Online and Phone Based Counseling

Cyber Counseling

The emergence and advancement of computer and internet technology has revolutionized and forever changed the way that normal everyday people live their lives. Practically no corner of society and culture in the United States and other industrialized countries around the world has been spared. Among the parts of life that have evolved and changed due to this cultural and societal shift is the world of counseling and psychology. While the normal tradition has been to do in-office visits for such services, there has been a more recent shift towards the use of tele-counseling and/or cyber counseling. There are many that say that such mediums are impersonal and inferior to more traditional in-office appointments. However, this is really not the case as cyber counseling and tele-counseling can actually expand the depth and breadth of what services can be rendered, to whom they can be rendered and the efficacy seen with all of the above. While it takes a licensed, trained and competent facilitator, cyber-counseling and tele-conferencing can be just as effective, if not more so in some situations, than traditional counseling arrangements and efforts.

History

Definition of Cyber Counseling

The definition of cyber counseling is pretty much explained by the words that make up the term. Of course, the traditional method of providing counseling is when a patient and provider meet at an agreed-upon location, usually an office location used by the counselor or psychologist that is doing the service. By contrast, cyber counseling occurs when the patient and the provider are in two different locations, whether it be in the same city or on the other side of the world, and they use online-based methods to communicate such as video chat, instant messengers or email. There is also the potential use of tele-conferencing and video-conferencing using other sorts of equipment. In short, counseling has evolved in that in-person one-on-one visits are not always required to establish and maintain a counseling relationship (Fang et al., 2013).

Creation of Cyber Counseling

While cyber-counseling and tele-counseling are certainly still not brand new, there is an absolute evolution and pattern to its emergence into the psychology and counseling realms. For example, a study by Johnson (2014) proposes a framework that should be used by Canadian psychologists (Johnson, 2014). One of the major catalysts for the creation of cyber-counseling options is that there is the ability to help many more people with less overall resources and headcount to serve them. One example of this in practice was found with college counseling centers, or CCC's. Quite often, the provider to student ratio in these centers is staggering. Indeed, it is common to see a single counselor for every 1,600 students. The use of cyber-based solutions allows for more people to be helped without overloading the limited staff that are on hand at any given time (Levin, Pistorello, Hayes, Seeley & Levin, 2015). When cyber counseling was in more of a nascent stage, one of the methods that was used to shape and perfect it was the use of pilot programs. One of the downsides to such a new paradigm is that the proper standards and ways to do things are either completely brand new or, at the very least, have not been fully figured out as of yet (Mishna, Tufford, Cook & Bogo, 2013).

Use of Cyber Counseling Today

One of the primary reasons that cyber counseling is becoming more and more prominent is because online presence and communication is increasing in general. Thus, it stands to reason that the counseling/psychology field could and would ride that proverbial wave when it is suitable and applicable for a given situation. Indeed, the options are quite varied as there is text-based, stand-alone and computer-mediated communication (CMC). Examples of CMC include email, texting, blogging and instant messaging. Of course, psychology and counseling is dictated and regulated by certain ethics and rules and thus some online mediums are not ethical or even legal due to concerns about privacy and the like. Even so, the increasingly online nature of everyday society has allowed cyber-counseling to be a realistic and workable option for people in need of assistance in an increasingly digital world (Okdie, Guadagno, Petrova & Shreves, 2013).

Advantages

Confidentiality

When it comes to psychology and counseling in general, one issue is confidentiality. The great thing about cyber counseling and tele-conferencing is that the precise tools used can be tailored based on the confidentiality that is needed or required for the situation. For example, something that is less serious can be administering using a microphone. On the other hand, something that is more sensitive such as addiction or abuse can be done on the telephone. The latter makes it much harder to overhear and snoop in on the conversation. Keeping counseling more discreet and private can make it much easier to help patients open up and share about their feelings and problems (Johnson, 2014).

Flexibility

One of the huge upsides to tele-counseling and online counseling in general is the convenience, flexibility and continuity that is allowed for in comparison to requiring in-office visits. This can be a huge plus for people that are rushed for time, are disabled and/or need a rapid response. Taking the time to commute to and from the provider's location can diminish the productivity and time that can be spent on assisting the patient. As such, an online or phone-based option is a huge asset in many situations. Similarly, follow-up and post-treatment procedures are much easier to accomplish so long as the patient remains engaged in their treatment and post-treatment activities and plans (Johnson, 2014).

Documentation

Some of the beauties of online counseling work is that that the pacing and handling of the sessions are much more modernized and easy to track. For examples, sessions can easily be recorded and the pace of any and all sessions can be done at the pace that is desired based on the agreement and arrangement of the people involved. The increased accessibility for the patients makes all of this quite easy. People with physical disabilities or other issues that could cause a reluctance or a problem getting help (e.g. agoraphobia, people in rural areas, etc.) are much more prone to embrace this medium and this makes scheduling sessions and documenting the same very easy (Mishna, Tufford, Cook & Bogo, 2013).

Challenges

Cyber Predators

Right off the top, one of the main challenges that exists when it comes to cyber-counseling and the like is that the same medium also makes it much easier to victimize people online. Whether it be stalking, online aggression in general and other crimes or at least unfortunate activities, the online world can be daunting, scary and full of predatory behavior to put it lightly. Young people in particular tend to be the most venom-filled and they also tend to be among the most commonly victimized (Runions, Shapka, Dooley & Modecki, 2013).

Qualifications/Certifications/Skills

However, this flexibility accompanies a requirement that psychologists and counselors have a "tele-presence" as they do their job. As stated by Johnson, tele-presence is the "ability of the psychologist to engage the client with communications that are warm, smooth, emotionally engaging, supportive, empathic, non-judgmental and reassuring and to avoid fractured conversations or communications that are too brief (Johnson, 2014). All of these skills and needs for people engaging in online and/or telephone-based interventions are using the standards and best practices that were established through pilot programs and studies done in the past in the earlier days of cyber-counseling (Mishna, Tufford, Cook & Bogo, 2013).

Logistics

Of course, there is a cost associated with counseling and this does not go away when the care is delivered via the phone or line. While the ease of getting the sessions done is much higher, there is equipment and internet costs associated with delivering care and the proper environment for the provider must be created, whether that be a home office or an office in a commercial building. One can make the argument that the compensation rates should be the same since the care is still being delivered while others say the ease of deliver should lead to less cost. Overall, the psychologists and counselors should be compensated fairly for the services that they deliver. Further, the counselors need to follow the rules and use the most common-sense yet allowable form of counseling. As noted elsewhere in this report, there are privacy concerns involved and some of them (e.g. HIPAA) have legal ramifications. However, some of the burden associated with privacy shifts to the patient since the provider does not control the environment on the other side of the internet or phone connection (Lemma & Fonagy, 2013).

Research

Existing Research

As noted earlier in this report, the signs of progress that have been created and enabled by the shift to a digital and online culture has been counteracted and attacked by those that are using these mediums for opposite efforts. In short, just as the social and cultural trends of our lives today are influencing counseling, they are also influencing the nasty underbelly of society and the deviance that manifests from the same (Runions, Shapka, Dooley & Modecki, 2013). A further challenge is that while unstructured and casual conversations can absolutely happen online and happen every day, the standards and practices that must be enforced with psychology and counseling are harder to pull off online and this can lead to many to question the feasibility of using such a medium to do counseling or psychological interventions online at all. One point of concern is that people come and go from online interactions rather randomly at times and this is a point of concern. However, one study found that this was not nearly as disrupting as one might think. Indeed, even if the structuring of the therapy and the associated groups (when used) is a little looser, there are indeed workable solutions so long as certain standards are met and followed (Lemma & Fonagy, 2013). Further, it has been found that online communications including asynchronous communications like email can often lead to a disinhibiting influence. Meaning, patients are more apt to open up through methods like email as compared to if they are speaking to someone in real time, even if it is online (Fang et al., 2013).

Even with the increased flexibility and options of cyber counseling, there are still going to be problems with alienation among college students. Just a few examples include graduated students as compared to existing students and black students as compared to whit students. If alienation feelings are present, even the offering of online mediums and resources might not be enough to attract people that feel their culture or identify is being aggrieved and disregarded. Further, these aggrieved parties may prefer or even demand to speak to someone of their race, ethnicity or religion before they even consider getting an intervention even if it is painfully obvious that one is needed (Delphin & Rollock, 1995). One group in particular that is quite prone to alienation and resistance to interventions in general are those with HIV. However, there have been studies and groups that have made a good-faith effort to reach such parties. One example was described in a 2010 study whereby there was a pilot project that used chat rooms to reach out to HIV-positive men and those that wished to discuss sexual subjects that pertained to the avoidance of contracting and spreading the disease (Rhodes et al., 2010).

Future Research

As with most to all aspects of society, culture is a big part of the psychology and counseling relationship. When the provider and the patient(s) are generally of the same culture, things are typically much smoother as all of the people involved identify with each other to at least some degree. However, when multiple cultures collide in a counseling relationship, things can get complicated quite quickly. To that end, there have been many studies that focus on the cross-cultural implications involved with cyber-counseling and other remote counseling options. One such study was done by Tsong and Goodyear in 2014. Within that study, there was an assessment of the supervision outcome scale's psychometric properties. This study and others like it have been very useful. However, there is still a lot of work to do in this regard and that could and should be the subject of future studies on the same and similar subjects (Tsong & Goodyear, 2014).