TILT Magazine (Issue 6) by Online Therapy Institute

Issue six July 2011

An Ethical Framework for the Use of Technology in EAPs PAGE 26

PAGE 9

Everyday Technology in Counselling and Supervision

PAGE 42

Multiple Streams of Income for Therapists

PLUS...

Legal Briefs, Cybersupervision, Marketing Toolbox and much, much more...

TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a free publication published six times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 1, Issue 6, July 2011 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Production Coordinator Agnes Ikotun Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Mark Goldenson Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Susan Giurleo Associate Editor for Film and Culture Jean-Anne Sutherland Associate Editor for Coaching Lyle Labardee Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute. If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture). If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.

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

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Features 9 Everyday Technology in

Counselling and Supervision

26 An Ethical Framework for the Use of Technology in EAPs

42 Multiple Streams of

Income for Therapists

Issue in every

6 News from the CyberStreet 16 Research Review 21 Ethical Dilemma 24 What Would You Do?! 25 Wounded Genius 34 Reel Culture 36 Legal Briefs 38 Technology Enhanced Coaching 52 A Day in the Life: Therapist 56 A Day in the Life: Coach 60 CyberSupervision 64 New Innovations 66 Marketing Toolbox 68 Get Verified! 69 OTI Open Office Hours 70 For the Love of Books 73 Advertiserâ&#x20AC;&#x2122;s CyberMarket

A Note From the Managing Editors… Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology. Our feature article this issue is the latest in the Institute’s suite of Ethical Frameworks – The Ethical Framework for the Use of Technology in Employee Assistance Programs, co-authored with Marina London, Manager of Web Services for the Employee Assistance Professionals Association (EAPA). The framework was reviewed and edited by EAPA’s Technology and Social Media Panel, and we are proud to collaborate with such an esteemed organization. We are also pleased to welcome back Casey Truffo, who offers us a fascinating analysis of how we can learn from our Coaching colleagues in creating multiple streams of income. She ponders the question “How do I do meaningful clinical work and sustain a good income over the short and long term, regardless of the economy?” - a question we are sure many practitioners consider over the development of their private practices. We recently took part in Casey’s Therapist Leadership Conference online, attended by over 4000 professionals over the course of the convention, which was a stunning experience for all concerned. Finally, we offer you an edited transcript of Kate’s recent 2011 keynote speech given to Scotland’s professional body for Counselling and Psychotherapy – COSCA. This annual ethical seminar took place in Stirling UK, in March, and it was a pleasure to talk to not only the COSCA members attending the venue but also the delegates who attended live via video livestream from the Highlands of Scotland, demonstrating the usefulness of technology in education in spite of geographical remoteness. The full transcript is available as a download from the Online Therapy Institute – keep an eye out for it! We are pleased also to welcome Bruce Hillowe into the fold, as Jason Zack takes a bit more of a backseat from the legal column due to pressure of exciting new work projects. Bruce’s focus this month is on general malpractice coverage for Coaching, before he focuses down on the use of technology in future issues. Our aim continues, issue by issue, to keep you up-to-date with developments in innovations in service delivery; publish interesting articles; provide resources; and feature members and friends of the Online Therapy Institute and the Online Coach Institute. All our other regular columnists are here, with useful and entertaining comment on online supervision; marketing; coaching; research; legalities; film culture; and new innovations. We also have our member’s responses to our last Ethical Dilemma, and a new one for you to consider and to post responses at our social network forums for publication in the first issue of Volume 2 (Issue 7). Our featured “Day in Life” therapist and coach are Chris Hight and Angie Taylor respectively – we hope you find it as interesting to hear about their work as we do. Also, our resident cartoonist, Wounded Genius, has given us another brilliant take on therapy to make you laugh along the way. We hope you enjoy our sixth issue, whatever professional world you inhabit. We look forward to our first birthday issue in September. J

Managing Editors

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

NEWS from the

CyberStreet The Cyberstreet is here to keep you informed of news even if you havenâ&#x20AC;&#x2122;t found time to visit the Online Therapy Institute Website or Social Network!

And remember, even if you are not on Twitter, you can still read member tweets at the homepage of www.onlinetherapysocialnetwork.com!

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Blog and forum News… Here is a glimpse of what is going on...get a taster and then head to www.onlinetherapyinstituteblog.com, www.onlinecoachinstitute.com/blog, the member blogs at www.onlinetherapysocialnetwork.com, and the OTI forums on the homepage of the Social Network! At the OTI and now the Online Coach Institute blog… DeeAnna tells us of the good news that the Board Certified Coach is now available and a grandfathering period is being offered through December 31st, 2011. To accommodate people who may require additional training, the Institute for Life Coach Training is offering a significant discount off a 30 hour training package. DeeAnna and Kate are on the faculty of ILCT. Kate gives a report of the inaugural BACP Coaching Division conference in London, where she presented on Online Coaching: Applications, Ethics and Practice. The conference was pleased to have Nancy Kline of Time to Think as the keynote speaker. You can also read about Blogging for Disablism Day, read our press release on the continual launch of our BACP Endorsed training programmes, and learn more about what is in store at the forthcoming Denver EAPA conference in October. At the member blogs, John Wilson gives us continuing news about his upcoming events, Stephen Goss gives some excellent resources regarding research into online work, and at the forums, discussions continue around accreditation in the UK and networking from a new start up in India.

Member news… Roos Korste has recently been to Dar Es Salaam, attending the eLearning-Africa Summit and visiting a few local mental health NGOs. He wrote a blog post about this trip and study: http://in2mentalhealth.wordpress. com/2011/06/07/challenges-in-mental-healthcare-tanzania-what-can-elearning-add/, strongly advocating for more attention for mental health care in Low income countries. T I L T MAGAZ I N E J ULY 2 0 1 1

TILT – Therapeutic Innovations in Light of Technology

Sandra Chapman has a free website and 70 minute audio called "How to Survive Grief" just released online for all those suffering losses from death, as well as those who lose their jobs, lose their relationships and lose their homes (as in the devastation caused by tornadoes and the fires in Arizona). For more information, and to access the audio, visit www.survivegrief.com. Kate Anthony had a section on using email and blogging therapeutically in “Write Yourself: Creative Writing and Personal Development” authored in the main by Gillie Bolton and published by Jessica Kingsley Publishers. Please see the For The Love Of Books section for more information! SoulFriends was recently selected as the winner of a Best of Expo Gold award in the Community category for their exhibit at the New Living Expo in San Francisco, CA (April 29-May 1, 2011). Best of Expo is a competition organized by independent media and industry leaders,

recognizing innovation and excellence in new products or services. The Best of Expo judges chose SoulFriends based on criteria such as "innovation, evidence of quality, forward thinking, contribution to their area, potential for use in daily living, unique features and benefits, and potential to contribute to the concerns of the community." The SoulFriends web portal provides uniquely enriching information and services to visitors by supporting the transpersonal and human experience through psychology, spirituality, and community Judy Cantwell is pleased to announce her fouryear contract renewal providing Employee Assistance Program (EAP) and cross-cultural services to expatriate and host national faculty, staff and family for a US medical school based in the Caribbean and West Indies. Judy uses email, telephone and Skype from her office base in Atlanta, Georgia – and regularly travels to the campus sites.

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Kate Anthony, DPsych, FBACP

Everyday Technology in Counselling and Supervision This transcript is a heavily edited version of a Keynote Speech given at the COSCA (Counselling and Psychotherapy in Scotland) Annual Ethical Seminar in March of 2011. To download the full hour transcript, it is available at http://www.onlinetherapymagazine.com/ articles/. A further version will appear in COSCAâ&#x20AC;&#x2122;s Counselling in Scotland Journal. Used with permission and with thanks to COSCA.

Welcome Everybody! We are talking today about the use of technology in counselling and supervision. I think we are now at the point where online therapy, although not mainstream, is accepted; certainly it has been accepted from an ethical point of view, although it is always a work in progress not least because of the many different technologies that pop up every day. So, on that note, what I am going to do is to take you through some of the technologies that are used right now. I am sure you are familiar with a variety of different kinds of websites. Static websites, although they do usually have a contact line and contact email address, do not involve any sort of interaction on line. They do sometimes have a telephone help line but that is as far as the communication goes. It is really just an information website. One step up from that is what is known as a Dear Abby website, such as Queendom.com. Here people will come onto the internet, go onto the website and will post their problem or question for experts and psychologists, therapists, counsellors, coaches, to answer them. These are very useful sites because as it is in the public domain, people can find similar problems and see what the experts have done to resolve other peoplesâ&#x20AC;&#x2122; problems. So it is very public, with nothing confidential about it at all. One step up from the above is on line therapy by email. We recommend Hushmail.com as the best email service provider to provide online therapy. It T I L T MAGAZ I N E J ULY 2 0 1 1

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is all encrypted and includes video footage, chat rooms and email service. Hushmail you can use for free - you just have to check into your account every three weeks and it gives that extra layer of security. Then we go into therapy using chat rooms, also known as instant messaging, where two people are online synchronously. This is where two people (or more for those doing group therapy) are in the chat room, talking to each other simultaneously. It is a very exciting and dynamic way of working and talking to your client in a real life conversation as it were. It is just not done

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through speaking, but through using text. A step up from that is using the telephone. Counselling has been done by telephone for 50/60 years, using landline technology. These days we also have Voice over Internet Protocol (VoIP), where you (often) have a head set and you talk to another person through your computer, so using World Wide Web technology in order to talk to the other person. Mobile phones are getting more and more sophisticated, with video, texting, email and chat now being available. I think using SMS text chat happens more than we realise and tends to be used for making and breaking appointments, but I do know of practitioners who have mobile phones in order to do therapeutic communication. It is also very useful for help lines, crisis lines. Indeed, the Samaritans use text messaging to help people who are suicidal and it is effective because having to reply to a text message will delay the person - if they are suicidal, it tends to put a buffer in place so that it delays

them acting on the suicidal thoughts. It does have its issues because it is not encrypted. Encryption is a word you will hear me talk a lot about during this presentation. It is very important to use encryption, and there is no excuse for not doing so. Video conferencing is becoming increasingly popular. It has surged in the last couple of years, and it is much better since Broadband came in. It is becoming more and more reliable and sophisticated. Skype is a useful piece of software, also free, which allows you to use encrypted video to talk to your clients. There is also stand-alone software. You are probably familiar with CCBT, (Computerized Cognitive Behavioural Therapy) and Beating the Blues, a software programme developed by therapists and psychologists in order to supply the client with a self-paced CBT programme. What Beating the Blues offers for therapists are things such as pinpointing problems and scheduling activities. It has been taken up by the NHS, and

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is successful for mild anxiety and depression. Virtual Reality Exposure is an interesting technology. An example of this is where the client wears a headset, and is immersed into a virtual reality. He/she is also standing on a platform that will emulate, for example, a rising lift in the case of treating a fear of heights. The therapist or psychologist will test out levels of anxiety. It is also used for social phobias. For example, the client is placed into a virtual library, or video store or something similar, and the therapist will then manipulate the other avatars (which are the computer generated representation of the person) to come nearer to the client or further away from the client, and gradually immerse them into getting used to them being around. It can also be used for fear of open spaces, public speaking, and post-traumatic stress disorder. There is also gaming. One example is Personal Investigator. This was introduced and developed in order to encourage adolescents going into therapy. Essentially, the client creates a journal, pinpoints problems, works their way through the game going into different rooms and collecting keys from certain people. Once they have watched videos, for example, of

other children who have been bullied and their experience of bullying, once they have worked through the programme they can collect keys, write in their journal, and self-treat. They can do it on their own, they can do it in the room with the therapist or remotely with the therapist and use that to level up through the game while they are moving up through their own mental health, which I think is a wonderful way of self-treating and destigmatising therapy for adolescents and young people. Second Life is a virtual environment, probably the biggest and most well-known. The Online Therapy Institute has a virtual office, and a virtual

conference centre. My name in second life is KateElize Larnia and I have my own persona and my own avatar. We advocate that therapists who are working in Second Life make their avatar as close to how they actually look like as possible. We have a lot of conferences on line in Second Life and people will turn up with their avatars using wheelchairs, or as aardvaks, sometimes they will turn up highly sexualised. It is fascinating to see just how people do picture themselves when they build their own avatar. When it comes to client work, I have a colleague who uses Second Life to meet his clients. He has a client who will actually change their avatar depending on how T I L T MAGAZ I N E J ULY 2 0 1 1

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they are feeling. So, if he is feeling particularly perky, very dynamic, and very strong, he will have a warrior type of avatar. Sometimes, if he is feeling really down, he will have a very, very plain avatar and so they work with how he is feeling through how he represents himself. Sometimes he changes avatar halfway through a session as well. Second life does have its ethical issues, not least because it is not encrypted. What we recommend is to a) to have what is known as a sky box - a

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room which is away up high in Second Life which is not normally seen by anyone who happens to be walking by, and b) to use Skype or other encrypted software because the encryption is not available in Second Life. So layering technology is used to make it as confidential as possible. Finally, there is social media. This has absolutely exploded, probably in just the last few years, with the advent of Facebook becoming global and the existence of Twitter, which is a microblog. There are also other

types, for instance LinkedIn. There are problems with using social media, because clients will think nothing of friending you on Facebook or following you on Twitter, or wanting to link with you on LinkedIn. The potential for the break in confidentiality is actually quite scary, particularly with LinkedIn because it runs by the process of six degrees of separation whereby you know someone, who knows someone, who knows someone. Gradually, purely because of that principle, sooner or later a client will get

Online Therapy Institute is proud to announce

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online workshop modules! We offer several modules comprising 5-10 clock hours of learning on many topics! Introduction to Cyberspace: A Primer for Helping Professionals Relationships in Cyberspace: An Introduction for Helping Professionals The Online Therapeutic Relationship: Theoretical Considerations Ethical Considerations of Online Therapy Working Therapeutically Using Asynchronous Email Working Therapeutically Using Synchronous Chat Working Therapeutically Using Telephone and Audio Using Video Conferencing to Conduct Online Therapy E-Therapy: Asynchronous Email/Web Board Therapy, Cyber-culture, Ethics

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have less knowledge of how the technology is working. Although, to be honest, if a client is working online they are usually well versed. You have to work within your scope of practice. If you are not qualified or not comfortable with seeing a client offline, e.g. if you do not feel comfortable working with drug and alcohol issues, you certainly should not be working with them online either. Being aware of your scope of practice in geographic areas is important as well. There are a handful of States in the United States where you are not allowed to counsel someone outwith State lines.

linked to someone you know and they, via their own linking with you, will be identifiable as a client. Making sure that as a therapist you behave professionally online at all times might mean that you take steps to prevent your clients from seeing on Facebook photos of you at a party. Your clients may well Google you, and so therapists need to maintain a responsible professional presence online

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and make sure that that their clients are protected as well. Practitioners need to have sufficient understanding of the technology. It is not enough just to know where the on button is – you have to be proficient in it. You need to immerse yourself in it, understand it, and make sure you have the basics and sufficient understanding of the technology. Certainly, at the very least in order to be able to help clients if they

Make sure that you have done the best you possibly can to make sure the client reads your online therapy terms and conditions, privacy policies, that they understand what is going to happen, that you do an assessment which is free the first time to see if they can fit these terms of service, and the ramifications where possible. The intake screening process is much harder online and that needs to be taken into account at the point of the client’s first contact with you. Training and CPD are very important. We offer a suite of training opportunities at the Online Therapy Institute. We have short modules of 5 hours

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each and have just launched our 40 hour Certificate course which includes video conferencing and telephone work as well as using the basic text based communications with your clients. Using technologies can be a very exciting and rewarding way of working. Thank you for inviting me today, I hope that was useful. n About the author Dr. Kate Anthony is co-founder of the Online Therapy Institute and Managing Editor of TILT Magazine – Therapeutic Innovations in Light of Technology. Her doctoral thesis was “Developing Counselling and Psychotherapy in the Age of Technology and the Internet”.

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TILT – Therapeutic Innovations in Light of Technology

Research Review Report on the

2011 International Socie on Internet Intervention

A major gathering of researchers, practitioners and service providers took place in Sydney, Australia, earlier in 2011 organised by the International Society for Research on Internet Interventions (ISRII). Among numerous papers of interest – far too many to be adequately represented here – Gerhard Andersson of Linköping University and Karolinska Institute, Sweden, reported on the growing evidence base for Internet delivered CBT (iCBT) now supported by numerous Randomised Controlled Trials (RCTs), most of which show equivalence with face-toface provision. While the body of research as a whole has not always influenced routine health provision policy to the extent that it should, Sweden now recommends iCBT as a treatment option for depression and anxiety, provided through state funding (this has been the case in the UK and some other countries for some time). Andersson’s own trial (Andersson, 2011) based on 463 patients with depression and 298 with panic disorder showed highly significant improvements for both groups comparing pre- and post- intervention data (effect sizes

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of 1.12 and 0.98 respectively – any effect size over 0.8 is usually considered a large effect). He concluded that Internet delivered CBT can be incorporated into routine mental health care effectively and, moreover, with low drop out rates. These findings were supported by other studies including, for example, a study of iCBT in a telephone crisis counselling service setting (Farrer et al, 2011), which reported that it led to decreased dangerous alcohol intake and better quality of life, as well as improved mental health literacy. Cavanagh et al (2011) tested the generalizability of existing research into the Beating the Blues computerised CBT programme to the context of a service-user led 3rd sector (nonprofit) setting, finding that 50% of those with significant levels of depression who completed just 2 or more sessions recovered in that time. Ebert et al (2011) reported on an RCT with 400 psychiatric patients that demonstrated the ability of Internet based care (which included email contact with a therapist, selfhelp materials, online symptom monitoring and an online support group) to enhance post treatment continuation of care across a range of diagnoses.

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S t e p h e n G o ss

Research Call

ety for Research ns (ISRII) Convention Self-help interventions were also the subject of papers by Kauer et al (2011), Lintvedt et al (2011) and Muñoz (2011), among others. The first, another RCT, reported significant reductions in depressive symptoms in a sample of 118 adolescents through self-monitoring of mood and stress. The second looked at the cost-effectiveness of translating selfhelp programmes into different languages. Translation cost just 27% of the original development costs, returning the investment 144 times. Just 400 users with mild to moderate depression would be required for such a project to break even (or 1000 less distressed people with sub-clinical levels of depressive symptoms) through improvements in their quality of life, giving a helpful indication of the scale of uptake required to make investment in making existing programmes available to different national or language groups worthwhile and the authors hoped that their findings will lead to more translation projects being undertaken. Muñoz also repeated his call for the online mental health community to take on the task of making effective, automated self-help materials far more widely available and free at the point of use – and extended through mobile platforms as well as usual Internet access and enhanced through direct practitioner input and management - effectively making access to

Niela Miller, known as Marly Milena in Second Life, is looking for a collaborator/researcher to study the effects of using SL technology and arts-based processes for coaching and therapy in cyberspace. Please contact her if you would like to explore this further. The projects set up would be dependent on mutual interests. Please send her a notecard in SL stating your interests and background. This is not a paid position. It could be a student project for education credits.

continued next page

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basic mental health care something that could be considered a fundamental human right. A selection of other papers included a further RCT reported by Andersson et al (2011) on Internet delivered guided behavioural couples therapy, perhaps the first of its kind. A moderate effect size of 0.53 was found, supporting the guided intervention. It is possible, however, that in this instance the control group (who were assigned to an online discussion forum) may also have received beneficial input so the total effect of the treatment may have been even larger than this design could indicate. Billings et al (2011) reported early findings from an RCT of Going Forward, a CCBT intervention for substance abuse focussing on relapse prevention. Long term effects remain to be evaluated but in addition to clear psychoeducative benefits, participants reported significantly increased confidence and selfefficacy in challenging situations that gives reason to expect that actual relapse rates should improve. Like the Kauer et al (2011) paper noted above, Christensen et al (2011) examined preventative CCBT, reported on preventative interventions, this time through two linked RCTS building on an earlier range of work by Christensen and colleagues that is also likely to be of interest to many readers of this column, including an older meta-analysis of randomised controlled trials (RCTs) of technologically mediated interventions for adults with depression (Christensen et al, 2008). Even at that date, an impressive 55 sufficiently high quality trials were identified, higher than found in some

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reviews of face-to-face interventions. If we were to add the number of non-RCT evaluative studies to the pool, and the wealth of research that has been produced since – evidenced not least by the References Andersson, G. (2011) Dissemination of iCBT in Sweden – moving from efficacy to effectiveness. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Andersson, G., Gustavsson, M., Andersson, A.-K., Stalby, M., Svensk, M., Andreen, H., Turesson, S., Wågström, T. and Carlbring, P. (2011) A new venue for Internet treatment research – behavioural couples therapy: a randomised controlled trial. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Anthony, K., Nagel, D.M. and Goss, S. (2010) The Use of Technology in Mental Health Applications, Ethcis and Practice. Springfield, Il.: CC Thomas. Billings, D., Hersch, R., Greenwood, G. and. Leaf, S. (2011) Web-based Cognitive Behavior Therapy for Substance Use Disorders: A Randomized Trial of Going Forward. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Cavanagh, K., Seccombe, N. and Lidbetter, N. (2011) The Implementation of Computerised Cognitive Behavioural Therapies in a Service User-led, Third Sector Self Help Clinic. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Christensen, H., Griffiths, K.M., Gulliver, A. (2008) Plenty of activity but little outcome data: a review of the "grey literature" on primary care anxiety and depression programs in Australia. Medical Journal of Australia. 16(12): S103-106. Christensen, H., Griffiths, K.M., Gulliver, A., Clack, D., Kljakovic, M. and Wells, L. (2008) Models in the delivery of depression care: A systematic review of randomised and controlled intervention trials. BMC Family Practice. 9: 25.

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impressive array at the ISRII event, it is clear that there is a very healthy level of research activity on the subject and a growing evidence base that practitioners should be aware of, despite Ebert, D., Tarnowski, T., Dippel, A., Pflicht, M., Eggenwirth, S., Sieland, B. and Berking, M. (2011) Back Home – but not Alone: 12-Month-Outcome of a Transdiagnostic Internet-based Continuation-Treatment after Inpatient Cognitive-Behavioral-Therapy. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Farrer, L., Christensen, H., Griffiths, K., Burgess, N., Mackinnon, A. and O’Neil, D. (2011) Secondary Outcomes of a Randomised Controlled Trial of Internet-based Cognitive Behaviour Therapy in a Telephone Counselling Setting. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Goss, S. and Anthony, K. (Eds) (2003) Technology in Counselling and Psychotherapy A Practitioner’s Guide. Basingstoke: Palgrave MacMillan. Goss, S., Anthony, K. Jamieson, A. and Palmer, S. (2001) Guidelines for Counselling and Psychotherapy. Rugby: BACP. Kauer, S., Reid, S., Jorm, A., Jackson, H. and Patton, G. (2011) Using Mobile Phones in the Prevention of Adolescent Depression: A Randomised Controlled Trial Examining Emotional Self-Awareness as a Mediating Variable. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Lintvedt, O., Griffiths, K., Eisemann, M. and Waterloo, K. (2011) Evaluating the translation process of an Internetbased self-help intervention for depression: A cost effectiveness analysis. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011. Muñoz, R. (2011) Blanketing the World with Self-Help Automated Interventions: Toward making health care a basic human right Everywhere. Paper presented at International Society for Research on Internet Interventions – Fifth Research Meeting. Sydney, Australia. 6-8th April, 2011.

the ongoing need for more outcome data noted at the time of the review (Christensen, Griffiths and Gulliver, 2008). Important factors identified then as influencing positive outcomes included, the active involvement of a practitioner to deliver care and manage cases (as opposed to automated systems), revision of professional roles and, significantly for those involved in delivering online services, the importance of patient preference. This suggests that online therapies are suitable for those that choose them, not everyone – technology should not be used for technology’s sake as cautious authors have always argued (Goss et al, 2001; Goss and Anthony, 2003; Anthony et al, 2010) Readers may also find other papers of interest at the impressive collection of resources hosted by the Australia National University at www. ehub.anu.edu.au/publications.php#delivery. Further resources related to online counselling and psychotherapy research can also be found through http://onlinetherapyinstitute.ning. com/profiles/blogs/research-resources?xg_ source=activity. Readers are invited to add their own favourites at this site too. n

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).

Please send reports of research studies, planned, in progress or completed, to editor@onlinetherapymagazine.com, Subject line: Research Review.

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TILT – Therapeutic Innovations in Light of Technology

Online Therapy Institute is proud to announce

Introduction to ONline Coaching Methods, Ethics and Responsible Social Networking

5 clock hours of instruction Online and self-paced An Introduction to Coaching Online: Considerations and Definitions Conducting and Enhancing your Online Coaching Client Relationship The Ethical Side of Online Coaching Maintaining a Responsible Online Presence Telephone, VoIP and Coaching via Videoconference

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Reader Responses

Ethical Dilemma IN THE LAST ISSUE WE ASKED:

You have been seeing your client for a few months and he discusses his blog frequently. You have his explicit permission to view the blog and have done so in the past, both feeling comfortable with the content and the boundaries surrounding discussing therapy on it. At the end of the last session, your client seemed uncomfortable, edgy and worried. He states “perhaps you should visit my blog again…” As agreed within the contract, you do so and while nothing your client has said about the therapy may be considered damning or destructive to the relationship and the therapy, you discover that it has been linked to by many mental health sites and gone viral, inviting thousands of comments, many of which are defamatory. What Would You Do?!

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Good article. If the blog is regulated by someone, the poster should be warned that action will be taken such as removing the post. You must be careful what you post online as it can be damaging if it reaches the wrong people.

Reply by

John Hardy

If the comments are defamatory about me and my work, I may wish to take steps to obtain some kind of redress, clarification or correction, but would probably be wrong to do so. The comments are not my problem, not least because if the blog is appropriately boundaried, I will not have been identified - so taking action would risk 'outing' both me and my client as a client of mine in itself. Cyberspace already has many negative views of therapy - these would be just a few more so I should probably weather the storm, other than addressing issues that have been raised about the therapy with my client, which almost certainly would be important and may well raise feelings about our relationship that should be explored. Done well, may even be helpful in building on our working alliance. If I had been personally identified in some way (eg if some of those commenting have worked out my identity) the situation may be different, but any action I took would be fraught with difficulties for the therapeutic relationship, which I would seek to preserve probably resulting in no action being taken beyond ensuring my client is clear about any erroneous impressions that may have been created. The defamation would have to be extremely strong (eg resulting in a complaint to my professional body that I had to defend or major loss to my practice) for the problem to be sufficient for me to risk threatening the security of the therapeutic frame at all. Defending against public defamation often risks publicising it further, potentially increasing the harm to me anyway and, if it refers to work with my client, breaching confidentiality in itself - as the recent case of Patrick Strudwick and his courageous campaign against therapists who seek to 'cure' homosexuality showed when one of them made very public statements in the leading UK national newspaper (http://www.guardian.co.uk/world/2011/may/27/gay-conversion-therapy-...).

Reply by

Stephen Goss 22

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This comment about online therapy is similar to the ones we get about online education. People who are 40+ see things as eroding the way of life they grew up with and thought would stay the same. Technology is moving faster. One for sure is that if you post it on the Internet it can be read by anyone. Never assume that what you text or say to your client will remain confidential. Even when you use a secure line it can be hacked. If they can do it to the Pentagon they can do it to you. They only way we have of protecting ourselves if we are a licensed professional is to record everything we say or write to a client. There are inexpensive software programs you can install that will do this automatically and record the date and time of the record. Larry, you are 100% right on the ethics question [see below].

Reply by

Deborah J. Boyd

Personally, I would want more detail before answering. I would want to know what specific boundaries were agreed upon between the therapist and the client. I personally would never agree to a "wide open" boundary that allows the client to discuss his therapy with me in a forum where others can "link in." Professionals online need to be particularly careful these days. Even with agreed upon terms where questions of possible confidentiality are concerned, clients can still claim a violation of that confidentiality.

Reply by

Vernon D. "Rusty" Ouder

My focus would be on his seeming uncomfortable, edgy, and worried. The next week I'd let him know I looked at his blog, then ask him what was going on for him at the end of last weeks' session. The fact that his blog has gone "viral" is not my concern, except to the extent that it affects my client.

Reply by

Larry F. Saidman

Longer (unedited) replies and further discussion are available at http://onlinetherapyinstitute. ning.com/forum/topics/coaches-and-therapistsethical thanks to everyone for their contributions!

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Hi Eve ry o n e!

In each issue of TILT we shall be presenting an ethical dilemma about a Web 2.0 experience and other ethical topics related to mental health and technology, and inviting readers to comment at the Online Therapy Institute’s social network. In the following issue of TILT, we shall publish a selection of comments about what YOU would do when faced with the dilemma, as well as our own considerations about what the issues are.

What Would You Do? dilemma Your client tells you that he often goes into Second Life to de-stress after a long day at work. He says he can "be himself"- a self that he cannot present to the real world. He asks you to join him in Second Life to meet his Avatar....

What would you do?! Weigh in at the OTI Social Network’s Discussion Forum! http://onlinetherapyinstitute.ning.com/forum/ topics/ethical-dilemma-what-would-you-3

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Wounded Genius Welcome to our Resident Cartoonist, Wounded Genius. We discovered WG through Facebook, when our colleague and friend Audrey Jung posted a cartoon on Facebook, and within half an hour we were chuckling away, following on Twitter, and were commenting on the main blog at http://talesoftherapy.wordpress.com/ - make sure you check out the archive of cartoons, written from the perspective of a client. We are thrilled to have WG on board, both for TILT and as a member of the OTI social network.

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An Ethical Use of

By Marina London, DeeAnna Merz Nagel and Kate Anthony

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l Framework for the Technology in EAPs EAPs require a separate ethical framework from other mental health related professional frameworks because of their unique involvement with the workplace at multiple levels. As described in the Employee Assistance Professionals Association’s (EAPA) Standards and Professional Guidelines, “Employee Assistance Programs (EAPs) serve organizations and their employees in multiple ways, ranging from consultation at the strategic level about issues with organization-wide implications to individual assistance to employees and family members experiencing personal difficulties. As workplace programs, the structure and operation of each EAP varies with the structure, functioning, and needs of the organization(s) it serves. In general, an EAP is a set of professional services specifically designed • to improve and/or maintain the productivity and healthy functioning of the workplace and to address a work organization’s particular business needs • through the application of specialized knowledge and expertise about human behavior and mental health.

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More specifically, an EAP is a workplace program designed to assist: (1) work organizations in addressing productivity issues, and (2) "employee clients" in identifying and resolving personal concerns, including health, marital, family, financial, alcohol, drug, legal, emotional, stress, or other personal issues that may affect job performance.” These components combine to create a unique approach to addressing work-organization productivity issues and "employee client" personal concerns affecting job performance. At the heart of EAP client cases there is a dual relationship (to the individual and the organization served) that Employee Assistance (EA) professionals must always keep in mind. Clearly the specialized EA field requires its own:

Ethical Framework for the Use of Technology in EAPs A competent employee assistance (EA) professional working online will always adhere to at least the following minimum standards and practices in order to be considered to be working in an ethical manner.

EA Professionals have a sufficient understanding of technology. EA professionals who deliver employee assistance services via technology should have grounding in technology basics. They should possess a basic understanding of technology as it relates to delivery of services.

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Encryption: EA Professionals understand how to access encrypted services to store records and deliver communication. Record storage can be hosted on a secure server with a third-party, stored on the EA Professionals’ hard drive utilizing encrypted folders or stored on an external drive that is safely backed up. Backup Systems: Records and data that are stored on the EA Professionals’ hard drive are backed up either to an external drive or remotely via the Internet. P a s s w o r d Protection: EA Professionals ensure confidentiality of client communication and other materials by password protecting their computer, drives and stored files or communication websites. Firewalls: EA Professionals utilize firewall protection at multiple levels: desktop/ laptop operating system level, local area network level and additionally utilize firewall resources provided by their Internet service provider. Virus Protection: EA Professionals assure that their work computers are protected from viruses that can be received from or transmitted to others. Hardware: EA Professionals understand the

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basic running platform of the work computer and know whether or not a clientâ&#x20AC;&#x2122;s hardware/platform is compatible with any communication programs the practitioner uses. Software: EA Professionals know how to download and operate software and assist employees and their families with the same when necessary to the delivery of services. Third-party services: EA Professionals utilize third-party technology service providers (e.g. for backup, storage, virus protection and communication) that offer an address and phone number so that contact is possible via means other than email.

EA Companies and Programs provide needed technological support. EA Programs will provide the structure and technology for communication, supervision, etc. to their staff members and affiliate providers. EA Programs ensure their EA Professionals are trained in using technology so they can provide assessment, counseling and referral services. EA Programs set standards of service based on the Employee Assistance Professionals Associationâ&#x20AC;&#x2122;s Standards and Professional Guidelines for Employee Assistance Programs, the EAPA Code of Ethics, the Guidelines for Use of EAPA Related Social Media, and the CEAP Code of Ethics.

EA Professionals work within their Scope of Practice. Scope of practice defines where a practitioner may work; for example, whether the practitioner may

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practice across various geographical boundaries. EA Professionals also represent themselves appropriately and follow local and regional laws and codes of ethics as applicable. Understand specific laws or ethics within ones’ own discipline or geographic location: EA Professionals understand the limits set forth by laws or ethics within their applicable discipline

and geographic location. For instance, in the United States, Licensed Professional Counselors cannot call themselves Psychologists, and in the UK the term “Chartered Psychologist” is reserved by law for use only by those with proper recognition from the appropriate authorities. Another example would be that a counselor in one state should be cognizant that most states prohibit a practitioner who is not licensed in that state from providing counseling to that state’s residents.

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EA Companies and Programs provide the means to communicate via technology. EAPs provide the technological equipment expertise, and support, as well as sufficient back up systems and plans to reasonably ensure communication continuity.

EA Companies and Programs provide or ensure training, knowledge and

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supervision. Training, knowledge and supervision regarding EA services and technology is paramount to delivering a standard of service that is considered “best practice” within a global context. Those EA Professionals who will be working online need to have proficiency and competency through specialized training for this type of work. Supervision is mandated for all EA Professionals because of the specialized effort required for the provision of EA distance services. Cultural and Setting Specific Knowledge: EA Programs provide EA Professionals with sufficient information about the client or client company’s culture, needs, and current circumstances. Training and supervision: EA Professionals seek out continuing education and supervision.

EA Companies, professionals and programs display pertinent and necessary information on Websites. EA websites provide access to information for potential and current clients and managers. Crisis Intervention Information: EAPs may display crisis intervention information on their website. EAPs understand that people in crisis may visit their website from anywhere in the world Organization Contact Information: EAPs offer contact information that includes email, post address and a telephone or VOIP number. EA clients should have a post address for formal correspondence. Practitioner Certification Information: EA Programs indicate that EAPA allows the general

public to verify whether an EAP practitioner currently holds the Certified Employee Assistance Professional (CEAP) credential. Encrypted Transmission of EAP sessions: EA Programs offer secure and encrypted means of communication. Video, email and chat programs in use are described along with encryption and security policies either embedded within the organization’s site or utilizing links to 3rd party platforms.

EAP Initial Intake and Screening process. EA professionals screen the client’s suitability for delivery of EA services via technology, considering language and keyboarding skills, presenting issues and clinical concerns.

EA Programs offer a Statement of Understanding that includes the following: Potential Advantages and Disadvantages of Online Sessions: Information is disseminated about the pros and cons of online sessions including such disadvantages as lack of visual and auditory cues and the limitations of confidentiality via technology, and advantages that include immediate access. Confidentiality and Technology Encryption: An explanation is provided to the client about the use of encryption during online exchanges. File Storage Procedures: The client is informed

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about how records are stored (web-based, third party or hard-drive/external drive) and for how long the records are maintained. All procedures conform to the standards laid down in applicable law and as required by any relevant authority (such as professional body) and, at least, include encryption and password protection and a commitment to destroy all records after a given period as required by law/regulation/best practice. Privacy Policy: The EA Programs’ confidentiality and privacy policy is also included in the Statement of Understanding process including information about how client identifying information and records are used, shared or stored. Other Issues

Informed

Consent

Physical Location & Geographical Jurisdiction: The physical location of the EA professional is stated in the Informed Consent and if the practitioner is licensed within a specific

jurisdiction, the Statement of Understanding states that the client understands services are rendered under the laws or jurisdiction of the relevant country, state or region. How to Proceed during a Technology Breakdown: The client is informed about how to proceed if a technology breakdown occurs during a session, e.g. “If we disconnect, try to reconnect within 10 minutes. If reconnection is not possible, email or call to reschedule an appointment.” Emergency Contact: EA Professionals offer specific information about who to contact in case of an emergency and set specific rules about which technologies to use to accomplish this. Online Relationships: EA Professionals discuss with clients the expected boundaries and expectations about forming relationships online. ©2011 Online Therapy Institute, Inc. ©2011 Employee Assistance Professionals Association, Inc.

Further Reading EA professionals and others wanting to further complement their knowledge of employee assistance related technology issues will find it useful to consult the EAPA’s Standards and Professional Guidelines for Employee Assistance Programs, the EAPA Code of Ethics, the Guidelines for Use of EAPA Related Social Media, and the CEAP Code of Ethics. They can be found at www.eapassn.org.

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ABOUT THE AUTHORS

Marina London, LCSW, CEAP, Manager of Web Services for the Employee Assistance Professionals Association (EAPA), served as principal writer for this framework. The framework was reviewed and edited by EAPAâ&#x20AC;&#x2122;s Technology and Social Media Panel. DeeAnna Merz Nagel and Kate Anthony are co-founders of the Online Therapy Institute and Managing Editors of TILT Magazine â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology.

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TILT – Therapeutic Innovations in Light of Technology

REEL CULTURE

Jean-Anne Sutherland

Blended Families in the Movies According to movie therapist, Bernie Wooder, film viewing can be a constructive therapeutic method. Wooder states, “Because films are seen from a third person's perspective, clients can overcome feelings of denial when working with deep-seated problems.” Certainly increasing numbers of therapists have begun to consider the potential of assigning films to clients in order to tap emotional experiences. As I have suggested in previous columns, it seems to me (the sociologist in the room full of psychotherapists) that while the technique may well produce positive results, there are considerations to be made before turning a client loose on a film. (Wooder cites no peerreviewed work on his website thus I am unclear as to how his methods are received in the psych community) Again, as the pesky sociologist, it seems important to make sure films are not accepted at face value. For instance, does a movie promote individualism (“anyone can do it if they try hard enough!”) at the expense of structural considerations (e.g., economic or racial privilege)? Most of us, after viewing Shirley Valentine, can’t exactly escape to Greece, no matter the tug. If told to watch Rocky for lessons on self-esteem, do we consider representations of hyper-masculinity? These thoughts, accompanied by some personal experiences, led me to consider how a film therapist 34

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might deal with issues related to blended families. As we know, the numbers of blended family households continue to increase. In the U.S., research shows that approximately 50% of Americans presently, or at some point in their lives, will live in a stepfamily relationship. These figures are a bit higher than data from Canada and Australia, but there too we see an increase. We also know that this “blending” is often anything but a “blend.” Oftentimes it feels more like trying to blend crushed glass into a smoothie. With the apparent difficulties that children and adults face while attempting this brave act, how might movies help? With this in mind, I went on a quest for blendedfamily films. Should a therapist want to refer clients to film images, what sorts of movies are out there? In short, I found that most of these films (as movies are wont to do) skirt the thorny and complex issues of family blending in favor of a “feel good” product. While most of them do grapple with the difficulties,

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they are also ripe with stereotypes and neatly wrapped up conclusions. Should you conduct a google search, you will no doubt land upon two U.S. films in particular. These seem to be the poster-children for stepfamily movies: Stepmom and Yours, Mine and Ours. At the risk of being the movie buzz-kill, I find these two films to be somewhat disastrous as a therapeutic tool (that is to say, I would not present them to my household expecting any sort of growth experience to follow). If you want a film that presses you to consider how your children’s lives might go on after your impending death, you’ll love Stepmom. Yes, we see the eventual respect develop between the dying mother and the nonnurturing stepmom. That’s a good thing. But we also have some problematic stereotypes at work. The stepmom (Julie Roberts) is, well, almost all bad, at least initially. She has no children and, in fact, does not seem particularly excited about having any. Perhaps that is because she, gasp, has a career. The mom (Susan Sarandon), however, is almost altogether good. Maybe it’s my accelerated cynicism (though many critiques of this film offer up similar concerns), but it feels too simplistic. Thus, might viewers watch this feel good/bad film and, on some level, imagine that such harmony is possible, if you only just TRY? Next on the list, Yours, Mine and Ours (the 2005 version), does not strike me as much more helpful. Speaking of over-the top representations of blended families: in this film we have the rigid military father (ala Christopher Plummer in The Sound of Music, complete with whistle), and the hippy mom (“free-spirited” apparently means welcoming a large pig as a house pet). He brings

8 children to the marriage, she brings 10. Okay, so the kids in my house might watch this and recognize something about “opposites” coming together. They might also find it amusing to see the kids work together, even as their common goal is to split the parents so they can exit one another’s lives. But, as Hollywood produced films so often do, this one wraps up happily. All we have to do is WANT the blend to work, and it will. We see similar themes in One Fine Day (1996) and Are We Done Yet? (2007). Both of these films offer delightful performances and (in the case of the latter) a hilarious series of pratfalls. We also have the over-zealous working mom (One Fine Day), and the bumbling Dad (both). These mom and dad stereotypes prevail, by the way. The ne’re-do-well Dad is found in numerous films (Kramer vs Kramer, Mr. Mom, Mrs. Doubtfire, Daddy Day Care). The tooaloof working mother is equally prolific (uh, Kramer vs Kramer, Mr. Mom, Mrs. Doubtfire, Daddy Day Care). We don’t expect films to be so realistic that no one wants to see them. Who, after all, wants to “escape” by watching a family struggle with the very real issues of loss and grief and anxiety – the kind of struggles that do not neatly wrap up just because we want them to? Yes, a family can find utter delight with these movies. At the same time, we can be a bit critical of the representations at hand. And, at least where Hollywood films are concerned, we can continue to hope that filmmakers give us more and more credit as thinking audiences – ones that don’t always need a neat and tidy ending. In Grand Canyon, Steve Martin says, “All of life’s riddles are answered in the movies.” Perhaps. As long as the answers are not too simplistic. llllll

Jean-Anne Sutherland, Ph.D. is assistant professor of sociology at University of North Carolina Wilmington, USA with one of her research focuses being sociology through film.

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Coaching and Liability I’m a licensed mental health professional , do I need malpractice coverage for coaching? Coaching, as distinguished from therapy, is meant to enhance normal functioning and not to treat symptoms of illness. Personal, life and executive coaches should have malpractice, or errors and omissions, insurance. Even coaches who are not licensed healthcare professionals- no license is needed in New York State to be a coach - should have insurance to cover any potential liability for coaching. The underlying question, then, is whether the malpractice coverage already in place for licensed professionals covers their coaching activities. There is a related broader issue, that of whether coaching conducted by licensed mental health professionals is necessarily within the scope of their professional practices. There is no legal answer to that question, or, more precisely, to the extent it’s a legal question, the answer is unclear. One California court decided that a professional serving as a life coach was subject to laws that mandate confidentiality for substance and alcohol treatment, and by implication was acting in a

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LEGAL BRIEFS

Bruce Hillowe

professional capacity (People v. Barrett, 109 Cal App 4, 437, 2003). But a federal court found that coaching, although offered by a counseling center, was not a "health care" or professional service (Wolf v. Fauquier County Board of Supervisors , 2007, ED Va). Whether coverage is in place therefore depends on the contract the professional has with his or her insurer. Some malpractice carriers for mental health professionals include coverage for coaching and some don’t. If your carrier doesn’t then you’ll need an additional policy to cover your coaching activities. Some malpractice carriers for mental health professionals condition coverage for coaching on it being part of the professional practice of the insured; in such instances, advertising should describe coaching as a professional, albeit not therapeutic, service.

Bruce Hillowe practices law in the state of New York, USA , Emphasizing Mental Healthcare Law, Healthcare Law and Mediation and has served his Community for 29 Years. This article is a reprint from his quarterly newsletter in which he offers a Health Law Supplement in each issue. Visit his website at: www.BruceHillowe.com

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Ly l e L a b a r d e e

TECHNOLOGY ENHANCED D Privacy Please: Privacy and Security Policies for Coaching Websites OK, I know, any column with the word "policies" in the title looks like an antidote for insomnia, but wait, don’t drift off just yet! Here's why anyone with an online coaching presence should care. Whether you're advertising traditional (over-thephone and face-to-face) coaching services or actually providing coaching services online, your privacy and security policy says a lot about you, your organization and your commitment to the industry's code of ethics. Consider for a moment the International Coaching Federation (ICF) Code of Ethics (part two, section 1, #7 http://www.coachfederation.org/about-icf/ ethics/icf-code-of-ethics/). It states: "I will maintain, store, and dispose of any records created during my coaching business in a manner that promotes confidentiality, security, and privacy, and complies with any applicable laws and agreements." "Applicable laws and agreements" in this case include, among others, the Fair Information Practice Codes enforced by the Federal Trade Commission (FTC) in the US, the Data Protection Act in the UK, and the Model Code for the Protection of Personal Information in Canada.

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By now you might be thinking, "Well of course I adhere to my profession's code of ethics and abide by laws and agreements governing confidentiality, security and privacy; just tell me what I need to know." For starters, keep your privacy policy simple, but not too simple. Here’s what not to do. (If by chance you recognize one of the policies below as yours rest assured we trust you mean well and you're committed to learning and improving just like the rest of us.) Both of the websites collect sensitive personal information via web forms: Privacy Policy – Poor Example #1: It’s simple. Everything we talked about during life coaching sessions is treated as confidential information and you are guaranteed a full protection of your privacy. Privacy Policy – Poor Example #2: Confidentiality is a sacred trust. We never sell, rent or trade our client’s personal data. We never spam. Well-informed visitors of the sites associated with these privacy policies may be left with more

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ENHANCED D COACHING than a few questions about how much personal information is collected and how exactly it’s kept secure. Phrases such as “it’s simple”, "guaranteed a full protection of your privacy “, and “confidentiality is a sacred trust” convey well-intended assurances but do not begin to incorporate the Fair Information Practice Principles derived from the FTC’s Fair Information Practice Codes. And before we speak too harshly about the inadequacies of the examples listed above we’ll want to bear in mind that even the big guys are faltering here as the Federal Trade Commission recently tagged Google and Twitter for failing to properly post privacy policies. So what should your privacy policy contain? You’ll want to make sure your policy covers the five core principles found in the Fair Information Practice Principles (of the FTC’s Practice Codes): 1. Notice/Awareness - Informs the website visitor that data is being collected and advises as to purpose for data collection 2. Choice/Consent - Provides options as to how information being collected is used 3. Access/Participation - Provides access to personal data that is being collected for review and correction 4. Integrity/Security - Describes steps taken to protect data and advises of limitations 5. Enforcement/Redress - Conveys process for addressing concerns

You can read more about the FTC’s Fair Information Practice Principles here: http://www.ftc.gov/ reports/privacy3/fairinfo.shtm Privacy policies typically incorporate these principles in a format that begins with an introduction and concludes with contact information. Introduction: This section established the fact that this is the company's policy on how it handles the collection and protection of information in its website, and it should also include whether or not the website has special conditions for collecting information from children (under 16, etc.). Information Collected: This part of the policy generally speaks to what type of information is collected, and clear examples such as "name", "address" and "age" are usually provided even though it might otherwise seem obvious. It is also important to detail what kind of information is being collected or logged by servers such as hostnames and IP addresses. Method of Collection: In this section of the policy it is important to identify how information is collected. For example is information collected only via web forms submitted by visitors, or is information also being collected automatically? Storage of Information: It's not quite enough to

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say that you will "keep information confidential" or "secure". This section of the policy provides details on the technical and administrative resources employed by the organization to protect data. Examples include industry standard data encryption and administrative procedures controlling access to data by personnel engaged by the company. Contact details: Finally, the policy should provide clear and practical contact information for those who might have questions of the company regarding its privacy policy practices. This information should include an email address as well as an actual street address.

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You can review this privacy policy outline and read more at eTrust : http://www.etrust.org/guidance/ privacy_policy.html Now that you, hopefully, have a more informed view of what needs to be included in privacy policies you may be better able to spot good examples out there on the web. To begin with you may want to take a look at the privacy policies posted by the International Coach Federation (ICF) located at http://www.coachfederation. org/about-icf/contact-icf/privacy-policy-foricf/, Tap The Potential at http://community. tapthepotential.com/about/Privacy_Policy.aspx, or the Institute for Life Coach Training at http:// lifecoachtraining.com/index.php/privacy_policy/

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The Frame of Mind coaching site is an example of a Canadian-based Privacy Policy at http://www. frameofmindcoaching.com/about/Privacy_Policy. aspx, and the Online Coach Institute is updating its own resources on this – watch out for those updates. Lastly, keep watch. The rising level of attention and scrutiny given to privacy on the web and the ever-evolving standards are not likely to ebb anytime soon. The Obama administration recently launched an interagency subcommittee on Privacy and Internet Policy that endeavors to build on the FTC guidelines and produce a framework emphasizing that:

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1. Companies should promote consumer privacy throughout their organizations. 2. Companies should simplify consumer choice about how their data is managed. 3. Companies should increase the transparency of their data practices. You can find more on the emerging guidelines in a post by Cameron Kerry, General Counsel for the U.S. Department of Commerce, in a post entitled: “Protecting Consumers & Promoting Innovation Online: A Call for Baseline Privacy Legislation” located at: http://www.commerce. gov/blog/2011/03/16/protecting-consumerspromoting-innovation-online-call-baselineprivacy-legislation

Lyle Labardee, LPC, DCC, is a distance counseling credentialed, Licensed Professional Counselor specializing in web-enabled coaching. He is cofounder and CEO of LifeOptions Group, Inc., and is based in Michigan, USA.

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Learning from Coaching Colleagues

Multiple Streams of Income for Therapists Daily I receive emails from therapists who are struggling to keep their private practices going. The note of desperation in these emails is hard to miss. â&#x20AC;&#x153;This economy is killing me. I need more clients. How do I find them and get them in the door?â&#x20AC;?

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ver the years, those of us who are practicebuilding coaches for therapists have been teaching the marketing skills that will draw more private-pay clients into waiting rooms. The question to which we keeping addressing ourselves and our efforts is and always has been: What can I do to fill more private-session hours? What’s the real question? Now I’m wondering if this isn’t the wrong question. Especially in a difficult economy, it seems that the right question really isn’t “How do we help therapists do more of the same— get more individual clients?” Perhaps the real question should be, “How do I do meaningful clinical work and sustain a good income over the short and long term, regardless of the economy?” Notice that this new question makes no mention of attracting individual private-pay clients. In fact, it now seems to me that the way we automatically think of therapy practice and how to build it—getting more traditional one-on-one, individual clients through our physical office doors--may no longer be an economically viable way of sustaining ourselves. Not only will the economy no longer permit the vast majority of therapists to build entire careers exclusively on private practice, but larger cultural forces are moving against it, as well. In short, the entire market for therapy and mental health services is shifting away from our traditional model of practice. Unfortunately, our profession still hasn’t recognized the vast changes that are happening in the popular zeitgeist in ways that are already having a profound impact on the mental-health marketplace.

BY Casey Truffo Why do I think that the old model is no longer cutting it and probably won’t be very useful, even when and if we do stagger out of the current economic crisis? For the past hundred years, psychotherapy has been virtually defined as the private meeting of one “patient” or “client” in a private office with one well-trained and respected mental health expert for roughly one hour of presumably helpful conversation. That private meeting used to be mostly psychoanalytic in nature, with the patient prone on a couch, but over the last thirty years or so, the patient has become a client, who sits in a chair and faces the therapist for exposure to any one of manifold clinical theories, models, and methods. Regardless of how innovative, abbreviated, high-tech, or just plain peculiar the therapy became, though, the one-to-one model never changed. But, in spite of our attachment to the private practice model, it is not the most efficient or creative way of helping people or making money. Many therapists would like to help more people than they can responsibly jam into an eight or ten or even twelve-hour workday. Or, they would like to be able to do something for all the people needing help, who simply can’t afford oneon-one therapy by the hour. Then there is the money crunch. Even if they raise their hourly fees, their total income will not rise by much. In fact, trading hours for dollars actually means we have jobs, rather than independent businesses—and jobs that don’t provide retirement plans, sick pay or paid vacation days. Further, since our income is tied to the number of in-person sessions we

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provide, a recession can send our own incomes hurtling right off a cliff. The New Zeitgeist Unlike our representative 55-year-old therapist, born, bred, and raised on private therapy, the young adults I meet in psychology and psychotherapy graduate school, all born after 1976 (and, I suspect, the Generation Y-ers coming after them), have an entirely different take on what they want from a career in psychotherapy. These young people place a higher value on making money than any previous generation. USA Today reports, “Eighty-one percent of 18- to 25-year-olds surveyed in a Pew Research Center poll … said getting rich is their generations most important or second-most-important life goal” (http://www.usatoday.com/news/nation/200701-09-gen-y-cover_x.htm). This doesn’t mean remotely that they all want to become the next wave of overpaid CEOs and ethically challenged financial speculators (assuming the markets recover). Indeed, I have often lectured about private practice at graduate schools, where I find a whole generation of activists—young people who are deeply committed to doing good in the world, but who unabashedly also want to do well in the world. Take Lupe and Mark, for example, a couple in their mid-20s. After my talk at their school, they pulled me aside and thanked me for talking about how to have a successful therapy business. “I want to help people,” Lupe said excitedly, “in fact I really want to be a sex therapist. But I also know the kind of lifestyle I want – not really extravagant but one which includes a nice home, some travel and kids. So, before I really commit myself to this career, I have to run the numbers

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and make sure this is a business that is going to work for us. I don’t want to have the life my parents did – with both of them working full time just to make ends meet.” So, Lupe and Mark are part of the cultural shift that is excited about business and they look forward to making money as well as making differences in people’s lives. They are looking for a profession that serves both purposes. As much as they want to help people, struggling with the old fee-for-service, one-client/one hour model to make a decent living simply doesn’t look to them

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prosperous, urban middle class, anyway) for selfdevelopment. The weekly hour spent in the office of your therapist, anguishing over your private demons, was a time-honored way of being ushered finally out of your benighted childhood and into the rarified precincts of true maturity! Almost nobody thinks this way anymore. First of all, people seeking psychological help don’t think of themselves as “patients,” or even “clients,” as much as they consider themselves consumers or customers. They want to be served what they want, on their terms, and at their convenience. When they have emotional or relationship problems, they look for a quick, effective solution that will help them get through a tough time, and old-fashioned therapy may not be at all what they think of first. They are not necessarily interested in an intense, open-ended relationship with a highly trained stranger, but a useful, practical, appealing, and reasonably priced product that will provide some relief and maybe a little long-term wisdom.

like a good way to do it. But, why is the old model less attractive to young people than it was and is to therapists their parents (and grandparents) age? The answer seems to me to be that it simply is not in synch with the huge social and cultural shifts in the way people now tend to think about therapy and therapists. Twenty and thirty years ago, it seems fair to say, the therapist was a revered person in the community, akin to a kind of secular priest. Individual therapy was a privilege, an almost iconic rite of passage (among the educated,

One reason for the increasing impatience with standard therapy (besides cost, of course) is our Internet-reinforced demand for instant gratification. Last year my Mother-in-law was ill and we needed some help dealing with her dementia. I had spent 10 years working with the geriatric psychiatric population, but when it was my family’s problem, I wanted information quickly. Therapy might have helped us through the crisis, but it would have taken a lot longer than the hour I spent searching through the web to find helpful resources, including free checklists and articles, as well as some downloadable material I could purchase online. Today, anybody facing virtually any life challenge can do the same thing—go online and within T I L T MAGAZ I N E J ULY 2 0 1 1

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a few minutes or an hour or even a day find that particularly helpful special report, audio recording, or book and have it delivered instantly to their email inbox. In short, they can be reading or listening to their solutions in the time it would have taken them to leave a message for a therapist. This means that therapists are competing with authors, gurus, and others offering various forms of self-help. Will our traditional model be seen as a viable one amidst these burgeoning alternatives? Another social transformation of our era is the almost universal time crunch—none of us ever has nearly enough of it. Thus, taking a couple of hours from a busy day to get to the therapist’s for a personal session and back again—regardless of whatever else is going on in life—feels to many like a grossly inefficient waste of time. It’s much more convenient to hire a life and relationship coach who is open to spur-of-the-moment telephone and electronic “sessions.” What to do, what to do? In general, we need to think more broadly about what we have to offer the world and how best to communicate it to as many people as possible. In short, we need to share our wisdom and knowledge in ways that both serve the community as it really is and better leverage our own time and energy in the process. It is time to construct a new model that supports us when the economy is booming and doesn’t desert us when the economy is tanking. Some psychotherapists, seeing the writing on the wall, are responding by updating the way they do one-on-one therapy to bring them more in line with what people seem to want. They are adding e-therapy (online via web, chat, text or 46

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email.) They are offering phone sessions in both hour sessions and abbreviated formats—fifteenminute ‘laser’ sessions, for example, helping clients could get back on track after a disturbing interaction at home or at work. Online therapy answers a lot of questions for those who want to continue doing one to one work but want to meet the demands of our culture. For example, our culture is seeking instant gratification. Imagine how helpful you could be to a client with a strategically placed instant message. Say, just before your client goes into a big job interview. Consider how helpful a wellphrased email could be - allowing the client to read it again and again. These are simple ways to leverage one's time and provide important benefits to the client. Some years ago, I too was at a point when I realized I was tired of always hustling to get more clients into my practice—which was feeling more and more like a job than a vocation. This particularly hit home one December. I was feeling very burned out and really needed some time off to rest and re-energize. I thought about the odd contradiction of our profession. We are a helping profession. Yet when we need some time to rest when we need to help ourselves - we do so at the expense of our income. I knew there had to be a better answer. I came upon a business model that had been used successfully in other fields, notably by Andrea Lee (http://www.andreajlee. com/blog/) in the coaching profession, called the Multiple Streams of Income model, found it useful, and decided to modify it for therapists. Simply put, in this model clinicians augment their current in-person practice with information

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products, physical or digital—books, CDs, audio recordings, e-books, and e-courses--which are created once and then sold either online or offline. Even though the products may be physical (CDs, audio-tapes), the real power of the Multiple Streams model comes from using the Internet to sell and deliver them. Using this model does four things at once: it meets consumer demand for instant gratification; it allows therapists to help people who don’t want or can’t afford therapy; it allows therapists to help people far beyond the reach of their local community—anywhere there is a computer connection, in fact; and, it offers dependable, additional income for therapists. When implementing this model, some therapists will choose to reduce the number of one-to-one hours and limit their in-person time to some high-end in-person workshops or retreats. Others will choose to stop all clinical work and spend more time creating and selling products or providing speaking and consulting services. The beauty of this model is that it can be adapted to the desires and personality of each provider.

easy for an independent practitioner to create a downloadable written or audio product and effectively compete with the big companies quickly and inexpensively. You don’t have to start big—in fact, one of the charms of this approach is that it does not require a huge commitment of time and money. First of all, before you do anything else, identify a niche—the specific clients, group, issues, areas of therapy, or specialty that interests and excites you the most. Let’s say you love working with kids and are particularly concerned about school bullying—something you emphasize at your website (you do have a website, don’t you?). Or perhaps you enjoy helping couples who are trying to have a baby; they might be interested in some information you have about the process. Many therapists I know are successfully working with and marketing

Getting Started But will this work? Can clinicians compete in the perhaps over-saturated self-help market and make a good living? After all, people have been publishing self-help literature for decades. How does one try and break into that market? You don’t do it by trying to get your idea published or produced by a big company— few are likely to take on the projects of an unknown psychotherapist. Not to worry. Technology has made it very T I L T MAGAZ I N E J ULY 2 0 1 1

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to five in-office sessions for $800 to $1,000. It’s a bargain!

to women who are tired of struggling with their weight. These niches are specific groups of people that have identifiable problems and are searching for information. This vital first step has been called “pink spoon marketing,” a term coined by Andrea J. Lee and Tina Forsyth, and referring to the free samples of ice cream, provided in tiny pink spoons, by ice-cream shops trying to interest customers in new flavors. The customer may like the free sample so much that she buys a cone or an entire half gallon to take home. Similarly, once your customer has her “pink spoonful” and you have her contact information, you can follow up by sending her a newsletter and, most important, introduce her to the first of several levels of products, along a price continuum. Once someone has obtained, and liked, your free item, it’s quite easy for her to decide to buy your 30-page e-book, “Teach Your Child to Stop Bullies in Their Tracks,” for $17, or even your $40 one-hour teleseminar. She is getting the help she needs for her son without having to commit

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And, having plunked down the money for the e-book or taken the one-hour teleseminar, she probably now feels she knows, likes, and trusts you well enough to wade even deeper into the water. Now, at level three, she’s moved past the “taste-testing” phase and is ready to spend “thinking money” (she will think about the purchase before making it) for a $100 CD/DVD set, a $125 live half-day workshop, or a $175 six-week e-course. Josue Maymi, a therapist in Houston, Texas augments his private practice income with a half-day relationship seminar for individuals and couples. This is a perfect way to reach more people and bring in additional income as well. Also, as the seminars get publicized, it raises his “credibility factor” and he gets more word of mouth referrals for his inoffice practice. At the fourth level--$200-$500, the customer will be ready to spring for your “big-ticket” items—a multi-day live event and packaged training programs—a workbook, 6 CDs and follow-up calls, for example. Say you are attracted to doing family work and enjoy teaching about conflict resolution. You could create a 2-day workshop – perhaps for family owned businesses. After the workshop, you could put your handouts and exercises into a workbook. Finally, you could record a couple of lectures to go with the written material. Now you have not only a multi-day live event you can market, but also you have also created a product to sell as a workbook and CD set. Or back to the mom who was worried about the bullying – perhaps you could team up with a partner and create a full day workshop. One of you could work with the children and one could

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work with the parents. This could be marketed locally and on your website. Then, again, you could take the handouts and exercises and create a workbook – add some lecture on a CD and you have a product to sell online. When a customer has reached this level of trust with you and is considering spending some significant money with you, she has reached what we call the “sweet spot,” the point at which she feels connected to you and your message and regards you as someone who can definitely help her. She may even begin acting as a mini-sales staff for you, telling others about your products and services. Finally, we reach the heights of level five, at which you offer your most valuable commodity—your time. Counseling, coaching, consulting, speaking and training are usually offered at this level, and people are willing to spend $500 an hour or even $2,000 - $5,000 a day or much more working with you one-on-one. Because you’ve taken the time to cultivate a strong relationship through the Funnel, there are multiple possibilities of what to offer. In an almost underground manner, some therapists around the world are implementing this Multiple Streams of Income for Therapists model. Some are just getting started and some have been doing it for years. Let’s take a look at a few of them. Josue Maymi, the therapist in Houston mentioned earlier, has been practicing since 1993. He decided that he’d like to create some small booklets with advice on various topics. He has honed in on the problems of couples in relationships. He has written a playful yet insightful booklet Ten Qualities You Want In A Friend, Lover, Employee & Business Partner and Twenty-One That You Don’t Want. He sells this

along with another booklet on his website. “I have a lot more ideas for products,” he said. “This is very exciting to see how I can sell information products on my website and help a lot of people that might not even be in my area.” Esther Kane, a counselor in British Columbia, Canada, offers books for women on relationships. She has a special affinity for those with eating disorders and has created 6 audio recordings that can be purchased and downloaded on to her site: www.endyoureatingdisorder.com. For $19.95, one can purchase audio recordings on such topics as “Mindful Eating.” These can be downloaded to an mp3 player and listened to at any time. Jennifer Fee is a psychologist in southern California. After practicing for several years, Jennifer felt called to do more. She wanted to help more people than she could accommodate in one-to-one sessions in her office. She wanted to provide service in more than just one way. Jennifer recognized that most people coming to her practice were complaining of anxiety. She created a CD with stress reduction exercises. She sold them on her website and as she networked in the community. This increased her credibility in the community, allowed her to reach more people, and brought in some additional income. Her reach was bigger and she had products to offer people who couldn't afford individual therapy. Jennifer now considers herself as having a psychotherapy business that has different modes of delivering services that result in different revenue streams. Jennifer was contacted by an online heath website that has contracted with her to write for them. "They pay very well for this service,"

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she reports. This additional exposure leads more people to her website - and not only does she attract more clients, she sells more CDs. All of this has led to more credibility and is meeting her need to help more people. And as she does, she is also making more money. These social and economic conditions are calling to us to provide alternate solutions. Therapists are uniquely trained and qualified to offer the education that the culture is asking for. One doesn’t have to be an internationally-known media psychotherapist to do so. It just takes the courage to start with one step – to look at a potential market and think, “What do I most want to share with them?” Even as more therapists implement the Multiple Streams of Income for Therapists model, I expect there will always be a place in private practice for in-person therapy sessions - especially if one considers Online Therapy. And there will be private practitioners who read this article and will be concerned about the legal and scope of practice issues. I am confident these can be addressed. There are other options to expand one's practice, leverage one's time and make more money besides Online Therapy and creating products. Here are just a few examples: • Satellite practices where the owner runs several offices staffed by licensed clinicians • Training centers where the clients are seen by pre-licensed people. • Treatment centers that either have a variety of practitioners or have a special niche such as eating disorders.

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• Speaking engagements as an additional source of revenue and credibility booster. The ideas are endless and I invite us all to open up and look at other professions to see some more opportunities for ourselves. Sadly, many private practices will not survive this economy. As a society, we need the skills and commitment of trained therapists and cannot afford to see them all leave the profession for other work. But, madly trying to find clients now or lower our fees will not serve us in the long run. We must respond to the social as well as economic climate with a model that works. Today the average therapist in the US is around 55 and that average is getting older each year. This puts us smack in the baby-boomer generation who came through the 1960’s and 1970’s when a ruling cultural value was “business is bad.” This worldview can hamper our ability to respond to a changing social and economic marketplace that respects business. While we can regard our current economic problems as signals that our traditional model—

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one client/one hour/one fee—is not working, they also serve as guideposts pointing us in the direction of new ways of working that are more in synch with the profound cultural, social, technological, and economic changes that we are experiencing. And, I think if our field can rethink some basic assumptions about what psychotherapy is and how it “should” be conducted, we have the skills to construct new ways of working that will give people precisely the kind of help they want and need in the 21st century and beyond. Like a root-bound plant, this model worked well while the field of psychotherapy was growing, but now we need to expand our thinking and

find a bigger, more capacious model, one encompassing new ways of thinking about our work and bringing our services to those who need them. Simply put, we need a bigger pot.

About the Author: Casey Truffo, MFT is an award-winning speaker and coach to therapists on five continents. She is the author of Be a Wealthy Therapist: Finally You Can Make a Living While Making a Difference. Founder of the International Therapist Leadership Institute (www. InTLI.com), her mission is to enrich the lives and careers of therapists worldwide. For tools, tips, videos, and her virtual conferences please visit www.INTLI. com, and www.BeAWealthyTherapist.com

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an Online Therapist

A Day in the Life of

‘What is a normal day in the life of an online therapist?’ I asked myself that question and realised that the great thing about being a therapist is that no two days are ever the same.

Chris Hight

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Because one of the advantages of online work is that clients can access you at any time, it means that during any one day someone can send me a webjournal and they haven’t had to make an appointment.

advance so that I know where face-to-face clients can fit. So Monday mornings are about refreshing the diary with available times.

But a typical day starts with me inputting to myself. Resourcing myself spiritually, physically and intellectually not only helps combat what could be a very sedentary lifestyle but also keeps me accountable for growth both personally and professionally.

The wonderful thing about working online is that I can have a cup of coffee by my side, or at night I can even have my slippers on, relaxing as I connect with a client online. If I’m doing a webjournal I can dash off and look something up if I’m not sure where to go, a luxury I don’t have when working face-to-face.

Checking in on Linkedin, Facebook and Online Therapy Institute occupies the first hour of my working day. I have online live chats booked that I will log in to as their time slots arise. If they are a new client, they note their presenting problem in the section provided, which means that I can log in and review that prior to their session. If I pace how many clients I see in a day then I can think about what the issue is and have something relevant in mind that may help, if that’s the direction the session takes. Much of the online work I do is for third party funders, which means that the client is often limited to three sessions. So the approach has to be solution focused. Client’s feed back that they appreciate links to resources or recommended books to read, plus CBT type strategies that might help right now. But far outweighing any clever ‘tricks’ I might have is the quality of the therapeutic relationship I manage to build in that short time. Often the feedback is about feeling heard, which is interesting for online work. There is a certain degree of pressure with only three sessions, so keeping current with what works online is vital, hence my study afternoons. But I also have face-to-face clients I see regularly. I try to make online times available two weeks in

Wednesday afternoons are my ongoing study days and the courses I am doing are also online.

If one day is heavier with online work than another, I make sure I space client appointments out so that I can go for a walk in the fresh air, connect with a friend for coffee and stay as much as possible connected with life here. The area I have to manage is the temptation to always be available. Because online work is accessible 24/7 it’s very easy to work late and then compromise the quality of work I do. The majority of issues that people come online to talk about are relationships, often work related, but more likely family related. Sometimes these are partner issues around things like pornography that clients can’t discuss face-to-face with a therapist. I love that people can feel semianonymous and get help. So I can’t really answer my question, ‘what’s a typical day’ because the wonderful thing about working online is that there isn’t one. About the authoR: Chris Hight has been a counsellor for over 20 years, primarily working in private practice in Auckland New Zealand. Chris is also part of trauma recovery team working with people in Christchurch who have lived through 3 earthquakes since September 2010. She has an online practice, which has led the way in online counselling in NZ. T I L T MAGAZ I N E J ULY 2 0 1 1

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an Online

A Day in the Life of

What my day is like and how long my day will last is dependent upon whether or not I have classes to teach and/or a client starting the birth process.....

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e Coach

Angie Taylor

I have two separate but inter-related businesses. I have a doctorate in natural health and use that degree in my life coaching business where I empower my clients to find balance in their lives and teach them about how balance will affect their overall health. I also use this degree in my other business where I work with expectant couples as they travel along their journey into parenthood. In addition to my doctorate, I am a certified life coach, childbirth educator, birth doula, postpartum doula, trust birth facilitator and breastfeeding support person as well as being a wife and the mother of nine; the five youngest are still at home being home-schooled. One might wonder how a life coach could also be so deeply involved in the birth world. I was a birth worker first but found that a lot of what I

was doing fell within the life coaching field. Even working on my doctorate came after teaching childbirth classes and supporting couples through the birth process. So in 2009, I decided to add life coach certification to my credentials. One of my specialties is healing from birth trauma. Besides, birth is all about life so being a life coach is rather fitting, don't you think? Anyway, it's not uncommon to find me teaching two or more childbirth classes each week along with coaching those expectant couples as they work through their fears regarding this normal, natural process. The classes are all held on weekends or weeknights, which gives me time during the day, after teaching my children, to work with a few life coaching clients. I have spent the past few years working mostly with weight loss clients but have also worked with many striving to improve their overall health. I have found that giving my clients the space to be vulnerable without being

taken advantage of is what allows them the room to grow as they become empowered to make the changes that will affect them and their families for years to come. Some days the coaching is scheduled but often I will receive that phone call or email wanting to know if I am available to help with an emergency. If such a session will work into the day then there is a quick chat about the coaching fee, followed by sending a quick invoice via email and the coaching begins. I typically work with life coaching clients for a few hours in the morning before homeschooling as well as a few hours in the afternoon after homeschooling and lunch when the kids are happily spending time with each other or with neighborhood friends. Most days end with preparing the family meal and sitting down with them to enjoy it. The days that I teach childbirth classes sometimes requires that I miss family dinner and baby's typically begin the birth process at some point during the night, which leads to a short nap before homeschooling. Coaching is always part of that birth T I L T MAGAZ I N E J ULY 2 0 1 1

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

process as I work with both the mother and father empowering them to release their fears so their baby can arrive. My husband and kids are very supportive of all that I do and played a major role in my ability to complete my doctorate with highest honors. Without them I could not do all that I am currently doing.

Angie Taylor empowers her clients to find balance in all areas of life as a coach with Dr. Keith Ablow Life Coaching. To reach Angie or hire a Dr. Keith Ablow Life Coach, please email lifecoach@keithablow.com

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TILT – Therapeutic Innovations in Light of Technology

Cyber Supervision Anne Stokes

In the first part of this article in May, I looked at the model itself and gave an overview of how it might be used online. This month, the focus is on the third stage, ‘space’, and two counsellors, who attended my recent online supervision workshop, have given me permission to use an extract of some work they did together. One of the questions that practitioners have is about whether they can work creatively online. Jones & Stokes, 2009 explores ways that image and sound can be used with clients and these can easily be adapted for supervision purposes. Below we look at how this may be done by simply using words within a live session. The ‘space’ is a time where the supervisor and supervisee respectfully play with ideas or

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techniques that may provide insight or ways of working with a client. Here in a group supervision setting, Mieke had been focusing on how she might work with a client and had wondered if working with an Inner Child might be possible online or not. To consider this, it was agreed that Jan (another member of the group) would take the role of a client and Mieke, that of counsellor. This would enable Mieke to learn about this way of online working first hand. llllll

Mieke: Inner child work has helped me a lot in the past, and this client reminds me of how I was in the past. This feels important. You are inexperienced in this technique… am I right in my thinking here? To start with,

would you like some more explanation first? Jan: I think I have enough of an idea – to engage with the feelings I had when I was young. Mieke: Jan I would like you to make a mental picture of your inner child Jan: ok Mieke: You can pick an age that feels important to you and imagine what your inner child would look like at that age... Jan: vision is fuzzy but there Mieke: How does she look? The colour of her hair, is it long or short? What kind of clothes does she wear. Just see what comes into your mind... if it helps just close your eyes for a little while and see what comes up

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Using the Page and Wosket Cyclical Model of Supervision Online (Part Two)

Anne Stokes is based in Hampshire, UK, and is a well-known online therapist, supervisor and trainer, and Director of online training for counsellors ltd.

Jan: hair short and dark - I look fuzzy really - not a clear picture - neat clean clothes but I dont feel neat and clean! I can see myself at a distance in one picture and then "be me" in the other - I have 2 pictures - may be different ages in each one really not clear Mieke: Can you pick one of the two and imagine she is in the room with you sitting opposite you? Jan: yes Mieke: You are doing really great!... Jan: thank you Mieke: now she is sitting opposite you, can you hear what she is trying to tell you? Again just let surface the first thing that comes to mind. What does your inner child have to tell you?

Jan: this feels really difficult and I am wellling up which is surprising me - have a real knot in my throat and nearly crying now that I am saying this

words directly to her?

Mieke: Awww, do you know where the tears are coming from?

Jan: you ARE important and you need to have a chance to say how you feel as that important person - you are a good girl

Jan: She says she feels lonely and insignificant / small tears are coming from me then at that time - but they are "stuck" Mieke: she feels lonely and small, can you ask her why? Jan: I am not important to anyone at school or at home Mieke: How does that make you feel to hear her say that? Jan: angry and I want to hug her but also want to let her have her space to explore further Mieke: Can you say those

Jan: (big sigh) Ok Mieke: you are doing great! Very brave!

Mieke: So powerful! Does she like to hear this? Jan: not really - shes confused Mieke: is she maybe afraid that you listened to her today but that you will contiue to ignore her like you did in the past? Jan: yes -just another adult Mieke: can you maybe assure her that now that you have found her that you will continue to talk to her and

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

she is safe and you are there to keep you both safe Jan: Donâ&#x20AC;&#x2122;t want to leave her though Mieke: you don't have to. From now on you can talk to her if she is scared and show her that you can take care of both of you now, but that she is heard and cared for Jan: ok not ignore her fears... but also assure her that you are an adult now and you have learnt so much since you were a child and you CAN take care of both of you now? Jan: yes but I will need to go and hold her to ensure she really feels that

Mieke: remind her of that and then ask her if it feels okay for her to take a step back for now so we can move back to the here and now Jan: It does feel like she is being held by someone who is bigger and stronger Mieke: ok

Mieke: Give her a big hug!

Jan: that is wonderful!

Jan: ok (crying)

Mieke: is she okay to do that for now

Mieke: does that feel good? Jan: yes less of a lump in my throat

Jan: thank you

Mieke: just let the emotions be there, your little child is being heard now and she is safe!

Jan: yup

Jan: yes Mieke: you can assure you

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Mieke: you are welcome

Deep breath :) Mieke: How was that for you? Jan: BLOODY SHATTERING LOL

Mieke: ouch Jan: It was amazing actually I am shaking! SOOOOO emotional and so powerful You made me feel safe I feel tired but feel that was really valuable Thank you, Mieke llllll

The supervision then moved into the next stage, Bridge, where the supervisor and supervisee look at how the work done in the Space can be integrated into the process with the client. I hope you will agree that the extract above gives a very good insight into the use of the Space. Mieke and Jan did some superb work, and I applaud their willingness to allow me to share it with TILT readers. n Thanks to: Mieke Haveman online counsellor and coach at www.safehavencoaching.eu, and to Jan, who is willing to be contacted through me at anne.stokes4@btinternet.com Reference: Jones, G. & Stokes A. (2009) Online Counselling: a Handbook for Practitioners. Basingstoke Palgrave Macmillan

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Expand your practice     Improve client access       Reduce No‐Shows  Connect to clients via web based HIPAA‐compliant video, email & chat   No expensive equipment or software to buy  Collect payments online and submit claims   Private label your practice  For information or a free demo call 616‐805‐9452 or email sales@breakthrough.com

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TILT – Therapeutic Innovations in Light of Technology

Ne wInnovations

The Benefits of Social Care Mark Goldenson According to a recent Pew study, 80% of Internet users use the web to research health information. This is understandable: it’s both quicker and cheaper to do an online search than to schedule and make a medical visit. Unlike the wild west of the web twenty years ago, people can now find valid answers to medical issues via trusted sites like WebMD and MayoClinic.com. Though doctors may tire of patients with Wikipedia print-outs of exotic diseases they don’t have, these sites can arm patients with valuable information that can prevent or inform medical visits. Further, over 40% 64

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of online searchers report reading someone else’s experience with a health issue. Of the twenty-six categories in Yahoo! Answers, a popular yet much-maligned source of user commentary on many subjects, “Health” questions were the fourth most-asked.

Expanding the “Health” field to include psychology-related queries in “Society and Culture” and “Family and Relationships,” these questions dominate the top eight categories, outnumbered only by questions about “Entertainment and Music."

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This data highlights the social aspect of health care. Why do people go beyond factual, sometimes regulated medical information into the swampy world of free web commentary? Here are three reasons: First, people may be seeking to confirm the fit of a diagnosis or treatment. Collages of symptoms for complex conditions, especially in mental health, are not straightforward. Does one patient’s moodiness, headaches, and insomnia indicate depression, anxiety, or just caffeine withdrawal? Is the cause a simple or rare disorder? Sites like RareShare.org for patients and Sermo.com for doctors can tease this out. Second, the clinical tone and jargon of some sites can be hard for some to parse. Dysthemic disorder, post-partum, SSRIs – these may be easy for mental health providers but to the uninitiated, they can be cryptic and scary. Further, right or wrong, some people just don’t trust healthcare providers. It’s uncomfortable but true that some would rather seek anecdotal evidence from peers than rigorous evidence from scientists.

Mark Goldenson is CEO of Breakthrough.com, a free virtual office for online counseling.

Finally, people who are suffering want and can benefit from connecting with others, especially those suffering with the same conditions. Patient forums such as PatientsLikeMe, InTheRooms, and DailyStrength connect such people. These sites don’t just offer information; like group counseling, they also offer connectedness to help people persevere.

oriented and let providers connect and troubleshoot. Socializing online doesn’t have to mean tweets, blogs, and friending. Be social and prosper!

These sites can be a good place to learn. Whether you treat many disorders or specialize in a few, amassing a greater set of experiences can improve your pattern recognition. Providerspecific sites like sermo.com and ismho.org are more clinically-

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TILT – Therapeutic Innovations in Light of Technology

Marketing Toolbox Susan Giurleo

The Key to Effective Marketing The key to effective marketing is to do it consistently. I suggest that therapists do something marketing related daily, even if it’s just posting a Facebook update or writing a blog post.

of marketing and advertising, don't they? You might think they are so well known they don't need to market, but yet, they are marketing all of the time. They're not household names by accident.

Some of my coaching clients have said that the need to market day after day, week after week is exhausting. And they wonder how to keep it up without feeling burned out.

Of course, you don't need to become internationally known (unless you want to be), but the only way you can get known and develop a steady flow of clients is to consistently show up in people's lives via email, social media or other marketing venues.

I'll admit that sometimes I do feel burned out by the continued need to do marketing again and again, but then I remember that lots of things in my business need to be done repeatedly. I need to keep writing session notes, pay my rent and light bills, take CE courses, file papers, do the banking. You get the idea... Marketing is part of a viable, successful business. If you want to grow, you can't just 'tack on' marketing as something nice to do when it’s convenient. It is a big part of building your practice. Look at it this way - Coke, Pepsi, McDonald's, Budweiser are all big brand recognized worldwide. And they do a LOT

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How do you keep from burning out?

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Susan Giurleo, Ph.D. manages http://drsusangiurleo.com, bringing mental health support to people via social media and online technologies. She is based in Massachusetts, USA. For more information on how to develop such relationships online as discussed, visit her new blog at her website and consider registering for her new report: “7 Steps to Ethical, Effective Health Care Social Media.

If the idea of marketing consistently makes you feel overwhelmed, here are a few ways to avoid burnout: • Accept marketing as part of doing business. A constant feeling of fear or resentment just leads to fighting the process and leads to burnout. It is what it is...a part of growing a successful business. • Plan time in your schedule for marketing every week. Put it in your calendar as you do client appointments. It's just as important. • Pick 2-3 things you can do weekly to keep up your marketing. This could be sending an e-newsletter, writing follow up treatment summaries to referral sources, or blogging. • Focus on 1-2 new marketing techniques at a time. If you just want to send an e-newsletter for a few weeks before using social media, that is fine. Don't get stuck feeling you have to do it ALL and collapsing under the overwhelm. One marketing approach is better than none. • Spend an hour or so a month writing down topics for your blog, newsletter, anything that requires content. It's easier to think of these things in a brainstorming session, rather than try to come up with them 'on the fly' weekly or daily. • If you're in the mood to write and create, put together several posts or articles at one sitting.

• Use audio and video, in addition to writing. Using video is a nice change and can be easier to create for those of us who don't like to write as much. • Enlist emotional support and cheerleading from peers and colleagues who are also focused on doing consistent marketing. This could be an informal group you join in your community, a mastermind group or a membership forum focused on marketing. • Give marketing time to work. Don't throw in the towel after sending 2 newsletters and say 'this stuff doesn't work.' Be patient, give it time. The only way it works is if you stay at it consistently. That's how I keep marketing and avoid burnout. Do you have other methods or ideas? I'm always looking for ways to make all of this easier for all of us!

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

Online Therapy Institute Verification When you see this seal on a website it means Online Therapy Institute has verified this website as compliant with Online Therapy Instituteâ&#x20AC;&#x2122;s Ethical Standards. We will display thumbnails of everyone who has become verified since the last issue.

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Int roducing

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Open Office Hours Stay tuned for new interactive ways to ask your questions! We are taking a summer break in July and when we return, we will be livestreamed from Second Life each month! You can join us in Second Life or simply view the livestream and join us in chat thanks to our partnership with OnlinEvents.co.uk. Details can be found at

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Upcoming Dates Our meetings are held once a month for one hour 2pm EST > August 11 > September 1 > October 6 > November 10 > December 5

Mon Offic thly e Even Hour ts ar e

to At ee tend !

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TILT – Therapeutic Innovations in Light of Technology

“The more you read, the more things you will know. The more that you learn, the more places you'll go.” ~Dr. Seuss, "I Can Read With My Eyes Shut!"

Love For the

Books of

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Cyberpsychology: An Introduction to Human-Computer Interaction Kent L. Norman

Cyberpsychology is about humans and computers and the psychology of how they interact. Computers permeate nearly every human activity in the modern world and affect human behavior from the most basic sensory-motor interactions to the most complex cognitive and social processes. This book begins with a brief history of psychology and computers and a comparison of the human nervous system and the circuitry of a computer. A number of theories and models of humancomputer interaction are presented, as well as research methods and techniques for usability testing. Following the typical contents of an introduction to psychology, the book then discusses sensation and perception, learning and memory, thinking and problem solving, language processing, individual differences, motivation and emotion, social relations, and abnormal behavior as they impact the humancomputer interface. Finally, specific issues of artificial intelligence, assistive technologies, video games, and electronic education are presented. Cyberpsychology is the new psychology.

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ADVERTORIAL A Quiet Journey Counseling, LLC Tom Tsakounis 301-370-6613 ttsakounis@aquietjourney.com www.aquietjourney.com

Demand is increasing for holistic health care, as more people seek an alternative to the traditional model of medicine. Bethesda’s newest mental health resource, A Quiet Journey Counseling, uses a whole person approach to mental health. Counselor Tom Tsakounis, a Licensed Counselor, uses a variety of therapies and technologies to treat his clients in mind, body and spirit. “I embarked on this journey over 10 years ago after my experience with medical school proved not to be the path to wellness that spoke to my heart,” said Mr. Tsakounis. “I yearned to explore a more holistic and balanced approach to mental health and wellbeing.” A Quiet Journey Counseling focuses on using a holistic approach to help patients struggling with sexual identity issues, including adolescents and the LGBT community. Mr. Tsakounis works with patients seeking help with other issues as well, including depression, PTSD, anger management and bereavement. Family, couples and group therapy are also available at A Quiet Journey Counseling, with programs and payment schedules individually tailored to fit the patient’s needs. “I enjoy sharing my experience and training with my clients,” says Mr. Tsakoumis. “Good health has just as much to do with the spiritual and emotional being as it does with the physical being. Mental health is equally relevant in the journey toward wellness.” Through the use of technology, therapy is available for individuals, couples and families. A Quiet Journey Counseling offers distance therapy by email, phone and video conference. Online counseling ensures that clients can fit the counseling they need into a busy lifestyle. Through the use of technology, A Quiet Journey is able to help clients who live in remote areas, are overseas, or may simply require a higher degree of anonymity. Mr. Tsakounis makes home visits to treat patients in Bethesda and the surrounding area who may be unable to visit his office. This kind of therapy is on the cutting edge of counseling practice. “Through the use of modern technology and by making house calls, I’m striving to reach people in need of counseling regardless of their circumstances,” says Mr. Tsakoumis. “Some clients may be differently abled, unable to reach my office due to distance or scheduling, or concerned about maintaining their privacy. Online counseling and home visits allow me to treat these clients in the way that makes them most comfortable.” “Each of us is called to a unique journey which we know as life,” said Mr. Tsakounis “I believe it is important to recognize that a client is more than just a mental health issue, a client is a whole person, body, mind and spirit.” A Quiet Journey Counseling is located in Bethesda. Tom Tsakounis is a Nationally Certified, Distance Credentialed and Licensed Counselor, Master Reiki Practitioner and is trained in a variety of therapies. Mr. Tsakounis is also an educator and speaker, and is a co founder of Whole Body Concepts.

For more information about Tom Tsakounis or a Quiet Journey Counseling, please CONTACT BY EMAIL ttsakounis@aquietjourney.com VISIT THE WEBSITE www.aquietjourney.com.

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We offer advertising opportunities through TILT, our online magazine. Websites that are Verified through the Online Therapy Institute or the Online Coach Institute are eligible for additional advertising opportunities through our Get Promoted service. Read on to learn more. TILT Magazine – Therapeutic Innovations in Light of Technology TILT Magazine is the premier online magazine dedicated to the use of technology by the helping professions. Readers look forward to our cutting edge content in each issue. TILT is published bi-monthly with an international readership. TILT Magazine has a “forever” shelf-life. Because we are an online publication that is offered at no cost to the reader, we keep back issues readily available on the website and advertisements remain intact with live links. TILT Magazine is the essential resource for coaches and mental health practitioners who want to learn about cutting edge technological delivery and emerging topics in the therapeutic innovations. With featured articles and regular columns, readers have the opportunity to remain abreast of regular topics of interest while learning about new and highlighted information in each issue. Regularly scheduled in each issue: The Cyberstreet- Member News

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What Would You Do? Ethical Dilemmas with Web 2.0

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A Day in the Life of an Online Therapist

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A Day in the Life of an Online Coach

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Partner With Us for More Advertising Options! Get Verified! $200.00 Get Verified. Show potential clients and customers that you have taken steps to demonstrate that your service or product delivery meets OTI’/OCI’s Ethical Standards. Get Verified for Coach Services and Products Click Here Get Verified for Mental Health Services and Products Click Here Get Verified and Promoted! $400.00 Includes Get Verified. Show potential clients and customers that you have taken steps to demonstrate that your service or product delivery meets OTI’/OCI’s Ethical Standards. Once you are verified, we will announce your Verified site with a dedicated blog post at the Online Therapy Institute Blog and the Online Coach Institute Blog. The blogs are fed to all of the major search engines as well as our Linkedin Groups, Facebook Business Pages and Twitter feeds (links to these social media sites are listed on the circulation page). • Your website will be listed in our Web Directory which is exclusive to Verified sites!

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• We will create and distribute a press release announcing that your site is Verified! Your press release will include a logo or image of your choice and a link to your website along with your contact information. • We will create an advertorial page on our blog that announces your press release. • We will include an ad in our CyberMarket section of TILT Magazine. This ad will run for at least 6 issues. The ad you submit must fit our CyberMarket specs. • If desire an ad larger than CyberMarket we will offer a $100 discount off any other TILT Magazine advertising package.. • For an additional $800 receive a full page Advertorial in TILT Magazine! You will also receive a pdf version of your advertorial to use at will. Click Below for Samples of: Sample CyberMarket Page | Sample Press Releases | Sample Blog Advertorial | Sample TILT Advertorial

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2011 MEDIA KIT

Advertising Specifcations Full Page Bleed Live Area (safety) Full Page (non-bleed) 1/2 page Horizontal 1/2 Page Vertical 1/4 Page 1/8 Page CyberMarket Ad (business card size)

SUPPORTED FILES TYPES .JPG, .EPS, .AI RESOLUTION RECOMENDATION 300 dpi FILE PREP • Convert all fonts to outlines • Full color (RGB) • Embed images

WIDTH

HEIGHT

8.75 in. 8 in 7.5 in 7.5 in. 3.625 in. 3.625 in 3.625 in. 3.5 in

11.5 in. 10.5 in. 10 in. 4.875 in. 10 in. 4.875 in. 2.3 in 2 in.

2011 MEDIA KIT

Advertising Specifcations continued

2011 MEDIA KIT

Advertorial Sample ADVERTORIAL A Quiet Journey Counseling, LLC Tom Tsakounis 301-370-6613 ttsakounis@aquietjourney.com www.aquietjourney.com

For more information about Tom Tsakounis or a Quiet Journey Counseling, please CONTACT BY EMAIL ttsakounis@aquietjourney.com VISIT THE WEBSITE www.aquietjourney.com. www.onlinetherapymagazine.com

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Stay tuned next issue for... 99 More great articles about online coaching, online therapy and related topics! 99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology! 99 If you are interested in submitting an article, review our author guidelines at www.onlinetherapymagazine.com 99 If you are interested in advertising in an upcoming issue, email advertise@onlinetherapymagazine.com