TILT Magazine Issue 21

Page 1

volume 5, Issue TWO WINTER 2015

A Therapist and Coach


Guide To Encryption PAGE 13

Immersion & Disinhibition How the Internet Has Changed Our Learning PAGE 32

Pathways to E-Mastery

A Supervisor’s Guidebook

Marketing Toolbox, Wired to Worry Research Review and much, much more!


TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a publication published four times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 5, Issue 2, WINTER 2015 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Distribution Coordinator Sophia Zollman Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Thomas Tsakounis Associate Editor for CyberSupervision Cedric Speyer Associate Editor for Marketing Toolbox Judyth Brown Resident cartoonist Christine Korol

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

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

T I L T M A G A Z I N E w inter 2 0 1 5

Features 13 Immersion & Disinhibition How the Internet Has Changed Our Learning

24 A Therapist and Coach Guide to Encryption

32 Pathways to E-Mastery A Supervisor’s Guidebook

Issue in every

6 Research Review 10 Research Call 20 Wired to Worry FEATURE

32 CyberSupervision 40 New Innovations

44 Marketing Toolbox

46 For the Love of Books

A Note from the Managing Editors… Welcome (or welcome back!) to Therapeutic Innovations in Light of Technology. We are pleased to bring you the second issue in Volume Five, funded by you our readers through our Kickstarter campaign! So what do we have lined up for you?! John Wilson of OnlinEvents and Kate write about the great free webinar opportunities that online therapy institute in second life the company provide – and how attendance at these events online really do provide a convenient and fun way of meeting our continuing professional development needs. What we miss in the physical handshake with colleagues (and posh sandwiches) at in-room conferences and other events, we really do make up for in the witty banter and networking in chat rooms, where conversation and co-learning thrive! kate anthony

& deeanna merz nagel with the

Brian Dear of iCouch talks us through what using encryption really means for us – how it works – and the minefield of HIPAA compliancy. We are really pleased to have such experts writing for you on these essential issues in our therapy and coaching practices, and Brian also gives us a handy cut-out ‘n’ keep definition of both HIPAA and the Business Associates Agreement. Keep an eye out for the iCouch advert in this issue, and check out what his platform can do for you! Finally, we are featuring Cedric Speyer’s new CyberSupervision column with an introductory feature on the background to his invaluable contributions to the field and his approach to online supervision. Cedric illustrates his work with verbatim quotes from the people who have benefitted from the work at Canadian EAP Morneau Shepell, and we know that this and his future columns will be essential reading for all of us in the field of online counselling, coaching and supervision. As always, our regular columnists are here – a great co-authored Research column on the sexual exploitation of women via Information Technology; marketing tips on utilising Twitter; new innovations in the apps world – and of course our resident cartoonist Christine Korol! Best wishes to all of you and happy reading!

Managing Editors

T I L T M A G A Z I N E w inter 2 0 1 5

TILT – Therapeutic Innovations in Light of Technology

Research rev

Sexual Exp via Informa O

nline technology is not the cause of sexual violence; however, it is reported that online technologies are increasingly being used to sexually exploit women (Hess 2014). While much research has focused on the experiences of children and young people, this column offers an overview of key research papers and articles on the sexual exploitation of adult women via information technologies. Sexual exploitation is defined here as referring to practices by which a person achieves sexual gratification or financial gain through the abuse or exploitation of a woman’s right to dignity, equality, autonomy and physical and mental well-being (Hughes 1999: 1).

Overview of Findings A number of articles have considered this issue in the context of cyber-bullying or stalking (Salter & Bryden, 2009; Perry 2012), highlighting an increasingly sophisticated use of technology, anonymity and the construction of identity online, and the



shortfalls of current legislation. Concerns about women’s experiences online (Ending Violence against Women Coalition, 2013) and so-called revenge porn (Scottish Women’s Aid, 2013) have been raised by organisations working to end violence against women and girls. Briefing papers and the media have increasingly begun to report intimate images of women being posted across social networking sites. A UK think tank, DEMOS, highlighted the misogyny women experience on social media sites such as Twitter, reporting that women consistently experience more abuse online than men (DEMOS, 2014). Feminist analysis provides the most comprehensive body of work and incorporates a gendered analysis of violence showing how technology such as live streaming, greater interactivity amongst users and file transfer protocols are just some of the ways information technologies are used to sexually exploit women by trafficking and disseminating increasingly violent images and films across the globe (Hughes, 1998; 2002; Maltzahn, 2006). Writers also point to the availability of violent porn on the internet leading to a porn culture (Dines, 2010). Research as far back as

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by Foziha Hamid and Stephen Goss

ploitation of Women ation Technology 2002 (Gossett & Bryne) used various search engines to locate so-called rape sites using coding methods to establish categories and themes, highlighting the increase in the use of violence and degrading practices. The demographics show the increase in the older age range of users of all top social platforms (GlobalWebIndex, 2014) and with up to 36 million adults in the UK accessing the internet every day (Office for National Statistics, 2013). This raises the question of the experiences of women in the general population. Much of the research uses analysis of social networking sites and experiences in victimisation (Henson et al., 2011) and looks at issues of consent when posting or sharing sexual images even where there has been a sexual assault (Powell, 2010). A major research project on technology-facilitated sexual violence and harassment is currently being undertaken in Australia (Henry & Powell, 2014) and has produced a number of articles that move away from women blaming to view this in the context of gender based violence, Beyond the ‘sext’: Technology facilitated sexual violence & harassment against adult women; The Dark Side of the Virtual World.

Women have not remained passive bystanders and have begun to organise themselves in order to challenge abuses of women’s rights online. In 2005, and in a subsequent study in 2011, the international Association for Progressive Communications (APC) offered one of the few comprehensive explorations of the intersection between online technologies and violence against women. The 2011 study drew on analysis and data of twelve national reports and international documents, conventions and treaties. The work of the APC is complex and seeks engagement across the globe with marginalised communities creating digital environments for women and girls to express the narrative of their experiences. They have been able to identify some key features of the abuse via information technologies, some of which are: re-victimisation through the sharing and uploading of images and film; the anonymity of abusers; and ease of propagation (Feminist Africa, 2013). The most recent study APC published is Technology Driven Violence Against Women in Pakistan (2014), a qualitative investigation detailing three case studies involving different forms of sexual exploitation using technology



TILT – Therapeutic Innovations in Light of Technology

Research review

co n t inu e d

complex and multiple ways in which information technologies can be used in relation to sexual violence. They also highlight the profound harm caused at personal, professional and psychological levels (Citron & Franks, 2014). The field of therapy has begun to consider the impact on victims of online exploitation and continues to do so with contributions such as that by Whittle et al. (2013) whose qualitative studies demonstrated the cyclical nature of grooming behaviours and identify specific risk factors specifically related to prior vulnerability.

Conclusion The review of the literature highlights the need for further research in this field as online technologies are increasingly part of the structure of everyday lives. It is critical to understand the notion of cyber boundaries and how women negotiate space in the cyber world (Halder & Jaishankar, 2011; Hess, 2014).n Please send reports of research studies, planned, in progress or completed, to the TILT Editor at info@onlinetherapyinstitute.com

and social media sites such as Twitter and Facebook. In all three cases a common theme was how the use of technology compounded the abuse the women experienced. The case studies provide an insight into the social context of the women’s experiences which could transfer to any part of the world. Recent debates on the criminalisation of so called revenge porn have put forward the



Stephen Goss, PhD, is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK. He is also Co-Editor (Counselling) of the British Journal of Guidance and Counselling (BJGC) (http://about.me/stephengoss).

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references Allerman, J. (2002) Online counselling: The Internet and mental health treatment, Psychotherapy, 39, 199209. Anthony, K (2000). Counselling in Cyberspace. Counselling Journal, 11(10), 625-627 Citron,D., K. and Franks M, A. (2014) Criminalising Revenge Porn. Wake Forest Law Review, Vol. 49, 2014, 345-391. Dines, G. (2010). Pornland: How Porn has Hijacked our Sexuality, Boston: Beacon Press. End Violence Against Women (2013). New Technology: Same Old Problems, End Violence Against Women Coalition, London. (Last accessed 10th July 2014) Fascendini, F. & Fialova, K. (2011). Voices from digital spaces: Technology related violence against women. Association for Progressive Communication. Feminist Africa. (2013) e-spaces: e-politics. Issue 18 December 2013 page 91. Cape Town: African Gender Institute. Global Web Index http://blog.globalwebindex.net/google-in-depth/ Accessed 10th October 2014 Gossett, J.L., & Byrne, S. (2002). Click Here: A Content Analysis of Internet Rape Sites, Gender & Society, 2002; 16; 689-709 Halder, D., & Jaishankar, K. (2011). Cyber Crime and the Victimization of Women: Laws, Rights and Regulations, India: Manonmaniam Sundaranar University. Henson, B., Reyns, B.W., & Fisher, B.S. (2011). Security in the 21st Century: Examining the Link Between Online Social Network Activity, Privacy, and Interpersonal Victimization. Criminal Justice Review vol. 36 no. 3 253268 Henry, N., & Powell, A. (2014). Beyond the ‘sext’: Technology-facilitated sexual violence and harassment against adult women. Australian & New Zealand Journal of Criminology, 0004865814524218. Henry, N. and Powell, A. (2014). Chapter 5 ‘The Dark Side of Virtual: Towards a digital sexual ethics’, in Henry, N. and Powell, A. (eds). Preventing Sexual Violence:

Interdisciplinary approaches to overcoming a rape culture. Palgrave Macmillian; Basingstoke, UK. Hess, A. (2014). Why Women Aren’t Welcome on the Internet. Available online at: http://www.psmag. com/navigation/health-and-behavior/women-arentwelcome-internet-72170/ (Last accessed 2 June 2014). Hughes, D.M. (2002). Use of New Information and Communication Technologies for Sexual Exploitation of Women, Hastings Women’s Law Journal, 13(1): 129– 148. Kee, S.M. (2005) Cultivating violence through technology? Exploring the connections between information technologies and violence against women. Women’s Network Support Program: Association for Progressive Communications. Kelly, L. (1988). Surviving Sexual Violence, Feminist Perspectives, Cambridge: Polity Press. Maltzahn, K. (2006). Digital Dangers: Dangers Information and Communication Technologies and Trafficking in Women, AWID and Women’s Networking Support Programme, APC WNSP. New Technology Same Old Problems (2013). Report of a roundtable on social media and violence against women and girls co-hosted by the End Violence Against Women Coalition and The Guardian, July 2013. Perry, J. (2012). Digital Stalking: A Guide to Technology Risks for Victims, Network for Surviving Stalking and Women’s Aid Federation of England. Powell, A. (2010). Configuring Consent: Emerging Technologies, Unauthorised Sexual Images and Sexual Assault, Australian and New Zealand Journal of Criminology. Vol. 43 no. 1 76-90. Salter, M. & Bryden, C. (2009). I Can See You: Harassment and Stalking on the Internet, Information & Communications Technology Law, 18(2): 99–122. Stop Revenge Porn (2013). A Scottish Women’s Aid Briefing. Whittle, H.C. Hamilton-Glachritsis, C., & Beech, A.R. (2013). Victims Voices: The Impact of Online Grooming and Sexual Abuse, Universal Journal of Psychology, 1(2): 59–71



TILT – Therapeutic Innovations in Light of Technology

Research Call

Ulrika Bladh is a student at Ersta Sköndal College University in Sweden who is studying to become a licensed psychotherapist, and who is now looking for participants for her thesis. The aim of the study is to examine psychodynamic psychotherapist’s experiences of performing psychodynamic psychotherapy via videoconference. The interviews will be conducted via Skype in January/ February

Ritika Sukthankar is a Counselling Psychologist in Training in her final year at the University of Surrey. As part of her doctoral thesis she is researching the experience of therapists who have practiced online chat therapy. In particular she is interested in the quality of the therapeutic relationship and the role of nonverbal communication, embodiment and intersubjectivity. She is currently looking for participants (therapists) to take part in her study. Participants will be interviewed for around 50 mins over the telephone or Vsee.





+46 703033844.

Ebrahim Alvandi is in the process of completing a PhD degree in Psychological Studies at Monash University. As part of a larger PhD project investigating a number of aspects regarding the provision and efficacy of tele-counselling, his survey aims to explore how widespread telecounselling is in the world and Australia, and the mechanisms by which it is provided. If you are currently providing or advertising online or tele-counselling services you can help in the research by answering a series of questions. IF INTERESTED IN PARTICIPATING: https://monash.az1.qualtrics.com/jfe/preview/SV_0uff6UOHoT3oEDj



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Immersion Disinhibition How the Internet Has Changed Our Learning

John Wilson and

Kate Anthony

TILT – Therapeutic Innovations in Light of Technology

For those of us in the talking therapies who have spent time and money training and developing ourselves to help create and maintain whole human relationships, the idea of continuing our professional development on our own using an electronic device seems like a long way from the heart of our profession’s core intentions. Yet that is what more and more therapists and coaches are choosing to do, and it is worth stepping back to consider the hows and whys of these learning experiences. When in private practice, the time spent on travel is unpaid and someone has to foot that bill. In the 21st century travel is expensive at any time of the year, and included in the cost of any professional development is the cost of getting there, perhaps accommodation, and of course the need to return home. In addition, we live in times where we are much more aware of our carbon foot print - we are conscious that every mile spent traveling in a fossil fueled vehicle has an impact on our environment which is rarely covered by the money that we pay for the privilege. Diluting our impact on the environment by reducing the miles that we travel every year has got to appeal to our environmentally responsible consciousness. So from a practical point of view, the journey to a learning experience being the walk across the kitchen floor, or the wander down the hall into the office, saves countless hours of travel, eliminating the stress of moving around the globe and significantly reducing our carbon footprint. The financial cost need be measured only in the wear on the carpet and slippers and what we spend on internet connection and devices.

But still, is it going to be any good?



As therapists we are looking for a specific kind of learning experience. We are not accountants or bankers turning up at a conference for the latest legislation or the most up to date tools to increase profit margins. We are practitioners who embarked on a vocation with a desire to connect and be part of a profession which makes a difference to the lives of other human beings. When we come together to learn we are also looking for that sense of connection for ourselves.

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when we come together is that we are actually together. All those hours in practice rooms with clients can feel isolating from other practitioners, especially in private practice when most of the people we would see in a working week are coming to us for assistance. So we need that time together to be nourished by each other. Is that really replicable online?

...the idea of continuing our professional development on our own using an electronic device seems like a long way from the heart of our profession’s core intentions. We recognise that there is a place for cutting edge research, we want to know what our colleagues are developing in other parts of the field, and we want to take home new ideas for our own practice and meet the amazing people that we have the privilege of working with. But in addition, we need something for ourselves, to be nourished in our own work - we need food for our souls. Is it really possible to get that sitting on our own, in our own environment, in front of our electronic devices? This is the question John and Sandra have been engaged with at OnlinEvents, now in its sixth year of streaming events live to the internet. The team turns up at the conference with cameras and computers and the filming is then viewable on their website. So as you sit at your device you can see the speaker present, you can see their PowerPoint, and while there might be a ten second delay between the speaker talking and you hearing through your computer, you are pretty much keeping up with the event as it happens. But does it feel like you are actually there? You can hear it, and you can see it, but can you feel it? One of the most important aspects for therapists

To answer this question, OnlinEvents has been passionate about the presence of a chat room at our events. Having a passive television experience works fine when watching our favorite soaps or an exciting movie, but it will not give us the sense of connection that we need from learning experiences. The chat room is central to the experience of being at an event online and allows participants to see each other in a different way than is possible at a venue. It is a box on the web page next to the video window with a space to enter thoughts in the form of text, and as each participant does this there is an ongoing roll of text which looks similar to a play script. Each participants name shows up in the left hand side of the page, with whatever they have chosen to type next to it. The experience this creates is reminiscent of what John Suler describes in his work on the disinhibition effect. Suler proposes that when we communicate online we lose some of the inhibitions that are present when we are physically in the room with someone, such as the impact of our consciousness of our own body



TILT – Therapeutic Innovations in Light of Technology

shape or that of the other, the social conventions that we have absorbed throughout childhood, and the fear of how the others in the interaction are perceiving us. Being online, where we are not able to see the bodies of those we are interacting with and they cannot see ours, we are protected from the experience of seeing the other person’s reaction to us in their facial expressions and this allows us to be disinhibited in ways that we might find surprising.

which don’t need to be contained. These can be voiced in this text environment without an audible interruption to the speaker. For some of the more technologically advanced conferences, delegates in the conference centre are also able to contribute to the chat room during the presentation. The cross fertilization of ideas from practitioners located in the venue with those located in their homes or offices – or even on the train - around the globe is beyond exciting!

This has been the role of the chat room at the company’s online events. How many times have you sat at a conference and had a question for the presenter that you would love to ask, but to speak in front of a room of peers has felt overwhelming? Or to question a leader in the field, to offer him or her another perspective? When it comes from a deeply passionate and experienced place within ourselves, such interaction may feel like a cardinal sin in contradicting someone we might perceive to hold so much power.

And when presenters are also able to view and absorb the interaction from the chat room into their presentations there is a learning experience co-created by all who are present both in body and virtually. This represents an unprecedented learning opportunity for us to come together and inspire each other whether we are privileged to deliver our ideas as presenters, can physically and financially afford to be in the venue, are at home in front of our laptops or on the train with our smartphones.

The disinhibition effect changes those dynamics - suddenly the speaker is confronted with an audience they cannot see, and if you make a comment or ask a question no one can see you. You can type the question, maybe retype it, and even if it comes out wrong, no one can see you blushing! The narrowing of the gap between those of us who have been able to write and research and publish and present and those of us who feel small and without much to contribute is something the chat room has offered at our events time and again.

But that’s about the learning, we are still not talking about the nourishing. For many people, the need for contact at professional development events can sometimes be the hardest part of conferencing. We might see someone across the room, or even sitting next to us, that looks like they would be a good connection - perhaps they made a comment at a presentation earlier or we can see by their name badge that they represent an organisation or work in a part of the field that we would love to know more about – but making that first audible sound by way of introduction can feel terrifying.

The hushed silence of the conference centre is certainly not reflected in the chat room: as the presenter delivers we are all having continual reactions, thoughts, ideas and inspirations



The feedback that OnlinEvents have had from our events is that not being seen physically in the chat room has freed participants up to be much more

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in the field whatever our resources and experience. Having the option of turning up in the chat room with only the name that we have chosen to show our fellow participants is an experience that can free us to be who we truly are as practitioners and to offer ourselves to each other in a way that is less inhibited and therefore more nourishing.

The opportunity of not being excluded from these experiences is vital for opening access to all of us in the field whatever our resources and experience. themselves. This means being able to be more sociable, and to interact with other delegates in ways that they have never been able to in the years of professional development events they have attended in-room. Never having felt able to offer a question or a comment to a presenter, they find themselves able to fully contribute to the debate and the discussion, including feeling valued as part of a group of passionate, inspired professionals who are able to come together in diversity and openness to hear and learn from each other. And of course to be nourished in that contact! Here in the UK counselling is still predominantly the preserve of the white middle classes: those of us who are privileged enough to have life styles that produce enough time and resources to spend years training without the guarantee of income. But what does that mean for those of us that don’t have those resources, who are not from the social and ethnic groups that dominate conference events in large venues that have been built and then hired at great expense? What about those of us that that cannot access those events due to limited financial and physical resources? The opportunity of not being excluded from these experiences is vital for opening access to all of us

We have presented to you a vision of meeting online that is centered around the traditional conference experience – however, online environments open up many more possibilities. OnlinEvents have been working with Marty Jencius and Debra London of Counselor Education in Second Life (CESL) to deliver four annual Counseling conferences in Second Life. Second Life is an online virtual environment that to the uninitiated looks something like a cartoon world. Each participant has an avatar that they use to move around in the virtual world and then interact with others. You might have heard of similar environments like World of Warcraft where participants come together to collaborate and compete to achieve a goal. Second Life is different in that it has no game scenario and there is no goal for the participants, it is simply a place to exist, and for that reason it lends itself well as an environment for collaboration, development and learning. At the four Virtual Conferences on Counselling organized by Marty and Debra, presenters have educated us from the all over the globe, and many



TILT – Therapeutic Innovations in Light of Technology

of them are counseling educators themselves and have logged into the conference in between teaching classes or faculty meetings to bring us their research, to offer their unique perspective on the field and to bring new and inspiring ideas to the participants. This means that catching the expertise of the presenters without costing any travel time, no travel cost and of course no travel stress is possible. And to do this in a window of opportunity in the presenter’s day without any need to cancel classes creates a unique opportunity to bring together an international pool of expertise using very little resources. The disinhibition effect is definitely experienced in Second Life: participants are able to shape and dress their avatars in ways that reflect themselves, their personalities and of course their mood at the conference. The opportunity to connect with practitioners from around the globe in an environment where no one has had to expend travel resources or needed to be able to afford expensive hotel costs is an incredible leveler and creates an environment that is open, friendly and nourishing! Attending an online professional development event is not like being at the venue: for humans, nothing quite replaces that body to body experience and mostly being in a venue where there are many bodies coming together to create an atmosphere that is electric, moving and inspirational all at the same time just isn’t possible online. To be truly nourishing the environment has to be right, and as a practitioner who is passionate about Carl Rogers’ theory around the therapeutic conditions vital in relationships that



About the authorS John Wilson runs onlinevents, a place to combine his skills as a therapist, trainer and facilitator in new and exciting ways. He is in private practice in West Lothian and online, and is also responsible for business development and a tutor at Temenos Education Ltd. He can be contacted at john@onlinevents. co.uk. Kate Anthony is CEO of Online Therapy Institute Europe Ltd and comanaging editor of TILT Magazine.

produce change, John also thinks this holds true online. At OnlinEvents they often need to struggle with the technology as computers work and don’t work in ways that no human can fully understand! There is the time pressure to set up in venues they don’t know and of course they have the stress of the journey instead of you. But their primary attention and their most passionate energies are aimed at the chat room: it is absolutely vital that the environment is as right as it can be for participants to arrive and experience a feeling of mutuality, of shared respect and an openness to be who we truly are together. And it is in that environment, whether we are present together with our bodies, or we are sitting in our homes, offices or on the train, we are together learning and being nourished to continue to offer the kinds of relationship to our clients that changes the world we live in. n

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

Kate Anthony, MSc, FBACP

Online Therapy Institute

DeeAnna Merz Nagel, LPC, DCC

Online Therapy Institute

Stephen Goss, PH.D., MBACP

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

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

Order Online at:

www.ccthomas.com TILT MAGAZINE WINTER 2015


TILT – Therapeutic Innovations in Light of Technology


Surviving Social Media Shame PART 2

Christine Korol

When Leon Festinger first proposed Social Comparison Theory in 1954 he couldn’t have imagined the extent to which the Internet was going to make it easy for us to decide how we measure up. Generally, we evaluate others on the basis of such things as money, attractiveness, intelligence and then decide for ourselves whether we are keeping up with the Joneses. Mitigating the damage of these comparisons can be challenging as people often internalize ideal images as the norm. We are also more likely to compare ourselves to those we view as similar to us in terms of age, sex, ethnicity and various other qualities. If, for example, we happen to be an 18-yearold female college student,



we are more likely to compare ourselves to other 18-year-old female college students, not a 62-year-old male accountant. Although media images can distort our view of the world, there is evidence that people can be inoculated to their impact by educating them about how those images are unhealthy and unattainable without abnormal effort. If we can highlight the differences between ourselves and the targets of our comparisons and we can cut ourselves some slack. Keeping this in mind, social media comparisons have the potential to be especially damaging because we end up comparing ourselves to friends we see as similar to ourselves. Therapists need to point out to their clients that what they are viewing

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online is a selective (and sometimes distorted) version of that person’s reality. Friends aren’t posting the huge credit card bill after that fun trip or unflattering pictures of their muffin tops after putting on a few pounds during the holidays. It’s surprising how many people forget this point and it can be a helpful reminder to not take social media postings so seriously. With skeptical clients, ask them to review what they have posted online and if that presents a full picture

of their own life. If their status updates and tweets present a selective picture of their own life ask them what the chances are that others are doing the same. Offline conversations with friends can also be helpful at obtaining a more balanced view of what is actually happening in their lives. Although most of us paint a rosy picture of our lives online, everyone struggles. Happiness comes from letting go of social media comparisons and living the life that is right for us.n

ABOUT THE AUTHOR/ ILLUSTRATOR: Christine Korol, Ph.D. is a psychologist in Inpatient Psychiatry at Vancouver General Hospital. She is also developing the new Kelty Online Therapy Service at Vancouver Coastal Health, set to launch in early 2015. You can find more cartoons, blog posts and tips for managing anxiety on her blog wiredtoworry.com.



TILT – Therapeutic Innovations in Light of Technology



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True or False If you use an encrypted email service to send emails to clients, you are in compliance with HIPAA. o True

R False

Skype is a HIPAA compliant video therapy solution because it uses encryption. o True

R False

TILT – Therapeutic Innovations in Light of Technology

Confused? You aren’t alone! Encryption, digital privacy and HIPAA are minefields. However, rather than pulling the plug on the wonderful tools that empower you to deliver better care to your clients, understanding the basic concepts behind encryption and digital privacy will give you the confidence to fully leverage technology to supercharge your productivity as well as improve the client experience. This guide is not meant to be legal advice; if you are uncertain about the laws in your jurisdiction, consult an attorney.



The exponential rise in digital communications and the seemingly endless digital tools for therapists and coaches brings both amazing opportunities to enhance client care but also serious consequences if misused. The digitally enabled therapy practice is the future. There’s no escaping it; clients expect to interact with your business the same way they expect to be able to order books from Amazon. Land-line phones are disappearing. Phone calls are often viewed, especially by Millennials and the younger

Generation X crowd, as intrusive annoyances. Mailing a check is as anachronistic as a house call. Telemedicine has gone mainstream with huge investments from Silicon Valley, insurers as well as governments. Welcome to the future. There are two extremes of opinion regarding the digitally enabled therapy practice. There are the Luddites, the ones who still use paper schedules, telephone calls and don’t even have an email address, web profile or other digital presence. Then, there are the early adopters. These are the therapists and coaches who were pioneering Second Life therapy, using video, as well as other tools like cloudbased practice management software. These will be the ones embracing virtual reality therapy. These technopractitioners agree that the digital tools are worth the apparent risk because the benefit to the client outweighs downsides. The anti-tech constituency views the issue from either a position of

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fear, ignorance or tradition. Regardless of where you fall within the spectrum, the digital landscape for medical and behavioral health can be overwhelming.

Dispelling the Myths “If I use an encrypted email service or if I have a Business Associates Agreement with my email provider, I’m HIPAA compliant.” This is the prevailing wisdom among many practitioners, however it’s just not true. The problem isn’t your end of the transaction, it’s the clients side of things. To understand this, it’s important to understand how encryption and email services work.

A Gentle Introduction to Encryption Encryption is nothing more than converting a message into a secret code. Decryption is the opposite. Some of you might remember secret encoder rings in cereal boxes that let little kids code and decode messages. With digital

information such as a computer file or email, encryption works the same way as those encoder rings. The bytes that make up the message are scrambled into a pattern that can later be unscrambled if you have the key. Think of a needle. When you place it on your desk, it’s easy to find. Anyone can walk over and view your needle. It’s insecure. Now, place that needle carefully in a haystack, but create a precise diagram depicting exactly where it’s located. Your needle is now “encrypted” and the map is the key. Without the map, that needle is lost forever. If you keep the map locked in a desk drawer and the key to that drawer was sitting next to your keyboard, it would be very easy to simply open the lock, steal the map and find your needle. The weak link in this situation is the key to the desk lock, otherwise known as a password. The strength of the encryption (the massive size of the haystack,) isn’t the problem, but the weakness in the password. Now imagine if you used the same key for all of your important hiding places! Let’s extend our needle in a haystack example to the

situation where you need to transmit that needle, in this case an email to someone else. When you send the encrypted message, the entire haystack is sent to your recipient. However, what about the map? Without the encryption key, the recipient can’t read your message. However, you can’t send your map — then anyone could open your message. So what do you do? Using a system call Public Key Encryption, it’s possible to send the message without revealing the “map.”

Public Key Encryption If Sandra wants to send an encrypted message to Dwight, Dwight provides Sandra something called a public key. This is digital file that describes how to encrypt something. It tells Sandra how to encrypt the message. This public key has a corresponding private key. Only Dwight has the private key. So Sandra can encrypt the message, but only Dwight can decrypt the message. The limitation to this approach is that it requires the participation of both people. Sandra would need to know Dwight’s public key. Dwight would have to



TILT – Therapeutic Innovations in Light of Technology

have a public key in the first place! Encrypted email solutions solve this problem by handling this automatically — however, it only works if both people use the same service. It would be impractical to require all of your clients to use your particular email provider. So what you have is a situation where your “encrypted” email isn’t actually encrypted at all. The storage of it might be encrypted, but once you’ve sent it — it’s out there in the open. If it were encrypted, your client couldn’t read it!

It Gets Worse… If you’re using an encrypted email service and you send a message to a client who uses the free version of Gmail (which is the vast majority,) then when that message arrives on Google’s servers, it’s scanned and harvested in order to provide contextual and target advertisements — not just within the Gmail application, but among the entire Google ad network! If you sent a client an email reminding them to take their lamotrigine or sent them an email mentioning hospitalization options, then suddenly as they’re surfing the web, targeted advertising 28


appears relating to hospitals, depression, bipolar disorder and treatment facilities. Imagine if their spouse or friends used their computer… This all happens regardless of how “secure” your particular email account happens to be. Imagine if you were counseling the client about a sexually transmitted disease or some other potentially sensitive issue. Some types of Gmail accounts, specifically Google Apps for Business do not use this email scanning system. However, unless the client is the administrator of that business, their emails might be subject to monitoring by their employer.

What Can You Do? While communicating with clients by email shouldn’t be eliminated, there are ways you can ensure your obligations both ethically and under HIPAA. If a client emails you, they are the furnisher of the health information. You aren’t held responsible for what they send you until you receive it. If you are using a free Gmail account, it’s strongly encouraged that you not use it for client communications, ever. If you are using Google Apps for Business, they do offer a BAA, however, that only extends to the storage of your email on

BUSINESS ASSOCIATES AGREEMENT A Business Associates Agreement is simply a document provided by a technology provider that guarantees their compliance with HIPAA and other related laws. This document essentially states that they represent that they comply with the relevant laws. By having this document, you are not responsible if their system has a failure that violates the law. However, you are not protected if your misuse of the system resulted in a privacy violation. For example, if you shared your password — you’d still be on the hook for a health privacy law violation since it was your negligence that resulted in the data being improperly exposed.

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their servers. There are several great providers of encrypted email providers, use one, but remember that only the email stored within your account is covered, not what you send to clients. Email is an important tool for therapists and coaches, however don’t be seduced into a false sense of security simply because your provider claims encryption. For email encryption to work, both parties of a message must use it. However, encrypted email services are valuable because you always want to ensure your messages are encrypted when in your possession (i.e. on your email provider’s servers.) Be cautious of what you email to clients and never include their original message when you reply to their email since once you send the message, you are now the provider of the information. When they send the message, they are the provider.

What About Video Therapy? Video therapy is one of the most important technological innovations in therapy. The benefits are well researched and documented, however

the privacy and security implications are muddled. Video therapy is generally very secure. Nearly all platforms use encrypted connections and the video stream itself is encrypted during transmission across the internet. However, there are still some significant concerns, not with the video itself, but with the platform itself.

Skype is Not HIPAA Compliant Skype has been a therapist and coach favorite for several years. Cheap, nearly ubiquitous and generally reliable. However, Skype is not HIPAA compliant. The first indicator is that Microsoft (the owner of Skype) does not include Skype within its BAA. Since there is no way to obtain a Microsoft BAA for Skype, it is not compliant. Microsoft is effectively saying that they will not guarantee Skype’s compliant with the security practices and data encryption requirements of HIPAA. If they won’t guarantee it, then any therapist or coach using it would be willfully violating the law. Another problem with Skype is that, despite claimed encryption, chat transcripts

What is HIPAA? The Health Insurance Portability and Accountability Act of 1996 is an American law that protects health insurance coverage for workers who change jobs as well as dictates administration standards for health care administration. Title II of the law concerns the Privacy Rule which is the section of the law that regulated the use and disclosure of Protected Health Information. The Health Information Technology for Economic and Clinical Health Act (HITECH Act) is a companion law that was passed in 2009. The HITECH app expands on the privacy protections of the HIPAA privacy rule. It sets requirements for notifications in the event of a data breach among other significant privacy protections. It also includes expanded provisions for Electronic Health Records implementation and meaningful use.



TILT – Therapeutic Innovations in Light of Technology

are stored on Skype servers. By looking at your own Skype conversations, you can see months of chat history — all stored on a platform that isn’t HIPAA compliant. There are records of who you talked to and for how long — all egregious violations of patient privacy since that information isn’t guaranteed secure, nor do you have a BAA protecting you from legal exposure in the event of a Skype data breach. However, the good news is that there are a variety of HIPAA



compliant v i d e o therapy platforms available that will sign a BAA. The best ones require no downloads and can work with a wide range of connection speeds. Do your homework w h e n choosing a platform. The most important thing is that your provider be willing to provide a BAA and the platform

be easy to use to ensure the widest accessibility for your clients.

Looking Forward The digitally connected therapy practice is a reality that is improving client outcomes, improving your business and making quality treatment more accessible. However, with great power comes great responsibility. Be aware of the limitations of your tools. If you’re interested in formal training on digital therapy, as recommended by most professional organizations, the Online Therapy Institute offers this through their various courses designed to suit you.

About the Author Brian Dear is a software engineer and the cofounder and CEO of iCouch, Inc., a digital platform for therapists. He has been involved with the digital therapy community for the past 5 years creating iCouch.me with his therapist wife and cofounder Jessica Dear.

Learn How Technology Can Enhance Your Reiki Practice! http://onlinetherapyinstitute.com/reiki-training/

Certified KYBERNETES MasteR Reiki Master

Offering Quality Continuing Education and Professional DevelopmenT

TILT – Therapeutic Innovations in Light of Technology

Editor’s note Welcome to Cedric as our new CyberSupervision columnist! Here, we welcome him with a feature article introducing his methods and approach.



Cyber Supervision

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Pathways to E-Mastery: A Supervisor’s Guidebook “Words can sometimes, in moments of grace, attain the quality of deeds.”

“I feel as if someone has put an arm over my shoulder and is talking with me.”

“I usually focus on client strengths from the beginning of the correspondence, as well as touching upon inner and outer resources to help the client deal with their life predicament. We go through some reframing and explore solution-focused perspectives. Yet it all begins with the joining and the feeling of ‘I am with you… I sense your pain and struggle… yet I perceive something else about you… let’s walk through this together.”

E-Counseling client

Dr. John Yaphe, E-Counsellor

Elie Wiesel



TILT – Therapeutic Innovations in Light of Technology

Welcome...to the first instalment of a new series of TILT supervision columns. First of all, I would like to pay tribute to my predecessor Anne Stokes, for the quality, dedication, and consistency she brought to this column. As the mantle is passed to me with guest appearances by my cosupervisor Michele Mani, I would like to thank Anne for the foundation she laid. Of course, my voice and approach will be a different one. I won’t try to emulate Anne which would just make you, the reader, miss her all the more. I never could adjust to Piers Morgan replacing Larry King, and hope the analogy doesn’t hold ;-) So subsequent to this introduction, I will be offering generic examples and excerpts from online supervision demonstrating the best practices we have discovered over 15 years and counting… while guiding E-counsellors along the path to E-mastery, as I like to call it. In the spring of 2000, I was parachuted into (hired by) a major EAP company to be the pioneer of online counselling in an EAP setting in Canada. It was still relatively uncharted territory at that time, yet equipped with a narrative perspective, short-term solution-oriented methods, and a love of letter-writing (asynchronous modality), I found a new ‘path and practice’ unfolding. These many years later, the anecdotal evidence of our success remains inspiring. Here is a typical example



of what our clients have experienced. “I have to admit that I was a bit skeptical at first. At the time I couldn’t see how this was possible and worried that this was another pop psychology answer to our instant oatmeal society. But I decided I didn’t have anything to lose. I was able to share thoughts and feelings that I know I wouldn’t have dared to express in a face-toface session. I had no idea it was possible to form a bond and a trust with someone based solely on the written word. Thoughts

and feelings just seemed to flow out of me in a way I never could have imagined. It was really like writing to an old friend… a really wise friend who knows when to challenge you and when to support you. I find myself missing his words and thoughts. Thankfully, I have past correspondences to rely upon. I was apprehensive about trying E-counselling but find it was the best move I ever made.” E-counselling client Yet in December, 2007, the following letter to the editor appeared in The Toronto Star

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in response to a feature article about the success of our online service. “I must admit that the whole concept of e-therapy makes me uneasy. If a patient is writing about his/her issues online, he/she can easily omit certain thoughts or feelings. Furthermore, the therapist does

not have the advantage of examining body language and tone of voice as the individual speaks. E-therapy might be part of a harm reduction strategy for those who flat out refuse to see a therapist face-to-face, but it’s not without risks. In general, it is much easier to distort the written word. Add mental illness to the

mix, and you have a potentially dangerous situation.” Yes, of course there are risks and we instituted a reliable risk management process according to the ethics of e-therapy. There is also professional due diligence for any “potentially dangerous situation”. Yet there is also



TILT – Therapeutic Innovations in Light of Technology

ample evidence of the quality of therapeutic alliance available online. The act of getting it down in writing, seeing it in print, or composing oneself is of great therapeutic benefit in itself. What might be lost from the immediate give-andtake of ‘live’ conversation can become a gain. The process is slowed down and with clients not ‘on the spot’, they have all the advantages of an introspective process that is still part of a therapeutic dialogue - a dialogue that takes place behind the scenes of appearance and personality in a shared space mediated by the third focus – the text itself. Both insight and catharsis are possible in the safest of environments as a window is opened to the thought and feeling processes on both sides of the computer. The textbased bonding that results includes the experience of telepresence, non-local presence, or the feeling of persons being next to each other, even at a physical distance. When this occurs in online counselling, clients routinely



use the language of face-toface encounters, e.g. “It has been really great talking to you.” Yet it’s more than talking. The text itself, the transcript of the correspondence, becomes a ‘transitional object’ facilitating self-compassion as the client internalizes the voice of the counsellor. Overall, the medium lends itself to a combination of intimacy and distance, a

clinical parallel to the discovery of balance between belonging and autonomy that is a theme common to many cases. The clients always express it best, and underlying the simplicity of the following comment is the depth of what the client means by “literally”. “Thank you for the beautiful e-mail. It literally touched me.

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I can feel how supportive you are just in one exchange of words - that’s what I want in a psychologist, and haven’t been able to find.” I’ve summarized the primary process because I view E-Counselling not just as a transfer of therapeutic skills to a different medium but as a new field of practice. This perspective naturally has an impact on the secondary process, namely E-Supervision. There’s a steep learning curve involved in developing the kind of text-based sensibility it takes for otherwise superb practitioners to transfer their talents to this medium. Those already working with us have showed the most promise in that direction. However they have all been subsequently surprised by what it takes in the challenging transition from the traditional ‘talking cure’ to the ‘writing cure’. As E-Counselling intake volume increased, so did the ‘E-team’ of E-counsellors. Due to the specialized skills needed, as well as the

heightened accountability and liability associated with written transcripts of online sessions, special attention was given to the recruitment, orientation and training of the E-team. When the service was launched and its credibility and safety had not yet been established, every case was closely monitored for quality assurance. Yet in keeping with developmental models of supervision, our program encouraged the evolving phases of increased counsellor autonomy. One of the constants to this day, however, has been that ‘hands-on’ supervision is always available and has the unique advantage of taking place mid-session. Counsellors can consult after the client has posted a message and before they respond. We’ve created a structure of accountability

that still applies and takes the form of three occasions for supervisory interventions: (a) clinically challenging cases needing supervisory support at intake and/or mid-case; (b) post-closure case review to refine online methods and consider different text-based approaches in the light of client feedback; (c) counsellor management support for modality specific procedures, protocols, policies and best practices. Case consultation can take place whenever an E-counsellor feels stuck, frustrated, unequipped or simply needing support on how to apply best practices to a particular case. Counsellors use case consults for immediate case management strategies as well as ongoing professional development. We take these

REFERENCE Yaphe, J. & Speyer, C., 2010. Using email to enrich counsellor training and supervision in Anthony, K., Nagel, D.M. & Goss, S. (Eds.). The Use of Technology in Mental Health: Applications, Ethics and Practice; Springfield IL; Charles C. Thomas, Publisher.



TILT – Therapeutic Innovations in Light of Technology

opportunities to enhance typical skill sets specific to the modality: the need to pay close attention to the client’s text; intuitive assessment without overdoing diagnostic questioning; practicing clientfriendly language and ‘voice’; maintaining a consistent online framework and parameters; reading between the lines for what is absent yet implicit in the text, i.e. what clients are not saying; mastering the nuances of tele-presence and feeling tone online, and leading the process without becoming didactic or falling back on psychoeducation which can take on a ‘counselling correct’ or pre-set ‘canned’ effect ( Yaphe & Speyer, 2010). With that professional ‘back

story’, here is a preview of things to come in this column as we open a supervisor’s guidebook to TILT readers. In training online novices, I always impress upon them that there are three ways of writing to a client. The first and least conducive to text-based bonding is when we write at the presenting problem with informed commentary on the nature of the issue (this is when clients might complain that they could gain the same from a textbook or self-help article). The second level of therapeutic writing is when we write to the issue, focusing mainly on the content of the client’s reported life situation, while investigating possible coping methods and potential therapeutic goals (this is when

ABOUT THE AUTHOR Cedric Speyer is Clinical Supervisor of E-Counselling for Morneau Shepell. As founder and pioneer of the Shepell E-Counselling service, he developed and implemented a short-term counselling model for online practitioners, edited the main textbook on the subject, and continues to engage in related writing and publishing, while serving as an e-therapy mentor.



the online exchange might sound like an advice column, consultation, or coaching session). The third and most advanced approach to creating the online alliance is when we are writing with the person behind the problem. We then position ourselves as coauthors of a bigger story in which the client can discover their growing edge under the circumstances or have a heroic role to play in what is first described as an intolerable life situation. We accomplish this by entering a shared narrative space from our side of the computer, where healing can take place as a result of an expanding point of view; when the client’s story and the E-Counsellor’s layered reading of it leads to a creative synergy producing new possibilities. We call it being in the zone and we know it from the energetic joining which is mutually felt, as if the client is in the room with you, and together you are exploring life-giving directions at the crossroads of their present predicament. n

TILT – Therapeutic Innovations in Light of Technology

Ne wInno vations

Apps: Technology Mental Health Re

Thomas Tsakounis

Those who facilitate healing understand the importance of empowerment. Working diligently to nurture, support and create an environment conducive to self-actualization is the goal in so many of those healing modalities. It would seem reasonable to include the mental and behavioral health modalities in these assertions and as a licensed clinical professional counselor I will address the rest of the article from that perspective. Alfred Adler was a pioneer in mental health in the late 1800s and developed the concept of social interest, which in a nutshell means that a person’s own health is deeply vested in their connection to the community.



While the concept was developed by him, the idea of involvement with community probably existed long before Adler. Those of us in the mental health community recognize that people need to be as engaged outside of the therapeutic session as they are in the session some may even argue that the client should be even more engaged outside the session. Many therapists would probably agree that in fact a bulk of the work is done outside of the therapeutic session. The challenge lies in getting the client to do that very hard work once they leave the office. I would dare say that many health professionals seek to empower their clients, as

well as share resources that help their clients achieve their long-term goals. It has long been a practice to literally share resources with clients as part of the therapeutic session. Resources have included: journaling; breathing exercise; mindfulness exercises; all forms of tapping techniques; books; yoga poses; aromatherapy; flower essences; exercise…; the list is practically endless. Interestingly, as technology has evolved so too have the resources, which are delivered to clients utilizing that technology. I practice in a suburban area just outside the USA’s capital and to demonstrate my point, I am sharing a list of apps, in no particular order, used by

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y Driven esources


some of the mental health professionals in this area. Next to each title is the cost of each app. 1. Stop Breathe and Think (free) 2. Calm (free) 3. Nature Melody (variety of 20 different sounds from nature - free) 4. Simply Being ($1.99) 5. Headspace (first ten - free, monthly fee thereafter) 6. Mindfulness App ($1.99 for the app and then a small fee for meditations) 7. Virtual Hope Box (not just mindfulness - free, upgradeable) 8. MentalWorkout (free, can upgrade) 9. Breathe2Relax 10. Insight Timer (free)

Some of the apps above have companion websites and some do not. Here is a list of websites that I visited and some notes: TaraBrach.com Tara continues to be an amazing resource and her website highlights this fact. Her website is incredibly rich with resources including meditations and Dharma teachings. Her recordings are akin to what a client might receive in a session where the therapist shares a guided meditation or visualization - in other words no music or nature sounds. A lot of free stuff, donations welcome!

mp3s, mindfulness apps for smartphones, and more. Calm.com Calm.com is exactly that a place of calm and simplicity. Free, easy to navigate and simply beautiful! Truly a favorite! HealthJourneys.com If you’re looking for an online store to supply your meditation needs then HealthJourneys.com is it. InnerHealthStudio.com This broad spectrum resource

MeditationOasis.com Great place for the beginner as well as the seasoned meditator! The site is chockfull of classes, compact discs,



TILT – Therapeutic Innovations in Light of Technology

About the Author is definitely a highlight of the website. They offer resources for kids and adults for issues ranging from anger management to panic, anxiety, stress, relaxation and so very much more. Coping skill worksheets are a nice addition and in my opinion invaluable. Most the resources on this site are free.



The resources mentioned here are in no way an exhaustive list. I encourage people to explore until they find the resource that feels right and meets your level of need and expertise. In the next issue we will take a look at other Apps that support the therapeutic process. n

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

TILT – Therapeutic Innovations in Light of Technology

Judyth Brown

Marketing Toolbox

GETTING TWITTER When it comes to social media for business, “I don’t get Twitter” is possibly the most common phrase I hear. And that’s not surprising, Twitter is an odd bird. The funny symbols, the character limitations and the almost alarming frequency with which people use it make Twitter a less than intuitive fit. But get past the initial strangeness and you’ll find a very effective, easy to use gateway into social media marketing. The path to Twitter success isn’t all that steep, if you keep a few things in mind.

u Twitter is a Tool You can use a hammer to open a can of sardines, but the results are pretty messy. The same is true for Twitter. Before promoting your business on Twitter, decide what results you want and how you’ll use the tool. You can engage your customers on Twitter and cultivate retweets to grow your influence. Maybe you’d like to connect with your competition’s clients to drive comparison shopping. Keep in mind as you plan that every marketing effort needs monitoring and engagement. As you cultivate a following,



Twitter can be fast paced and consuming. But the rewards are market insights in real time. It’s a very useful tool, provided that you understand the job at hand.

v Learn the Lingo Twitter is driven by patterns. People search their interests on Twitter using a relevant word or phrase. Some words are used so often that they come to represent a topic, and these are known as keywords. A hashtag # is a symbol that denotes a keyword. The @ symbol makes a word into a unique identifier, like a name. Using relevant keywords, hashtags and @ in your tweets makes you easier to find but don’t overdo it, use only 2 hashtags per tweet.

w Tweet Like You Mean It There are thousands of tweets every second, millions every day. Your chances of standing out in all that activity are slim to none. Best strategy here? Don’t try. If you want to capture the crowd, be yourself. Tweet about the business topics that interest you, lead with your passion. People of a like mind will follow you.

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x Listen Before You Tweet.

z Get Off Twitter

One of the first principals of dating is that nobody likes the guy who’s talking only about themselves. And eventually no one pays attention to them. Get on twitter to listen to clients. Search for relevant keywords and hashtags and above all, let followers know you’ve heard them by retweeting their content.

If Twitter is your first touch point in a sale you can tweet the path to closing. Tweet your company newsletter, a link to your Facebook page, a landing page for special offers or event registration. When it comes to client/vendor interaction the possibilities for a relationship of more than 140 characters are endless.

y Follow and Be Followed The unwritten rule of Twitter engagement is; if I follow you, you follow me. So follow other people often. The same rule applies to favorites and retweets. Favorite and share other people’s content and they’ll at least want to know who you are.

ABOUT THE AUTHOR Judyth Brown is Digital Media Strategist for Walkabout Media Enterprises, and is based in New Jersey, USA.



TILT – Therapeutic Innovations in Light of Technology

Love For the of


v oks o b e h t read y l g, n n o i d u a o e y r f I “ lse is e e n o y r that eve only think what g.” n i k n you can i h t e is s l e e n o every akami

i Mur k u r a H ~





British Journal of Guidance and Counselling Volume 43, Issue 1, 2015 Symposium On Online Practice in Guidance and Counselling Edited by Stephen Goss and Tristram Hooley Deidre Hughes, co-editor of the symposia series, states: “This make an important contribution to research and practice issues related to the application (or otherwise) of technologies in the fields of guidance and counselling.” Deidre’s overview of the academic contributions: Goss, S. & Hooley, T. Symposium on online practice Bimrose, J., Kettunen, J., & Goddard, T. ICT the new frontier? Bright, J. If you go down to the woods today you are in for a big surprise: seeing the wood for the tress in online delivery of career guidance Anthony, K. Training therapists to work effectively online and offline within digital culture


Kettunen, J., Sampson, J., & Vuorinen, R. Career practitioners’ conceptions of competency for social media in career services Richards, P. & Simpson, S. Beyond the therapeutic hour: an exploratory pilot study of using technology to enhance alliance and engagement within face-to-face psychotherapy Gillat, I & Reshef, E. The perceived helpfulness of rendering emotional first aid via email Buffini, K.B. & Gordon, M. One-to-one support for crisis intervention using online synchronous instant messaging Rodda, S.N., Lubman, D.T., Cheetham, A., & Dowling, N.A. Single session web-based counselling Nieuwboer, C.C., Fukkink, R.G., & Hermanns, J.M.A. Single session email consultation for parents Haxell, A. J. On becoming textually active at Youthline, New Zealand Lekka, F., Efstathiou, G. & Kalantzi-Azizi, A.K. The effect of counselling-based training on online peer support

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

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