Online Counseling

Online Counseling

Online counseling is a growing phenomenon, and like most things internet, depending on your experience with the computer and the medium, you are enthused about the potential or aghast at the issues.

A good friend of mine, an M.D., told me that his significant other, a library sciences professional, is preparing for a future where libraries are online, on a server somewhere.

I know that law schools are ranked at this stage of the game by the footage and/or number of volumes in their libraries, so the traditionalists in the law library sciences will probably not like the changes coming to this field, for example.

Traditionalists in the counseling field are probably the same.

I know that as I watched a good friend of mine increase the number of telephone sessions that she did, I experienced some dissonance around the inability to see subtle nonverbal behaviors, but my reading of research has reassured me that when I cannot see a client, I become more attuned to subtle changes in intonation, almost like my visual cortex begins to work with the auditory centers in the brain, and that is just what happens.

But if you are a legislator responsible to your constituents for a budget, and you can save dollars by building virtual libraries and selling the old buildings, as beautiful as they are, or perhaps selling a college campus to cut overhead, if all those classes can be done online, do you not have to advocate for virtual libraries and campuses?

I believe that online counseling is going to happen now and fast, and initially it will outstrip the ethical standards built around a counseling practice based on face to face contact.

I believe that technological innovations like Google Wave will put group therapy online, especially for folks in the hinterlands.

But for now, the National Board for Certified Counselors has put together an ethical model for the Practice on Internet Counseling.

I think that their efforts should be applauded.

There are also efforts towards research to identify factors which make online counseling successful.

Advantages and Disadvantages of Online Counseling

Advantages over in-person therapy

Unlike other forms of counseling, online counseling is potentially free of certain constraining factors that affect traditional therapy, including geography, time, duration, and cost, making this form of counseling more accessible for a number of people who would be unable to attend traditional psychotherapy. It also provides a degree of anonymity that is comforting to some participants, reducing the intimidation that some people may feel at the prospect of seeking treatment with a traditional in-person therapist and encouraging disclosure.

Disadvantages over in-person therapy

Being physically present with your counselor may help you feel more connected with him or her; an online relationship may contribute to "distance" in the therapeutic relationship. Some people feel safer letting themselves become emotional in the physical presence of another person.

Because the client often participates from a location that is part of their day-to-day life, calls often center around, or are interrupted by, situational pressures that the person is currently immersed in. This can have both positive and negative effects on the counseling provided; by allowing the counselor some insight into the person's situation, the counselor can be more objective. Conversely, the disruptions and pressures of situational factors may make it difficult for the client to adopt a reflective state or maintain full focus on the counseling session.

The following materials from the National Board of Certified Counselors lays out the issues for online counselors to be concerned with and for consumers to ask about. It is great information.

From the National Board of Certified Counselors



NBCC

The Practice of Internet Counseling

National Board for Certified Counselors, Inc. andCenter for Credentialing and Education, Inc.3 Terrace Way, Suite DGreensboro, NC 27403

This document contains a statement of principles for guiding the evolving practice of Internet counseling. In order to provide a context for these principles, the following definition of Internet counseling, which is one element of technology-assisted distance counseling, is provided. The Internet counseling standards follow the definitions presented below.

A Taxonomy for Defining Face-To-Face and Technology-Assisted Distance Counseling

The delivery of technology-assisted distance counseling continues to grow and evolve. Technology assistance in the form of computer-assisted assessment, computer-assisted information systems, and telephone counseling has been available and widely used for some time. The rapid development and use of the Internet to deliver information and foster communication has resulted in the creation of new forms of counseling. Developments have occurred so rapidly that it is difficult to communicate a common understanding of these new forms of counseling practice.

The purpose of this document is to create standard definitions of technology-assisted distance counseling that can be easily updated in response to evolutions in technology and practice. A definition of traditional face-to-face counseling is also presented to show similarities and differences with respect to various applications of technology in counseling. A taxonomy of forms of counseling is also presented to further clarify how technology relates to counseling practice.

Nature of Counseling

Counseling is the application of mental health, psychological, or human development principles, through cognitive, affective, behavioral or systemic intervention strategies, that address wellness, personal growth, or career development, as well as pathology.

Depending on the needs of the client and the availability of services, counseling may range from a few brief interactions in a short period of time, to numerous interactions over an extended period of time. Brief interventions, such as classroom discussions, workshop presentations, or assistance in using assessment, information, or instructional resources, may be sufficient to meet individual needs. Or, these brief interventions may lead to longer-term counseling interventions for individuals with more substantial needs. Counseling may be delivered by a single counselor, two counselors working collaboratively, or a single counselor with brief assistance from another counselor who has specialized expertise that is needed by the client.

Forms of Counseling

Counseling can be delivered in a variety of forms that share the definition presented above. Forms of counseling differ with respect to participants, delivery location, communication medium, and interaction process. Counseling participants can be individuals, couples, or groups. The location for counseling delivery can be face-to-face or at a distance with the assistance of technology. The communication medium for counseling can be what is read from text, what is heard from audio, or what is seen and heard in person or from video. The interaction process for counseling can be synchronous or asynchronous. Synchronous interaction occurs with little or no gap in time between the responses of the counselor and the client. Asynchronous interaction occurs with a gap in time between the responses of the counselor and the client.

The selection of a specific form of counseling is based on the needs and preferences of the client within the range of services available. Distance counseling supplements face-to-face counseling by providing increased access to counseling on the basis of necessity or convenience. Barriers, such as being a long distance from counseling services, geographic separation of a couple, or limited physical mobility as a result of having a disability, can make it necessary to provide counseling at a distance. Options, such as scheduling counseling sessions outside of traditional service delivery hours or delivering counseling services at a place of residence or employment, can make it more convenient to provide counseling at a distance.

A Taxonomy of Forms of Counseling Practice. Table 1 presents a taxonomy of currently available forms of counseling practice. This schema is intended to show the relationships among counseling forms.

Table 1

A Taxonomy of Face-To-Face and Technology-Assisted Distance Counseling

Counseling

* Face-To-Face Counseling o Individual Counseling o Couple Counseling o Group Counseling

* Technology-Assisted Distance Counseling

o Telecounseling

+ Telephone-Based Individual Counseling

+ Telephone-Based Couple Counseling

+ Telephone-Based Group Counseling

o Internet Counseling

+ E-Mail-Based Individual Counseling

+ Chat-Based Individual Counseling

+ Chat-Based Couple Counseling

+ Chat-Based Group Counseling

+ Video-Based Individual Counseling

+ Video-Based Couple Counseling

+ Video-Based Group Counseling

Definitions

Counseling is the application of mental health, psychological, or human development principles, through cognitive, affective, behavioral or systemic intervention strategies, that address wellness, personal growth, or career development, as well as pathology.

Face-to-face counseling for individuals, couples, and groups involves synchronous interaction between and among counselors and clients using what is seen and heard in person to communicate.

Technology-assisted distance counseling for individuals, couples, and groups involves the use of the telephone or the computer to enable counselors and clients to communicate at a distance when circumstances make this approach necessary or convenient.

Telecounseling involves synchronous distance interaction among counselors and clients using one-to-one or conferencing features of the telephone to communicate.

Telephone-based individual counseling involves synchronous distance interaction between a counselor and a client using what is heard via audio to communicate.

Telephone-based couple counseling involves synchronous distance interaction among a counselor or counselors and a couple using what is heard via audio to communicate.

Telephone-based group counseling involves synchronous distance interaction among counselors and clients using what is heard via audio to communicate.

Internet counseling involves asynchronous and synchronous distance interaction among counselors and clients using e-mail, chat, and videoconferencing features of the Internet to communicate.

E-mail-based individual Internet counseling involves asynchronous distance interaction between counselor and client using what is read via text to communicate.

Chat-based individual Internet counseling involves synchronous distance interaction between counselor and client using what is read via text to communicate.

Chat-based couple Internet counseling involves synchronous distance interaction among a counselor or counselors and a couple using what is read via text to communicate.

Chat-based group Internet counseling involves synchronous distance interaction among counselors and clients using what is read via text to communicate.

Video-based individual Internet counseling involves synchronous distance interaction between counselor and client using what is seen and heard via video to communicate.

Video-based couple Internet counseling involves synchronous distance interaction among a counselor or counselors and a couple using what is seen and heard via video to communicate.

Video-based group Internet counseling involves synchronous distance interaction among counselors and clients using what is seen and heard via video to communicate.

Standards for the Ethical Practice of Internet Counseling

These standards govern the practice of Internet counseling and are intended for use by counselors, clients, the public, counselor educators, and organizations that examine and deliver Internet counseling. These standards are intended to address practices that are unique to Internet counseling and Internet counselors and do not duplicate principles found in traditional codes of ethics.

These Internet counseling standards of practice are based upon the principles of ethical practice embodied in the NBCC Code of Ethics. Therefore, these standards should be used in conjunction with the most recent version of the NBCC ethical code. Related content in the NBCC Code are indicated in parentheses after each standard.

Recognizing that significant new technology emerges continuously, these standards should be reviewed frequently. It is also recognized that Internet counseling ethics cases should be reviewed in light of delivery systems existing at the moment rather than at the time the standards were adopted.

In addition to following the NBCC® Code of Ethics pertaining to the practice of professional counseling, Internet counselors shall observe the following standards of practice:

Internet Counseling Relationship

1. In situations where it is difficult to verify the identity of the Internet client, steps are taken to address impostor concerns, such as by using code words or numbers.

2. Internet counselors determine if a client is a minor and therefore in need of parental/guardian consent. When parent/guardian consent is required to provide Internet counseling to minors, the identity of the consenting person is verified.

3. As part of the counseling orientation process, the Internet counselor explains to clients the procedures for contacting the Internet counselor when he or she is off-line and, in the case of asynchronous counseling, how often e-mail messages will be checked by the Internet counselor.

4. As part of the counseling orientation process, the Internet counselor explains to clients the possibility of technology failure and discusses alternative modes of communication, if that failure occurs.

5. As part of the counseling orientation process, the Internet counselor explains to clients how to cope with potential misunderstandings when visual cues do not exist.

6. As a part of the counseling orientation process, the Internet counselor collaborates with the Internet client to identify an appropriately trained professional who can provide local assistance, including crisis intervention, if needed. The Internet counselor and Internet client should also collaborate to determine the local crisis hotline telephone number and the local emergency telephone number.

7. The Internet counselor has an obligation, when appropriate, to make clients aware of free public access points to the Internet within the community for accessing Internet counseling or Web-based assessment, information, and instructional resources.

8. Within the limits of readily available technology, Internet counselors have an obligation to make their Web site a barrier-free environment to clients with disabilities.

9. Internet counselors are aware that some clients may communicate in different languages, live in different time zones, and have unique cultural perspectives. Internet counselors are also aware that local conditions and events may impact the client.

Confidentiality in Internet Counseling

10. The Internet counselor informs Internet clients of encryption methods being used to help insure the security of client/counselor/supervisor communications.

Encryption methods should be used whenever possible. If encryption is not made available to clients, clients must be informed of the potential hazards of unsecured communication on the Internet. Hazards may include unauthorized monitoring of transmissions and/or records of Internet counseling sessions.

11. The Internet counselor informs Internet clients if, how, and how long session data are being preserved.

Session data may include Internet counselor/Internet client e-mail, test results, audio/video session recordings, session notes, and counselor/supervisor communications. The likelihood of electronic sessions being preserved is greater because of the ease and decreased costs involved in recording. Thus, its potential use in supervision, research, and legal proceedings increases.

12. Internet counselors follow appropriate procedures regarding the release of information for sharing Internet client information with other electronic sources.

Because of the relative ease with which e-mail messages can be forwarded to formal and casual referral sources, Internet counselors must work to insure the confidentiality of the Internet counseling relationship.

Legal Considerations, Licensure, and Certification

13. Internet counselors review pertinent legal and ethical codes for guidance on the practice of Internet counseling and supervision.

Local, state, provincial, and national statutes as well as codes of professional membership organizations, professional certifying bodies, and state or provincial licensing boards need to be reviewed. Also, as varying state rules and opinions exist on questions pertaining to whether Internet counseling takes place in the Internet counselor's location or the Internet client's location, it is important to review codes in the counselor's home jurisdiction as well as the client's. Internet counselors also consider carefully local customs regarding age of consent and child abuse reporting, and liability insurance policies need to be reviewed to determine if the practice of Internet counseling is a covered activity.

14. The Internet counselor's Web site provides links to websites of all appropriate certification bodies and licensure boards to facilitate consumer protection.

© 2007 NBCC

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