Online Counseling

Upon the death of Steve Jobs, a friend of mine* posted on Facebook, “Three apples changed the world: the one that Eve ate, the one that hit Newton on the head, and the one Steve Jobs offered us all.”  Jobs, the founder of Apple, certainly changed the way we use technology today.  It is more accessible, and constant, and personal. But how has Jobs (and his technology) impacted the world of counseling?

Well, in the trend of online counseling, he has enabled clients to literally keep their counselor in the palm of their hand.  Some counselors offer services via Skype or other live internet communication; clients can be in touch on their iphone or ipad while maintaining physical distance.  Some counselors also offer email communication (known as asynchronous communication, where the interaction does not occur in real time).  Clients also have access to lots of information about mental health, both accurate and inaccurate, through the web (Gladding & Newsome, 2010).

With email, counselors and clients can keep in touch conveniently and work with a flexible schedule, in a way that may even out the spread of power between client and counselor (each can communicate with a home court advantage).  However, email shares many risks with other internet counseling methods; namely crises in which the counselor is not present, issues of confidentiality and protecting privacy in a secure manner, as well as third-party payments (Gladding & Newsome, 2010).  In addition, there is a greater chance of miscommunication when technology is involved.  When videochatting, there is the potential for the connection to break up at a key moment.  In email, a sarcastic phrase may be taken as fact or adolescent slang may be difficult to decode.

In a recent New York Times article, one psychologist (Elaine Ducharme) discusses her long-distance practice. Ducharme uses Skype to videoconference with patients from her former practice, and is licensed to practice both in the state in which she counsels online and the one in which she lives.  She will only videoconference with a patient she has already met, and periodically returns to have face-to-face appointments.  “‘There is definitely something important about bearing witness,’ she said. ‘There is so much that happens in a room that I can’t see on Skype’” (Hoffman, 2011).  The article continues on to address the pitfalls and benefits of online counseling.

The National Board of Certified Counselors (NBCC) began putting together a task force to address technology-assisted counseling in 1995, an endeavor that tackles ethical and practical issues and led to today’s Standards for the Practice of Internet Counseling (Gladding and Newsome, 2010).  With the massive presence of the Internet in our lives, it is necessary to set these guidelines and enforce a standard in order to protect the professional integrity of counselors, both online and off.

As a beginning student, I see myself working in a more traditional face-to-face practice, as opposed to using Skype or email as a central mode of communication.  There are already so many concerns in the practice of counseling as to how to best work with a client and act in their best interest, without worrying about a dropped videocall or a crisis thousands of miles away.  I recently read what constitutes malpractice, and sat staring wide-eyed at the textbook for a good five minutes, contemplating all the ways I could screw up.  I don’t feel I need to add any additional potential for disaster to the list.  I appreciate the momentous contributions of Steve Jobs and the impact of the growth of technology on my daily and professional life, but as a starting counselor I think I may check the technology at the door.  I’ve been spending a lot of time lately learning how to be with someone, how to listen and share time and space in a therapeutic manner, and I plan to put those skills to use by counseling face to face.  As I learned in my orientation, the only real technology you need in a counseling session is a box of tissues and a clock.

Gladding, S. & Newsome, J. (2010). Clinical Mental Health Counseling in Community and Agency Settings  (3rd ed.).  Upper Saddle River, NJ: Prentice Hall.

Hoffman, J.  (2011, 23 September). When Your Therapist is Only a Click Away. New York Times, pp. ST1.

*Thanks to Michael Fleischmann for sharing this popular post.

Johanna Bond

Author: Johanna Bond

Johanna Bond is a master's student in the community mental health counseling program at the Warner School of Education at the University of Rochester.  She is from the Rochester area and graduated from Swarthmore College in 2010 with a degree in psychology and English.

10 thoughts on “Online Counseling”

  1. I really enjoyed reading your blog, Johanna.  As an older student of life, (but too young to know Eve and Newton personally), I worry that I am not that embedded into technology especially in relation to my advisees and students.  I respect your perspective.

  2. I believe there’s a transference of empathy by being present that cannot be conveyed through any electronic medium, however I wouldn’t rule out their use as a support tool. It comes down to the counseling model being used and the clients specific needs.

  3. This is a good post as it highlights the importance of face to face counseling. Nothing will replace the empathy that is able to be transmitted in a real way when looking at and listening to someone. Technology is a good tool to use after the initial sessions but should really be used only when face to face appointments are not possible at certain times.

  4. Enjoyed the post Johanna – technology is amazing. I’m sure its hard for someone to move away from their primary counselor, but technology allows them to keep their relationship going…

  5. I have a friend who counsels parents dealing with drug problems with their kids. She has been doing it on a local level however she has been getting calls from other states with people really wanting her help. She has recently contemplated using skype as a tool to help the parents. Her concerns were dropped skype calls, so she is contemplating doing some sort of seminar where she can travel talk to larger groups then work something out with the individual parents. She is still in the early stages of the thought process.

  6. With young people today finding more comfort in front of a screen than at the dinner table I think that online counseling and support is a huge factor for mental health moving forward.  Good article I definitely learned something here keep it up!
     

  7. Personally I think there must be a transference of empathy by being present that can’t be conveyed through any electronic medium. Although it may be great when used as a form of support tool. At the end of the day i think it may depend on what kind of counseling it refers too.
     
    Ann
     
     
     
     

  8. I see your point about the importance of counseling face to face. But for some instances where it is not possible to  be physically with the person you are counseling with, counseling through Skype and maybe even through the phone or email could still be beneficial especially if the person you are talking to knows and trusts you already.

  9. I think the online medium is certainly better than nothing.  And for some, I think it’s a way to connect with someone that they might not otherwise have the opportunity to.  For others, I think online counseling can be a less intimidating experience.

  10. E-Mail is a very poor means of maintaining communication with a case; there’s so much inflection in spoken language that cannot be inferred through text alone; sarcasm, emphasis and the body language that are missing can often lead to HUGE misunderstandings and while live-chat is a step towards ameliorating the miscommunication, there is no replacement for face-to-face communication. In counselling AND real-life.

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