CYBERCOUNSELLING: The Use of Text Chat and Video to Effect Clinical Change

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CYBERCOUNSELLINGThe Use of Text Chat and Video
to Effect Clinical Change

• Lawrence Murphy
• Worldwide Therapy Online Inc.
• CCPA Conference
• May 16, 2013
• http//www.therapyonline.ca
• http//www.cybercounselling.com
• lmurphy_at_privacemail.com

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A Brief History of Therapy Online

• 1994 - founded by Lawrence Murphy and Dan
  Mitchell
• 1998 - Co-authored the first online ethical code
  with the NBCC
• 1998 - Published seminal work When Writing Helps
  to Heal
• 2009 - Publication in BJSW compares F2F and
  online
• 2013 COSCE assessment tool published in RSWP
• Developed secure encrypted e-mail, chat video
  and client management system (wwto.PrivacEmail.com
  )
• Provide certificate Cybercounselling training in
  collaboration with the University of Toronto.

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Online Ethics

• The USA PATRIOT Act
• allows federal agents to access routing
  information, pages visited, activities online
• allows investigation of email routing information
• does NOT require proof of wrongdoing
• Judge may NOT refuse.

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Online Ethics

• Having an email address on your website
• Tracing clients in emergencies
• Using email for booking appointments
• Who controls what the client says?
• Who is watching you?
• What will your insurance company say?

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It Just Crept In

• Mishna et. al (2012) Clin Soc Work J
• Clients tend to initiate more than social workers
• Slippery slope from administrative to
  therapeutic
• Privacy issues
• Intercepted email
• Sharing on Facebook or via twitter
• Boundaries become permeable
• A sense of inevitability.

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When is Online Counselling Indicated?

• The majority of face-to-face counselling issues
  are appropriate for online work
• People who are especially sensitive to the
  presence or judgment of others and who would not
  otherwise connect with mental health services are
  often very well served by eCounselling (Leibert
  et al., 2006).

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When is Online Counselling Indicated?

• People with physical, psychological or mental
  challenges
• Marginalised and disenfranchised people
• Those for whom we claim to offer services
• The right to treatment?.

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When is Online Counselling Contraindicated?

• Clients with mental health issues that involve a
  serious distortion in reality who are unmedicated
• Clients disclosing past sexual abuse for the
  first time (text only)
• Clients who are suicidal
• Risky for clients in a live-in relationship with
  ongoing violence.

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Theoretical and Practical Issues in Asynchronous
Work

• Anonymity
• Reply when youre ready
• A Permanent Record (C)
• Power and Empowerment (c)
• Lack of Tone and Non-Verbals (C).

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Theoretical and Practical Issues in Chat

• Loss of contact (V)
• Live communication means higher expectations for
  software (V)
• Speed of replies
• How long is too long to be typing?
• Spelling and grammar
• Guiding clients.

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Theoretical and Practical Issues in Video

• High bandwidth demands
• Hardware and software must be very good
• Where do I look?
• You are entering the clients home
• Whats on the wall?
• Was that violence on TV or next door?
• When does what become a clinical issue?.

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Recent Research

• Murphy et al, British Journal of Social Work
  (2009)
• Compared counselling clients engaged in either
  face to face or online counselling
• Difference in
• scores on Global Assessment of Functioning (0 to
  100 pre and post clinical assessment)
• and Client Satisfaction Survey.

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CSS

• My counsellor helped me feel comfortable in
  discussing my problems
• My counsellors efforts and suggestions helped me
  develop a plan for addressing my problems
• My counsellor had the skills and expertise to
  assist me with my concerns.

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Results

• No statistically significant differences between
  the two groups for outcome
• No statistically significant differences between
  the two groups in terms of client satisfaction.

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Other Research

• Barak et. al (2008) Meta Analysis JTHS
• Online interventions showed an overall effect
  size of 0.53, comparable to F2F
• King et. al (2009) Video in opioid addiction
  treatment JSAT
• Comparable levels of satisfaction and compliance
• Online clients indicated a preference for online
  work
• Moessner Bower (2012) Email and eating
  disorders JMH
• 57.3 first time accessing professional help
• half of these reported that they engaged in
  additional services
• most would have not done so without the online
  service.

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Conclusions from Research

• The therapeutic alliance (TA) can be established
  in the media of online counselling
• Online counselling can as impactful as face to
  face counselling
• Online counselling may be an alternative or
  adjunct to face to face work.