TILT Magazine (Issue 8)

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volume 2, Issue two November 2011

Engaging Gamers

The Evolution of Social Development in Gen X, Y and Z



Counselor Education in Second Life and 3VCC PAGE 47

Login2Life: Expanding the Cyberculture POV PAGE 58

Virtual Ability as Virtual Community PLUS...

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

TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a free publication published six times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 2, Issue 2, november 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 Cover image credit "Meditating" Thanks to Martin Jencius and Debra London 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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9 Counselor Education in Second Life and 3VCC

30 Engaging Gamers

The Evolution of Social Development in Gen X, Y and Z

47 Login2Life

Expanding the Cyberculture POV

58 Virtual Ability as

Virtual Community

Issue in every

6 News from the CyberStreet 14 Research Review 19 Ethical Dilemma/

Cybersupervision Special

28 What Would You Do?! 29 Wounded Genius 37 Reel Culture 40 Legal Briefs 42 Technology Enhanced Coaching 51 A Day in the Life: Therapist 54 A Day in the Life: Coach 66 New Innovations 68 Marketing Toolbox 70 OTI Open Office Hours 71 Get Verified! 72 For the Love of Books 74 Advertiser’s CyberMarket

A Note from the Managing Editors… Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology.

kate anthony

& deeanna merz nagel with the

online therapy institute in second life

We have a theme of virtual reality running through this issue for you, an area which is gaining more and more ground in being used for mental health services and peer support. We, the editors, offer a piece on the film Login2Life, about which we recently interviewed the Director for the 2011 Counselor Education in Second Life (CESL) conference. You can follow the twitter feed of the film with @login2life for more information as to when the film is being aired.

One of the participants of Login2Life, Alice Krueger (AKA Gentle Heron in SL) tells us how her online community came into being to support those with disabilities such as her own Multiple Sclerosis. The film emphasises the positive uses of virtual environments and the community of Virtual Ability Island is testament to the good work that is possible using VR, rather than the often negative view offered by the press. The organisers of CESL, Debra and Marty, talk us through their process about how this successful annual event came into being and how it developed. Even without a presence in Second Life, you can attend the virtual conference through a bridged chat room, ensuring everyone interested can take part. If you haven’t attended before, we thoroughly recommend being there to hear and watch the varied presentations from all over the world either inworld or via the livestream. Shawn Ware-Avant discusses the parallels of having a virtual life with the work of Erikson, in a fascinating examination of the psychosocial stages of development and how they relate to stages of development within creating a virtual existence for life and/or gaming. She points out that analysts have predicted that by 2020, virtual worlds will be as widespread as the World Wide Web is now. We are pleased also to welcome Frank Taney, Jr. to take over our Legal Briefs column. Frank discusses the often forgotten legal aspects of working therapeutically in a virtual environment, and what practitioners need to be aware of – particularly in light of jurisdictional issues in a world where geographical locations mean something different to those in the physical world. 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 coaching; research; legalities; film culture; and new innovations. We also have a special feature for our Ethical Dilemma that was published in the last issue from Anne Stokes and her colleagues, and a new one for you to consider and to post responses at our social network forums for publication in the third issue of Volume 2 (Issue 9). Our featured “Day in Life” therapist and coach are Helen Glatt and Mieke Haveman 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 this issue, whatever professional world you inhabit J

Managing Editors

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TILT – Therapeutic Innovations in Light of Technology

NEWS from the

CyberStreet The Cyberstreet is here to keep you informed of news even if you haven’t found time to visit the Online Therapy Institute Website or Social Network!

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


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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 OCI blogs…. As part of World Mental Health Day on October 10th, Kate blogged about her experiences having gone to see Ruby Wax in “Losing It”, her two-hander performance about her own mental illness and subsequent breakdown. PsychCentral featured the blog as part of their one day Blog Party, along with that of TILT’s Resident Cartoonist, Wounded Genius. DeeAnna blogged information on the EAPA conference in Denver, and offers a report on all the exciting presentations there. She notes the increased levels of interest in technology and wonders – is there a climate change approaching? There is important information from Kate about your chance to contribute to the new Journal of the BACP Coaching Division over at the Online Coach Institute blog. Kate and DeeAnna have written the lead article for the inaugural edition of the publication (Coaching Today), and we look forward to seeing it in print in January. At the member blogs, John Wilson continues to keep us up to date with his workshops at http://www.onlinevents.co.uk/; there are great opportunities for employment based in the UK; the date for the 4th OCTIA Conference in Bristol UK for 2012 has been announced; there’s news of the definition of a HIPAA Business Associate; more about spiritual journaling and a blog about how negative media can effect depression.

Member news… It’s been a busy time for various members in the media since our last issue, with technology and mental health being featured in the New York Times, the Los Angeles Times, The Times London and the

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TILT – Therapeutic Innovations in Light of Technology

CBS News San Francisco affiliate. For a list of links to these articles and interviews visit http:// onlinetherapyinstitute.ning.com/forum/topics/ oti-oci-members-in-the-news.

LinkedIn participation reminder LinkedIn offers a great opportunity for all members of OTI and OCI to discuss online mental health – don’t miss the chance to visit the groups for even more resources for your work. In an effort to keep the conversation flowing while allowing for self-promotion, if your post to the group is selling or offering a free service, this should be listed in promotions. If your post is a promotion under the guise of a discussion it should still go in promotions. We all have valuable resources- including the group founders at Online Therapy Institute and Online Coach Institute, so we do encourage cross promotion - just in the promotional section.

growing your email list or whether discussion is your true intention. We have posted this before as well- and so far this has not been a concern, but just a reminder that our group is not appropriate for case or client discussion. Thanks to everybody who takes part in our LinkedIn discussions! Finally, we are proud to announce that the Online Coach Institute is an organizational member of the Association for Coaching!

If someone asks a direct question and you have the answer via a product that is listed in the promotional section- please point them to the resources you have listed in promotions. If you have written a blog or an article that you think is worthy of discussion, by all means, post. But please use your own discretion about whether or not the blog is truly about selling a product or

TILT Magazine is published bi-monthly by The Online Therapy Institute. Each issue is filled with articles, news, business tips, reader comments, and much more.

Subscribe Today! 8

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Counselor Education in Second Life & 3VCC by Debra London and Marty Jencius

Once upon a time

(don’t you love stories that begin this way) a new doctoral student (Debra) met a faculty member (Marty) and the two began a relationship that has grown and developed into something neither could have imagined. No, this is not a story of ethically inappropriate behavior, but it is a love story about technology. T I L T M A G A Z I N E novem b er 2 0 1 1


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When Debra first met Marty she was struck by how passionate he was about emerging technologies and how these technologies could support and enhance student development and professional communication. He routinely gave out CD’s with all class resource materials neatly organized so students could have them handy as needed. He also started a thriving email list, CESNET, which is the primary discussion and information forum for Counselor Educators. Debra learned that Marty’s “tech” credentials were extensive and he readily embraced new ways of communicating. Debra is a geek at heart. She says that proudly, knowing how impactful technology has been in her life. She would rather build a computer than buy one and came to her doctoral program with years of experience helping companies develop and implement suitable technologies to manage


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their processes. Her passion for finding new ways to implement technological solutions matched Marty’s interest in the first class she took from him as doc student. As part of the class on college teaching for doctoral students, Marty challenged the students to identify and develop technological ways to deliver course content to students. Debra started rambling on about this place called Second Life and how it could have a major impact on teaching and training. During one class she showed her cohort what this odd virtual world looked like as she talked about the potential to have people interact through avatars from anywhere on the planet. As she talked, she flew around the Second Life world sharing what she thought was the next great thing in distance training. Her classmates tried to show interest but for most it was too far out of their realm

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of experience to be engaging. She wrapped up her presentation noting that at least her instructor (Marty) showed interest. Marty had become aware of Second Life and had attended a conference about it the previous July. He went about creating an avatar (Kimbo Scribe) and began his exploration of this virtual environment. Shortly after Debra’s class presentation he sent a message to her avatar (Debra Hilra) and invited her to see what he had been doing. Marty had rented a small piece of virtual land on which he had placed a building. He furnished the building to look like a counseling center naming it Satori Mental Health Center. His vision was to develop a virtual location that students could use to practice basic diagnosis and communication skills on each other. Debra’s response when she saw what Marty had created was “that is the ugliest building I have ever seen” but she was very impressed with how he jumped in and started developing in Second Life. The two began a conversation on how this virtual world could best be used. As Satori evolved the need for a larger more substantial location became evident. It was also clear that Satori did not encompass the vision the two were developing. A new name and a new mission came in to being Counselor Educators in Second Life (CESL). The two searched Second Life looking for larger land to build their new facility on. At the same time they continued to talk about what value this location could bring to the counselor educators, students and clinicians. The need they identified was to develop ways to gain the benefits of attending professional conferences without the hassle of leaving home. Once they found a piece of land to call home Debra set to work building. The idea was to create a location that had meeting room that could hold 40 avatars for large presentations along with smaller rooms that could be used for one-on-one or small group experiences. Within a few days the new structure came into (virtual) being and the old

(Debra still says ugly) Sartori building was no more. The two decide to try an experiment. Would people attend a “virtual” conference and would they find it valuable? They began planning towards the Virtual Conference on Counseling (VCC) held in September of 2009. Like any conference there was a myriad of details to work out: calls for proposals needed to go out and then be selected, registration procedures needed to be developed, ways to provide continuing education credits needed to be considered, and conference materials would need development. In addition to the usual conference details, matters unique to Second Life also had to be considered. They developed plans to train presenters on how to present and how to introduce attendees to the world of Second Life and provide them with the necessary skills to function in this new environment. Somehow they pulled all this together and produced the first Virtual Conference on Counseling. VCC Presenters stated that they found the process of delivering their information effective and attendees said they found the information very useful. Technical issues did create some challenges. Marty and Debra worked fast and furious to resolve them and keep the conference moving. By its close, the conference had over 30 presentations and over 130 attendees from 9 countries. As they wrapped up the conference it was clear that virtual conferencing fulfilled a need and this should not be a one-time experiment. Plans were made towards the Second Virtual Conference on Counseling (2VCC) along with conversations about how to expand CESL’s impact. 2VCC, held in September of 2010, was more of a surprising success than the first conference. Debra thought that people attended and presented at the first conference because it was something new and different but was pretty sure very few would be interested in the second. Wrong. The number of proposals increased as did the attendance. Attendees were very pleased in this new way T I L T M A G A Z I N E novem b er 2 0 1 1


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of having a conference experience without the trouble of leaving home. Marty and Debra made sure to include as many social aspects into the conference as possible and even hosted a party with a live musician on the center’s roof top. The feedback from 2VCC was so positive that they both knew that 3VCC would be happening this year. As part of 2VCC Marty and Debra engaged the attendees in a conversation about what types of programs they would like to see CESL offer. One consensus was that participants wanted a series of workshops that would be more substantial than one hour presentations. During 2011, CESL offered 4 workshops ranging from 2 to 4 hours on the topics of play therapy, supervision, digital storytelling, and teaching counseling through Second life. One of the programs (play therapy) was so well attended that it was offered twice. Again they saw the interest in training and plan on expanding the offering for 2012. 3VCC has just been completed in September and over 250 people attended the over 35 presentations from 13 different countries and the feedback has been overwhelmingly positive. 3VCC had program books in PDF and ePub format as well as a virtual conference totebag for each attendee. For a full 12

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conference schedule of presentations see http:// miniurl.org/3vccprogram. This year’s conference had a different presence to it. With over 60% first time users of Second Life there was a significant “wow” factor for those new to virtual environments, but there were also a significant percentage of previous VCC attendees who brought some institutional memory to the experience. We are happy to have had the Online Therapy Institute at each conference with their support as presenters and encouragement as colleagues. All three conferences have been webstreamed through http://www.onlinevents.co.uk There seems to be a natural momentum to keep the Virtual Conference on Counseling returning annually. In addition to the above programs CESL makes its facilities available to others who wish to utilize the Second Life environment as a training platform. Instructors from universities have used the CESL site to deliver training and class sessions to their students. One of the unique factors of virtual technology is the ability to create any type of environment needed and this enhances the realism of training role-plays facilitating student skill development. CESL has done that with a working play therapy room where students can simulate working with instructors posing as virtual children.

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What began as small exchange between two like-minded people has grown to fill a need for training without many of the complications of attending a conference in the physical world. If you are interested in knowing more about our work, or how you can develop your idea in Second life come visit us at http://slurl.com/secondlife/ Tranquil/180/170/30/ , message either of us inworld (Kimbo Scribe, Debra Hilra) or email us (Marty mjencius@kent.edu, Debra dlondon@kent. edu)

ABOUT THE AUTHORs When not in Second Life, Debra London is a Doctoral student at Kent State University. She teaches in the counseling program at Indiana University of Pennsylvania and provides mental health services through a private practice and at a free medical clinic in Cleveland, Ohio. Dr. Marty Jencius is an Associate Professor of Counseling at Kent State University. His writing and research focuses on the use of new media in training counselors.

Stop by our offices in Second Life ande!

om h t a lf e s r u o y e k a m

Location address: http://www.onlinetherapyinstitute.com/second-life/

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TILT – Therapeutic Innovations in Light of Technology

Research Review

When Virtu Meets Offlin It has long been known that behaviours learned or practiced in virtual environments have the potential to impact on offline behaviour and that these carry clear implications for their relevance to counselling, psychotherapy and coaching. This brief article can only give a small sampling of the wealth of research materials that have been developed over the past two decades. As long ago as the mid-1990s, when contemporary reports still described virtual environments as being in their infancy (McComas et al, 1998), Riva et al (1998) already noted that “Virtual Reality (VR) offers the potential to develop human testing and training environments that allow for the precise control of complex stimulus presentations in which human cognitive and functional performance can be accurately assessed and rehabilitated.” Among their reports, McComas et al (1998) already indicated important benefits, for example for children with disabilities, including improvements in quality of life, social participation and life skills and, importantly,


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the transfer of skills and knowledge to offline experiencing (e.g. Standen and Cromby, 1995). The potential of VR in assessment and delivery of counselling and psychotherapy or as an aid to intervention in itself is now increasingly well established, for example in treating specific phobias (Botella et al, 1998; 2000; Parsons and Rizzo, 2008), even when used in the reduced formats available for mobile phones or through ‘serious gaming’ and augmented reality features (Botella et al, 2011), and with good results for treating phobias in children and young people (Bouchard, 2011). Just a sample of other conditions for which evidence is available includes PTSD (Difede and Hoffman, 2002; Rizzo et al, 2009; Reger et al, 2011), ADHD (Parsons et al, 2007; Anton et al, 2009), Anxiety Disorders (Powers and Emmelkamp, 2007), Autism (Mundy, 2010; Jarrold et al, 2010;) among numerous others (see Anthony et al., 2011 for further resources) in addition to the use of virtual environments as tools for such things as social support (Green-Hamann, et al., 2011) and increasing practitioners’ understanding of

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S t e p h e n G o ss

conditions like schizophrenia and psychosis (Yellowlees, 2006; Sri Kalyanaraman et al, 2010). For some years, authors have suggested that virtual reality environments and, particularly, hybrids of offline and virtual experiencing will prove superior to other forms of telehealth (like email, chat etc) through their powerful potential for creating a strong sense of presence, improved levels of trust and relational cohesion (Gorini et al, 2008). Increasing evidence now suggests that immersive simulations can have superior learning outcomes compared to offline instruction (Sitzmann, 2011), for example as a means of providing social skills training for people with schizophrenia (Ku et al, 2007), boding well for their use as both psychoeducational tools and treatment platforms. Opportunities for people with disabilities – both mental and physical - are also particularly highlighted by some authors (e.g. Stendhal et al, 2011; Balandin, 2011). A recent study (Davis, 2011) confirms several of the beliefs about social interactions in

ual Reality ne Life

virtual worlds, including the potential for the formation of strong emotional relationships. These included romantic and extra-marital relationships which, as other research has demonstrated, carry clear potential for harm by competing with offline living – especially given a seemingly widespread idealizing effect by which participants tend to view virtual-world relationships more positively than those conducted offline (Gilbert, et al., 2011). However, the obvious indication of the potential to develop deep, powerful bonds should encourage therapists that equally strong, non-romantic sensitive relationships can also flourish. Several studies have reported experiencing a reduced sense of consequence that increased their confidence in exploring their real selves, aided by the apparent anonymity on offer. Participants in this (Davies, 2011) small study also reported increased willingness to trust others in virtual worlds, when compared to offline situations, expanding on findings elsewhere that have led continued next page

“...virtual environments are obviously capable of having psychoactive effects.”

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some authors to refer to such environments as facilitating the development of ‘hyperpersonal relationships’ (Green-Hamann, et al., 2011). Idealization should also hold therapeutic potential given the expansion of possible transference effects predicted many years ago now (Anthony, 2000). It is reported that practitioners perceive the benefits of using virtual reality in their practice to outweigh the costs (Segal et al., 2011). This is perhaps especially so when existing platforms are applied, as opposed to bespoke environments, given the dramatically reduced development input required. However, “off the shelf” environments for general use may not be suitable for conducting therapy given their sometimes limited ability to offer adequate levels of privacy. Second Life, for example, is not currently recommended by the Online Therapy Institute for handling sensitive personal data, which should be communicated through more secure channels, perhaps in parallel. What is clear, however, is that virtual environments are obviously capable of having psychoactive effects. There is a great deal more research to be done, and numerous interesting


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avenues are already being explored, for example regarding their use with children with intellectual or developmental difficulties (Bunning, et al, 2009; Durkin, 2010) among many others as this brief foray into the research literature indicates. When we ask whether experiences in virtual worlds transfer to experience in the offline world, the wealth of data from so many studies of virtual world experiences seems to offer a clear answer. Yes it can. Whether the influence on offline life is desirable or the opposite depends on which virtual environments are used, and how. n For the full reference list for this column, please visit: http://www.onlinetherapyinstituteblog.com/?p=1436

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

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

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Research Call Have you ever wondered if other practitioners require a face-to-face session prior to distance sessions? Perhaps you are curious about the number of practitioners offering services outside their own state/province. Steven Starks, a graduate student in mental health counseling at Walden University, has proposed a survey investigating current practices, knowledge, and training in distance counseling. The survey design was a collaborative effort, incorporating the input of DeeAnna Merz Nagel, Kate Anthony, and Stephen Goss. Your responses are completely anonymous and the results will be published in Therapeutic Innovations in Light of Technology (TILT) Magazine. The survey takes approximately 10 minutes to complete. To participate in the survey, you must be able to practice independently in your geographical/ jurisdictional area. Your participation is vital to this project as a large number of respondents will yield a more realistic picture of current trends in the industry. If you have questions or concerns, feel free to contact Stephen Starks. email Steven Starks skrats6@yahoo.com COMPLETE THE SURVEY HERE: www.surveymonkey.com/s/distancecounseling

Therapion.com This is a call for research papers on online therapy and/or counselling and/or popular science. We'll accept submissions in any language. Minimum word count: 450 words. The aim of this international publishing programme is to provide a platform for researchers, practitioners, academicians and professionals from diverse domains of psychology and psychotherapy to share innovative research achievements & practical experiences to stimulate scholarly debate in the development of online therapy and counseling. The articles will be published online with full author's bio. Compensation: Either a small monetary compensation, or a commercial link of author's choice published with the article. SUBMISSION GUIDELINES Please submit first: a. The title of your article b. Brief author's bio c. Estimated word count CONTACT: info@therapion.com For further information: Please visit our website: http://www.therapion. com. For already published articles, please visit: http://www.therapion.com/papers.php

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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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Supervisor Responses

Ethical Dilemma CyberSupervision

l a i c e Sp with Anne Stokes


In the last issue, we included an email from an online supervisee, Chris, to a supervisor in summarised form. I asked four online supervisors to respond to ‘Chris’ and their full replies are reproduced on the following pages as well as the original email from the Supervisee. Read on supervisor responses

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original email from the Supervisee the time that I felt n a few weeks ago. I said at isio erv sup to ht ug bro I om Jo, wh now discovering what You will remember my client e a horrible feeling that I am hav I ll, We . g’ ttin ‘ge ite qu t sn’ there was something that I wa wing quite how to handle it. kno t how much it is and it’s leaving me no rtly untrue – but I don’t know pa be y ma m for ake int the t Jo gave on ibed drugs was I think that the information tha t use of alcohol or non prescr ou ab ion est qu the t tha e pretty sur nds, and no drug of it is or isn’t. For a start, I am asional alcohol intake with frie occ d sai r we ans the – use actual either a lie or way below the said: ling me about a night out and tel use. In the last email, Jo was ppened,…..’ ldn’t really recall what had ha cou I ng rni mo t nex the al, age of 18, ‘As usu work with anyone under the n’t do I t tha ar cle ite qu am I . As you know, was given as 19. Then there’s a question of age form (my double check!). It ake int the on th bir of e dat ir age and and clients have to give the wonder: was a sentence that made me re the ail, em t las the in in However, aga ool four years ago….’ ‘When I started secondary sch 15, I think. anything That would make Jo around should I wait and see whether or int po s thi at Jo ge llen this – should I cha then I can’t be I am unsure where to go with information and if clients lie, for ed ask had I as ally leg nk I am OK if Jo is 15, do I refer more is said. If so, how? I thi ts have a right to know? And ren pa do lly ica eth y, rall Mo ver…. held responsible, can I? Howe be wrong too! s in England, but that could live Jo w, kno I as far As y? tel on immedia here before replying to Jo. s, but I felt I’d like some help ge han exc al rm no r ou een Sorry to send an email betw Thanks as always, Chris

Here I would simply like to draw out some of the important points for consideration when finding our way through an ethical dilemma. Bond (2000) suggests steps in ethical problem solving that apply as much to online supervision as to face-toface work. These are: 1. Produce a brief description of the problem or dilemma 2. Ask yourself whose dilemma it is 3. Consider all available ethical principles and guidelines as well as what is required or prohibited by law 4. Identify all possible courses of action without evaluating them at this point 5. Select the best course of action and consider it


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for fit with the ethical principles 6. Implement the course of action 7. Evaluate the outcome In considering Chris’s email, we need to ask ourselves if there is a full enough description of the issue. One of the respondents clearly would like to know more before being sure about the way forward – particularly about the contract. Another seeks clarification concerning the various issues, both for herself and for Chris. It is an interesting question about whose dilemma it may be. All of our online supervisors make reference to this in some way. In this case, it would seem to be the supervisee’s – though of course there is also the matter of the accountability of the supervisor if s/he feels that

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Chris may act in a way that would harm Jo, the client, (ethical principle of nonmaleficence) or be prohibited or required by law. All of the respondents are based in the UK (specifically England, as differing (although similar) statutes apply in Scotland and elsewhere), so do draw attention to ‘Gillick competence’, which means assessing whether a child can understand the contract and process and therefore is able enter counselling without parental consent or knowledge. However, as one supervisor points out, a client under the age of 18 cannot make a legally binding contract, and this may have ramifications.

sessions and being able to bring the issue to supervision feels very affirming and further support is mentioned. There is encouragement to stand back and reflect on what may be going on in the relationship and for Jo. It is very easy for both supervisor and supervisee to rush into action before having considered the therapeutic issues as well as the legal and ethical ones. A useful question to ask sometimes is ‘What would be wrong with doing nothing?’ This does not imply a thoughtless refusal to acknowledge or tease out the issue, but rather a full consideration of the effect of taking no action at this moment.

Useful ethical principles to apply to an ethical dilemma are:

From here, we would hope that Chris would decide the most suitable course of action – the counsellor is the person in this exchange who knows the client best. However, before implementing it, it might be wise to ‘talk it out’ with the supervisor through another email exchange or a live session. Once the action has been undertaken, that shouldn’t be the end of it. The supervisor will encourage Chris to evaluate what has transpired and discuss both any further action needed with this client, so embedding what has been learned from considering the dilemma.

• avoiding doing harm to the client (nonmaleficence), • a commitment to benefitting the client (benefice), • honouring the contract on which the trust and relationship is built (fidelity), • consideration of whether all clients would receive the same consideration and service from the counsellor (justice) • the counsellor’s entitlement to adherence to these principles by the client as well (selfinterest) • and the right to autonomy. Perhaps here, the last two are need to be thought through clearly – has Jo broken the terms of the contract, causing the counsellor to question the trust between them? If so, then self-interest may raise its head! And what about the autonomy of the client – might that be put in jeopardy through hasty responses or action by the counsellor? While the online contract may state clearly that any legal procedures would be under the jurisdiction of the counsellor’s country of residence, this may have no standing if Jo is under 18. In thinking about point 4 above, our online supervisors offer a number of courses of action, though rarely suggesting or advising a way forward. The affirmation that they offer Chris in contacting them between

The responses of the online supervisors now follow. I would like to thank them most warmly for their willingness to share their thoughts with us. You will see clearly that there is no one ‘right way forward’, but rather a series of possibilities and considerations. Anne Stokes is based in Hampshire, UK, and is a wellknown online therapist, supervisor and trainer and Director of Online Training ltd.

REFERENCES AND FURTHER INFORMATION Bond T (2000) Standards and Ethics for Counselling in Action London Sage Gillick Competence - http://en.wikipedia.org/wiki/ Gillick_competence NB Chris is a composite client, based on actual clients but mostly fictional.

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TILT – Therapeutic Innovations in Light of Technology

Supervisor responses and thoughts to Chris’s Dilemma I would want to know more information e.g. the terms of the contract this counsellor used and under what terms was she providing counselling – was it through an organisation and free, or was it private and was payment required? A child can take up counselling without the consent of his/her parents as long as she is Gillick competent. This means that she can understand the terms of the agreement etc. Most children of age 15 would be considered as Gillick competent. So her age alone would not be likely to preclude her from receiving counselling without the consent of her parents. However she cannot make a legally binding contract with the counsellor if she is under 18. This means that if the counsellor is working privately and expecting payment for services then she could not enforce any claim for payment. The contract would need to be signed by the child’s parent to be enforceable. The risk is therefore that any work carried out would not be paid. However if the counsellor is working without payment then this would be less problematic. This client appears not to have been quite frank about her alcohol intake. However another way of understanding what she said was that although she only takes alcohol occasionally, when she does, she drinks to excess and doesn’t remember what happened. I wonder what response the client might be expecting in relation to this and whether there could be a part of her that expects to be told off. If this were to be the case, there might also be a pull to some counter transference feelings about being parental. Of course this could happen regardless of the client’s actual age. So it might be helpful for Chris to look at what would help him to remain in adult state rather than moving to parent. This would allow him to keep more objective and might also encourage the client to move from her potential child place to her own adult state.

Reply by

Kirstie Adamson, kirstieadamson@hotmail.com Kirstie works in both a University Counselling Service and in Independent Practice


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Dear Chris, Don’t apologise for sending me an email between sessions; this clearly is troubling you and I’m glad you took the opportunity to put your thoughts into writing. There do seem to be several issues here. I’ll try and put them across as I see them and hope they will help you find how you go on with Jo from here. I’m only thinking about how you manage your concerns until our next supervision session when we will both have more time to think this through. From what you wrote, it feels difficult to continue working with Jo without getting clarification on the two issues that have just surfaced. Clarification might uncover if Jo deliberately lied or concealed information. If so, does this mean the trust between you is broken down irretrievably or could you work on why she chose to do this, perhaps extending the depth of the relationship in the process? So what are your options? 1. Challenge Jo in your next online session 2. Say nothing yet 3. Discuss your concerns with me in a live supervision session where we can ‘play’ with possibilities in real time I can offer you some thoughts about the legality of working with a minor who has chosen to lie about their age online. If you apply the principle of ‘Gillick competency’ (see Wikipedia for clarification) and believe she does understand the nature of the counselling relationship, there’s no legal reason for her parents to know and you can continue working with Jo provided you feel comfortable and competent to do so (you have a working alliance with Jo already). The question of alcohol/drug misuse might be more difficult as you may not feel competent working in this area online. Some people think e-counselling is not the ideal medium for addictions work as the counsellor can’t tell when the client is writing under the influence of the addictive substance. And the fact that she may be drinking/drug taking illegally is another factor to take into account as well. I hope my reflections help you in your decision and I look forward to hearing more about your work with Jo at our next supervision. Warm wishes, Gill

Reply by

Gill JONES, gilljones@olt4c.co.uk Gill is the Director of Online Training Ltd, and also in Independent Practice. T I L T M A G A Z I N E novem b er 2 0 1 1


TILT – Therapeutic Innovations in Light of Technology

Hello Chris,

I do remember you expressing some disquiet about this client; I guess had you met Jo f2f you would hav it with her. Unfortunately, when we work online, although we make every effort to work ethically, by ex the clients are not always honest with us (or themselves). They will have their reasons for this and it look able to access or felt confident to talk about face to face. I do appreciate your feelings of apprehension

I am wondering what it is about Jo’s response that raises the alarm bells. Is it the ‘as usual’? I agree that i

If she is 15 as you suggest then she is likely to feel the effects of alcohol much more keenly than a more ‘se if the occasion had been to celebrate a friend’s birthday for example.

I don’t know whether you have noticed or not but there seems to have developed a culture of 'pre-dr hitting the town, once a week - I guess it could be classed as 'occasionally' but 'binge' what do you think

Or perhaps your concern is that her lack of recall is directly linked to her taking drugs, and this would be illegal' whereas they can be very dangerous as I know you are aware)

Since you have a hunch that Jo is excessively drinking or using drugs Chris I wonder if you have con understanding of what you are working with and ask for honesty, basically, whilst also explaining param

I guess Chris since you were already feeling unsure about Jo this piece of information will have made you Since you state clearly on your website that you do not work with under 18’s Jo will have known she was concern she is causing you.

However, you do need to exercise caution because in some counties such as Leicestershire children don’

Since Jo has not actually admitted to being or doing anything different from what she wrote on the inta

I ask myself why Jo is choosing to write to you as if she were 19 if she isn’t. I also ask why she feels she n

I guess a big part of online counselling is taking what our clients say on trust and on them trusting our being totally honest then perhaps you could gently suggest to her that this may be the case

If you are assume Jo is 15 I guess you have to consider how well she complies with the Fraser or Gillick with her then there is no rule that says her parents need to be informed. However, she may be telling th

I am wondering Chris if you are aware of the work of COAP (www.coap.co.uk). There is some very intere you and your client. Remember that Jo has chosen to write to you because she feels you can help her. Hopefully my response is helpful to you. Do get back in touch if you need further clarification. Warm wishes, Gill

Reply by

Gill Webb, gillwebb1@hotmail.com Gill is a tutor with Online Training for Counsellors, a Life Coach, and an Independent Relationship Counsellor. 24

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ve realised that there had been some mistake regarding her age if she is 15 and would have addressed xpressly stating our terms and conditions and by insisting prospective clients complete an intake form ks as if Jo is using the anonymity of the internet to seek support for a problem she may not have been and I am pleased that you are using supervision to explore how you can best respond to Jo.

it suggests that the nights out are regular occurrences but they may not necessarily be.

easoned’ drinker would so not recalling what had happened the next morning is a possibility especially

rinking' amongst young women these days, where they sink a bottle of vodka between them before k?

e a concern if she's using 'legal highs' (young people often think 'legal' means 'safe' as opposed to 'not

nsidered tentatively asking her a few questions stating for example that it is so you have a deeper meters of confidentiality under BACP guidelines.

u more wary, but as you say she gave her age as 19 and there was no reason for you to doubt her entry. s taking a risk although she may not have realised the seriousness of making such a claim or how much

’t start secondary school until they are 14 in which case Jo could be telling you the truth about her age.

ake form I guess there are various options available to you.

needs to say that she does not have a drink/drugs habit if she does. What could her reasons be?

r professionalism to help them resolve their difficulties. Jo is confiding in you but if you feel she is not

k set of competences. If you sense that Jo is mature enough to handle the counselling you are sharing he truth.

esting information stored on that site and it may help you to decide what the best way forward is for

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TILT – Therapeutic Innovations in Light of Technology

Dear Chris Thank you for sending me this, as you say it is between sessions but we do have in our contract the ability to look at anything that is of an urgent nature. The things you mention certainly come in to that category. Well done for coming forward with this early and not letting it run on. Yes. So you have some unconfirmed suspicions at this time, great to have them in the open here. OK, good to know it might be surfacing. Uhm I definitely something not adding up here, in regards to her age. I would guide you to challenge now as it is now you have the uncertainties. This will do two things. One show Jo that you are hearing everything that is said, and two it will keep you safe legally in that you have acted as soon as you became aware that you think not everything is adding up. This can be tricky; you will want to come across in your norm empathetic way as well as needing to be very clear in what you are saying. A straight observation comment might be a good starting point. Something along the lines of ‘Jo in the form you filled in before we began work you told me you were 19, and in your last email to me you said ‘When I started secondary school four years ago….’ I am having trouble matching these two in my head, please can you help by again telling me exactly how old you are. As you know I do not work with people under 18 and if you are about 15 as your statement about school suggests we would not be able to continue to work much longer. I will be able to help you to access counselling where you age would be no problem i.e. through jo@samaritans.com . I do not wish us to end abruptly but to look at this and to help you find the right way forward for yourself. You said, "I think I am OK legally as I had asked for information and if clients lie, then I can’t be held responsible, can I? " You are right here as backed by the BACP guide for online counselling 2009 2.2 Then you asked, "...Morally, ethically do parents have a right to know?" Here we come into the area of testing Gillick competence, if you need more information on this please let me know. What we do know is that you are clear in your mind that you do not work with under 18’s. If you want to rethink this decision we would need to do some preparation here in supervision to help you make the changes. As far as doubting whether Jo lives in England.... Of course you will now be looking at and doubting much of what you have heard. It could be that she is not in England, but you have not picked up a sense of that and she does talk of secondary school which is a very British term. We may need to look at the uncertainties that this has raised for you some more later. Thank you for trusting me with this and asking for the help you need. I look forward to hearing how this goes in our next session. Warm wishes Jacqui

Reply by

Jacqui Atkinson, Jacqui.atkinson@ntlworld.com Jacqui is the Campus counsellor for training groups with Online Training Ltd. She has worked in Further Education as a counsellor, and now has an Independent Practice 26

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TILT – Therapeutic Innovations in Light of Technology

Hi Eve ry o n e!

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

What Would You Do? dilemma Your face-2-face client has been talking about the virtual game, World of Warcraft for several weeks. While you try to listen intently, you really don't understand what WoW is or how it might be relevant to your client's therapeutic goals. What should you do?

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


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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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TILT – Therapeutic Innovations in Light of Technology

By Shawn Ware-Avant


Gamers The Evolution of Social Development in Gen X, Y and Z


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As clinicians, we are trained to assess for pathology in the clients we see. In essence this means determining what mental health disturbance is contributing to a person’s inability to function and integrate in an appropriate social manner.

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TILT – Therapeutic Innovations in Light of Technology

We endeavor to help our clients to develop coping skills so they may function socially in a way that allows them to acquire and maintain meaningful relationships. This sometimes requires a creative approach to exploring the client’s pathology and developing strategies that address their mental health needs in a holistic way. This is especially true when the presenting issue is around Internet use, online social networking and/or gaming. We are experiencing an evolution of interpersonal relations and as helping professionals we must look closer at how technology is impacting psychosocial development. Generations X,Y, and Z (the “Net Generations”) include people who were born between approximately 1961 and 2010 and are comprised of the current and upcoming workforces and their preteen children. This group has always had knowledge of and access to computerized technology and its use for communication. As a result, it has become increasingly interwoven into their experience of daily life and productivity. Most public schools and the majority of colleges and universities teach and assign work that requires the use of computers and networks. Distance teaching via the Internet and conferencing technologies allow children and adults to learn from others all over the world. The majority of individuals who have matured during the last 4 decades have used digital/electronic technology and gaming for entertainment. During this time, computerized communication and social networking have increased at an accelerated rate. The most significant shifts have occurred in the last 10-15 years with the release of innovative networking and digital communications programs and devices that are being used and integrated as quickly as within a few weeks.

A New Perspective on Social Development Theory Eric Erikson (1902-1994) was a developmental psychologist and psychoanalyst who believed that an 32

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identity crisis is one of the most important conflicts people face in development. He said that “an identity crisis is a time of intensive analysis and exploration of different ways of looking at oneself.” (Erikson 1970). A review of Erickson’s theory reminds us that the psychosocial stages of development are marked by a series of eight conflicts a human being goes through from birth to death. Erikson believed that beginning in infancy, successful resolution at each stage results in a favorable outcome. For example, the first conflict, Stage 1: Trust vs. Mistrust, is successfully resolved if the infant learns and understands that caretakers are reliable. These conflicts are initiated by important events in our lives, and relationships provide experiences that teach each the individual the extremes of the challenges in that life stage. When both extremes are understood and mutually accepted as required and useful, the ideal virtue then surfaces in the individual. In 2007, I learned about a virtual world where people developed businesses, owned virtual homes and participated in a virtual economy where real world money could be converted into virtual currency, invested and converted back for withdrawal. As a Generation Xer who had been exposed to video games since the age of 10, I became intrigued and decided to log on to see for myself. During the time that followed, I discovered many opportunities to explore interests, learn about other cultures and test my own beliefs about “self” and others in a way that might have been impossible to discover otherwise. My clinical work with children and adolescents struggling with balancing their digital relationships with face-toface ones were excellent stepping stones to realizing that their parents, (and my peers), were also struggling with similar difficulties they hid in fear of judgment. Prior to the Internet, we all defined ourselves based upon the community surrounding us and from that framework began to build an identity. Currently, we have access to people and cultures all over the world and our social framework is so expansive that people

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Erickson’s Psychosocial Stages and Virtual Self Development Shawn Ware-Avant, MS, LPC, RPT/S Stage


Important Event

Favorable Outcome

Trust v. Mistrust

Gaining trust in self and environment v. feeling mistrust and wariness of others

“Who are you and are you going to try to hack my computer?”

Ability to create a trusted social group (guild, friend’s list, network)

Autonomy v. Shame/Doubt

Achieving a sense of autonomy v. shame and doubt over one’s ability to be independent

“What a stupid rule, I want to try it this way!”

Being able to question rules and limits in a way that does not hurt others.

Initiative v. Guilt

Learning how to take initiative comfortably v. feeling guilty over motivations and needs

“I feel like I shouldn’t be doing this, but I like it so I’m going to continue.”

Challenging previously ingrained values in unconventional ways and identifying things useful to personal development

Industry v. Inferiority

Forming a sense of one’s own identity vs. role confusion and self questioning

“I enjoy having knowledge of how all this works and helping people to figure it out.”

Sense of comfort in virtual identity and able to develop since of personal morality

Intimacy v. Isolation

Achieving intimacy and connection with others v. feeling isolated and fearful of rejection

“I enjoy spending time with my online friends and the times we all get together for meetings and fun.”

Creating relationships that extend beyond the virtual world – real world meetings/ties (Mastery II)

Generativity v. Stagnation

Leaving a Legacy/Giving back v. feeling stagnant and unfulfilled

“I have done so much online and been successful. I’ve always wanted to do __. I want to try it in the real world.”

Creating a means to evolve the means and process of social connectedness Testing of virtual skills in real world projects to achieve goals/dreams

Ego Integrity V. Despair

Achieving ego integrity and relative peace with one’s life v. a sense of despair and wastedness

“I have found success in following my dream of being __, the sky is the limit!”

Integration of Virtual and Tangible selves with less interest in virtual presence. Movement toward producing similar success in RW to that of Virtual World (Mastery III)

may find they relate to many different ways of “being.” It’s no wonder that some people have a difficult time “committing” to one sense of identity. Upon examination of the process of balancing digital and face-to-face relationships in myself and my clients, I discovered that analogous to Erikson’s psychosocial developmental stages, a similar process of conflict and struggle happens in the social development of those engaged in digital social communities. These experiences facilitated an increased awareness of the

presentation of clinical issues related to what I now call the digital psychosocial developmental process. I theorize an evolutionary shift in psychosocial development for myself, my peers and their children, who use online social networks (i.e., Facebook, Twitter) and/or Multilevel Multiplayer Online Role Playing Games [MMORPGs] (i.e., Second Life, World of Warcraft) as an important part of their social lives. Additionally, I propose that when the clinician is aware of how the process of resolution and integration is

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TILT – Therapeutic Innovations in Light of Technology

translated in digital connectedness, the individual progresses much more rapidly than when asked to terminate their online experiences altogether. For example, Trust vs. Mistrust (Stage 1), might involve the experience of entering a new online social network or gaming platform for the first time and the conflicts involved in learning to navigate it with the assistance of more experienced users. If the individual is able to engage others and rely on their guidance, he/she becomes more confident in their experience with the medium and is able to form a sense of competence and safety in those interactions. The individual might then feel ready to gain a sense of mastery similar to their mentors. They may then begin to overcome their sense of doubt around awkward attempts to use the social platform and become more skilled and fluid (Stage 2: Autonomy vs. Shame/Doubt). Research which empirically validates assumptions around the impact of digital and online communication on social development at all eight stages, and the efficacy of adapted treatment models, is underway.

Treatment Considerations As with any human activity, in excess, online social networking and gaming can become disruptive to an individual’s offline functioning. With the increase in relationships that are created and/or maintained exclusively online, some clinicians find it difficult to plan treatment because clients are resistant to eliminating this means of social connectedness altogether. Many who seek help to overcome difficulties report that clinicians don’t seem to understand their experiences and don’t view their online relationships and gaming as “real” (Anthony 2001). However, it is clear that the paradigm for social development and connectedness is changing. As the way people access each other and information continues to evolve, so too will the way we provide services as clinical professionals. There is a camp of professionals that have labeled “excessive” use of the computers and the Internet as an “addiction” and have attempted to apply similar


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diagnostic criteria to that of gamblers. A subjective label of “excessive”, relative to online social networking and gaming, requires close examination. Texting and e-mail communication is deeply embedded in our social culture personally and professionally and could easily be placed under the same label. Time invested in work activities and watching television and movies could also meet the same definition. What is truly being evaluated is how the activity interferes with healthy social interaction. Examination using this lens, might shape a more accurate definition for “excessive Internet/gaming use” or “addiction”, as the time being invested in these digital interactions is, in fact, social. More useful criteria for evaluating the health of an individual’s psychosocial development would be to consider if their use of digital technology has a severely negative impact on the creation and maintenance of face-to-face personal, familial and professional relationships. For example, an individual who uses the Internet “excessively” for pornography would not be considered under this definition, because the interactions are not designed to engender ongoing social connectedness. The drive is primarily to satisfy sexual urges. This alternative perspective conceptualizes computer and online usage as a symbol of evolutionary progression and views gaming and online social networking as part of that process. As such, focus of clinical intervention is placed on guiding the individual toward balance and assisting them in acquiring a better understanding of psychosocial processes and where they may be stuck.

Assisting Clients in Integrating Virtual and Real World Personas Facilitating the integration of an individual’s digital/ virtual self with their tangible lives and relationships is the central focus of treatment. Initial sessions are used to assess client concerns and the nature of dysfunctional behavior. If the client presents issues they believe stem from online use, consider they may

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be experiencing conflict with social relationships and evaluate what stage of psychosocial development they may be struggling to resolve. Often clients also present with clinically significant anxiety and depression and may have a more favorable view of their online relationships than their tangible ones. Referral for a medication evaluation to assist with those symptoms might be useful to allow the client to develop healthy coping skills if their online use is indicative of escapism.

face interactions. Incorporating a revised treatment approach that includes an understanding of the impact of technology on psychosocial development will allow clinical professionals to more effectively support the “Net Generations” in bring balance to their lives.

The treatment process involves helping the client to define and assess relationship problems online and offline; the clinician challenging avoidant behavior patterns; and assisting the client in goal-setting and encouraging their follow through. Bringing online relationships into safe and healthy offline social interactions might also be indicated. Solution-Focused and Cognitive treatment models seem to work well in teaching the client to challenge distortions; develop realistic expectations of themselves and others; and gain mastery over goal-setting and achievement. Individuals will also need to learn how to set appropriate boundaries around their online relationships and understand the benefits of compartmentalization.

Erikson, E.H. (1970). Reflections on the dissent of contemporary youth. International Journal of Psychoanalysis, 51, 11-22.

Conclusion Clinicians who consider how our daily experiences are impacted by the growth of technology in our society, are ahead of the curve. The mobility of the Internet made possible by 3G, 4G and wireless technologies has contributed to a significant shift in the way people are connecting to each other. Text messaging, social networking and online gaming have become embedded in our world’s social fabric. Analysts have predicted that by 2020, virtual worlds will be as widespread as the World Wide Web is now. Exploring how we are evolving socially is imperative as we move into a time when online relationships and communication have become as important as face-to-

REFERENCES Anthony, K. (2001). “Online Relationships & CyberInfidelity”. BACP Counselling Journal, 12 (9) 38-9

Erik Erikson first published his eight stage theory of human development in his 1950 book Childhood and Society. The chapter featuring the model was titled 'The Eight Ages of Man'. He expanded and refined his theory in later books and revisions, notably: Identity and the Life Cycle (1959); Insight and Responsibility (1964); The Life Cycle Completed: A Review (1982, revised 1996 by Joan Erikson); and Vital Involvement in Old Age (1989).

ABOUT THE AUTHOR Shawn Ware-Avant has provided mental health services to children, adolescents and adults for over a decade. She is skilled using both faceto-face and distance (online, e-mail and avatar) treatment methods and specializes in Online/ Cyber Relationships and personal development (social, emotional, spiritual). Shawn also has a passion for treating attachment and regulation challenges (RAD, Autism, Sensory Integration Dysfunction) and enjoys assisting parents of children with disabilities (especially Autism). She is happily married, for 16 years, with 3 children, including a set of twins and a son on the autism spectrum. She works and resides in Hampton Roads, Virginia. T I L T M A G A Z I N E novem b er 2 0 1 1


Online Therapy Institute is proud to announce

TILT – Therapeutic Innovations in Light of Technology

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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We have also launched a new Certificate in the Therapeutic Use of Technology. This is the first in our Certificate Programme series. This Certificate is a 40 clock hour facilitated course and truly prepares the mental health practitioner in the delivery of online therapy.

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C E / C P D h ou r s a r e a v a i l a b l e

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Jean-Anne Sutherland

The Help: Racial Enlightenment or Just Another White Savior Film? If you don’t know the book or the movie, The Help (Kathryn Stockett) chronicles the experiences of black domestic help in the early 1960’s American south. Skeeter, the liberal, fresh-out-of-college white woman of privilege decides to interview the maids in her Alabama town so that “their” story can be told (and Skeeter, the ambitious writer, can impress the New York publishers). Abilene and Minny agree to talk to Skeeter even amidst the very real dangers that would befall them should their identities become known. As racial tensions increase (in particular, the killing of black activist Medgar Evers in 1963), Skeeter finds more and more maids willing to share their stories. And these are not pretty stories; these are tales of indignities and injustices. They can’t use the toilets in the white homes, they utter “yes ma’am” with downcast eyes when their white bosses speak to them with the inauthentic, high-pitched tones one would use with a child. Public reactions to The Help represent two ends of a continuum. On one end is the deafening praise, mostly

from white audiences. These reactions include horror at the treatment of African-Americans in the Jim Crow south and the utter disregard that the white women show to the maids. Reviews argue that The Help has encouraged scores of white audiences to take a look at the overt racism and discrimination in our not so distant past. For these folk, there’s a chance feel some sense of pride that those days are over (“we don’t do that anymore!”); maybe too a re-consideration of their childhoods as they reflect on a maid or a nanny. There’s the opportunity to, as one would say in the U.S. south, “clutch their pearls” as they try to imagine such daily, harsh conditions not only for domestic workers, but for African-Americans in the pre-civil rights. Most, if not all of the white women that I know who have seen the movie declare it to be glorious. They laughed, but mostly they cried. They felt shame, they felt guilt and they fell utterly in love with the grace and tenderness of Abilene and the feisty, rebellious spirit of Minny. I saw the film alone during a matinee showing. Only 12 or so people attended the film that day. At the further end of my row sat an elderly white woman who, like me, was alone. I heard her sniffles throughout the film. At the movies’ conclusion, we both remained in the theatre until the last song of the credits concluded. As the intrusive sociologist, I simply had to know what stirred her. In her 70’s and privileged, Perley would have been the age and social class of the young, white homemakers in the film. When I tentatively asked her what moved her about the film, her tears came in T I L T M A G A Z I N E novem b er 2 0 1 1


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full. She told me of Lottie, the maid who worked in her home for over 20 years. Perley loved Lottie, she said, and while she did tell her so in later years, she wished she’d done more. “She was family…I know this is not right to say but, she was more important in my life than my own mother.” At the other end of the reaction continuum are those who dismiss the film as an ahistorical, literal whitewashing of black’s experiences in the Jim Crow south. This critique, from mostly black audiences, finds The Help to be just another “white savior movie.” Poor black folk can’t get anything done unless a white person comes along and saves them (think: The Blind Side, Dangerous Minds, Mississippi Burning). The characters are onedimensional; the film portrays African-Americans as ignorant – the women nothing more than the mammy stereotype, speaking in an exaggerated dialect. The film glorifies white children over black children while it reduces the very real horrors of the Jim Crow era – all for the sake of good entertainment. Some would argue that, while Perley’s tears were real, she is still missing the point: more than likely, to Lottie, Perley and her children were not “family.” Rather, Lottie had a child of her own and this was her job. Not a career she chose for the love of the white family but, rather, one of few possibilities for black women in the south. Both responses are, of course, “real.” Many would agree

that The Help, written by a white woman, was intended for a white audience. In that sense, it has done its job. It’s brought many a white person to tears of guilt, shame and recognition while encouraging women like Perley to reconsider old relationships. At the same time, it is “real” that for many African-Americans, this one-dimensional story still clings to insulting stereotypes of the black woman. For black Americans, the Jim Crow south is not so easily forgotten. The horrors; the indignation, the segregation, the denial of basic civil rights, the rapes and beatings and lynchings – these were real events that happened to black Americans (and, of course, racism continues today in a variety of forms). For many white people, The Help is a celebration of spirit and tenacity with love and goodness defeating evil. For many African-Americans, it is a superficial telling of their stories by a white woman. Both reactions come from a place of life-experiences and knowledge (or lack of ).


While white folks embrace The Help and weep and feel better for emoting – let us not disregard the reactions of our black neighbors who might just (rightly) roll their eyes at our “enlightenment.”

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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TILT – Therapeutic Innovations in Light of Technology

BY Fr ank Taney, Jr.

Virtual Therapy vs. Professional Obligations

Millions of people participate in virtual world environments, for a wide range of reasons. For these people, virtual worlds are immersive and engaging, and enable them to have experiences that would be difficult or even impossible outside of a virtual world. Therapists are among those who are exploring virtual worlds as a treatment modality, and some see virtual worlds as having much promise in this regard. While virtual worlds certainly have potential, the environment raises a number of legal issues of which therapists should be aware and which they should address before providing therapy within virtual worlds. As an initial matter, and at the risk of stating the obvious, a virtual world is an online environment. Therefore, a therapist should first determine whether the jurisdiction in which the therapist resides allows or places any restrictions 40

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on providing therapy. These regulations may govern issues like informed consent, data privacy and security, and reporting obligations. I will discuss the implications of virtual worlds for these concerns in further detail later in this article. Therapists also need to consider licensure. Because virtual worlds connect people from all over the world, the therapist must first determine whether the jurisdiction where the client resides will allow the therapist to treat the client without obtaining a license in that jurisdiction. Further, because virtual worlds allow participants to be anonymous or pseudononymous, a therapist should have some reliable means of determining a client's age and location. Virtual worlds also raise significant privacy and security issues for therapists seeking to treat clients within virtual worlds. A number of virtual world environments are hosted by third party

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From a security standpoint, therapists should also determine whether the virtual world enables the therapist to preclude third parties from monitoring or eavesdropping on therapy sessions. Further, the therapist should determine whether any confidential information that will be necessarily stored within the virtual world will in fact be secure from security breaches. Virtual worlds terms of service present additional issues for therapists who seek to place content of a general informational or instructional nature within the virtual world. To the extent that a therapist wishes to retain and/or protect the therapist's intellectual property rights in such content, the therapist should ensure that the terms of service do not claim ownership of the intellectual property inherent in content placed within the virtual world, or require the grant of licenses to such content that conflict with the therapist's intended uses of the content. Finally, as with other potential online treatment modalities, virtual worlds also require therapists to address their obligations with obtaining informed consent from clients with respect to treatment. In addition, therapists must take care to comply with the obligations that the applicable jurisdictions impose with respect to notifying authorities about situations involving physical risk to the client or third


service providers who may have technical access to confidential client data to an extent that may contravene applicable regulations. Further, virtual world proprietors typically require users to consent to so-called "terms of service" or "terms of use" that govern user behavior within the environment. These terms of service may require users to grant the proprietor, and even other users, certain licenses with respect to the use of information or content placed within the virtual world. These conditions may also conflict with applicable regulations.

parties that become apparent from the therapy sessions. Similarly, virtual worlds do not affect a therapist's potential liability for common law tort claims that may arise from a therapist's treatment, such as malpractice and negligent or intentional misrepresentation, as well as claims for breach of contract. In sum, while virtual worlds present significant promise as a therapy modality, therapists must understand that the virtual nature of the therapy space does not lessen their professional obligations in the slightest. Further, virtual worlds require attention to additional technical and legal issues not applicable to therapy delivered outside of virtual worlds. Therapists exploring virtual worlds as a means of providing therapy should therefore proceed with caution.

Francis ("Frank") X. Taney, Jr. is a shareholder in the law firm of Buchanan Ingersoll & Rooney PC, where he serves as the chair of the information technology litigation practice group and is a member of the technology transactions group. This article is general and informational only and does not constitute legal advice.

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TILT – Therapeutic Innovations in Light of Technology

L y le L a b a rdee

TECHNOLOGY ENHANCED D “My Next Move” O*NET’s Career Coaching Web Application Whatever your coaching or clinical practice specialty may be, chances are good you know someone who is in job transition. The demand for career coaching assistance is unprecedented, and in this edition of our TEC column we’ll be taking a look at one of the most powerful, web– based applications available to those who may be coaching individuals through career transition: “My Next Move”. “My Next Move”, is one of many career resources provided through O*NET, the U.S. Department of Labor’s primary source of occupational information. It is a user-friendly, self-directed application for assessing vocational interests and researching corresponding occupations. Best of all, it’s completely free. A Bureau of Labor Statistics Employment Situation Summary report released on Friday, October 7, 2011 indicated that there are 14 million unemployed persons in the U.S. and the unemployment rate has been fairly constant at 9.1%. The report also indicated, there were “1 million discouraged workers”, persons not currently looking for work because they believe no jobs are available for them. 42

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In my pro-bono coaching of those who are in career transition I am always surprised by the individual’s lack of awareness of the wealth of career planning information and resources available on the web. Who in our culture is not accessing the web for just about any kind of information imaginable? Yet, the wealth of career assessment and guidance resources available on the web and cultivated through the compilation of an immense amount of labor data remains often untapped by job seekers and career coaches alike.

My Next Move - Overview Grounded in the data-rich, U.S. Department of Labor-based, O*NET Resource Center (http:// www.onetcenter.org/overview.html?p=2), My Next Move (http://www.mynextmove.org/) helps new job seekers, students, and other career explorers investigate over 900 occupations.

My Next Move Landing Page The landing page provides users with a simple, straightforward and intuitive approach to answering the most important question regarding

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ENHANCED D COACHING work: What do you want to do for a living? The underlying premise here is that successful searches are strengths-based, i.e., consistent with the job seeker’s vocational interests as measured by an assessment consistent with Holland’s R-I-A-S-E-C constructs (http://www.google.com/search?q =holland+interest+code+and+O*NET+interest+profiler&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:enUS:official&client=firefox-a. Users can access data through any one of three routes: keywords, industry, or interests.

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TILT – Therapeutic Innovations in Light of Technology

Occupations List Page

Factoring in Education and Experience

Results from searching on the key word, “nursing” or industry, “Health & Counseling” results in a list of hyperlinked occupations from which the user can select occupations of interest.

In that the assessment of vocational interests alone tends to produce a wide array of potential occupations ranging from unskilled jobs to professional careers requiring advanced education and training, the O*NET Interest Profiler provides users with the opportunity to specify a “Job Zone” that corresponds with degree of “experience, education and training” required to perform the job.

Selected Occupational Overview Selecting “Registered Nurse” produces a colorful, comprehensive and easy-to-read overview of just about everything a job seeker or career coach needs to know about the occupation including required aptitude, education or training required and job outlook. Well-placed hyperlinks provide gateways to additional information on training and local job outlook data.

O*NET Interest Profiler For those who may arrive at the main landing page of “My Next Move” and find themselves unsure as to the kind of job they might be interested in they may elect the option depicted in the third box: “Tell Us What You Like to do.” Clicking on this link brings the user to the O*NET Interest Profiler: a step-wise, point-and-click approach to discovering one’s Holland-based interest profile.

Interest Profiler Questions The web-based interest assessment is served up in a window with 12 easy-to-review, brightly colored, Likert-scaled questions. A slider at the top of the inventory indicates progress completing the inventory.

Interest Profiler Results Results are presented via colorful text, histogram and hyperlinks. 44

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Job Zone Selector The Interest Profiler job zone selector makes it easy for user to review and select the job zone that corresponds with their background, interests and goals.

Interests + Job Zone Selection of a job zone produces a summary profile reflecting the users vocational interests and job zone.

O*NET Interest Profiler Results Page Compilation of the user’s vocational interests and job zone produces a list of hyperlinked occupations appearing in a scroll window. Users can quickly and easily review a list of related occupations.

Selected Occupational Overview Selecting “Emergency Management Director ” produces the same colorful, comprehensive and easy-to-read occupational overview provided via the other occupation search channels (keyword and industry) provided on the “My Next Move” landing page.

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TILT – Therapeutic Innovations in Light of Technology

In summary, the O*NET Resource Center (http:// www.mynextmove.org/profile/ext/onet ) provides job seekers and career coaches with a storehouse of occupational information and resources, from interest inventories to up-to-date national and local occupational outlooks and links to education and training. My Next Move appears to be an excellent, free, easy-to-access resource for coaches working with those in career transition. In keeping with the coaching maxim, “the client does the work”, coaches would do well to consider guiding the “discouraged”, resource-constrained job seeking client to the O*NET Resource Center and My Next Move. The web-based resources and tools bring the world of work to life and ultimately provide well-coached clients with a fresh new canvas upon which to paint a brighter career picture. n Lyle Labardee, LPC, DCC, is a distance counseling credentialed, Licensed Professional Counselor specializing in web-enabled coaching. He is co-founder and CEO of LifeOptions Group, Inc., and is based in Michigan, USA.

Check Out the Online Coach Institute! Resources for Coaches and Helping Professionals!


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DeeAnna Nagel and Kate Anthony


Expanding the Cyberculture POV Login2Life is a documentary that reviews various uses of Second Life and World of Warcraft from a positive lens and captures the essence of online community and real relationships in cyberspace. As the news across the globe is filled with the negative consequences of gaming and technology, and as the helping professions debate about how the constant connectivity of our culture is breaking down our ability as humans to form real and lasting relationships, Login2Life busily and rather diminutively demonstrates how avatars can offer new life for many.

TILT – Therapeutic Innovations in Light of Technology

Kate and DeeAnna interview Daniel Moshel in Second Life at the CESL Conference in Second Life.

Take for instance Corey, a quadriplegic whose world literally came crashing down around him after a devastating car accident. Now with the aid of his mother and other personal care assistants, he remains at home most of the time with limited mobility. And yet he experiences rich and meaningful encounters in the game World of Warcraft. His mother becomes involved in


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Second Life and finds an outlet for her story- the story of her son and his disability. There is Kevin, who makes a living by simulating sex acts in real life so that avatars within virtual worlds can experience a sexual connection with someone else. He is part of the virtual sex industry and in the process, helps people who may not have the opportunity for sexual expression due

to disability or other life circumstances to be able to engage in sexual expression and connection. Alice Krueger, aka Gentle Heron in Second Life, has multiple sclerosis. Her daily routine is partly filled with the management of MS and partly filled with her involvement in Second Life. Her disability and subsequent discovery of Second Life inspired her to

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to earn in-game currency, power and items which are then sold for real money to “serious” players. Other participants in the film include Julianne, a singer from Berlin who has found fame in the virtual world; Philippe, who makes award winning “machinima” films (the use of real-time 3D computer graphics rendering engines to create a cinematic production); and Thomas, the most famous Guild leader in War of Warcraft, considered a hero in gaming communities.

launch Virtual Ability Island, a place in Second Life that people with disabilities can receive information and peer support as well as forge new friendships.

And finally, there is the Director, Daniel Moshel, who boldly set out to create this film in an effort to shed new light on a not-so-new way of being in relationship and community with others. We interviewed Daniel as the opener to the 2011 CESL Conference in Second Life, and it was a pleasure to meet him and have the opportunity to discuss his film and other works further.

A young woman, Miko, left her home village to look for a better life in the urban areas of China. In Shanghai, she found a new way to make money – Gold Farming. She works for a shady organization, playing a character in “World of Warcraft”

What can therapists and coaches learn from a documentary about virtual worlds and gaming? The above illustrations from the film describe people with wants and needs who find a way to fulfill those wants and needs in a ways that some

view as atypical. Therapists are overheard discussing what constitutes “pathological use” of the Internet and now we hear about many people who are “suffering” from gaming addictions. And while there may be people whose lives have become unmanageable due to the Internet and the possibilities that gaming and virtual worlds offer, that seems to be mostly what we hear. The cautionary note when therapists and coaches hear that their clients are engaging online “for hours and hours” is to deconstruct that with the client to find out what benefit he or she may be gaining. Understanding cyberculture and virtual relationships is fundamental as we become more and more engaged in 3-D environments, whether as children logged on to Club Penguin or as employees of a corporation who is hosting an employee meeting in Second Life. While we may be building a farm via Farmville on Facebook, we may also be forming new relationships. While we attend conferences in Second Life to fulfill our professional education requirements, we may also be meeting new and influential colleagues. Login2Life is not the first T I L T M A G A Z I N E novem b er 2 0 1 1


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documentary to portray and examine how people interact online, but it is one of the first to demonstrate the positive possibilities. While each of us may have opinions about how Second Life and World of Warcraft might impact us personally, and while we may

or may not choose to enter those worlds, we mustn’t forget that we are called to hear our clients’ stories and sometimes what is new and misunderstood by us is the very thing that is giving someone else’s life a meaningful pulse. Furthermore, we can help the client pursue

Are you an online therapist or coach?

We would love to hear from you! Contribute to our "Day in the Life" columns with 500-1000 words! Submit your article to editor@onlinetherapymagazine.com


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an integrated life – using both their physical and digital ones – to explore and develop a fully rounded healthy personality. Understanding cyberspace and the myriad of ways it impacts on our clients’ lives is no longer a quirk that we might choose to dismiss. Those who use virtual worlds and gaming need their therapist or coach to be fully informed about it in order to be a competent practitioner who is able to understand, respect, and ultimately provide the service the client needs. ABOUT THE AUTHORS Kate Anthony, DPsych, FBACP and DeeAnna Nagel, LPC, DCC are joint Managing Editors of TILT Magazine and co-founders of the Online Therapy Institute and the Online Coach Institute.

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an Online Therapist

A Day in the Life of

I work entirely online from my private practice using encrypted email counselling. I work from a Humanistic theoretical foundation and specialise in working with individuals who are experiencing unhappiness in their relationships or are feeling generally stuck. As far as my clients go, I tend to wait ages for one to come along and then, like London taxis, three or four turn up at the same time.

Helen Glatt

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TILT – Therapeutic Innovations in Light of Technology

I am more or less glued to my laptop and my work begins the moment I receive a counselling email. If it’s a new enquiry, I tend to trust my gut instinct in terms of whether I feel I’d be useful to the client and if I feel we’d be able to form a working relationship. Recently, I received an email from someone I felt I wouldn’t be comfortable working with, so I crafted a response which was designed to help her find more appropriate support. But if the enquiry is from someone I feel is likely to benefit from online therapy, I’ll read and re-read the email, then get on with my day, thinking about and processing what I’ve read. I always respond back by creating a Word document, then responding within the client’s text, in a new colour. The client then responds back to me in yet another colour and our relationship develops and grows along with our document. Since launching my online practice three years ago, I’ve worked with all kinds of people, both men and women, some wishing they were in relationships, some wishing they weren’t … and their problems have ranged from feeling upset about their partner’s behaviour, to feeling anxious they won’t complete their PhD. I don’t know if there is a correlation between my website content and design and the kinds of clients I hear from, but generally speaking, I find that the people who find me are people I feel happy to work with. The best piece of advice I’ve ever had was to wait 24 hours before pressing ‘send’. I’m naturally quite an impatient person with a drive to do everything NOW, plus I’m very aware that my clients is awaiting my response, so I’ve had to work hard to learn to restrain myself and not rush to ‘please’. Nevertheless, I do note down my initial


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responses as I read through the client’s material and sometimes feel retrospectively that I was very much ‘with’ the client, but sometimes realise I really wasn’t at all. The absolute joy of working online (for me) is to have the time to think. I find myself thinking about my clients’ stories, words and patterns throughout the day and often as I’m falling asleep (am I a bit obsessed?) I also really love working with words. In online work it’s possible to ‘interrupt’ without affecting the flow and encourage the client to have another look at what they’ve written, notice and wonder about their use of vocabulary, invite them to think about how they’ve responded or not responded and share my own reactions and feelings about their material as a way of inviting deeper exploration. I really encourage my clients to ‘disagree’ with me, ie. ‘no NO…I didn’t feel at all upset/angry/disappointed… I was relieved’, because this indicates to me that my client is reaching and expressing their real feelings and I also encourage humour, shorthand and the use of images and metaphors. ‘Yes…yes! that’s exactly it! I didn’t bury those feelings….I hid them in the back of my wardrobe’. I have clients who have had six or seven sessions with me who then vanish into the ‘black hole’, only to return sometimes months and months later asking for more sessions. Others disappear after their first session, never to return. I’ve learnt not to take it personally or worry about ‘was it something I said?’ My greatest sense of achievement was when a client, who’d suffered a miscarriage then failed to conceive again for over 18 months, became pregnant after her second counselling session. My supervisor and I decided to take full credit for that fantastic result!

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Supervision for me is with a group of peers. Three of us get together every fortnight on Skype and discuss our various clients and support each other’s work after first emailing some background material to the group. I often think about how much support and care our clients are actually receiving, if they only knew it, having not only their counsellor on the case, but their supervisor and their supervisor… and I wonder how aware they are of this?

hold the Administration Officer post and help with Membership processing. I’m very enthusiastic about online counselling and do my best to try to widen access to and spread the word about this creative and engaging therapeutic activity.

Other aspects of my online counselling day include general admin (keeping secure records of all my client work and supervision) maintaining my website and updating any advertising I have, as well as making sure my insurance, data protection status, BACP membership etc. are all up to date. I am also on the ACTO (Association of Counselling and Therapy Online) Executive Committee, where I

Helen Glatt is a BACP integrative, humanistic counsellor with additional training in online counselling, launching her private online practice at www.offload-onlinecounselling.co.uk in 2008. She is an Executive Committee member of ACTO, the Association for Counselling and Therapy Online. Helen lives in North London with her partner, daughter and dogs.

h About the authoR:

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an Online

A Day in the Life of

My day usually starts at 8 a.m. in the morning.I listen to the news while still in bed and after getting up, I need breakfast before I can do anything else and combine that with a look at the morning newspaper. 54

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e Coach

Mieke Haveman

After that I head up to the attic where I have my office and start up my laptop. The first thing I do every morning is start up feedly where all my blog bookmarks are kept in magazine style so it takes me only about half an hour to select those entries I really want to read and share with my friends and colleagues on my facebook page and my twitter feed. If there is any time left in the morning I like to watch webinars or documentaries that touch upon my work on my laptop. After that I take a hot shower and get dressed. Because of a slight disability I am not able to work for hours on end so I plan plenty of breaks during the day in which I read or watch some DVD’s. The shower break is the first of many of those breaks. When I return to the computer I spend the rest of the morning going through my email, reply-

ing to enquiries from students and/or clients and posting links on Twitter and a few times a week on Facebook.

After lunch I first go outdoors for a half hour walk. I am lucky to live just at the edge of town so within minutes I can walk in the countryside. The area I live in is called the ‘green heart of Holland’ and has nice green polders with lots of water and cows. Coming back from that I am energized to start the afternoon’s part of work. Thursday is usually the day that I update my blog with a post that I hope is of interest to my clients, so I try to write something useful for highly sensitive people or those with chronic pain, such as tips and information. But sometimes I touch on things more interesting for fellow coaches and counsellors. Although my website is bilingual, I only blog in English for now as I find maintaining one blog is more than enough work. On other days I work on client replies, marketing and/or tutoring. Right now I only work online and mostly through email and text chat. I will write a reply usually the same day

that I receive a client’s email and usually in one go. During that time I close down my Internet browser and my email program and give the emails my undivided attention. Then I close the email and let it simmer for 24 hours. The next day I open it again and go through it with fresh eyes to see if I have overlooked anything or if a night’s sleep has given me new insights. So at the end of the afternoon I will send off the emails that are ready to go. Chat sessions are also usually scheduled in the afternoon or early evening and held on Skype. As I am both a coach and a counsellor, it often depends on the needs of the client if we chose a counselling or coaching approach. If the focus changes during our emails or chats together it is something we discuss and change track if we both agree on it. I work client-centred so the client has a lot of control in what goes on during our sessions and the work is very goal oriented. After dinner early evenings are sometimes free or otherwise filled with tutor sessions or peer supervision. Supervision is important to me as I work from home on my own, so I like this contact with fellow counsellors and coaches. Our online group T I L T M A G A Z I N E novem b er 2 0 1 1


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comes together every 2 weeks. During weekends I make sure that I keep my work laptop closed so I can spend those days to relax and do fun things with my friends. One of my biggest hobbies is playing boardgames. Around 8 o’clock in the evening I shut down the computer for the day and head off to my bedroom where I snuggle up in bed and spend the next couple of hours reading fiction and enjoying some time away from the digital world.

Mieke Haveman is an online coach & counsellor at www.safehavencoaching.eu, based in the Netherlands but working worldwide. She specialises in working with highly sensitive people and those coping with chronic pain. She is also a tutor at Online Training for Counsellors LTD.


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TILT – Therapeutic Innovations in Light of Technology

Virtual Ability as V By Alice Krueger

Virtual Ability is a community of support for people with many kinds of chronic illnesses and disabilities. It resides in the virtual world Second Life. Its function in the virtual world is supported by a nonprofit corporation, Virtual Ability, Inc. 58

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Virtual Community

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TILT – Therapeutic Innovations in Light of Technology

Geographic communities and

communities of interest have been widely studied from many perspectives, including social, anthropological, economic, and developmental. Communities within virtual environments are now being examined as those environments become more pervasive, with related research in varied electronic environments dating back over a decade. In all usages of the term “community,” the affective bonds among members seem to be the most significant defining characteristic (Jones 1997). McMillan and Chavis (1986) outlined a four-dimensional framework describing these bonds. The

dimensions include: feelings of membership and belonging; feelings of having and being influenced by the community; feelings of being supported and providing support; and feelings of relationships and emotional connection. Community members are aware of these feelings, making it difficult to determine whether these characteristics define the community or are an outcome of community functioning (Garcia, Giuliani, & Wiesenfeld 1999). Awareness of these characteristics is termed the Sense of Community (SOC). Community members experience SOC as a feeling of “belonging, a feeling that members matter to one

Table 1: Sense of Community Dimensions and Studies SOC Dimension Membership

Baym 1995, 1997; Blanchard & Markus 2004; Donath 1996; Greer 2000; Kollock & Smith 1994; Markus, Manville & Agres 2000; Phillips 1996


Baym 1997; Dholakia, Bagozzi & Pearo 2004; Kollock & Smith 1994; McLaughlin, Osborne & Smith 1995; Pliskin & Romm 1997


Baym 1997; Blanchard & Markus 2004; Greer 2000; Preece 1999; Rheingold 1993

Emotional Connections


Representative Studies in Virtual Communities

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Blanchard & Markus 2004; Greer 2000; Preece 1999; Rheingold 1993

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another and to the group, and a shared faith the members’ needs will be met through their commitment to be together� (McMillan & Chavis 1986, p. 9). Elements of SOC are influenced by environmental factors (Pretty 1990). McMillan and Chavis (1986) proposed a theoretical model to account for the origins of SOC. Membership identification and the sense of belonging arise from perceptions of safety within

community boundaries and are related to time invested within the community. The community and the individual mutually influence each other through interactions between a need for individual validation and a need for conformity to norms. Need fulfillment and support are mutually established, and come through competent group functioning as an earned value. Emotional connections and relationships are created over time through

participation in quality interactions and group events, and engagement in the group’s development. An SOC measure has been developed and used extensively in many research contexts. Elements from all four dimensions of SOC have been identified in numerous virtual community settings, as shown in Table 1. Yet virtual community characteristics are not identical to those of other communities. Blanchard and

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TILT – Therapeutic Innovations in Light of Technology

Markus (2002) claim that while the process of offering and receiving support is identical in virtual and other communities, two related processes that may be unique to virtual communities are creating a personal identity and identifying others as legitimate community members; and developing trust among community members. Koh and Kim (2004) propose that leaders’ enthusiasm, offline activities, and enjoyability are also factors in virtual SOC. Blanchard and Markus (2004) explain that the dimensions of SOC in a virtual setting are modified by the communication modality (electronic vs.


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The second most popular reason for joining communities created around health/wellness and professional/ occupational topics was “social support”, while “friendship” was the second most popular reason among members in communities related to personal interests.

face-to-face). Preece (2000) introduces the concepts of sociability (collective purpose) and usability (accessibility) of virtual communities. Blanchard (2008) includes interactions with others outside the virtual community as a mediator of SOC in a virtual setting. Koh et al. (2007) distinguish different levels of member participation in virtual communities. Individuals enter all types of virtual environments most often to obtain information (Ridings & Gefen, 2006). However, the second most popular reason for joining communities created around health/wellness and professional/occupational topics was “social support”,

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while “friendship” was the second most popular reason among members in communities related to personal interests. Virtual Ability in Second Life displays the four dimensions of sense of community, as shown in Table 2. Significant benefits accrue for people with disabilities from being in a virtual world. Murphy et al. (2012) found that participation by people with disabilities in Second Life significantly decreased depressive symptoms, trait anxiety, and loneliness, concurrent with significant improvements in positive affect, life satisfaction, and self-esteem. The saying is that “it takes a village to raise a child.” Virtual Ability has found that it takes a community to allow an individual to become complete.

Table 2 Sense of Community Dimensions and Studies SOC Dimension

Examples in Virtual Ability


Members self-identify as belonging to Virtual Ability. Members are protective of other members, especially when in the presence of people who don’t understand disabilities. The group is diverse, respectful of individual differences, yet always maintains a PG setting.


Members offer skills classes and conduct tours of interesting places they have found, to share with others.


Members use the Group Chat function to request information, advice, or simply a virtual hug of reassurance from other members who are concurrently online. Members provide assistance to others when asked. Members offer testimonials indicating support received from the community.

ABOUT THE AUTHOR Alice Krueger is president of Virtual Ability, Inc., a nonprofit corporation whose mission is to support the participation of persons with disabilities in virtual worlds. She has taught primary through college-level science and special education, conducted educational research for a national laboratory, and has published several academic articles about virtual world participation by persons with disabilities.

Members offer assistance to newcomers entering Second Life on Virtual Ability Island, passing on what they have learned.

Emotional Connections

Members ask leaders and other members about the health and well-being of those who have not appeared inworld for lengths of time. Those with a planned hospitalization or absence report to someone so others will know where they are. Virtual memorial services are held for community members who have died.

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TILT – Therapeutic Innovations in Light of Technology

REFERENCES for Virtual Ability as Virtual Community Baym, N 1995, ‘The emergence of community in computer mediated communication’, in SG Jones (ed.) Cybersociety: Computer mediated communication and community, Sage, Thousand Oaks, CA, pp. 138-163. Baym, N 1997, ‘Interpreting soap operas and creating community: Inside an electronic fan culture’, in S Keisler (ed.) Culture of the Internet, Lawrence Erlbaum Associates, Manhaw, NJ, pp. 103-120. Blanchard, AL 2008, ‘Testing a model of sense of virtual community’, Computers in Human Behavior 24, pp. 2107-2123. Blanchard, AL & Markus, ML 2002, ‘Sense of virtual community: Maintaining the experience of belonging’, Proceedings of the 35th Hawaii International Conference on System Sciences. 35th Hawaii International Conference on System Science, Waikoloa, HI. Blanchard, AL & Markus, ML 2004, ‘The experienced “sense” of a virtual community: Characteristics and processes’, Newsletter ACM SIGMIS Database, vol. 35, no. 1. Dohlakia, UM Bagozzi, RP & Pearo, LK 2004, ‘A social influence model of consumer participation in network- and small-groupbased virtual communities’, International Journal of Research in Marketing, vol. 21, pp. 241-263. Donath, JS 1996, ‘Identity and deception in the virtual community’, in P Kollock & M Smith (eds.), Communities in Cyberspace, Routledge, London, pp. 29-59. Garcia, I, Giuliani, F & Wiesenfeld, E 1999, ‘Community and sense of community: The case of an urban barrio in Caracas’, Journal of Community Psychology 27(6), pp. 727-740. Greer, BG 2000, ‘Psychological and social functions of an e-mail mailing list for persons with cerebral palsy’, CyberPsychology, vol. 3, pp. 221-233. Jones, Q 1997, ‘Virtual communities, virtual settlements, and cyber-archaeology: A theoretical outline”. Journal of ComputerMediated Communication, vol. 3, viewed 20 October 2011, <jcmc.indiana.edu/vol3/issue3/jones.html> Koh, J & Kim, Y-G 2004, ‘Sense of virtual community: A conceptualization framework and empirical validation’, International Journal of Electronic Commerce, vol. 8, no. 2, pp. 75-93. Koh, J, Kim Y-G, Butler, B & Bock, G-W 2007, ‘Encouraging participation in virtual communities’, Communications of the ACM, vol. 50, no. 2, pp. 69-73. Kollock, P & Smith, M 1994. Managing the virtual commons: Cooperation and conflict in computer communities, viewed 20 October 2011, <http://www.sscnet.ucla.edu/soc/csoc/papers/virtcomm/Virtcomm.htm> Markus, ML, Manville, B & Agres, C 2000, ‘What makes a virtual organization work: Lessons from the open source world’, Sloan Management Review, vol. 42, pp. 13-26. McLaughlin, ML, Osborne, KK & Smith, CB 1995, ‘Standards of conduct on Usenet’. in SG Jones (ed.). Cybersociety: Computer mediated communication and community. Sage, Thousand Oaks, CA, pp. 90-111. McMillan, DW & Chavis, DM 1986, ‘Sense of community: A definition and theory’, Journal of Community Psychology, vol. 14, no. 1, pp. 6-23. Murphy, N, Gilbert, R, Krueger, A, Ludwig, A & Effron, T 2012, ‘Social-emotional outcomes of Second Life for individuals with disabilities,’ Poster accepted for presentation for the Meeting of the Society for Personality and Social Psychology (January, 2012). Phillips, DJ 1996., ‘Defending the boundaries: Identifying and countering threats in a Usenet newsgroup’, The Information Society, vol. 12, pp. 39-62. Pliskin, N & Romm, CT 1997, ‘The impact of email on the evolution of a virtual community during a strike’, Information and Management, vol. 32, pp. 245-254. Preece, J 1999. ‘Empathic communities: Balancing emotional and factual communication’, Interacting with Computers, vol. 12, pp. 63-77. Pretty, GMH 1990, ‘Relating psychological sense of community to social climate characteristics’, Journal of Community Psychology, vol. 18, no. 1, pp. 60-65. Rheingold, H 1993, The virtual community: Homesteading on the electronic frontier, Addison-Wesley, Reading, MA. Ridings, CM & Gefen, D 2006, ‘Virtual community attraction: Why people hang out online’, Jvol. 10, no. 1.


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TILT – Therapeutic Innovations in Light of Technology

Ne wInnovations How & Why to Build a Website for Your Therapy Practice Mark Goldenson “Location, location, location.” –William Dillard, founder of Dillard’s

Until the Internet, thousands of years of commerce happened locally. That placed a premium on good locations that were affordable and well-trafficked. Otherwise high-quality stores would perish when customers were far away. The Internet has dramatically changed this; competitors can now be just clicks apart. The Internet is also increasingly the first way that people learn about and purchase from a business. In ten years, more than a few industries that are currently retail will become predominantly digital (e.g. Borders vs. Amazon). Therapy isn’t as far along that spectrum as


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books but it’s clear that an online presence can benefit therapists. Here are three basic steps to consider in building an online presence.


Get a good domain name

Domain names like www. mayoclinic.com are the Internet’s street address. An online business’s domain name is its first and strongest marketing asset. Finding a good one for yourself is worth the investment of time and money. A generically good name like therapy.com or counseling.com will likely be out-of-reach. The next best thing may be your name. Now that the internet has over 200 top-level domains - suffixes such as .com, .org., and .info – your

name could well be available in one of these domains. Domize. com is a good, free tool to check their availability (click the Options link on Domize to search more than the main suffixes). Once you find the domain you want, you can purchase it from a domain registrar such as GoDaddy, NameCheap, and 1&1. Domains cost about $10 per year and

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hosting a website on the domain costs about $5 per month. These costs are well worth it.


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

Choose a website builder

Once you have your domain, you can start creating a website. There are many tools to do this and it’s no longer necessary to learn HTML. There are free and low-cost tools that let you create websites in a way called What You See Is What You Get (WYSIWYG). This means you can type text into a page and the tool will show you what it will look like when published. Some of the best free website builders include Wix, Weebly, and Webs.com. They can help you create a basic, professionallooking site in less than an hour. One option is to build your website as a blog. Wordpress and Blogger are the two most popular blogging services and are both free. Building a blog is a good choice if you can invest time into writing

interesting articles that other sites might link to and thus increase your visibility in search engines like Google and Bing. To make your site look more professional, consider investing in custom graphics and photography. You can hire a decent graphic designer for $50 per hour. A designer can create a logo and website design that helps you stand out.


Market your website

Once you have a new digital home, you need to invite people in! That means marketing your website wherever people may find you. To find potential clients, therapy

directories are a good place to start. Google Adwords lets you buy affordable advertising that people will see when they search for terms that you specify, such as “therapist Palo Alto”. Social media sites like Facebook, Twitter, and LinkedIn let you publicize your website and build a following. I know all of this can seem overwhelming but you don’t have to do everything at once. If you invest just a few hours a week, you can have a domain, website, and early marketing presence going within a month or two. If you need help, you can always reach out to a techie-minded friend or acquaintance. You don’t need to limit yourself to just one location. There’s a whole world waiting to meet you! n

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TILT – Therapeutic Innovations in Light of Technology

Marketing Toolbox Susan Giurleo

Using Twitter to Market Your Practice I often get asked how to use social media to market a mental health practice. Currently, there are many options to market a practice, and my preferred social media platform is Twitter.

2. Decide on the professional focus of your account. Will you tweet about general mental health or something more specific? The more niched your focus, the better chance to attract your right clients. 3. Do a search on Twitter for the things you are interested in. Type in “depression”, “bipolar”, “online therapy” and see what comes up. Twitter is a powerful search tool. When you see people tweeting things that look interested follow them, so you can receive more of their tweets.

Why Twitter?

Here are 6 ways to use Twitter to market your practice:

4. Start to tweet information you feel would be helpful to your ideal client. When I used Twitter to market my parent coaching practice I tweeted facts about ADHD, Mr. Rogers quotes, links to articles about autism. Don’t just tweet your own content, become a “go to” source for people looking for information about your particular specialty.

1. Complete your profile with a recent picture of yourself, a brief bio about you and your practice. Use the first person to describe yourself. Make sure your account links to your website.

5. Join a Tweetchat. Tweetchats are usually an hour long with a focus relevant to a particular community of folks with a common interest. There are Tweetchats on parenting kids with special needs (#tck),

Twitter is simple and easy to use. It’s free and can be a powerful community builder. Twitter also does not require a great deal of time to use and can be leveraged throughout the day to connect with others.


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people living with mental illness (#mhsm) and soon a chat by licensed mental health professionals, hosted by Kathy Morelli (#mhon). 6. Repeat. Every day take 10-15 minutes to post useful items, follow a few new people and chat with folks from around the world who are interested in your shares. The ultimate goal is to be seen as an expert in your field, grow an online community and get some people to your blog/website to learn more about you and what you can do to help them.

FOLLOW TILT MAGAZINE on Facebook and Twitter

It can take some time to build a following, but a few minutes a day can grow your Twitter following and make the experience enjoyable and a no cost, productive way to market your practice.

ABOUT THE AUTHOR Dr. Susan Giurleo is a psychologist who blogs about health care, small business and social media marketing at http://drsusangiurleo. com. You can connect with her on Twitter at @SusanGiurleo

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TILT – Therapeutic Innovations in Light of Technology

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“The smallest bookstore still contains more ideas of worth than have been presented in the entire history of television. ” ~Andrew Ross

Love For the

Books of


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Learning Online with Games, Simulations, and Virtual Worlds: Strategies for Online Instruction Clark Aldrich Higher education institutions are increasingly delivering content online, but the content is often not sufficiently engaging. Learning Online with Games, Simulations, and Virtual Worlds provides a simple and practical guide to identifying when and what kind of games, simulations, and virtual environments should be used, how to get them, how to deploy them, and how to measure their effectiveness. Using frameworks, tips, case studies, real examples, and resources, this cutting-edge tool will help faculty members and instructional designers comfortably use games, simulations, and virtual environments to enhance learning.


Understanding Virtual Reality: Interface, Application, and Design William R. Sherman and Alan B. Craig Understanding Virtual Reality arrives at a time when the technologies behind virtual reality have advanced to the point that it is possible to develop and deploy meaningful, productive virtual reality applications. The aim of this thorough, accessible exploration is to help you take advantage of this moment, equipping you with the understanding needed to identify and prepare for ways VR can be used in your field, whatever your field may be. By approaching VR as a communications medium, the authors have created a resource that will remain relevant even as the underlying technologies evolve. You get a history of VR, along with a good look at systems currently in use. However, the focus remains squarely on the application of VR and the many issues that arise in the application design and implementation, including hardware requirements, system integration, interaction techniques, and usability. This book also counters both exaggerated claims for VR and the view that would reduce it to entertainment, citing dozens of real-world examples from many different fields and presenting (in a series of appendices) four in-depth application case studies.


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