supportive, and was a useful tool to keep people stable enough until their own physical body could re-establish its own stability and viability to exist off the external support systems of respirators, IV fluids, tube feedings, chest tubes, defibrillators etc. I also realized that the machinery was a technical support for me, but that I still had to use all my skills as a nurse to provide the highest level of care. The equipment could not stand alone. The patient needed me to assess and facilitate the correct use of the support equipment. The medical field and most of the

public appear to be accepting, and are usually grateful for the advances in medical technology to help prolong life. If you think about it, there are many parallels between the medical technology supports and technology in the nurse psychotherapy field. I believe, from my own experience, that if used correctly, with the nurse clinician being in charge of its use, technology is a wonderful tool for the nurse clinician and the patient. But to make the transition to utilizing technology with my patients, I first had to shift some paradigms of treatment that I had been taught. For instance, there was the notion that you must be physically in the room

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with a client in order to be effective with psychotherapy. Obviously this is not possible with video teleconferencing. But when I use video teleconferencing, I am privy to the patient’s environment. I have the opportunity to see their actual living environment, and may even meet their pet or be introduced to a friend or family member that they have invited into the session. This adds depth to the therapeutic relationship that I could not access before in the more formal office setting of my therapy room. The client is often more relaxed in their own environment, which can be a catalyst for opening up more easily to the therapeutic process. I also like the use of video teleconferencing for when my patients are traveling out of town, returning home for college breaks, or for when the weather has created dangerous commuting conditions. It allows for a continuity of care that was previously unavailable. I often work with college students, and there was a large 28

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gap in the treatment due to vacations and semester breaks. Now we can continue the individual psychotherapy from a distance, while they access local therapeutic groups and/ or additional support systems. My patients have been very grateful for this service. It truly is my belief that technology, if used correctly, is a valuable asset in the nurse psychotherapy field. As nurse clinicians we just need to first become comfortable with the technology, and realize that it is there to serve us, not the other way around. We make the decision as to which form of technology will be used and for which patient. I do not see that as any different than what we have been previously doing in our practices on a daily basis. Don’t you evaluate what approach or level of care is best suited for the patient in front of you in your office? Now you just include: Would technology be a worthwhile format for this client? What is the best type of technology to meet this patient’s needs? What should be the frequency of interactions

via technology for this patient? If you feel yourself resistant to this thought, think about the number of different techniques you have learned over the years to help reach the client and assist them to a better quality of life - DBT, Internal Family Systems, Rogerian, Gestalt, ACT, EMDR and the list goes on. Most nurse clinicians are open to learning new approaches, although they may not become an expert in particular approach, but do not dispute


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its viability for the trained nurse clinician. Technology does not require the nurse clinician to change who they are or their preferred modality of therapy, it just allows us to deliver our style in a different venue. Of the various distance therapies, I myself prefer the video teleconferencing over the telephone, therapeutic encrypted emailing (all emails need to be encrypted for HIPAA and HITECH compliance), or

avatars (which I call a virtual form of psychodrama - my current challenge is to simply get my avatar to walk and sit correctly!). However, I do believe that they all have therapeutic value, if the clinician knows their own skill and comfort, and also the patient’s. Many of my patients will use the encrypted emailing to share thoughts at times that I am not available. They tell me that it is helpful to get their thoughts out in the moment. Some nurse clinicians are comfortable with replying in a therapeutic manner as part

of the service they provide, I do not. I let my patient’s know that I will read the encrypted email and we will discuss it in our next scheduled session. My clients have an emergency plan to follow if they are in crisis and I am not available. I share this because the issue is not to let your fear of technology get in the way of using its tools. Open up to learning how to use them, and then decide how to adapt them to your practice in a beneficial way. Since I mentioned that we

need to know our strengths and limitations, I’d like to go back to my son-in-law's initial suggestion to use video teleconferencing in my practice. I felt confident about my clinical skills, but not so confident about how to use technology in a HIPAA and HITECH compliant manner. I just knew that if I was to embrace the technology, it had to be done in a professional and legal manner. I researched the web and at that time was not able to locate any viable venues to help me. It was also a bit confusing when I called T I LT M AG A Z I N E FA L L 2 0 1 3

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my licensing boards and malpractice insurance, they both responded in a similar manner by stating that they would cover whatever the other one covers or states in their policies. The problem with this was, at that time, I found these policies to be very ambiguous. There do not seem to be consistent or clear guidelines from state or federal regulators or from many licensing boards with regards to practicing using the tools of technology. There are more legal uncertainties than certainties, and little guidance. But this situation is evolving, and various licensing boards are attempting to address some of the technology issues. To make the best decision for you and your practice, it is important to stay current with the latest updates from your nursing licensing board and from state and federal laws. This may create some uncertainty or unease for you, but if you do your homework and can show that you have done everything possible to embrace the existing laws, I believe you have 30

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acted in good faith. That is just my opinion though, as I am not a lawyer, so please do your own research and reach out for any legal or professional support that you think is necessary to calm your nerves and left brain! For me, it continues to be about the ethics of “do no harm� and staying as transparent as possible with the technology. I personally invested in the services of lawyers specializing in HIPAA/HITECH compliance who informed me that technology was advancing faster than legal clarity within our profession. I reported to them that I was conscientiously attempting to meet the standards of practice and ethics within my nursing discipline and within the federal and state guidelines, and that I was delivering my services via a HIPPA/HITECH compliant online portal called Virtual Therapy ConnectSM . This system/portal allows me to provide secure video teleconferencing and an encrypted emailing system to my patients. The lawyers, in their opinion, felt confident that with all the above in place,

I was legally and ethically prepared to provide distance therapy. There are now a few other sites, in addition to Virtual Therapy ConnectSM, that also offer services to nurse clinicians to help them bring technology into their practice. I tell my patients that the video teleconferencing sessions may not be paid for by their insurance company. I have had insurance companies give approval for the video teleconferencing sessions and then reimburse the patient (I work on a fee for service model), because I was an advocate for the patient and upfront with the insurance company about the venue. My best advice is to be honest with the client and the insurance companies, any less than this could be construed as possible fraud. There can be a temptation when the client asks you to use a CPT billing code that indicates a face to face service, so that their insurance will reimburse, when in fact you are seeing them through video teleconferencing. This type of action could ethically and legally compromise you as


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a nurse clinician. It is best not to let your heart overpower your intellect in this situation. The state of Virginia does support the use of secure video teleconferencing for the delivery of services and the American Telemedicine Association is a good up-to-date resource for reimbursement information.

with research and additional outcome studies, the consciousness and acceptance of technology as a tool for psychotherapy will increase for the nurse clinician, the patient, and insurers. However, integrity and “do not harm� remain the mantras for any health care provider, regardless of the delivery modality.

On a more therapeutic note, the Veteran’s administration is reportedly using various types of distance and technology driven therapies with good outcome studies (i.e. treating veterans with PTSD). Hopefully

As a nurse clinician looking for a way to explore bringing technology into your practice, I would look for a service or services that have developed a technical infrastructure which allows, you, the nurse clinician

to be the nurse psychotherapist, while having access to a HIPAA and HITECH portal for your practice. The expensive technical nuts and bolts have been established for you, and the machinery has been designed. All you must do as an informed nurse psychotherapist is to confidently bring your insight and skill of the therapeutic process to the machinery of the technology. Remember, technology is there to serve you, and it is here to stay. So make sure you develop a healthy relationship with all the tools of our trade! <

Dr Martha Ireland, a Distance Credentialed Counselor, began her career 25 years ago as a traditional psychotherapist specializing in eating disorders, then five years ago founded Virtual Therapy Connect - a HIPAA compliant web portal offering a variety of distance therapy tools for clinicians. Recently she launched an online initiative to support eating disorder prevention at www.StudentEatingDisorders.info. She also operates a private practice in Virginia and routinely speaks about integrating technology and psychotherapy.

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TILT – Therapeutic Innovations in Light of Technology

REEL CULTURE FROM YOUR EDITORS

The Future Starts Here

Another Great Project from Tiffany Shlain Last spring TILT Magazine featured Tiffany Shlain's film Connected in the Reel Culture column and guess what? She has another great project out! We spoke with Tiffany and asked her how she thought her project, The Future Starts Here might be beneficial to therapists and coaches, and without missing a beat she explained how this project is really about humanity and technologyand specifically how we can be mindful with our use of technology in a fast-paced world. She emphasized the importance of finding balance 32

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and taking breaks from technology as needed so that the technology does not "take over our lives." We agree with Tiffany. We think these are themes that therapists and coaches can relate to both with finding their own balance and guiding clients to find balance as well. Tiffany explores what it means to be human as we rush “head first into the future”. There are 8 episodes, each 3 to 6 minutes long, that employ Tiffany’s award-winning signature style and blend of unique original animation, archival footage, deep research, big ideas, humor, and


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personal commentary, all set to music in a way that makes it feel like a music video about the important conversations of our day. For example, Episode 3, “Tech Etiquette” summarizes in 4 minutes, the etiquette of the Internet. We all have technology pet-peeves. They happen every day, all around us. So who’s in charge of fixing them? Historically, etiquette was dictated by books and your local Miss Manners. But with technology changing at an exponential rate, bringing about more and more bizarre human behaviors that go along with them, who’s responsible for creating the rules? In this episode, Tiffany charts some entertaining tech pitfalls as well as possibilities for elevating etiquette and creating a harmonious gadget-filled 21st Century. Tiffany offers wonderful vignettes in all 8 episodes and they are available for viewing anytime! Enjoy!

Episode Titles & Links to Watch nn Technology Shabbats How might a tech Shabbat change your life? Tiffany explores the ancient roots of this ritual, the past, present, and future of unplugging, the importance of mindfulness, and the neurological implications of being online 24/7. oo Motherhood Remixed Tiffany speaks to how the Internet, flexible schedules, and shifts in gender roles have revolutionized what it means to be a parent in today’s world. pp Tech Etiquette Tiffany charts some entertaining tech pitfalls as well as possibilities for elevating etiquette and creating a harmonious gadget-filled 21st Century qq Why We Love Robots Tiffany takes a tour of the history and future of robots with her husband, UC Berkeley robotics professor Ken Goldberg, a pioneer in the new paradigm of "Cloud Robots." rr The Participatory Revolution Tiffany shares how her own experiences in forging a new kind of collaborative filmmaking she calls “Cloud Filmmaking” give her a unique window into the new creative landscape where everyone has the tools to record, share, express themselves, and be part of the larger story of humanity. ss The Creative Process in 10 Acts Through behind-the-scenes footage of her acclaimed feature documentary Connected, Tiffany shares the creative process she has developed over the years -- the hunch, the darkness, the breakthroughs, and everything in between. tt Idea Porn This episode takes a fresh look at both how collective thinking has evolved and what it means to each of us today. uu A Case for Optimism Tiffany looks through history to the present to amplify the notion that the world is actually getting better -- through 200 years of liberation movements, Stephen Pinker’s work on humanity’s steady decrease in violence, new thinking on thinking, and the potential of technology, all illustrating why today, more than ever, we can be optimistic about where we are headed.

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STUDENT SPOTLIGHT

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by Berta Rodrigues

Online Services - My Evolution In 1997, I was in the process of completing my second year field placement as a Master of Social Work student. At that time, I remember hearing about email therapy and one day I was talking to one of my peers about it. She was flabbergasted about it and didn’t want it to gain popularity. I remember having several simultaneous thoughts: that it was impersonal and unethical, or that maybe I was being closed minded and hadn’t considered the potential benefits of it and that it would become a lot more common if for no other reason than it being more convenient than driving to an office location. Since that time, I have periodically thought about incorporating online services but still didn’t feel completely at ease about it. I continued to have concerns about liability and ethics and also worried that client privacy could be easily compromised. Between 2003 and 2006, I began to do more research and when I made inquiries about it to my professional association it was clear that it was frowned upon and that


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some of the policies and laws in regards to online therapy were non-existent or ambiguous. I was told that it was imperative to use encryption and to obtain regular professional consultation about how to incorporate online services ethically. In 2008, I began to have severe health problems that compromised my immune system and along with many other symptoms I was experiencing debilitating fatigue. Once again, I began to contemplate the use of online services because I had a limited adrenaline reserve and thought that if I provided online services I could conserve some physical energy. I could not afford to be on disability and truly did not want to stop working. I learned about the Online Therapy and Coach Institute’s (OTI/OCI) courses, and began to realize that incorporating online services would take some time unless I did it haphazardly. I was not only concerned with the legalities but it was even more important that I could tell my clients that their sessions would be private. My health has improved gradually and in January 2013, I started the OCI coach certification course and have learned so much about the benefits and challenges of online services. Throughout this year, I have created a life coaching website that meets professional ethical guidelines and is linked to my encrypted virtual office. Although creating a website and setting up my virtual office was challenging, it was also empowering and it educated me further about many online technologies. I also learned how to incorporate social media such as a business Facebook page and Google+ account. I am in the process of completing my OCI field placement and have been providing video coaching sessions to a client who is a first time

mom caring for her 4 month old daughter – not having to drive to a physical location affords her more time to spend with her daughter. Overall, it has been fun and fulfilling to offer online services. At times, it has also been challenging because of technical difficulties, such as echoing noise or slight communication lags. This does not deter me though because all systems are not without some error. For instance, there are interruptions that can occur even when seeing clients in person. In my private practice and in agency settings, I have experienced dealing with a variety of noisy distractions such as construction site noise, beeping of car horns or someone knocking at my door during client sessions. What I’ve found is that you can use some of the online technical difficulties to your advantage. For instance, I have become even more mindful of my communications to optimize my client’s session time and not interject unnecessary comments that can interrupt my client’s flow of thought and expression. I’ll soon be incorporating audio conference, email and echat therapy and coaching sessions. There is so much flexibility with online services which offers many possibilities for the future practice of therapy and coaching. Both in person and online services are valuable and should be individualized based on the client’s needs. n

About the Author Berta Rodrigues is a psychotherapist licensed in the states of NJ and NY. She provides psychotherapy and life coaching in her West Milford, NJ office. She also teaches graduate and undergraduate courses with Rutgers University and has done trainings with Montclair State University’s Child Welfare Training Partnership. For more about Berta see www.heartmight.com

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Hold on to your hats—your graduation caps to be exact!

Big News!

MSc in Cyberculture We have changed things up a bit… We now offer a Certified Cyber Facilitator (CCF) Credential (choosing 1 of the 10 Specialist Certificates as your focus). Our CCF credential focus areas form the entry criteria to a second year of study toward a Master’s degree with Metanoia Institute, subject to validation by Middlesex University and starting in October 2014. Online Therapy w Online Coaching Online Supervision w Avatar Identities Intuitive Studies

For more information:

http://onlinetherapyinstitute.com/earn-masters-degree/


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by David Haniff

&

Technology Intrusive Thoughts (a Work in Progress)

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This article looks at the nature of bad thoughts that are not wanted, a mental health problem affecting 5% of the population (Baer, 2002).

I

ntrusive thoughts are ‘unwanted thoughts’. For example, people with PostTraumatic Stress Disorder (PTSD) can experience flashbacks where they recall their experiences (Crosby, 2008). Here I explore how technology can be used to help treat intrusive thoughts. One method that has been used is to challenge the thoughts. Another method is 'en vivo' or exposure therapy - exposing people in a safe environment to an extent that it no longer becomes a problem. This has been used to treat problems acquired during wars, postnatal depression and grieving. It also looks at the biology of intrusive thoughts as well as further work. There is a link between the

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physiology of the brain and the psychology - as the phrase goes 'get the head right and the rest follows'. Work on PTSD highlights the use of the 'amygdala' which resides in the centre middle of the brain. The amygdala is used in fight or flight responses (Morey et al., 2012). Intrusive thoughts are associated with anger and are activated by the fight response. The amygdala releases a stress hormone which in turn can lead to long-term memory damage and poor decision making if you have sustained anger or anxiety. The fight or flight response is necessary as it is crucial to survival and without it the human race would not have survived, as you have to sometimes flee and sometimes you have to stand up and fight. However,

it being used in unnecessary situations such as with PTSD is not good for the brain, physically and mentally. One way to address intrusive thoughts is to challenge them (Williams & Garland, 2002). A system being developed is the use of speech recognition to verbalise the thought and convey positive affirmations through text to speech. For example, if you have a thought about a friend or relative then text can counteract it and say something positive such as 'they are a good person who helped you through difficult times'. Challenging thoughts is a form of replacement and after some time would become intuitive. In other words, within time the challenges would become automatic.


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Computer technology can be used to help people with mental health issues. Cognitive Behavioural Therapy (CBT) has already been used in Internet based applications such as 'Fear Fighter' and 'Beating the Blues'. The Internet has the advantage of being widely available, inexpensive and accessible at any time of day. Technologies such as

mobile phones are becoming pervasive. Devices such as Personal Digital Assistants (PDAs) have been used to present positive information for depression - for example, pictures, voices and videos of loved ones - the idea being to counteract the negative emotions and lift the mood of patients with good memories to help them get themselves out of depression. A Serious Game (game with a serious purpose) has been created to help treat depression, developed in Flash Catalyst and presenting advice for triggers

of depression. The idea behind a Serious Game is to teach a serious subject in a fun way. The use of Flash is to enable an Internet based game so it is easily accessible and reaches a large audience and is freely available here. The game was developed using a 'Big Lottery Grant' within the United Kingdom, and in a survey created for the game using 'Survey Monkey', 30 people rated the concept of a game to help treat depression as over 70% as a good idea physically. The utility of a game for mental health therefore seems to be advantageous.

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Virtual Reality (VR) has also been used to help treat PTSD and phobias such as arachnophobia, fear of flying and fear of storms. The idea behind using VR is that you can simulate the dangerous situation in a safe way through technology while also providing realism. In some studies the VR has given similar physiological and mental responses to the real event. A study at MIT (Massachusetts Institute of Technology) indicated that with shy males, the males responded physically in the same way with an Avatar as a real attractive woman (Pan

& Slater, 2007). In addition, physcically there has been a marked improvement in the United States of America, for instance in sweating and eye pupil dilation as well as increased heart beat. VR has also been used to treat brain injuries, rehabilitating a person to an extent that they can function better in daily life. For instance, if a person has a tumor or an injury caused by combat then VR can be used to help physical motor response. Mental health problems can be tackled through technology in a new and innovative way.

For more information please e-mail info@pervasive-technology-lab.org

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The work in progress addresses the issue of challenging thoughts through speech recognition, which today is becoming more accurate and mobile. The work being conducted at the Pervasive Technology Lab is developing a speech recogniser that examines what a person verbalises and challenges it. The organisation is a nonprofit Community Interest Company (CIC) based in the United Kingdom looking into the use of new technology to help people with mental health problems. The system looks at keywords, for instance,


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'my MUM hates me' and then challenges it though a database and text-to-speech saying 'Your MUM loves you'. Mobile smart phones such as the iPhone have speech recognition capability that is accurate. The notion is that you replace negative thoughts with positive thoughts if these negative thoughts are irrational and unwanted. Technology such as Bluetooth headsets can make the recogniser unobtrusive. The prototype uses Dragon Dictate Š which has a speech-to-text and textto-script capability in addition to the use of VBScript for the software environment. Speech recognition has advanced remarkably over recent years and accuracy is good, and in addition the hardware for noise cancellation has improved to gain further accuracy. The system produced will be tested using patients from a local mental health charity 'Milton Keynes Mind' based in the United Kingdom. The system will be assessed though interviews where an improvement would be monitored, using SurveyMonkey to collate the data. The

Speech recognition has advanced remarkably over recent years and accuracy is good, and in addition the hardware for noise cancellation has improved to gain further accuracy.

initial specification used focus groups with counselling and a literature review to ascertain the needs of the patients. A technology review was also conducted to gain information about the kind of hardware that could be used and it was decided that the iPhone would have enough intelligence to handle the processing of data and applications. A technology review was also used for software to give an idea of the capabilities needed to meet the requirements of the applications. Future work includes the use of a Global Positioning System (GPS) to locate people outdoors with dementia who might wander outside of the home. A GPS can give the longitude and latitude

of the individual and link it to a database of where the longitude and latitude are located within the country. There have been a number of cases where people with dementia have walked outside of the home, slept in the cold and died, so if you have their location then you know exactly where they are. In addition, the organisation is looking at the use of EEG (Electroencephalography - brain waves) to ascertain relation levels and provide feedback as to their level of relaxation. The VR system would use various scenarios to provide exposure therapy, for example, exposing the patient to a dirty house to help them get used to it. Another example of relaxation is the use of subliminal (below

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earshot) relaxation music. The individual could put the music on an .mpg player and speakers and subliminally receive relaxation music that would affect their subconscious. This article has described the use of new technology to help people with mental health problems such as PDAs, VR and Serious Games. It has also described the use of technology for unwanted thoughts that challenge the original notions, by changing negative thoughts and emotions to positive thoughts and emotions through

verbalisation of thoughts using a database linked to keywords that initiate negative to positive affirmations. n

ABOUT THE AUTHOR Dr David Haniff has a 1st Class Computer Science degree, MSc in Cognitive Science and Ph.D in Augmented Reality. He has worked as a researcher at the University of Birmingham, Open University and Loughborough University.

References Baer, L. (2002) The Imp of the Mind, Barnes and Noble. Crosby, J. P. (2008) A Mind Frozen in Time: A PTSD Recovery Guide, Springer. Pan X & Slater M (2007). A Preliminary Study of Shy Males Interacting, with a Virtual Female. Presence 2007 pp. 101-108. Williams, C J. & Garland, A. (2002) A cognitive–behavioural therapy assessment model for use in everyday clinical practice. Advances in Psychiatric Treatment, 8, 172–179. Rajendra A. Morey, MD, MS; Andrea L. Gold, MS; Kevin S. LaBar, PhD; Shannon K. Beall, BS; Vanessa M. Brown, BA |(2012) Amygdala Volume Changes in Posttraumatic Stress Disorder in a Large Case-Controlled Veterans Group, ARCH GEN PSYCHIATRY/ VOL 69 (NO. 11), NOV 2012.

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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, thereâ&#x20AC;&#x2122;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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TILT – Therapeutic Innovations in Light of Technology

Cyber Supervision Anne Stokes

During the last few months I have been mulling over issues around online supervision of and in organisations. What are the differences from supervising a f2f practitioner? It is a multi-faceted role in many ways. Supervisors can add value to an organisation as they are often in a unique position ‘on its edge’, and yet have insight into what is going well and less well systemically. They often have information about how a particular part of the organisation is functioning and the impact of changes on employees’ morale and stress levels. However, offering useful insight and feedback without breaking confidentiality is a delicate balance. This is so when a supervisor is employed in a f2f context, and I would maintain that working online

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brings other practical issues as well. Often supervisors begin to work in or with organisations by happenstance. Maybe they know someone in the organisation, or may be a supervisee has moved in to counselling within a business. So what are the types of supervision which you may be providing? You could be: • An external online supervisor of a counsellor who provides online counselling as an employee of an organisation, with you being paid for by the counsellor or directly by the business. • An external online supervisor of a counsellor who provides online

counselling for employees as an independent practitioner • A supervisor directly employed by the organisation to provide online supervision for one or more of its online counsellors • A supervisor in any of the versions above who is providing online supervision for one or more counsellors in an organisation which offers f2f counselling in a number of its businesses globally Are you still with me? Or are you fazed already by all these possibilities - and I am sure there are more! I would suggest that as an online practitioner, there needs


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Dilemmas in Online Workplace Supervision to be even more awareness of the four -cornered contract (client, counsellor, supervisor and organisation) than f2f. What are your responsibilities or accountabilities towards the organisation? You may be thinking that you are an independent online supervisor, paid by the supervisee, so the client and the organisation donâ&#x20AC;&#x2122;t know you even exist in any practical sense. While to me that is a fair enough argument with regard to clients, I donâ&#x20AC;&#x2122;t think it holds water in terms of the organisation. If you believe that the online counsellor is working unethically or to a low standard, what is your response? You obviously discuss it with your supervisee, but just suppose that they disagree or choose to ignore

you. What then? You could simply walk away from the supervision contract. Does that let you off the hook? I donâ&#x20AC;&#x2122;t think so, as the employees of that organisation are potentially still being short changed at the very least. The organisation is paying this counsellor to provide a service, and you may be the only person in a position to whistle blow. Not something we like doing in our empathic profession! Conversely, the issues that the supervisee is bringing to you are about the systems within the organisation and you both

agree that these are causing immense stress to a number of employees. How do you support the counsellor to take

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TILT – Therapeutic Innovations in Light of Technology

CyberSupervision continued

these back appropriately to HR or a manager? What happens if they are not heard or are ignored? Is there a role for you to step in and work directly with the organisation? I don’t think there are specific answers to the questions I am raising. It will vary according to the situation and the contract. What I would like to highlight is the fact that in online supervision, you may find it more difficult to decide what the best route really might be. You cannot physically walk in to the business and discuss the matter with anyone. You will have to take action by email or possibly through a conference meeting online. As an independent online supervisor, do you, should you, have a contract with anyone in the organisation, regardless of who is paying you, so at least you do have a contact person and some sort of agreement for such eventualities? If you are employed directly by the organisation, you may be

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in a slightly easier position. However, it is still likely that you have never met your contact, either f2f or online until an issue arises. When I began to put together ideas for this column, I thought I could cover everything with ease in the allotted space. I can’t, so what I am going to do is to set out a dilemma for the online supervisor below, and invite you to respond to my email address given below. In the January edition, I will pull together your thoughts and say a little more. Please do respond!

Dilemma Your online supervisee, Jo, works from home, but is employed to provide online counselling and support for employees of a large organisation. A supervision issue has emerged concerning pressure on counsellors providing this service to be available to monitor and

support employees in the chat room at the same time as being available for drop in sessions with online clients. The organisation’s stance is that often there are no dropin clients, so it makes sense for the counsellor on duty to be also responsible for the chat room at this time. You both agree that there are both practical and ethical issues involved here. What suggestions do you have for the supervisor and the supervisee to take this forward? You are an external supervisor, paid for by Jo. Is there anything that with hindsight might have been done in the past to help now?

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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COMING SOON! • Douglass, Donna—SELF-ESTEEM, RECOVERY AND THE PERFORMING ARTS: A Textbook and Guide for Mental Health Practitioners, Educators and Students. '11, 232 pp. (7 x 10), 6 il., 5 tables.

• Kocsis, Richard N.—APPLIED CRIMINAL PSYCHOLOGY: A Guide to Forensic Behavioral Sciences. '09, 306 pp. (7 x 10), 4 il., 2 tables, $65.95, hard, $45.95, paper.

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Web: www.ccthomas.com Complete catalog available at www.ccthomas.com or email books@ccthomas.com Books sent on approval • Shipping charges: $7.75 min. U.S. / Outside U.S., actual shipping fees will be charged • Prices subject to change without notice *Savings include all titles shown here and on our web site. For a limited time only. When ordering, please refer to promotional code TILT1110 to receive your discount.


TILT – Therapeutic Innovations in Light of Technology

Ne wInno vations

Check out our inno We are contacted regularly from businesses and organizations who offer new products and services to our audience so we have decided to expand our catalogue beyond course listings to include platforms, apps and other services of interest to therapists, coaches and other helping professionals! Would you like to be listed in our Catalog of Services?

What does a listing in our Catalog of Services mean for you? Your listing will be properly categorized in the same Catalogue as our course and events listings and graduates of our program - so our students and potential students will see your product or service. We use our catalogue to point people when asked questions daily such as “what secure email providers or e-clinics do you recommend?”, or “where do I start in building my online practice?” or "Can you recommend a virtual assistant?" Monthly subscription fee

Yearly subscription fee

$9.99/£6.50

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And what else? In each issue of TILT, we will showcase catalogue listings here in the New Innovations column with more information about the innovative features of a particular service or product.

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ovative Catalog of Services! If you are a communication platform, while we do not have a formal application to be listed in our catalogue, we ask that you only subscribe if your platform is secure and encrypted. We will not list communication platforms that are not secure and encrypted.

Click here to visit our Catalogue and view the current listings!

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TILT – Therapeutic Innovations in Light of Technology

Marketing Toolbox

Clinton Power

I recently created and published my first eBook for the Kindle store in Amazon and have found the process rewarding, enjoyable and relatively easy. So I want to share with you some of the basics you need to know to get underway with writing your first eBook. Firstly, you might be asking why write an eBook to sell on Amazon? Here are a few reasons: •

to broaden the number of people you can reach with your therapy or coaching messages

to increase your perceived expertise and authority in your chosen niche

to take of advantage of the world's second biggest search engine- Amazon- and get lots of free traffic to your product

people can purchase your product with one easy click and Amazon has hundreds of thousands of customer’s credit cards on file to find new leads that can convert into therapy and coaching clients

Getting started with your writing Firstly, I think it's important you do some research in Google and Amazon to see who's already written on your area of expertise of passion. This will give you an overview of what products people

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will pay for, as well as let you see a range of eBooks or varying quality and quantity. You want to make sure that your eBook provides a solution to a problem. People only buy information products that give them some solution to a current problem, or provide ideas for resolving a current pain. As therapists and coaches, we have an enormous skill set and knowledge about how people can live better lives. Much of this information is a perfect fit for your first eBook. I suggest that once you have your topic, write an outline for your book. Come up with the chapter titles and a brief synopsis. This will guide you in the writing process. Tips for your writing process There were a few things I did that were very helpful in getting me to complete the writing of my eBook. 1. Give yourself a deadline: Decide on a deadline that it must be completed by. Make sure you stick to it with no excuses. 2. Decide on your daily word count: Work out how many words you need to write a day to complete the book within your required time frame. 3. Keep yourself accountable: Find an accountability partner who you can check in with on a regular basis with your progress.


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How to....

Create & Publish Your First eBook for Kindle I'm part of a Mastermind group, so I posted a message in our private Facebook group everyday to let them know about my progress. 4. Write without editing: It's essential that you don't edit as you write the first draft. Allow yourself to write as badly as you want, but just get your ideas out and onto the computer. 5. Be strategic with your time management: I didn't allow myself to check email or go on social media any day until I had finished my required word count. 6. Repurpose content: See if there is any content you can use that youâ&#x20AC;&#x2122;ve already written before,

such as blog posts. This saved me an enormous amount of time as 40%-50% of my 25,000 word eBook was edited blog posts I had already written. 7. Use a copy editor: Make sure you proof read your writing for grammar and typos before submitting to Amazon. Use a professional for this to ensure you create the best product possible. Which software should you use to write your eBook? There are a number of different products out there you can use to write your eBook, but I used PressBooks.com and was extremely happy with the results. If you're familiar with WordPress, using PressBooks will be a breeze. Each post you create becomes a chapter and you can easily add front matter, back matter and it automatically generates a table of contents. Once your eBook is complete and you are ready to upload it to Amazon, you just export the .mobi file, which is needed for Amazon Kindle. There is a small charge of $10 to remove the PressBooks watermark from your book, so this is worth doing. You can then edit and export your eBook as many times as you want.

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TILT â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology

Uploading to Kindle To upload your book, you need to sign up at www.kdp.amazon.com, which is the Kindle Direct Publishing site. You can log in with your current Amazon account to get started. By this point, you want to make sure you've had a graphic designer create an attractive book cover for you, which is 1563 x 2500 pixels to get optimum results. You then upload your .mobi file with your book cover, write a book description, add keywords and then set your price. Within 12 hours Amazon publishes your book and you're live in the Kindle store! The great thing about this platform is you can upload a new version of your eBook anytime you want. I've continued to make small changes and have uploaded about 7 versions of my book already. Amazon marketplace tips You might want to experiment with price to find the 'sweet spot'. I started at $6.99 and then lowered it to $4.99, which seems to be getting better results. I also signed up with KDP-Select, which means Amazon has exclusive distribution rights (it can't be sold anywhere else on the Internet for 90 days) and you can release your book for free for up to 5 days throughout the 90 days. This was a great way to increase my downloads. I made mine free for 48 hours and received over 350 downloads and went to #1 in the free list for my category. A word about reviews It's essential you get some reviews for your eBook, as it will determine how Amazon displays your books to other readers. It's worth saying that you need to ask for honest reviews of your eBook and

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please don't pay or write any fake reviews. Amazon has a very hard stance on this and if they catch you, you'll be thrown out of the Amazon store never to return. Bad news for you and bad news for your eBook. I had my eBook formatted into a PDF by my graphic designer and gave away 100 free copies in exchange for reviews. So far I've had about 10% of people leave reviews, which is to be expected, but that's more reviews than I had to start with, so this strategy can really help you get off to a strong start. Final thoughts Finally, make sure you sign up for authorcentral. amazon.com to track your book ranking, complete your author profile and track your reviews. While writing an eBook is not going to make you a lot of money, it's a powerful and effective way to broadcast your message to thousands of people who never would have heard it. If you would like to watch a webinar I ran on this topic where I discuss all the factors in much more detail, click here. And you can check out my own eBook here! n

ABOUT THE AUTHOR Clinton Power is a Sydney-based Gestalt therapist and the owner of Clinton Power + Associates - a private practice dedicated to helping singles and couples move out of relationship pain. He is also the founder of Australia Counselling Directory, a free directory for find counsellors and psychologists in Australia. Clinton is also a passionate coach and consultant for healthcare professionals. Find him on Google+ or Facebook.


TILT – Therapeutic Innovations in Light of Technology

Love For the

Books of

v g, o d a f o “Outside best friend. n's a m s i k too s ' t a boo i g o ad f o e d i s In .” d a e r o t dark o Marx

h ~Grouc

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s

v

Cybercultures: Cultures in Cyberspace Communities by Sabine Bauman Cybercultures: Cultures in Cyberspace Communities is a collection of essays that investigate the interaction of the real and the virtual life and their mutual influence on how members of communities adapt their behaviour in changing contexts. Especially the impact of virtually created identities with regards to personality and identity in real lives is a focal point for continuous exploration of individuals, nations or organisations. Conversations in cyber communities often extend those of the real world to previously unavailable or complicated subjects (both in the sense of topic and/or recipients), including reverse projections of cybercultural expressions and objects to the offline world. Conceptualising the habitat of cyberspaces needs a spatial praxis that ultimately provides orientation in the non-physical and potentially unlimited virtual space through reflections of cybergeography and maps of community networks.

BUY NOW

The New Media and Cybercultures Anthology Pramod K. Nayar Moving beyond traditional cyberculture studies paradigms in several key ways, this comprehensive collection marks the increasing convergence of cyberculture with other forms of media, and with all aspects of our lives in a digitized world. • Includes essential readings for both the student and scholar of a diverse range of fields, including new and digital media, internet studies, digital arts and culture studies, network culture studies, and the information society • Incorporates essays by both new and established scholars of digital cultures, including Andy Miah, Eugene Thacker, Lisa Nakamura, Chris Hables Gray, Sonia Livingstone and Espen Aarseth • Created explicitly for the undergraduate student, with comprehensive introductions to each section that outline the main ideas of each essay

BUY NOW

• Explores the many facets of cyberculture, and includes sections on race, politics, gender, theory, gaming, and space

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/

TILT Magazine Issue 16  

Therapeutic Innovations in Light of Technology is about envisioning therapeutic interventions in a new way. TILT magazine is published quart...

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