TILT Magazine (Issue 11)

volume 2, Issue five Summer 2012

The Dark Side of the Internet A Story of Disinhibition and Murder PAGE 23

PAGE 14

The Online Couch PAGE 40

Counseling Services and the Distance Learner 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 four times a year online at www.onlinetherapymagazine.com.

ISSN 2156-5619 Volume 2, Issue 5, Summer 2012 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Distribution Coordinator Sophia Zollman Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Jay Ostrowski Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Susan Giurleo Associate Editor for Film and Culture Jean-Anne Sutherland Associate Editor for Coaching Lyle Labardee Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute.

If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture).

If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.

TILT is about envisioning therapeutic interventions in a new way. While Kate was visiting DeeAnna on the Jersey Shore, they took a late afternoon boat ride and a display of sail boats tilting against the sunset came within view. It reminded them how, as helping professionals, we should always be willing to tilt our heads a bit to be able to envision which innovations – however seemingly unconventional – may fit our clients’ needs.

Our clients are experiencing issues in new ways in light of the presence of technology in their lives. As helping professionals, so are we. TILT and the Online Therapy Institute is about embracing the changes technology brings to the profession, keeping you informed and aware of those developments, and entertaining you along the way.

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Features 14 Counseling Services

& the Distance Learner

23 The Dark Side of the Internet

A Story of Disinhibition and Murder

40 The Online Couch Mental Health Care is Going Online

Issue in every

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News from the CyberStreet

10 Research Review 20 Wired to Worry 32 Legal Briefs 36 Technology Enhanced Coaching 46 A Day in the Life: Therapist 49 A Day in the Life: Coach 52 CyberSupervision 56 New Innovations 60 Marketing Toolbox

62 For the Love of Books 64 Advertiser’s CyberMarket

A Note from the Managing Editors…

Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology.

In this issue, columnist Jean-Anne Sutherland offers us a full article on her topic of Reel Culture, analysing the film Talhotblond: Everybody Lies Online, a disturbing tale of one of the dark sides of the internet.

Written, directed and edited by Barbara Schroeder, the award winning documentary gives an account of the extraordinary tale of three people caught up in kate anthony & deeanna merz nagel with the a terrifying tale of deception, fantasy and ultimately online therapy institute in second life murder. By associating the concept of the Online Disinhibition Effect to the events of the documentary as it unfolds, we can learn just how important a full understanding of the concept is to our every day work as online therapists and coaches. This article is our fifth foray into exploring how we can use film and media technology that focuses on aspects of cyberpsychology to inform our work, and we welcome Jean-Anne’s valuable contribution. You will find details of the second edition of her edited book “Cinematic Sociology: Social Life in Film” in our Love of Books section.

Also in this issue, Mary Ann Hollingsworth and Debbie Dean examine Counseling Services and the Distance Learner, examining how the changes in how students study in light of new technologies affects their needs for updated counseling services that reflect that. The authors describe how the results of a Needs Assessment survey led to the creation of the counselling service at the University of West Alabama, concluding that “Higher education has provided mental health counseling services to traditional students and the time has come to also provide these services to online learners through distance counseling.”

Our final feature this issue is The Online Couch by Jane Sarasohn-Kahn, summarizing the white paper, The Online Couch: Mental Health Care on the Web, published in June 2012 by The California HealthCare Foundation. jane looks at the options available to those seeking online intervention, and looks at the barriers to each in the USA, concluding that the most significant barrier which could slow the adoption of mental health care online is payment, while acknowledging that technology can help bridge the gap between pent-up demand for and undersupply of face-to-face behavioral health services.

Our aim continues, issue by issue, to keep you up-to-date with developments in innovations in service delivery. In particular, the Cyberstreet is about what is new and noteworthy at the Institutes as well as with our Verified Members and Certificate Trainees.

All our other regular columnists are here, with useful and entertaining comment on coaching; research; marketing; legalities; and CyberSupervision. We are also pleased to welcome our new Innovations Columnist, Jay Ostrowski to our happy team! Our featured “Day in Life” therapist and coach are Stephanie Adams and Diane Parker respectively – we hope you find it as interesting to hear about their work as we do.

And of course there is a good dose of humour from our resident cartoonist, Christine Korol. We hope you enjoy this issue, whatever professional world you inhabit. J

Managing Editors T I L T M A G A Z I N E S u mmer 2 0 1 2

NEWS CyberStreet

TILT – Therapeutic Innovations in Light of Technology

from the

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Are you interested in becoming a Certified Coach?

INSTITUTE NEWS! Look who has become verified for inclusion in our Directory!!

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Online Coach Institute is now approved as a Coach Training Provider by the NBCC’s (National Board of Certified Counselors) CCE (Center for Credentialing and Education) BCC (Board Certified Coach) Program. Our Coach Competency Series has been fully approved!

Online Coach Institute has also partnered with Grow Training Institute to offer GTI’s Certified Professional Coach (CPC) credential with a new Tech Track. GTI is also a BCC Provider.

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News from the Training Room!

We have several new courses at OTI/OCI! Remember, all our courses are approved for CE! Weight Management: How to Motivate Clients to Succeed with Their Diet & Exercise Program Cognitive Behavioural Coaching: Definitions and Applications Emotions at Work: A Cognitive Behavioural Coaching Approach Safe Interventions for Victims of Domestic Violence: Considerations for the use of Technology and the Internet Online Psychological Testing and Assessment: Considerations and Applications Clinical Supervision: Current Models, Techniques, Roles and Functions including Cybersupervision

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TILT – Therapeutic Innovations in Light of Technology

40-hour Specialist Certificates We now offer several Specialist Certificates with self-paced and fast-track enrollment options! It is not too late to enroll for fall classes! Read more and enroll!

Specialist Certificate in Online Therapy Specialist Certificate in Avatar Therapy Specialist Certificate in Online Supervision Specialist Certificate in Online Coaching Read more and ENROLL!

In other training news...

Kate, for the Association for Coaching, presented “Online Coaching: Applications, Ethics and Practice” in London on 23rd May 2012, and also attended the AC conference in Edinburgh in June. She described the different types of technologically delivered interventions - online self-coach packages and apps, email, chat, audio, SMS, video and virtual reality applications. She discussed the Institute’s Ethical Framework for the Use of Technology in Coaching (Labardee, Nagel & Anthony, 2011), and in particular focussed on the pitfalls and benefits of using social media and other aspects of Web2.0/Cyberspace for marketing and communication with clients. This event is now in preparation for Dublin and Belfast in the near future.

DeeAnna presented “Legal and Ethical Issues of Online Therapy” to Center for Career Services and Cooperative Education at Montclair State University in New Jersey in July. She will be 8

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conducting this same 1-day workshop for the Kansas City EAPA Chapter on September 14th, 2012. More information Kate and DeeAnna are teaching their “Introduction to Online Coaching” course at the Institute for Life Coach Training (ILCT). ILCT is a Verified member of Online Coach Institute. For details check out http://onlinetherapyinstitute. ning.com/events/introduc tion-to - online coaching For more information contact Ellen at ellen@lifecoachtraining.com Plans are also afoot for Kate and DeeAnna to present for the 4VCC CESL conference and to deliver a presentation to the EAPA- SA conference in Cape Town, both in September. Watch out for further information at the OTI/OCI events pages, LinkedIn, Facebook or Twitter!

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DeeAnna will be presenting “How to Maintain a Responsible and Ethical Online Presence as a Mental Health Practitioner” for GoodTherapy. org’s CE Webinar Series August 3rd.

DeeAnna is facilitating Distance Credentialed Counselor trainings in Georgia, Maryland, Washington and Arkansas this fall! For details check out http://www.readyminds.com/training/ dcc_event.asp or email lisa@readyminds.com

HealthCare Foundation. The full paper can be accessed via the CHCF website at http://www. chcf.org/publications/2012/06/online-couchmental-health. A summary of that paper appears in this issue!

SOCIAL MEDIA We have many social media outlets for you to find out the latest news!

OPEN OFFICE HOURS Join us each month for our Open Office Hour and ask your questions about online therapy and online coaching!

Upcoming Open Office Hour Dates!

Time is 2pm EST/7pm GMT 16th Aug 20th Sep 11th Oct 29th Nov 20th Dec

You can join our Linkedin Groups Online Therapy Institute Online Coach Institute Like us on Facebook Online Therapy Institute Online Coach Institute Follow us on Twitter @TherapyOnline @KateAnthony @onlinecoachtech @TILTmag

Sign up here http://therapistsandcoachesopentotechnology. com/

Join our own social network where membership is free! www.onlinecoachsocialnetwork.com www.onlinetherapysocialnetwork.com

Media News Online Therapy Institute was featured in a white paper, The Online Couch: Mental Health Care on the Web, published in June 2012 by The California

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Research Review

When Em A recent study carried out by the University of Portsmouth Counselling Service, and part funded by the British Association for Counselling and Psychotherapy (BACP), has reported interesting distinct advantages for asynchronous, email therapy provision in comparison with f2f work.

The study (Dunn, 2011a, 2011b, in press) gathered data from six University counselling services and 10 former clients through semi-structured electronically conducted interviews, analysed through Interpretive Phenomenological Analysis (IPA), to elucidate the experience of receiving therapy online and to investigate the impact of this modality on the therapeutic relationship.

Among others items of interest, reported with rich detail in the qualitative evidence presented, recurrent themes included ‘the ability to conceal oneself’(Dunn, 2011a, p. 24), perhaps concomitant with the anonymity and disinhibition also reported, the distinct uses of text and images (e.g. emoticons, different colours or fonts, interpolating replies into a conversational ‘living document’ (Anthony and Nagel, 2010, p. 54) etc.), the value of clear, consistent boundaries and the role of fantasy.

Shame and fear were mitigated by the felt possibility to “hide behind a computer screen … it gave me the confidence to tell the truth … email just gives you that little bit of distance that protects you”. Similarly, “by doing it online, I could see what they said without having to see their

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reaction … I have always found it hard to explain my feelings in person”.

Counsellors concurred, while also indicating that email therapy is not for everyone: “some people have chosen online but find it too distant and want to see the therapist”. They agreed with clients, however, on the freedom inherent in cyberspace as a location for therapy where one can be “unaware even of the room or time of day … walking around and thinking about someone else’s world, with time to explore what’s important without distraction”, noting also that “Freud would have loved it – free association!”

The creation of a permanent record of exchanges was considered valuable (“One of the best things about email counselling, and … that makes it better than face to face counselling, is that your [sic] can read back over the reply again and again… at different points throughout the week and in various different frames of mind. I think as a result I was able to get a lot more out of this counselling than previous face to face counselling”) as was the time to think afforded by asynchronous working, despite the obvious loss of immediacy (“the additional time allowed me to consider … if necessary i [sic] could type out a response and then come back to it a few hours/day later and rewrite it if my feelings had changed”).

Reasons for choosing online work included “heightened self-consciousness and lowconfidence” possibly creating “a half-way house

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Review S t e p h e n G oss

mail Works between internal reflection and external sharing” (Dunn, 2011a, p. 33) but, critically, included several indications from clients that they were responding to an egalitarian shift in power and control that allowed them to engage with their therapist with greater ease than would otherwise have been the case (cf. Goss and Anthony, 2012).

Therapeutic relationships were described as intense, developing quickly with mutuality, collaboration and trust being all the more significant in light of several participants’ reports of previous unsatisfactory therapeutic experiences. Stronger transference was also reported in online work, which added to disagreement among respondents about the value of combining it with f2f work.

Significant change was also reported as being attributable to the email therapy, including both behavioural and emotional change as well as transitions and the development of insight: e.g. “I have a sense of eclients beginning to hear and trust their own voice for the first time”.

This column can only report a selection of findings of this study, which is one of relatively few detailed accounts of the experience of therapy by email.

It is highly suggestive of special advantages to this modality that, regardless of the development of newer technologies, lie in its reliance on both text and asynchronicity as a medium in which therapeutic bonds can, and do, flourish. n

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

REFERENCES Anthony, K. and Nagel, D. (2010) Therapy Online [a practical guide]. London: Sage.

Dunn, K. (2011a) The Online Counselling Relationship: To Meet or Not to Meet – That is the Question A qualitative investigation into the online counselling relationship. Unpublished MA Thesis, University of Portsmouth.

Dunn, K. (2011b) How does meeting online impact the therapeutic relationship? Therapy Today, 22(8), 48-50.’

Dunn, K. (in press) A qualitative investigation into the online counselling relationship: To meet or not to meet, that is the question.

Counselling and Psychotherapy Research.

Goss, S. and Anthony, K. (2012) The Evolution of Guidelines for Online Counselling and Psychotherapy: The Development of Ethical Practice, in B.I. Popoola and O.F. Adebowale (Eds) Online Guidance and Counseling: Toward Effectively Applying Technology. Hershey, PA: IGI Global.

Please send reports of research studies, planned, in progress or completed, to the TILT Editor at editor@onlinetherapymagazine.com T I L T M A G A Z I N E S u mmer 2 0 1 2

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Research Call

Wayne State University are offering a Postdoctoral research fellowship in technologydelivered brief interventions for perinatal drug and alcohol use/abuse. This fellowship offers advanced training in the use of interactive technology and motivational approaches to address illicit drug use, smoking, and problem alcohol use, particularly with pregnant and post-partum women.

Applicants must have completed relevant doctoral-level training. Strong writing skill in English is necessary and interest in grant writing, mentoring doctoral students, and pursuing a career in research is essential. Salary is competitive.

This position is open to U.S. citizens and/or Permanent Residents.

FOR MORE DETAILS, CONTACT Dr. Steven J. Ondersma 313-444-9797 sondersm@med.wayne.edu

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This online counseling platform is currently in beta and free to join. Feedback is welcomed as they continue to improve the site to meet the needs of online mental health practitioners.

From the owner: Hello, I am Dr. Carvajal, PhD, LCP, Owner and CEO of E Mental Health Center. E Mental Health Center is a FREE beta platform that allows you to see clients via Video, Audio, Chat, or Email channels. Please visit us at www.e-mhc.com. We are constantly improving our system and all we ask of you in exchange for all of the features we offer is to help us make it even better. We are committed to making behavioral telehealth mainstream and scientifically demonstrating that online approaches can be beneficial when it comes to multiple psychological conditions.

VISIT ONLINE www.e-mhc.com

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Counselin & the Dista

by Ma a

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ng Services ance Learner

ary Ann Hollingsworth and Debbie Dean

When a young man went to Harvard College in 1640, learning with other students also meant living with other students. This collegiate lifestyle continues to abound for many who live on campus and participate in a myriad of extracurricular activities while earning their higher education. The student who learns and lives on campus not only has extracurricular activities in which to engage, but also has support services, such as career advisement and mental health counseling.

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But with more and more non-traditional students in the collegial atmosphere, one must wonder what is the collegiate experience for a forty-year-old single mom who works all day and attends school at night via online classes?

Is there a need for her university to also provide support to enhance the quality of her learning – or is it merely enough for her to acquire her academic credentials there, while she gains her extracurricular and service support in her other world in which she lives? The University of West Alabama thinks not.

As online learning grows, so grows the need for university support to the online learner.

Some of the reasons for attraction to online learning also indicate potential need for counseling support through enhancement of coping and management strategies such as finances, time management and multitasking, communication and relationships, stress management, and career management.

When a student takes to learning online, he usually has to consistently stretch time and multi-task. The online learner is often a working professional who wants to improve professional potential and thus will learn and earn at the same time.

Many find that online learning fits a need for education while also attending to a family and a household.

If a person travels frequently, he can take the laptop along and be a student wherever Wi-Fi remains available.

The online classroom is present twenty-four hours a day seven days a week. With so much flexibility on personal scheduling it can be easy to overschedule or to procrastinate. Therefore time management and task management become priority needs for online students.

Through the Internet people can learn, shop, and socialize globally 24/7. And higher education, once only available in the brick and mortar confines of a college campus, has followed that trend.

Cyberspace is fast becoming a new normal in which we spend a major portion of our waking hours.

The Internet connects computers and the people sitting at the computers around the world. Through the Internet people can learn, shop, and socialize globally 24/7. And higher education, once only available in the brick and mortar confines of a college campus, has followed that trend.

As institutions of higher education continue to embrace and maintain the online learning format, online learners have a right to services afforded their on-campus counterparts. One of the most essential services continues to be mental health counseling.

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Students enrolled in online education program face high levels of stress as much or more than traditional students with the added

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responsibilities of work and family. With the opportunities for online learning, there is also a need for colleges and universities to consider providing counseling services to students in an effort to address mental health pathology, improve quality of life, and enhance chances of students completing degrees. The Southern Association of Colleges and Schools (2010) includes distance learning programs and course work in its principles for accreditation and in 1998, Abrahamson discussed a goal in higher education for distance learning to be an equivalent experience to that of on-campus learning.

The University of West Alabama (UWA) has included personal mental health counseling as a service to students enrolled in their online programs. Online students were asked to complete a Needs Assessment and from this a distance based counseling service was developed in response to online student needs to address stress, depression, and anxiety that interfered with the students’ academic performance and retention. The services include access to a licensed professional counselor who provides counseling via a distance format of email exchanges, telephonic session, and use of the Blackboard Learn platform for private, interactive chats, and use T I L T M A G A Z I N E S u mmer 2 0 1 2

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of educational materials and information to enhance coping and academic skills.

The Blackboard Learn platform allows for confidential, interactive chats and video collaboration as well as the opportunity for telephonic and email exchanges. In addition, this platform provides access for students to learn about mental health issues, treatment options, signs and symptoms of certain pathologies, and opportunities to have input in discussion forums, support groups, blogs, webinars, and podcasts.

As with face-to-face counseling, students who receive services from the licensed professional

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counselor complete an intake and informed consent form. The counselor also offers a Life History Questionnaire for students to complete that provides better understanding of the student background.

Power Point presentations, fact sheets, and links are provided with psychoeducational support for students in the areas of mental health most noted per periodic student needs assessment.

As many mental health issues are strongly connected with academic concerns, UWA’s distance counseling support also offers general information to help with academic support and includes academic issues as a focus of counseling when needed. This includes general study tips, tutorial pod casts, and links

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Higher education has provided mental health counseling services to traditional students and the time has come to also provide these services to online learners through distance counseling. to additional resources on issues such as test anxiety and test taking tips. Finally, distance counseling for the students includes support for students who are at a point of crisis. As students initially acquire distance counseling support, the counselor and student agree on a plan for crisis support if the need arises for the student. The student is also given information on various crisis hot line numbers and of course reminded to always call 911 as needed.

Distance learning is fast becoming a new normal in higher education. These online students have life needs that impact on their academic pursuit and may not have the right local resources to attain needed therapeutic support as they learn. All students in an institution of higher learning should have access to equal support services. Higher education has provided mental health counseling services to

traditional students and the time has come to also provide these services to online learners through distance counseling. As counselors embrace the opportunity to provide therapy through technology, the growing world of distance learning offers a rich opportunity to use distance learning resources such as Blackboard as a medium to support therapy through technology for that growing number of people who are learning and earning at the same time as online students.

REFERENCES Abrahamson, C. (1998). Issues in interactive communication in distance education. College Student Journal. 32 (1), 33.

SACS, (2010). The principles of accreditation: Foundations for quality enhancement. Decatur, GA: Southern Association of Colleges and Schools Commission on Colleges.

ABOUT THE AUTHORS Dr Mary Ann Hollingsworth and Dr Debbie Dean are with Counseling Services for the University of West Alabama in Livingston, Alabama. They both are Licensed Professional Counselors in Alabama and Mississippi and both are Distance Certified Counselors.

They provide face to face and distance counseling to on-campus and online students for the University. They may be reached at ahollingsworth@uwa.edu or ddean@uwa.edu.

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Technically Avoiding the Situation

by Christine Korol

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Who doesn’t love tech? It keeps us connected, helps us find information on the spot, lets us pay bills at 3am and impulsively buy eBooks (I have about 30 books on my Kindle that I have yet to start reading). The great thing about being a tech savvy therapist is that you can anticipate some unintended uses of technology by your clients struggling with anxiety and avoidance.

Obviously, Google searches and checking email repeatedly can become a problem for clients with health anxiety and obsessive-compulsive disorder and most therapists remember to ask their clients about their behaviour online.

Fewer therapists are aware of how technology can be used as a form of avoidance that keep clients stuck even though they are going through the motions of facing their fears.

In order to overcome most types of anxiety, the rule is approach - don’t avoid. If you stay in the anxiety provoking situation long enough while nothing bad is happening to you, your body cannot stay afraid and you will lose your fear of previously dreaded situations and triggers.

However, for exposure therapy to work, it’s not enough for your body to be present while your mind is elsewhere. Facing your fears

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is an experiential process where you stay close to the thing that you dread with both your mind and your body. For example, if you go to a networking meeting, but hide in the corner looking busy while you madly type on your phone, you are not going to make any progress with your social anxiety. The smartphone can become a crutch or a safety behavior that interferes with this process. This can frustrate

many clients who feel like they are actively doing their exposure exercises while making no progress.

When helping clients face their fears, it is always a good idea to tell them to put their smartphones and tablets away so that they can be completely present and engaged. Angry Birds, the reassuring call to a partner, kitten videos and online shoe shopping (maybe that

last one is just me) can wait for another day or perhaps be a little reward for a job well done!

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

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Jean-Anne Sutherland

The Dark Side of the Internet

A Story of Disinhibition and Murder T I L T M A G A Z I N E S u mmer 2 0 1 2

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W

atching Barbara Schroeder’s “Talhotblond: Everybody Lies Online” is like trying to NOT watch an accident site that you pass on the highway. Knowing the image won’t be pretty, you gawk anyway.

If this were a fictional, blockbuster film, we’d all leave the theatre saying, “That could never happen.

Not really.” Sadly, this documentary details real events, extraordinary though they are. As the documentary’s website summates:

change dramatically when we move from face-toface (f2f ) to computer technology. Researchers across disciplines have explored online interactional behaviors, specifically the tendency for people disclose far more of themselves online than one would in f2f settings. In 2004, John Suler wrote his oft-cited piece in what he coined the term Online Disinhibition Effect (ODE hereafter) which outlines six factors which help explain the deterioration of psycho-social barriers that typically block us from such hyper self-disclosure.

Talhotblond is the true story (and screen name) of a beautiful teenage vixen who uses Internet game rooms to lure men into her cyberspace web.

I don’t want to offer too much of the plot as the twists and turns are too rich for me to reveal. I only seek to set the stage so that we can think about this movie as a teaching tool for ODE, as it applies to text communication (video chat being less prolific at the time). As online therapists, we can learn much from these stories of the “dark side of the internet”. We can examine the fantasies humans construct in light of what may be considered partial information about the other person, and relate that to our work in understanding ODE. However, this needs to be done without buying into the fantasy the client has and also not allowing ourselves to be disinhibitioned online to the detriment of the client.

When she discovers she’s been double crossed and lied to by one of her victims, she wants revenge, and unleashes a fantasy online that escalates into real life murder – all because of a girl no one ever met in person.

Drawing from exclusive access to internet messages, secret notes and letters, as well as police evidence files and exclusive prison interviews, talhotblond details the horrific results of what can happen when people lie online.

This documentary offers essential lessons concerning cyberspace. It exposes the dark side of the internet; the presence of predators and liars, the potential addiction to excitement and secretkeeping and, the interactional dynamics of online communication. It is on this last point that I shall focus.

As we all know, the internet provides a landscape for us to construct new identities and say things we would not ordinarily say. The rules of interaction

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Thomas Montgomery is a 47 year old married father with two young daughters. He goes to work, barbeques out back with his family, and teaches Sunday school. He appears as the prototype of the middle-aged, devoted dad, husband and community member. But he is restless. Problems exist in his marriage and he’s told by church advisors to open communication with his wife. Seemingly incapable of doing so, Tom instead begins a slow retreat into the internet, beginning with extended hours of game playing. During one of his gaming sessions, he receives a message from another player Jesse (aka talhotblond) asking if he is aware that the site is for kids. His response unleashes what

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will manifest into a maddening online relationship that will result in the destruction of families and even murder. The middle-aged Tom replied to Jesse, “I’m 18.”

Jesse is a beautiful 18 year old West Virginian with long, blond hair (thus the user name). She and “Tommy,” the 18 year old that Tom constructs, begin a wrenching online love affair. They send pictures – he, a photo of himself as a young, U.S. Marine, fresh from Parris Island boot camp (actually an old picture of the middle-aged Tom). She sends numerous pictures in various poses and clothing.

“Tommy” is smitten and the two fall in love. Like two teens, they pledge an eternal bond, even as he is (fictionally, of course) shipped off to the war in Iraq. Jesse is in so deep that she considers herself engaged to Tommy.

In time, Tom’s wife discovers the “affair” and the duplicity of her husband’s actions. She writes to Jesse, telling her the truth. Naturally, Jesse is devastated and a period of silence ensues but the communication between she and Tom resumes.

Jesse’s mom intervenes, telling Tom to leave her daughter alone. Against the pleas from family, they continue to talk, fluctuating between bursts of vicious anger and tearful declarations of love.

Even as Jesse knows Tommy to be fictional, she wants his continued presence. One demands the other stop all contact. But they participate in the pulling back in.

In the period of reprisal, when Jesse is furious at Tom for deceiving her, she reaches out to a coworker of Tom’s, 23 year old Brian Barrett. Brian begins a love affair with Jesse which, like the one with Tom, includes photos and sex via text. Tom grows increasingly jealous and he and Jesse begin their communication again. Brian, egged-on by Jesse, exposes Tom in their workplace. Eventually, however, Brian breaks off with Jesse whom he has come to see as “crazy.”

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Back and forth go the communications between Tom and Jesse. Months go by without Brian in the picture… until Jesse reaches out again to Brian though his MySpace page. Tom sees Brian’s name appear on Jesse’s page and is incensed. Even as Jesse assures him that she and Brian are not “together,” Tom’s rage against Brian increases. Tom’s anger flares and his threats intensify, taking on a volatile (and exceedingly racist!) tone. Eventually, true to the Marine, sniper persona he created online, he shoots and kills Brian.

.........

Tom and Jesse’s disclosure of personal information was immediate (whether “true” or not). As research on other forms of online media (e.g., Second Life, Facebook) has shown, something about cyberspace encourages us to spew more emotions than we would f2f.

So how does this relate to online mental health interventions? In online therapy and coaching, the same phenomenon is possible; a client will divulge quickly and with more detail than they would f2f.

From the practitioner’s perspective, it can appear as an instant rapport. As I discussed this article with DeeAnna Merz Nagel, co-editor of TILT, she noted, “We (Online Therapy Institute) teach therapists that it is typical for someone to divulge more than they would in f2f. But the client could also experience feelings of vulnerability because they shared too quickly. It is up to the therapist to pace disclosure because without that knowledge, online therapy could be a train wreck.”

Taking Suler’s factors for ODE, we can see how the phenomenon applied to Tom and Jessie’s situation. Learning from this, we can appreciate the importance of recognizing when our clients’ tendencies to behave in a disinhibited way need attention, both outwith the therapeutic relationship and also within it.

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Dissociative anonymity refers to the process whereby we separate our actions online from our actions in-person. The relative anonymity of the internet can help us feel less vulnerability when selfdisclosing and acting out. Anonymity allows for the freedom to discuss otherwise difficult topics.

Like putting on a mask and stepping out in public, online interaction allows us to hide our “real” identities and create new personas, should we wish to (Psyblog, 2010).

Tom adorned the mask of “Tommy.” He was 18 years, muscular (of course) and a Marine. Even as it became more and more clear that Jesse was falling in love with a fictitious man, Tom continued the seduction. In the beginning, he felt little to no accountability for his actions stating that he could, after all, stop anytime he chose. In this early stage of the relationship, Tom still regarded Jesse as an abstract. He was restless and she served as a delicious distraction from his mundane life.

She was not “real” to him in the sense that he need worry about her reaction should he cease communication.

A recent Saturday Night Live skit called “The Comments Section” spoofed those individuals with user names such as “xxxdeathbyfartsxxx,” “ultimatestud2good2betru, or “DaTruf.” When the show “moderator” asks “xxxdeathbyfartsxxx” why he commented so hatefully on a video, the commenter replies, proudly, “Hey, I just calls ‘em like I see’s em.” To that the moderator replies, sardonically, “That and there’s no consequences as you’ll never meet and of these people.” Much to deathbyfart’s surprise, the old lady he’d ridiculed online is invited on stage to shame him.

The anonymity that technology provides creates a kind of “flaming,” as Daniel Goleman, of the New York Times pointed out. In a piece entitled, “Flame First, Think Later,” Goleman describes an “old”

internet problem that exists. Sitting alone with our computers or phones leads to a kind of dialogue (or monologue!) that more than likely would not happen f2f. With seeming anonymity, we are more likely to send a message that “is taken as offensive, embarrassing or downright rude.”

In psychological terms, this phenomenon is also known as dissociation or, “the disconnection or lack of connection between things usually associated with each other.” (ISTDD, 2011) Depending on the person’s ability to compartmentalize or dissociate behavior, affect, sensation or knowledge in his or her real life experience and to what extent this dissociation has been functional or problematic (Braun, 1988) may determine how dissociated a person may be from the online experience.

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Invisibility means just that: we can’t be seen; on message boards, through blogging, and chats. This invisibility, like anonymity, fuels the likelihood of oversharing.

We can’t see the body language of those with whom we interact; the rolling of eyes, the sigh of displeasure, blushing, sweating, or the crossing of arms. We can avoid eye contact. Invisible, we can sneak around naked (literally or figuratively) in our interactions with others.

Imagine the various cartoons or goofy movies you’ve seen that involve a character becoming invisible. Inevitably they stir up trouble for others or acquire, through scheming, something that they want to see, (for example, SpongeBob and Patrick episode involving invisible spray, as described on the wiki dedicated to the cartoon) In the same way, the invisibility factor cheers us on to do and say things that we’d ordinarily have to own-up to.

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virtual infidelity, asking why he did not work on their relationship instead of turning to “Jesse,” his response was that it was “easier for me to talk to someone I can’t see.” Tom pointed to the anger his wife felt in that moment and used it as evidence of why he felt he could not talk to her. Essentially he tells her, “See how angry you are right now.” With Jesse he could be intimate, angry, volatile and racist with no price tag attached.

Persson argues that rather than talking front stage to front stage with strangers, the internet makes it so that we are actually interacting back stage to back stage. When logging into chat rooms or blogs, we are more often in our private (or back stage) places – our homes or offices. Safely back stage we let down the “performance” that is our essential self.

Sociologist Erving Goffman’s dramaturgical analysis (1959) posits that social life is much like a stage performance. We learn our roles through socialization and institutional structures and, these roles are reinforced through day-to-day interactions with others. Through clothing, language, and nonverbal cues, we actively present our SELF to the public. We perform for the audience (a.k.a society).

Our “scripts” are largely written for us. For example, when someone steps into the role of “mother,” the behavior associated with that status is already written. In my research with mothers, I have never come across a mother that cannot answer this question: “What does it mean to be a “good mother?” From what many have said, “A good mother does not yell.” In front stage, a mother will seek to play that role appropriately, not screeching at her children in a public place. Back stage, however, a mother can let loose the constraints of the script and yell to her heart’s content.

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Anders Persson, in his paper presented at the XVII World Congress of Sociology in 2010, uses the work of Goffman to examine interaction in social media, specifically his distinction of front stage and back stage. When we are front stage, we are performing. Back stage, of course, is hidden from the audience. In public we are front stage, constructing our presentation of self, following cultural norms. When front stage we typically do not divulge our secrets and emotions to strangers.

That divulgence happens back stage, in our private lives, away from the eyes of strangers.

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By asynchronicity, Suler meant that in cyberspace, we don’t often interact in “real” time. There are delays between responses which allow for a type of dialogue not experienced f2f. As Kate Anthony (2009) explains:

In e-mail and message boards, where there are delays in feedback, people’s train of thought may progress more steadily and quickly towards deeper expressions of what they are thinking and feeling in comparison to instantaneous communications. Some people may even experience asynchronous communication as “running away” after posting a message that is personal, emotional, or hostile. It feels safe putting it “out there” where it can be left behind.

While anonymity and invisibility can increase the likelihood of our over-sharing, the asynchronicity of technology allows us to stop and start conversations.

We can post something inflammatory and then walk away. At the same time we can stop to collect our thoughts between exchanges.

As one of the facets of ODE, Tommy and Jesse would have experienced this from both sides – both as instigator of an “emotional hit & run” and in experiencing the unpleasantness of being on the receiving end.

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S o l i p sistic introjection refers to the process whereby we construct an image of the other partly by how they present themselves and partly by our internal representational system (built from life experiences). Even as we receive “data” from another (images and language) we then assign a voice, a tone and a visual to that person.

Thus, our understanding of the “other” is based largely on what we bring to the interpretive process.

Jesse’s hunger for a love relationship helped construct the image of Tommy. All Jesse had was a photo and chat exchanges. However, she drew from her own desire for a man such as Tommy – one who could “rescue” her from the boredom of her West Virginia life – and in so doing helped solidify Tommy, the sniper Marine.

Similarly, Tommy, drawing from “voices in his head” participated in the construction of Jesse. Like he did for her, Jesse “rescued” Tom from his monotonous life. Jesse’s presentation of self was then filtered through Tom’s “internal monologue.”

As sociological social psychologists point out, the construction of the self is interactional. According to Charles Horton Cooley’s (1902) looking glass self we, 1) imagine how we look to others, 2) imagine how others judge what they see and, 3) develop a self-concept. How we think people feel about us is part of the construction of our own self. It is this interactional process that contributes to our global sense of self. It is not only how we present

ourselves, but how others go about defining the presentations that creates self-concept. In relation to online therapy and coaching, therapists need to be aware of their online presence - what (if any) picture they have on their website - what their searchable online identity “looks like” and to be aware of both the client’s perception of the therapist and the therapist’s perception of the client. This is why interjecting more cues (aural and visual) into the process may compromise the initial rapport. Imagine if Jesse and Tommy had talked early on or seen real images of one another?

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Dissociative imagination reminds us that what happens online can become a kind of make believe world that allows us to enter and exit at will. Rex Beaber, the clinical psychologist whose analysis is offered throughout the film, notes that what makes relationships particularly satisfying is the “fantasy of what is possible.” With that we can

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begin to imagine just how intense were the feelings between Jesse and Tom. After all, the _whole of their relationship was a colossal, unending sense of what might be. This is important in relation to our online work as we as practitioners must attempt to avoid this fantasy creation within the client, and – likewise – the therapist.

Many psychologists will argue that this story is one of addiction. This is correct, but Beaber is quick to note that Jesse and Tom were not necessarily addicted to the internet, per se. Rather, he argues, they were addicted to the excited and intrigue that the relationship provided. Love is powerful, Baeber reminds us, even pathological love. Tom “took the step through the looking glass hole and into a world of unreal.”

In cyberworld, anything is possible. A 47 year old, average Joe of an American guy, with mortgages and mundane work, can transform into an 18 year old hunk of a boy, full of wonder and excitement about his future with the lovely Jesse. And this fantasy is exactly what Tom loved about “Tommy.”

As Tom told the filmmaker, the relationship with Jesse made him “feel like a kid again.” Through his construction of Tommy he could accomplish the very things he’d desired as a kid of 18. He could be the strapping, sexy sniper, Marine.

Of course, the same rule of love and interaction do not apply in the make-believe world. Here, one can click the stop button and end the “game.” After all, we feel anonymous and invisible anyway, and our task as therapists is to keep the dialogue real, holding oneself and the client accountable to the process.

But, for Tom, the make-believe world began to suddenly and then tragically enter his real-life world. It seems as though Tom was living out the [W.I] Thomas theorem (1928) which states

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that, if we define something as real, it is real in its consequences. To Tom, Jesse was not only “real,” but she was his love, his woman. To Tom, Jesse’s dalliance with Brian was “real.” On that fateful evening as Brian walked to his truck, Tom’s sense of jealous vehemence was real. Though by now Jesse was nothing but a MySpace name, Tom shot him point blank into the head and neck.

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A Minimization of authority can exist in cyberspace. From the perspective of a social control or exchange theorist, when we are making (rational) choices to deviate, we weigh the costs and benefits. Whether it’s a violation of a social norm (e.g., blatantly mean comments) or of a law (e.g., sex with a minor) – we unconsciously ask ourselves, does the benefit of this action outweigh the cost of this action? In f2f settings, these decisions can be made fairly easily if an authority figure’s presence is clear. That is, we are far less likely to rant, as does xxxdeathbyfartsxxx” in the SNL skit, if the person to whom the ridicule is directed stands in front of us. The cost is too high. What if she slugs back, but with a baseball bat? What if others reprimand and embarrass us?

Online, negative sanctioning is far different than f2f (not that sanctioning doesn’t occur in chat rooms it most certainly can and does). Online, if punished, one can usually slink away and find another group, with little cost to us.

Just as we can be negatively sanctioned, we can also receive positive sanctions. In a therapeutic situation, this can be as simple as a client divulging something perceived as shameful, yet the response from the therapist reframes the client’s perception of the information he or she has divulged.

When Brian and Jesse conspired to make Tom’s actions known in the workplace, Tom exploded.

Prior to that, Tom did not have a sense of shame that might derive from social disapproval. When Brian uncovered Tom’s actions (which followed his wife’s discovery), the fantasy world came crashing down on him. Suddenly there was a sense of authority looming. And with the authority came Tom’s sense of shame and, perhaps, self-loathing.

Indeed it might not be a stretch to say that it was self-loathing that led Tom to kill Brian.

Therapists (and often coaches) should keep ODE in mind when particularly difficult content is revealed by the client. This film allows and helps us to develop an understanding of ODE as it may potentially affect client’s lives (such as leading to murder); how to manage the HUGE fantasy that the recipient puts into the text (either outside the therapy or within it); and how as online therapists we can relate that to our work in understanding ODE without either buying into the fantasy the client has or allowing ourselves to be disinhibited online to the detriment of the client. Media such as this should be embraced by our professional

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community as a learning tool for the future of online work.

INTERESTED IN VIEWING talhotblond?

Purchase here: http://astore.amazon.com/onlitherinst-20/detail/ B0036K9CVO Or download to your Kindle: http://astore.amazon.com/onlitherinst-20/detail/ B0030949FU

This documentary has recently been made into a Lifetime movie so check Lifetime's viewing schedule: http://www.mylifetime.com/ movies/talhotblond

ABOUT THE AUTHOR Jean-Anne Sutherland is assistant professor of sociology at University of North Carolina, Wilmington, USA; one of her areas of research is sociology through film. Her Reel Culture column, expanded as a feature article here, can be seen in each issue of TILT. Be sure to check out her other film reviews.

REFERENCES not linked in text: Braun, B.G. (1988). The BASK (Behavior, Affect, Sensation, Knowledge) model of dissociation.

DISSOCIATION, 1(1), 4-23.

Cooley, Charles Horton. 1902. Human Nature and the Social Order. New York: Scribner's.

Goffman, Erving. 1959. The Presentation of Self In Everyday Life. New York: Doubleday.

Suler, J. (2004). The online disinhibition effect. CyberPsychology and Behavior, 7, 321-326 Thomas, W.I. and Dorthy Swaine Thomas. 1928. The Child in America: Behavior Problems and Programs. Knopf.

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Closing the gap with “Generation Y” Olivia, a new therapist who just graduated from college, is never far from her mobile device, texting at a pace that makes your fingers feel tired just watching her. While talking with Olivia you learn she has a Facebook page, a blog on healthcare reform, and 2,000 followers for her Twitter feed.

Olivia and Steve could easily be at odds, leaving you, their coworker, smack in the middle. To avoid conflict—and to help Olivia steer clear of problems caused by online privacy violations—it helps to under- stand Olivia’s generation, Generation Y, and how it differs from other generations.

On the other hand Steve, who’s been employed for 25 years and just learned that Twitter isn’t what you do simply for fun, checks his Facebook page only when his kids remind him they’ve posted new photos of the grandchildren. He can’t imagine texting them instead of picking up a phone and calling.

What’s Generation Y? We’ve all heard of the Baby Boomer generation and Generation X (a 2008 essay by trendspotter Marian Salzman on cnn.com added the Cuspers, who straddle the divide between Boomers and Gen Xers), but what’s Generation Y? Also called the Millennials, Net Generation, and Nexters, this young generation includes those born between 1979 and 2003 and is the fastest growing segment of today’s workforce. It’s important to avoid stereotyping, but some general traits of Gen Y include a commitment to civic duty, acceptance of diversity, and an ability to be empathetic. Gen Y is the most optimistic of all generations that came before them.

Each generation has its own view of history and cultural touchstones. Members of Gen Y grew up in the digital age, don’t remember when there was an East and West Germany, and may not have even been born when the Twin Towers came under terrorist attack. They’ve been exposed to random violence, so it’s not surprising that they value safety and security.

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Challenges of Gen Y

This freeform sharing can cause problems in the work setting, where professional ethics on confidentiality and privacy regulations such as the Health Insurance Portability and Accountability Act (HIPAA) require strict adherence. It’s important to help your Gen Y coworkers understand that sharing confidential information about a client violates legal, regulatory, and ethical principles. That way, you help them—and your organization—avoid potential liability issues. The costs of such events can be high. Fines for violating HIPAA regulations can run as high as $250,000, and offenses can be punishable with jail time.

Some organizations block Internet access at work. Talk with your supervisors to encourage open access. Closed access turns off Gen Y members like Olivia and may make them look for a job at an organization with a more liberal policy, leaving you short staffed. According to an Australian study, nearly half of employees who use MySpace and Facebook during work hours would turn down a job offer from an employer that banned the sites. Of course, it’s still important not to spend too much time online, in the same way you wouldn’t talk excessively with others while on the job.

Working with Gen Y You can be an effective coworker and help colleagues like Olivia understand the importance of confidentiality and other liability issues by understanding how her generation prefers to

LEGAL BRIEFS

Gen Y grew up exchanging information all the time in all locations. They’re used to texting their friends almost constantly to share the latest details of their lives. They’re less conscious of privacy as some may post somewhat embarrassing photos of their latest party on their Facebook page.

work. Gen Y likes group work and doesn’t like hierarchy. To help your coworkers, you might start a discussion group of Gen Y staff to talk about case examples related to privacy issues. For example, in February 2009 two Wisconsin nurses were fired for posting a patient’s X-rays on a Facebook page, even though the patient wasn’t identified. Because members of Gen Y aren’t in awe of authority figures, consider coleading the discussion with a Gen Y representative.

Gen Y prefers communication to be electronic, timely, and positive. Seek out interactive videos to teach this generation about privacy issues.

When your Gen Y coworker does something great, consider texting a positive note right after an event instead of sending an email later.

Remember that Gen Y also craves feedback from those around them. You can build a solid collabora- tive relationship by providing frequent, sincere positive feedback as appropriate.

Finding common threads— and differences If you become frustrated with a member of Gen Y, take time to consider generational similarities.

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GENERATIONS NAME

BIRTH YEARS

WORK VALUES

Veterans

1928-1945

Loyal, respect authority, value stability, hard working

Baby Boomers

1946-1953

Skeptical of authority, idealistic, competitive, like teamwork

Cuspers

1954-1965

Value traditional notions of family but see men and women as equals in parenting, embrace digital technology

Generation X

1966-1978

Value self-reliance, rely more on friends than institutions, irreverent humor, more pessimistic, not loyal to company

Generation Y

1978-2003

Like to figure things out, confident, want challenge but not responsibility, like group work, not in awe of authority figures, don’t want to pay dues, like the idea of being with one or two companies

code—that’s a lot in common. Family is the top priority for all generations. You can use that to facilitate discussions of integrity in the workplace.

For example, you can ask, “How do you think your mother would feel if information about her illness was posted on a Facebook page?”

At the same time, leverage generational differences. For example, Gen Y is very technology oriented. Members of this generation can help you learn how to set privacy tools on their social media pages to improve confidentiality.

Above all, remember what it was like when

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you started working with others from different generations. Respect each person’s individuality while helping him or her understand the need to keep client information confidential.

Cynthia Saver, MS, RN, President, CLS Development, Columbia, Maryland

Reprinted with permission from Healthcare Providers Service Organization (HPSO); 159 E. County Line Road, Hatboro,PA 19040 1-800-9829491 HPSO Risk Advisor 2011-2012.

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TECHNOLOGY ENHANCED D

10

The

Most Important Coaching Web App Features

Are We There Yet? 36

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D COACHING Lyle Labardee Tell us what you think.

While there are a number of well-developed and effective coaching web apps available, such as JournalEngine, Coaches Console, Coaching-Websites, bLife and others, adoption of these web apps on a large scale by coaches remains modest relative to the tens of thousands of professionals currently coaching.

In this column I’ll be asking, “why?” and proposing “The Ten Most Important Web App Features” that coaches and clients alike are looking for in a coaching app.

When it comes to day-to-day coaching, most coaches, it seems, still prefer to rely on faceto-face or telephone services. In other words, the coaches and clients who would otherwise demand these apps do not see enough value to readily and quickly adopt them.

This modest adoption rate suggests that the use of coaching web apps is still at the “Early Adopter” (Moore, 2002) level. In his book Crossing the Chasm, Moore explains that a chasm exists between the technology adoption

stages characterized by “Early Adopters”, where a growing body of users put innovative ideas into practice, and the “Early Majority” where the technology is readily and quickly adopted by the mainstream market.

So, why are we not seeing a majority of coaches and clients adopting coaching web apps?

Is it the technology, the non-technical nature of the person who is inclined to coach, or the coaching process itself that leaves coaching web applications little more than a curiosity at best for many coaches? While the answer to the question goes beyond the scope of this article, there’s something to be said for starting with the question: what are coaches and their clients looking for in a coaching web application, and what kind of functionality might actually enhance the coaching-client interaction? While it may be difficult to identify a precise and accurate answer to this question ahead of time, the veracity of the answer will be made evident by rapid and unsurpassed adoption of the coaching web application that “gets it right”.

While being the first to admit that I don’t hold the answer to the question concerning what kind of functionality will lead to “Majority Adoption” of a coaching web application, I do hope to stimulate thoughts, feedback and discussion around what

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TECHNOLOGY ENHANCED COACHING coaches want to see in coaching web applications.

All of the coaching applications mentioned at the top of this article include many of the features outlined below and in many respects represent the pioneering efforts of those who conceived and developed those apps. While all of the apps have various functional strengths none offer a thorough presentation of all of the features I have outlined below. Take a look and let me know what you think. I’ll be publishing reader feedback in the next issue (I’ll be sure to ask your permission before using your name in print).

The 10 Most Important Coaching Web App Features 1. Private and Secure: Every aspect of the application conforms to globally-accepted, privacy and security standards as outlined in The Ethical Framework for The Use of Technology in Coaching (Labardee, Nagel & Anthony, 2010).

2. Affordable: Users of the app need to have a high level of confidence in return on investment realized through: a. client interest in using the app (more clients)

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b. time saved on non-billable administrative tasks, and applied to billable coaching service c. money saved on outside marketing, site administration resources.

4. Human-Ready: The user interface design is clear, simple and easy to navigate. It incorporates the use of white space, large text, large text entry fields, and as few steps as possible. It minimizes the use of large color palettes, and ultimately serves to enhance, not overshadow the coach-client interaction.

5. Automatically sizes itself to fit the screen of the device upon which it is being viewed.

These devices include, iPad, iPhone, Android, laptop, TV monitor, etc. The coach and client interaction becomes mobile.

6. Connect-Ready: The web app supports easy to use, mobile-ready, scrolling coach-client interaction features such as private messaging, journaling and chat.

7. Group-Ready: The web app allows the coach to invite users to join groups to participate in group coaching. Group members can easily engage one another and share documents and media.

8. Marketing-Ready: The web app provides coaches with easy-to-use resources for keeping

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continued their website updated, attractive and working to attract more clients. Coach-managed functionality includes tools to support SEO, surveys, e-news and social media.

9. Publishing-Ready: The web app allows coaches to publish own blogs, develop and publish assessments, news, information and courses for selected clients. Clients can easily access information and resources.

10. Admin-Ready: The web app allows coaches to save time managing paper records and files, and makes it easy for clients to complete intake information and billing information online. The admin functions support document loading, document interaction (form completion) and printing. It also supports client self-scheduling, payment and case management.

REFERENCES Moore, G. (2002). Crossing The Chasm. (Revised Edition). New York: Harper Collins Publishers, Inc. Labardee, L., Nagel, D.M & Anthony, K. (2010).

Ethical Framework for the Use of Technology in Coaching. TILT Magazine, Volume 1, Issue 4: 24

Lyle Labardee is a Licensed Counselor and Board Certified Coach. He writes the TEC column for TILT Magazine and serves as CEO of the Institute for Life Coach Training .

11. Media-Ready: The web app supports streaming video and other rich-media files that support and enhance the coach-client interaction.

Tell us what you think; we look forward to your feedback.

Send your feedback to : lyle@lifecoachtraining.com

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The

ONLINE COU mental health care is goi

by Jane Sarasohn-Kahn

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UCH ing online This article summarizes the white paper, The Online Couch: Mental Health Care on the Web, published in June 2012 by The California HealthCare Foundation. The full paper can be accessed via the CHCF website at http://www.chcf.org/ publications/2012/06/online-couch-mental-health.

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There is growing demand for mental health services that help people with mild to moderate depression and anxiety. For this expanding patient base, mental health care is moving outside of the therapist’s office, via virtual and online modes.

An undersupply of mental health professionals, the adoption of communication and information technologies by both consumers and professionals, patient demand

for access and convenience, and value-based payment in health care underlie this emerging trend.

Payors of health services recognize the economic burden of depression. More days of work are lost due to depression than any other medical condition. For this reason, depression is considered “the common cold of mental illness” by employers, for whom depression is the #1 financial line item in employee

assistance programs (EAPs).

Thus, enlightened employers and public sector plan sponsors (eg. Medicaid, Veterans Administration) are targeting depression as a population health challenge among employees, dependents and enrollees. In response, health plans have begun to serve up innovative programs, such as computerized cognitive behavioral therapy (CCBT). One such health plan, The University of Pittsburgh Medical Center’s UPMC Health Plan (with 1.5 million members) researched CCBT programs from all around the world, deciding on Beating the Blues (BtB). BtB originated in the United Kingdom and has a substantial evidence base to support its efficacy: the landmark publication presenting early evidence for BtB was published in 2003, and since then BtB has amassed the largest evidence base available for a CCBT program.

Beyond BtB, other CCBT programs are available on the market in 2012, with several in development at the time The Online Couch went to print in June 2012.

In addition to CCBT, other service are expanding options for people seeking treatment for mild to moderate

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depression outside of the therapist’s office such as: • Online therapy, a fastgrowing segment. This category of technologyenabled mental health can be described as “safe Skyping,” whereby secure videoconferencing connections support therapeutic encounters between patients and therapists. Some programs develop networks of therapists who contract independently with patients (in a direct-to-consumer model) for services. Other programs have networks of providers and offer a comprehensive service to self-insured employers, health plans and specialty mental health companies.

• Online social networks.

Patients support other “people like me” in online social networks, where people with depression are often managing other comorbidities such as multiple sclerosis, diabetes, heart disease, HIV/AIDS, and other medical issues. In these networks, patients who opt into the communities can benefit from a peer-to-peer support system.

• Mobile platforms for selftracking. The adoption of the mobile phone (especially the smartphone) and tablet computing (notably, the iPad) by both consumers and clinicians enables patients to manage depression on-the-go – where they live, work and play. Many programs launched on mobile platforms are focused on self-help and self-tracking, such as MedHelp’s MoodTracker and What’s My M3, developed by psychiatrists from Columbia University, Georgetown University, and the Bipolar Collaborative Network.

Beyond these health apps, simple SMS texting has also been found to be useful in managing behavioral health outcomes (Fjeldsoe, Marshall and Miller, 2009).1 • Games for behavioral health. Gamification has come to health care, but games in the sphere of mental health haven’t been tested to the extent they have in other areas of health care. Existing research on therapeutic computer games suggests that some clients are more cooperative with therapists when using games, that

session attendance rates can be improved due to reduced stigma, and that children and adolescents who require therapy benefit from games (Lewinson, Rohde & Sealey, 1998).2 The SPARX program in New Zealand targeted adolescents seeking help for depression, and resulted in clinically significant reduction in the condition among young patients using a gamified CCBT program (Merry et al, 2012).3 • Virtual reality. VR uses computers, visual immersion devices, and artificial created environments to give patients simulated experiences that can be used to diagnose and treat psychological conditions.

There is a growing evidence base supporting VR for mental health applications coming through the Veterans Administration (VA) health system. With a growing number of veterans returning to the U.S. following service in Afghanistan and Iraq war theatres with post-traumatic stress, the VA has initiated programs based on VR to help this population: Virtual Iraq and BusWorld, among them. These applications are

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all in the investigative stage, with the VA a trailblazer in exploring the potential for virtual reality and telehealth, writ large, to deal with challenging mental health problems among veterans and families.

Across all of these technology platforms dealing with mental and behavioral health, there are many barriers that can slow adoption in the U.S. While many U.S. health citizens lack access to mental health services in general, these and other people in the U.S. also lack access to the infrastructure technologies that have the potential to expand services to the under-served – especially, broad bandwidth in areas lacking the so-called “last mile.” In addition, there are therapists who are entirely committed to the traditional face-to-face model of therapy, and are reticent to experiment with virtual/etherapy. For some of these more technoconservative clinicians, privacy is seen as a barrier to providing care at a distance. However, most of the new Skype-type platforms for distance therapy offer secure (some make the claim of “HIPAA-compliant”) environments. One of the

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inducements offered by some of the etherapy companies to attract therapists to join their service is electronic health records systems, among other benefits.

The most significant barrier which could slow the adoption of mental health care online is payment. The fact is that telehealth, in general, is more advanced in other parts of the world outside of the United States because their health care payments are tightly budgeted and feature strong primary care “backbones” at the front line of health care. This can be the case in the UK, home of Beating the Blues, which today often functions as first-line therapy prescribed for British health citizens diagnosed with mild to moderate depression – tried out before an antidepressant is prescribed.

In the U.S., Medicaid is the largest payer of mental health services, accounting for 26% of total mental health spending

in the nation. Medicaid covers mental health services delivered in a broad range of settings: home, school, and workplace, through the full complement of mental health professionals. With the expected influx of at least 30 million newly-insured people expected to enter the U.S. insured population in 2014 will come dramatically expanded demand for mental health services which cannot be delivered based on the current face-to-face model.

The Affordable Care act could, therefore, impact payment for mental health services

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even more dramatically than the Mental Health Parity Act of 2008 did. The ACA’s model for integrating care through accountable care organizations and patient-centered medical homes would offer compelling motivation for primary care providers to bring mental health into the primary care practice, enabling earlier detection and treatment of people with mild to moderate mental health conditions.

Accountable care financing would incentivize providers to channel patients to the most cost-effective form of mental health care. For patients with mild-to-moderate depression, CCBT could be a cost-effective alternative, in addition to telemental health.

Technology can help bridge the gap between pent-up demand for and undersupply of faceto-face behavioral health services. With technology costs falling and broadband and mobile platforms penetrating the U.S., technology-enabled mental health care can improve access for more people needing behavioral health interventions. The drivers of demand, patient and technology are converging for this market to grow. What could ultimately hold back the growth of this market isn’t the technology – it’s provider willingness to embrace a new model of care delivery.

REFERENCES Fjeldsoe BS, AL Marshall, and YD Miller. Behavior Change Interventions Delivered by Mobile Telephone Short-Message Service.” American Journal of Preventive Medicine, 36, 165-173, 2009.

1

Lewinsohn PM, P Rohde, JR Sealey. Major Depressive Disorder in Older Adolescents, Prevalence, Risk Factors and Clinical Implications. Clinical Psychological Review, 18:765-94, 1998.

2

Merry SN, K Stasiak, M Shepherd, C Frampton, T Fleming, MFG Lucassen. The Effectiveness of SPARX, a Computerised Self Help Intervention for Adolescents Seeking Help for Depression: Randomized Controlled Non-Inferiority Trial. British Medical Journal, 34:e2588, April 19, 2012.

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About the Author Jane Sarasohn-Kahn, MA (Econ.), MHSA is a health economist and management consultant who works with health care stakeholders at nexus of health care and technology applying the tools of environmental analysis, scenario and strategic planning, forecasting, and health policy analysis. Jane writes the Health Populi blog and is a frequent public speaker and writer on the subject of health technology, consumers and economics. While Jane is passionate about her work, she is even more passionate about her family and home, Slow Food, Botticelli and Picasso, big Tuscan reds, and living a full and balanced life.

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an Online Therapist

A Day in the Life of

If there is one thing I've discovered in being an online therapist, it's that there is no typical day in the life of an online therapist.

Fortunately, that's just how I like it!

Stephanie Adams

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As the independent business owner of Beginnings Counseling and Consulting, on any given day I'm the staff counselor, life coach, accountant, marketing director, PR representative, administrative assistant, IT person and more.

Though that might sound really intimidating, I like that it gives me incredible freedom to create the business I think will serve my clients best.

Though there are many different ways to conduct online therapy, I operate through 4 means: live videoconference, live chat, phone, and email. All these methods are facilitated by the online practice management and therapy tool I use - counsol.com. You may recognize the name as they've recently been verified by OTI! I've been using counsol. com for months now, and it's the only system I've ever seen that completely includes everything I need for a session: PayPal support, note-taking applications, intake forms, client session reminder emails, quality video feed and more. It even stores securely old chat sessions so that I can review them before a client meeting!

Although I don't have a client session on every given day, most days, if not all, I have a client email or call to respond to. My advertising hasn't changed much since my pre-online practice days.

I list my practice in Psychology Today much like many brick-and-mortar counselors, but instead of a local address, I give my website address and write "Online-Only Practice." Though I still get a lot of confused calls looking for my building, I also get a lot of people that call to say, "I hear your practice is online. Can you tell me more about that?

Most days, I also try to apply to my work a few principles that have defined my online-only practice.

1. When talking to potential clients, I emphasize the benefits of online therapy for their particular demographic. Since online therapy is somewhat new, people want to know why they should use it as opposed to what else is out there. My online practice is focused on emerging adults - those people that are just beyond their parent's complete supervision but not yet wholly on their own. So, every time I get a call from a parent or a potential young adult client, I explain: my generation and the ones since have grown up on technology.

Because of this, many times I can elicit more from my clients with the use of online tools than I could sitting face-to-face in a room with them. Older teenagers and young adults communicate by email, by chat, by phone. It's more client-focused and more respectful to offer them the option of therapy on their own terms.

2. I create systems for myself to more easily address problems that arrive. For example: Usually, if I have technology failure issue, it's not with my computer or counsol.com, because I check frequently to make sure everything is running properly! So a project I'm working on right now is creating an automatic email that I can send to clients the day before our first session, reminding them to do all software updates on their computer, update their flash player, and restart their computer before we meet for the first time. Since I'm the sole proprietor, I know if I implement a system, it will save me trouble later on.

3. I don't allow myself to apologize for what I have to offer. For a while, I felt a little guilty because I couldn't offer private counseling at a physical location as well as an online location. I focused on the fact that offering online therapy was

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Special Discount Code:

convenient for me and blamed myself for not finding a way to offer a physical location to the clients that called requesting it. But the fact was, those people that called looking for a physical location weren't yet my clients, and so I had no obligations to them. I have many fine local places to refer callers to when I cannot work with them. When I don't focus on what my practice can't do, I can focus on the many benefits it has to offer instead, for example, to college students who don't have cars to come see me, or moms who can't pay for both babysitters and therapy sessions.

Online therapy has helped me grow in both my therapy skills and in my confidence as a practitioner. I believe the healthier and happier the therapist, the better that they are able to help their 48

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For $9.95 off month ly subscription to CounSol.com(Ste phanie's favorite online counseling so lution) enter discount code BegCounselor201 2 at purchase!

clients! I have been in online practice for over a year now, and I don't see a point in my life in which it will not be at least part of what I have to offer clients.

about the author Stephanie Adams, MA, LPC provides E-Therapy and E-Coaching at Beginnings Counseling and Consulting. She also serves part-time as the staff counselor for the Sexual Assault Resource Center. Stephanie runs the blog and social networking site Beginning Counselor and is the coauthor of The Beginning Counselor's Survival Guide. Her next project is an innovative business education program for private practice therapists called MBA In Private Practice.

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an Online Coach A Day in the Life of

by Diane Parker

A typical day in my working week would depend on what day of the week you caught me. At the moment, as well as running my private coaching practice, I am studying for a Masters degree in dance movement psychotherapy and I also edit the British Association for Counselling and Psychotherapy’s Coaching Division journal, Coaching Today.

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During term-time, I attend college two days per week and then a further day on clinical placement. Those days can be fairly intense, so I try as much as I can to carve out space around those days and keep them clear of other work, e.g. client sessions and consultations or work on the journal, though of course that’s not always possible.

My own professional background is in the arts (I was originally a dancer) and my coaching training was accredited by Performance Coach Training through the Cultural Leadership Programme, so I specialise in creative and cultural industry leadership coaching. Many of my clients, like me, have creative portfolio careers, the majority are self-employed or freelance and are juggling creative/artistic work with other, more ‘mainstream’ work.

Because I also work with the body, on a deep somatic level, I am also rapidly developing another client stream, working in the area of sexuality, spirituality and intimate relationships. Sometimes, the two overlap, which is having an impact on how I market myself, as the boundaries between ‘business’ and ‘pleasure’ become increasingly blurred.

I rely heavily on the Internet

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and social media to reach my audience. In addition to my website, I also have a Facebook page and a Twitter account for my business, The Good Witch of the North. I also have a Facebook profile, a Twitter account and a private blog as my alter ego Ruby Slippers, where I post and share content related to sexuality and relationships. Often, I will share content across both sites/accounts. I also regularly contribute to an online forum on sex and relationships.

On a day when I am not in college or in placement, I will typically be up and at my desk by 8.30am, with hot black coffee, albeit still in my pyjamas! I first log into my work email account, closely followed by Facebook and Twitter. Because I work at home, in isolation, social media for me serves a similar purpose as the ‘office gossip round the watercooler’ – some of that ‘gossip’ may be more work-related than other, but I tend not to make such a differentiation these days.

I’m a member of various groups on Facebook so as well as sharing content on my personal profile and business page, I may contribute to a discussion thread or two. I’ll then attend to any journalrelated correspondence for a couple of hours. It’s also

on these days that I take any client consultations, so I may have a half hour telephone conversation with a prospective client. I also have regular dual supervision over Skype for an hour per month, which works brilliantly – using audio only, I and my fellow supervisee can have a threeway conversation with our supervisor. I’ll then continue on into the afternoon, working on the journal, dealing with professional correspondence and conducting research, and will typically down tools around 5.30pm, unless I have a client in the evening. Most of my client sessions at the moment are conducted by telephone, though I have seen clients here at home, working face-to-face.

Both modalities have their advantages and drawbacks.

The most obvious advantage when I am working on the phone is that I don’t have to worry too much about how ‘presentable’ either I am or my flat is! Having said that, even before a telephone client, I take time to prepare by hoovering and tidying the room in which I work. That may sound a little weird but this helps me to ‘hold space’ for the client, as I find too much mess distracting. I also take a few moments to centre myself with some deep breathing, yoga or mindfulness

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meditation. I’ve usually spent the majority of the day hunched over my computer screen, so it’s important that I get back into my body before working with my client, even if all I have time for is a few minutes just lying down on the floor, reconnecting with my body and the earth. I use a lot of imagery in my work with clients, and often draw their attention to their bodies and their senses, so it’s important that I am embodied myself, and in touch with my own senses.

The main focus of my work is to help others reconnect with their sense of home; home

being a place of centredness and fulfilment with oneself, living in alignment with one’s own core values and beliefs, a strong inner core that remains constant regardless of what may be happening around us. It’s that place that we tend to lose when our world is in turmoil, when we experience fear, uncertainty and selfdoubt, and we can easily forget that we always knew the way to get back there. Sometimes, we just need a gentle reminder, and a helping hand to guide us homeward. So whether I am offering creative leadership, career or personal coaching as The Good Witch of the

North, or sex and relationship coaching as my alter ego Ruby Slippers, at its heart, my motivation is the same. To help others find their way home to their authentic, true selves, and to live, love, work and play from that centre.

ABOUT THE AUTHOR Diane Parker is a creative leadership coach and facilitator, a writer and editor, and a trainee dance movement psychotherapist.

She lives in London with her cat, her computer and lots of books.

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Cyber Supervision Anne Stokes

Recently a colleague asked “Do your supervisees do any preparation that you know about? If so, what?”

I hadn’t really thought that someone might be curious about this, but once the question was in my mind, it didn’t leave.

The short answer is: some supervisees tell me about their pre-session preparation ahead of time, and some don’t. In the latter group, there are some who prepare for the session by themselves, and tell me about this at the beginning, and some who prefer to meet and work spontaneously. These two

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groups are very similar to faceto-face supervisees.

Maybe it’s the group who do let me know ahead of sessions what they want included that my colleague was more interested in. How they do this varies, and supervisees may use all of the methods below at different times, though most have a ‘generally preferred method’.

The shortest and simplest presession communication was: ‘Hi Anne, I would like to talk about endings in our next session’.

A bit of an ambiguous statement, as we are both of an age where retirement raises its head from time-to-time! I was glad that he started the session

by writing ‘You probably wondered if I was talking about our ending or my endings with clients. It’s the latter. I am sorry I wasn’t clear.’

However, it taught us both about the need to be clear when setting agendas or it won’t aid my preparation for sessions. Perhaps that doesn’t matter if you take the view that it is the supervisee’s preparation that’s important, not the supervisor’s. However, I think that if it is going to be shared with me, then I need to be able to understand the theme, at the very least. So another supervisee might write: ‘I’d like to discuss whether I am sufficiently bracketing off my own not dissimilar experiences

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Preparation For Online Text-based Synchronous Supervision Sessions with client F. I’ve also two new clients I’d like to introduce.’

That’s more helpful and all I need to do at the beginning of a session is to check whether these are still the areas the supervisee wants to look at, how we might divide the time, and if I’ve understood and remembered correctly the experiences referred to.

The two examples above only take me a short time to read and do my own preparation for the session. The following take more time, so some online supervisors might feel that they don’t want to encourage this, as it intrudes into time that not set aside for work, or that isn’t being specifically paid for. It’s valid to raise these objections.

We each need to find ways

of working that sit well with ourselves. I allow time for preparation if that’s the way the supervisee wants to work for a number of reasons: • it enables us to cover more if the background is already given since it takes longer to write/read than to speak • If it’s how a supervisee generally chooses to work, I can factor it into my work schedule and fee structures • It often gives extra insight into supervisees’ work and thinking In the first of these more timeconsuming ways, supervisees send an email, rather as if we were engaged in asynchronous supervision. So it gives client details, or updates of where work has got to, for as many

clients as the supervisee is hoping we’ll explore. They may also include details about anything else they want to discuss, for example CPD or organisational issues. I don’t reply, other than to acknowledge receipt, as this is solely preparation for the live session.

The final way has a formula, developed by one supervisee, though others now use it in their personalised form. Initially we used it in asynchronous exchanges, but continued with it when we changed to live sessions. Here the supervisee sends me an email which updates across a spectrum: • Me as me - particularly useful when there are personal events which may affect the work.

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• Me as a professional an overview of work life, changes, updates etc • A chart showing names of each client, number of sessions since last supervision, and themes of sessions • Further details of clients or issues to be discussed in the session • Sometimes a further paragraph of anything supervisees feel is relevant, not mentioned elsewhere.

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This does take time to read and reflect. It can however enhance the quality of sessions, and help tackle the thorny question arising when professional organisations need to ensure

that online supervision hours equal f2f hours!

I am sure that there are many other ways of preparing for live sessions – I’d love to hear about them! Do email me.

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

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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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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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TILT – Therapeutic Innovations in Light of Technology

NewInnovations

The Biggest Threat to Innovation Jay Ostrowski I made a rookie mistake. One evening, two time zones away, the other end of the phone went silent. Well, almost silent. This conversation had not gone the way the client or I had expected. We both began the discussion with anticipation of great things to come. Our trusting relationship led to the client’s request for this idea. I worked hard on it and made a great pitch. But I hadn’t adequately prepared the client for the concept, nor anticipated resistance.

Now, in the background I heard crickets on the phone.

Literally, crickets. This was not therapeutic silence. It was a

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business client, a therapist in fact, and their business was about to take a turn based on this conversation.

As I saw the doors of opportunity closing before me, I continued, hoping to squeeze the concept through before those mental doors were completely shut. This too had a predictably painful outcome. Instead of slowing down I pressed on and prayed for an open mind on the other end. I explained how we could use text messaging in a unique way to create a new referral stream and attract new telemental health clients. There

were therapeutic possibilities too. The technology was ready, the concept was sound, but the client wasn’t ready. The response, more crickets. I laughed a little inside. Rookie mistake. In my enthusiasm for the new idea, I hadn’t made sure he was ready. Fortunately, the relationship and trust was strong enough to make up for it.

Working in any aspect of online counseling will create the need to innovate. While many have gone before you, there will be times when you will have to create new methods or procedures. Innovation

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is dangerous, messy and wonderful. It is accomplishing what others think is impossible and therefore is typically met with skepticism by those who hold a death grip on the status quo and are late adopters to technology. Looking around and seeing that no one around you is interested or in pursuit of these ideas can cause you to wonder if you’re crazy or a genius (or both). It can be rather lonely at times. Since there is natural resistance of change, we can expect the wary eye from colleagues and clients. Resistance is the biggest threat to innovation.

Don’t let them discourage you.

Try some new tactics and focus on the willing.

Innovators are rarely appreciated until their ideas are working perfectly or they’re dead. On that happy thought, consider the light bulb. You’ll recall that it was actually invented about 80 years prior to Edison by Humphry Davy in the early 1800s. Edison improved upon the idea to make it sellable. Online counseling is in a similar phase.

Today the key ingredients exist and the adopters are growing daily in numbers and clout. We just need to refine and persist to reach full potential.

The concept of telemental health existed years ago; however the conditions that will make telemental health the norm are just coming to fruition. Momentum is growing in the United States, Canada and around the world. There is growth in professional trainings and certification for distance counseling. The technology is ready. Over one hundred different technologies are specifically designed for telemental health. New Apps are developed just about every month for therapeutic intervention. Third party payers are funding online counseling, and many states

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are now mandating the same payment for video counseling as face-to-face care. The number of clients served is rapidly increasing as well. The U.S. Department of Defense, for instance, is on course to perform over 200,000 online therapy encounters in 2012.

It’s easy for early adopters to get intoxicated by the ability to provide services to people in rural settings, in prisons, and on military bases across the world, without leaving the office. New innovations like the texting idea will arise with each new technology on the market. For innovation in any practice to work, it must be aligned with felt needs and solve problems clients and colleagues have identified.

To overcome resistance to change and become the new norm, innovations should be delivered at a pace that can be embraced. The client may need to step slowly towards these ideas. They may need

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trial runs and easy exit plans to feel comfortable using the innovation.

Fair warning, sometimes, even the best presentation will not open the mind of the person who has determined to keep it shut.

Dichotomous thinkers will predict doom and dissuade you without experiencing the innovation or reading the research. Innovating in telemental health can be a frustrating a lonely experience as you wait

patiently for colleagues and clients to catch up. At the same time, the potential impact is so big and so important, we cannot help but try.

Jay Ostrowski is a Telemental health and marketing innovator with www.

BehavioralHealthInnovation. com. BHI created www. telementalhealthcomparisons. com to help professionals choose technology. He lives in Grand Rapids, Michigan, USA.

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Marketing Toolbox

Susan Giurleo

Many experts in online marketing proclaim that blogging is the secret to success.

Over the past 12 months I have done a personal experiment of sorts with my online marketing for my therapy practice: I have stopped blogging.

My website has a blog with several relevant articles to my specialty, but I have not updated those in over a year.

What I have found is that those articles are still a great marketing tool. People who didn’t know of my work previously, find the website, read the articles and call my office to make an appointment. The supposedly stagnant blog is still client attractive.

This outcome is reassuring that those of us who don’t have the time or inclination to write new blog content on a regular basis can still get a great return on several blog entries that have relevance and value for our ideal clients.

However, those who do enjoy writing can still blog regularly and attract clients as well.

Should you blog?

The appropriate answer to this question is, “It depends.”

When we start our website and are establishing our expertise online, it makes sense to have 60

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relevant, regular new content on your blog for search engines and to demonstrate your professional expertise.

After you have clients and some reputation in your niche, I think it is perfectly ok to dial back your blogging efforts.

If you decide to discontinue blogging, it will be important to place your BEST articles and posts at the top of your blog, so new visitors will see those first. I actually took down all of my weaker, less powerful content and just left 10 solid posts in my blog for new visitors to read. These articles were highly relevant to my ideal client, offered a great deal of valuable information and were optimized for search engine optimization.

What About Future SEO? Many people suggest that blogging is good for search engine optimization, so that people who search online for your type of business can find you in search more easily.

For most therapists the truth is that we won’t be found easily in search no matter how much we blog. Optimizing for your name, town your practice is located or specialty is worthwhile, but most often therapists’ online directories trump all small business SEO efforts because they are so big and spend significant money on optimizing

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To Blog or Not to Blog?

SEO for their members. The bigger the market you practice in (such as a large metropolitan area or a popular specialty) the less successful you will be at your personal SEO. Therefore, one shouldn’t feel too much pressure to blog continuously purely for SEO purposes.

Marketing Must Continue Even if you decide to slow down your blogging efforts, this does not mean you can stop marketing altogether. I still recommend a regular email newsletter be sent to people who opt-in to your email list and utilizing social media in some way to build a community and establish yourself as a

leader in your field. Of course, you can market in your community as well with other professionals and referral sources.

Ultimately, you must try several different marketing methods and measure your results to see which ones lead to the most referrals and new clients. Once you find the two or three that work well, do more of those and eliminate your time, energy and money on those that aren’t working well.

Marketing isn’t an exact science, but can be done successfully online and in the community with some creativity, patience and consistency.

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

T I L T M A G A Z I N E S u mmer 2 0 1 2

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Cinematic Sociology: Social Life in Film (2nd Edition) Jean-Anne Sutherland and Kathryn M. Feltey Cinematic Sociology is a one-of-a-kind resource that helps students recognize and critique sociological concepts as they appear in blockbuster Hollywood films.

In addition, it provides pedagogy for instructors who use film in their classes. . In this engaging text the authors take readers beyond watching movies and demonstrate how to “read” films sociologically. In the process, students are exposed to major substantive areas of sociology and encouraged to critically think about their social world. The book’s 27 essays from expert scholars in sociology and cultural studies explore the ways social life is presenteddistorted, magnified, or politicized- in popular film.

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99 More great articles about online coaching, online therapy and related topics!

99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology!

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