Whatdowe know ab out online the rap y? - Dr Naomi Moller and Dr And reas Vossler http s://www.p icp ed ia.org/hig hway-signs/o/online.html - BACP
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Wh a t d o w e kn o w
a b o u t o n lin e th e ra p y?
Dr Nao m i Mo lle r and Dr And re as Vo ssle r
http s://www.p icp e d ia.o rg / hig hway-sig ns/ o /o nline .htm l
http s://www.p ickp ik.co m /cyb o rg -fo rward -
d ig itizatio n-ro b o t-sci-fi-wo m an-59155
Wh a t is o n lin e
th e ra p y?
In clu d e s:
• Vid e o -co nfe re ncing b ase d
• Aud io -o nly/te le p ho ne
• Te xt-b ase d
• Synchro no us = instant
m e ssag ing
• Asynchro no us = e m ail
+ all typ e s o f co unse lling e .g . co up le ,
fam ily, g ro up and o ne -to -o ne
Also in clu d e s: co m p ute r
p ro g ram m e s/ap p s
• Do e s o nline the rap y wo rk?
• Do clie nts and p ractitio ne rs e xp e rie nce
Ke y o nline the rap y?
• What hap p e ns to the the rap e utic re latio nship
q u e stio n s in o nline the rap y?
• What ab o ut e thics and risk in o nline the rap y?
• Ho w sho uld o nline the rap ists b e traine d ?
Co nte xt o f talk
• CO VID-19 has cre ate d hug e
CO VID-1 9 shift in co unse lling p ractice
Curre nt • Mass m ig ratio n to
and future , o nline /d istance te chno lo g ie s
sig nificant YET
m e ntal he alth
• Evid e nce o f lo ng -stand ing
b urd e n
d istrust ab o ut o nline the rap y
http s://www.rawp ixe l.co m / se arch/cre ative %20co m m o ns?so rt=curate d &p ag e =1
Do e s o n lin e th e ra p y w o rk?
So m e intro d u cto ry co m m e nts :
• (O f co urse ) m uch le ss re se arch than o n face -to -face the rap ie s
• Lo ts o f RCTs and m e ta-analytic stud ie s BUT b ig g e st fo cus is o n co m p ute r p ro g ram m e s/ap p s
• Evid e nce o n the rap ist-g uid e d inte rve ntio ns = co m p a ra b le o u tco m e s a s fa ce 2 fa ce –
no te this e vid e nce is stro ng /cre d ib le - d ifficult to d ism iss (And e rsso n, To p o o co , Havik, & No rd g re e n, 2016;
Karyo taki e t al., 2018)
• A g ro wing lite rature sug g e sts p ro m ise o f ‘b le nd e d ’ ap p ro ache s whe re F2F the rap y is
co m b ine d with co m p ute rise d (Erb e e t al., 2017)
Wo n ’t b e ta lking fu rth e r ab o u t th e s e to d a y b u t w o rth th in king ab o u t?
http s://www.p ickp ik.co m / wo m an-d ate -co ffe e -lo ve -g irl-co ffe e -sho p -61728
Cu rre n t lite ra tu re
• Fo cus o n o nline the rap y fo r
sp e cific p o p ulatio ns fo r
who m F2F the rap y = hard e r
o e .g . p o p ulatio ns with illne ss o r
d isab ilitie s; rural p o p ulatio ns;
yo ung p e o p le
• Majo rity o f re se arch = CBT
(d e Bite nco urt Machad o e t al., 2016)
Vid e o -co n fe re n cin g – tw o re ce n t m e ta -a n a lytic stu d ie s
• Be rryhill e t al., 2019 - fo cus o n d e p re ssio n, includ e d 33
stud ie s; 24/33 we re CBT/b e havio ural activatio n o r CBT/BA
with e xp o sure the rap y. Tw o th ird s o f stu d ie s re p o rte d
O ve ra ll a s sta tistica lly sig n ifica n t re d u ctio n s in d e p re ssio n (e .g .
fo u n d to b e e ffe ctive ).
e ffe ctive a s • Norwood, Moghaddam, Malins and Sab in ‐Fa rre ll, 2018 –
fa ce -to -fa ce fo cus o n o utco m e s and the rap y alliance ; 12 stud ie s, all CBT
‘fam ily’. Fo und that altho ug h alliance was hig h in vid e o
co unse lling , it was still lo we r than that re p o rte d in face -to -
face co unse lling . Th e re w a s n o d iffe re n t in o u tco m e o f
co u n se llin g a s b o th th e ra p y typ e s w e re e q u a lly e ffe ctive .
Note : in many of the studie s vide o-confe re ncing the rap y
provided ‘in clinic’.
http s://i2.p ickp ik.co m /p ho to s/416/622/491/p ho ne -o ld -ye ar-b uilt-
1955-b ake lite -p re vie w.jp g
Wh a t ab o u t p h o n e o r te xt-b a s e d ?
• Ph o n e - Evid e nce o f e q uivale nt o utco m e s (Cas tro e t al, 2020; Coughtre y & Pistrang , 2018) and p ro ce ss e .g . the rap e utic alliance
and e m p athy (Irvine e t al., 2020).
• Ch a t/ in sta n t m e ssa g in g – Evid e nce o f e q uivale nt o utco m e s (Ho e rm ann e t al., 2017; Ersahin & Hanle y, 2017)
• Em a il - Lack o f re ce nt re se arch b ut e vid e nce o f e q uivale nt o utco m e s fo r synchro no us/ asynchro no us
m e tho d s (Barak e t al., 2008)
Many p ractitio ne rs Many
g uard e d o r p ractitio ne rs
susp icio us ab o ut id e ntify
o nline the rap ie s (e .g . challe ng e s and
Evans, 2014); se e as b e st
risks o f o nline
fo r ‘m ild e r’
the rap y p ractice
Co u n se llo r p re se ntatio ns (To p o cco e t
al., 2018)
(e .g . Schuste r e t al, 2018;
Co nno lly e t al., 2020)
p e rce p tio n s
& e xp e rie n ce Practitio ne rs
p re fe r fa ce -to -
If g o ing to use
fa ce to o nline
p re fe r ‘b le nd e d ’
e ve n tho ug h the y
o nline and face -
re co g nise
to -face p ro visio n
b e ne fits o f o nline (To p o cco e t al., 2018)
the rap y (Co nno lly e t al.,
2020)
Clie n t e xp e rie n ce s
a n d p e rce p tio n s
Actu a l e xp e rie n ce
• Syste m atic re vie w (14 stud ie s id e ntifie d ) co m p aring tre atm e nt
satisfactio n F2F vs. p ho ne /vid e o the rap y = e q uivale nt o utco m e s
(J e nkins-Guarnie ri e t al., 2015)
• sim ilar in q ualitative stud y with co up le s (Kyse ly e t al., 2019); and
q uantitative stud ie s with ve te rans (Eg e d e e t al., 2016; Whe alin e t al.,
2017)
Pe rce p tio n
• 72% o f ad o le sce nts (N = 217) wo uld try o nline the rap y; 32%
wo uld cho o se an o nline the rap y o ve r F2F (Swe e ne y e t al., 2019) BUT
• O nly 25-40% o f US stud e nts (N= 662) p re p are d to try o nline
m e ntal he alth inc. o nline the rap y (To sco s e t al., 2018)
• Stud y o f > 2000 Ge rm an ad ults fo und that alm o st 80% wo uld
no t want to p articip ate in vid e o p sycho the rap y (Paslakis e t al., 2019) http s://p ixab ay.co m /illustratio ns/ fe e d b ack-o p inio n-custo m e r-1977986/Th e ra p y re la tio n sh ip o n lin e • Diffe re nce s d e p e nd e nt o n typ e o f o nline the rap y • Ge ne rally le ss co nte xtual/no n-ve rb al cue s availab le fo r re lating (fro m no sm e ll to no vid e o /aud ito ry) - le ss ‘re al’ and e m o tio nally attune d re latio nship (e .g . Scharff, 2012) ? YET • Sig ns that clie nts rate the q uality and ing re d ie nts o f the re latio nship as p o sitive as f2f the rap y (e .g .; Mishna e t al., 2015), ind e p e nd e nt o f d e live ry m o d e s and co m m unicatio n m o d alit y (Be rg e r, 2016; Re e se e t al., 2016; She p le r at al., 2016). • Practitio ne rs o fte n have m o re co nce rns ab o ut alliance than clie nts and ne e d to m ake ad justm e nts to fe e l co m fo rtab le (Lo p e z e t al. 2019)
Build ing o nline the rap e utic
re latio nship s
• Ad justm e nts m ig ht b e ne e d e d , b ut p o ssib le to
e stab lish/m aintain an alliance sufficie nt to
facilitate p sycho lo g ical chang e (Be rg e r, 2016’ Hanle y &
Re yno ld s, 2009).
• Clie nts are re p o rte d to q uickly d e ve lo p e d
g o o d and trusting re latio nship with the ir o nline
the rap ist (Ersahin & Hanle y, 2017).
• O nline wo rk p o te ntially le ss aro using /
thre ate ning (at le ast fo r so m e clie nt g ro up s; D’Arce y
e t al, 2015 ).
• Ways to co m p e nsate lack o f cue s can (e .g . with
wo rd s, acro nym s and e m o tico ns) and cre ate
m e ntal re p re se ntatio ns o f e ach o the r which he lp
to b uild the the rap e utic alliance (Sule r, 2010 ).
http ://ke n-fo und atio n-aware ne ss.b lo g sp o t.co m /p /so cial-ne two rking _08.htm lO nline
d isinhib itio n
• O nline d isinhib itio n e ffe ct: Pe o p le d o /say thing s o nline the y
wo uld no t in p e rso n (le ss re strictio n & g re ate r willing ne ss
o ne se lf o p e nly; Sule r, 2004 ).
• Ano nym ity & the lack o f visual, aud ito ry and co nte xtual cue s
(e .g . so cial status o r e thnic b ackg ro und ) = p e o p le fe e l b o th le ss
vulne rab le to jud g m e nt / le ss re sp o nsib le fo r actio ns.
Effe cts o n clie nts:
• fe we r inhib itio ns in d isclo sing intim ate info rm atio n, which is
o fte n b ro ug ht up at a m uch faste r p ace o nline (e .g . Mishna e t al., 2015)
• m o re o p e n/willing to talk ab o ut d ifficult/stig m atise d to p ics.
• m o re p re p are d to o p e nly d isag re e with the co unse llo r (le ss
co nce rne d ho w the y are p e rce ive d b y co unse llo r). http ://ke n-fo und atio n-
ahttp ://true ce nte rp ub lishing .co m /p sycyb e r
/d isinhib it.htm lware ne ss.b lo g sp o t.co m /p / s
o cial-ne two rking _08.htm lPo we r and co ntro l
o nline
• Clie nts re p o rt shift o f co ntro l o ve r co unse lling
p ro ce sse s and inte rve ntio ns (e .g . ho w m uch
clie nts want to d isclo se ; Gib so n & Cartwrig ht, 2014).
• Vid e o co nfe re ncing : clie nts re p o rt that ‘the
e nhance d co ntro l and p e rso nal sp ace that the y
fe e l in vid e o the rap y can e nhance the the rap e utic
alliance ’ (Sim p so n & Re id , 2014, p . 295).
• Incre ase d d e g re e o f auto no m y and m o re
co ntro l fo r clie nts (e .g . can cho o se whe re /ho w to
ap p e ar o n cam e ra; te rm inate the se ssio n with a
m o use click; Drum & Little to n, 2014 )
• Mig ht fe e l unco m fo rtab le fo r co unse llo rs ne w
to o nline the rap y and ne e d s ad justm e nt.
http s://fr.123rf.co m /im ag e s-lib re s-d e -d ro its/50497041.htm l?sti=nco 0d id ahfo utp xwlj|Re latio nship am b ig uitie s and
challe ng e s o nline
• Lack o f cue s/info rm atio n = le ap o f faith re q uire d fro m
clie nts/the rap ists (Fle tche r-To m e nius & Vo ssle r, 2009, Ersahin &
Hanle y, 2017)
• Se lf-co nscio usne ss, e xace rb ate d b y b e ing p re se nte d with an im ag e
o f o ne se lf o n scre e n - Po te ntial fo r m o re narcissistic/so lip sistic
e nco unte rs (Balick, 2014)
• Enhance d sco p e fo r clie nts to p re se nt id e alise d and d iffe re nt se lve s
(Vince nt e t al., 2017)
• Virtual m e e ting s b lur b o und arie s in ways that are m e aning ful fo r
co unse lling (e .g . vid e o : p ro lo ng e d e ye -to -e ye g aze and insig ht into
clie nt’s p rivate sp ace )
• Challe ng e to p ro vid e se cure e nviro nm e nt and d e al with
te chno lo g ical b re akd o wns and crisis situatio ns (Chip o le tta e t al.,
2018)Risk a n d e th ics in
o n lin e th e ra p y
• Pe rce p tio n that asse ssm e nt and e sp e cially
risk asse ssm e nt is p ro b le m atic o r le ss
p o ssib le o nline .
• Lite rature re fe rs to p ractitio ne rs co nce rns
aro und to p ics like co nfid e ntiality and se curity
o nline (He rtle in e t al., 2015; Russe l, 2018)
YET
http s://www.hcalawye rs.co m .au/b lo g / m e
• ‘Ab so lute se curity in the d ig ital wo rld d o e s
d ical-ne g lig e nce -claim -failure -ad vise -
risks-asso ciate d -m e d ical-tre atm e nt/
no t e xist’ (BACP Go o d Practice Guid e line 047, p 6) – task fo r
p ractitio ne rs to m axim ise
se curity/co nfid e ntiality o nline .
• Lack o f e m p irical re se arch o n risks/e thics and
ho w the se issue s are ne g o tiate d o nline (e .g .
e thics co m p laints o r safe g uard ing co nce rns)Ch a lle n g e Risk
Risks and
Se curity of clie nt Physical o r e le ctro nic d ata b re e ch – b re e ch
data o f co nfid e ntiality – e ithe r at co unse llo r’s o r
clie nt’s e nd
challe ng e s in Contracting / - Uncle ar b o und arie s (e .g . re
the rap y
ag re e ing availab ility/re sp o nse tim e s) and co nse nt
boundarie s issue s
- m isund e rstand ing s/m isco m m unicatio n
o nline - co m m unicatio n b re akd o wn if no ‘Plan B’
fo r te chno lo g y failure
Risk ass e s sme nt Clie nt no t suitab le fo r o nline wo rk (e .g . lack
o f te chnical skills, lack o f p rivacy fo r o nline
wo rk, p sycho lo g ical state no t suitab le )
Risk manag eme nt Risks (e .g . se lf-injury/suicid al id e atio ns)
re m ain und e te cte d , lack o f arrang e m e nt
fo r e m e rg e ncy/crisis situatio nCh a lle n g e Go o d p ra ctice
Se curity of clie nt Taking re aso nab le , p ro active ste p s to
data e nsure ad e q uate le ve ls o f se curity fo r the
BACP Fact
typ e o f se rvice b e ing p ro vid e d (e .g .
p asswo rd p ro te ctio n, e ncryp tio n, ad e q uate
so ftware ). Taking im m e d iate actio n to
p re ve nt o r lim it any harm o f b re e ch o f d ata.
She e t 47
Contracting / Ag re e ing alte rnative way o f p ro vid ing
ag re e ing boundarie s se rvice s if the p rim ary m e tho d o f
co m m unicatio n fails. Wo rking o nline in the co unse lling
p ro fe ssio ns
Risk ass e s sme nt Ad ap t asse ssm e nt o f clie nt suitab ility,
includ ing suitab ility fo r wo rking o nline
(te chnical, p ractical, p sycho lo g ical
suitab ility).
Risk manag eme nt Having d iscusse d /ag re e d with clie nt ho w
the y m ig ht b e assiste d if a crisis situatio n
arise s (e .g . with ad d itio nal, lo cal sup p o rt) .O n lin e th e ra p y
tra in in g
• Curre ntly stand ard s are no t we ll d e fine d , and the re are
fe w training o r e d ucatio n p ro g ram s fo r o nline the rap y
(Sto ll e t al, 2020).
• Skills fo r o nline p ro visio n are no t includ e d in m o st
trad itio nal training curricula (Harris & Birnb aum , 2015) - altho ug h
this will p ro b ab ly chang e in future (Antho ny, 2015; Blackm o re e t al,
2015)
http s://www.hcalawye rs.co m .au/b lo g / m e
Sp e cific a d d itio n a l tra in in g re q u ire d :
d ical-ne g lig e nce -claim -failure -ad vise -
risks-asso ciate d -m e d ical-tre atm e nt/
• to e nsure ap p ro p riate te chno lo g y-re late d co m p e te nce s
and the rap e utic co m p e te nce s sp e cific to o nline
the rap y (f2f the rap y skills d o no t auto m atically translate
into o nline p ro visio n; Malle n e t al., 2005 )
• sp e cific kno wle d g e o f e thical g uid e line s and le g al
re q uire m e nts and p o licie s (J o hnso n, 2014)Challe ng e s fo r o nline
the rap y training
Co u rse s n e e d to b e u p d a te d co n sta n tly:
• Ke e p ing ab re ast o f d ig ital culture /typ e o f o nline
e nviro nm e nts that clie nts inhab it (Antho ny, 2015).
• Ke e p ing up with the sp e e d at which te chno lo g y
and o nline m e ntal he alth se rvice s e vo lve .
• Te aching e thical and le g al co nsid e ratio ns fo r
o nline wo rk in the UK b ut also in an inte rnatio nal
co nte xt (fo r cro ss-b o rd e r se rvice s).
Pro fe ssio n a l b o d ie s:
• Ne e d to m o nito r ne w d e ve lo p m e nts in
te chno lo g y-b ase d co unse lling and ke e p
the rap y.co m /o nline -co up le s-the rap y-
g uid e line s/stand ard s fo r o nline the rap e utic wo rk
up d ate d .
http s://www.he ad and he art-
Re se a rch n e e d e d :
• Q uality / ap p ro p riate ne ss o f training
• Stud ie s co m p aring typ e s o f training (e .g .
o nline /f2f) in te rm s o f clie nt o utco m e s
te xas/Fre e CPD o nline co urse :
Ho w to d o co u n se llin g o n lin e :
a co n o ra viru s p rim e r
• Pro d uce d b y the O p e n Unive rsity in p artne rship with BACP
• O n O p e nLe arn Cre ate , the O p e n Unive rsity’s fre e le arning
p latfo rm – co urse take s ab o ut 6 ho urs (d e p e nd ing o n the
ind ivid ual le arne r).
• Aim to o ffe r a p rim e r o n wo rking o nline as a co unse llo r o r
p sycho the rap ist at a tim e whe n face -to -face the rap y is
ne ithe r p o ssib le no r safe .
http s://www.o p e n.e d u/o p e n
• Pro vid e s ke y skills and kno wle d g e fo r p ro vid ing the rap y le arncre ate /co unse lling -
o nline .
o nline
• Co ntains 9 to p ic b lo cks co ve ring te chno lo g ical, e thical and
p ractical issue s and the wo rk with d iffe re nt fo rm s o f o nline
the rap y (vid e o, aud io, te xt-b ase d , ap p s).
• Q uiz at the e nd , with ce rtificate o f co m p le tio n and
e le ctro nic b ad g e (if p ass).How to do counselling online:
a co n o ra viru s p rim e r
Pra ctitio n e r fe e d b a ck
‘This is re ally he lpful!!! De ve loping my knowledge
about how to sa fe ly p rovide e mpirically b ase d and
informed the rap y is impe rative at this time ’
‘Fa ntastic online course on how to do counse lling
online . I’ve made my way thro ug h (I e arned a b adge http s://www.o p e n.e d u/o p e nle arncre ate /co unse
lling -o nline
to p rove it!) and can he artily re comme nd’
Num b e rs afte r le ss than o ne we e k live (21 Ap ril
‘I had alre ady informed stude nts and colle ag ue s to
2020):
atte nd this course . I thought I’d g ive it a g o too - and I
- Particip ants: 2643
love it.’
- Bad g e s: 500Co nclusio ns = Mo re re se a rch n e e d e d
Doe s online the rapy work? Re se arch sug g e sts that o nline the rap ie s can b e as e ffe ctive as face -
Q uality/q uantity o f re se arch
to -face p sycho lo g ical the rap ie s b ut m o re re se arch is ne e d e d .
How do clie nts and the rap ists Bo th clie nts and the rap ists o fte n se e m to p re fe r face 2face the rap y
e xpe rie nce online the rap y? to o nline b ut clie nts who have e ng ag e d in o nline the rap ie s e xp re ss
sim ilar satisfactio n as tho se e xp e rie ncing face -to -face .
What happe ns to the the rap y Re se arch sug g e sts it is p o ssib le to e stab lish/m aintain an alliance o f
re lationship in online the rap y? an ap p ro p riate stand ard o nline . Sig ns that clie nts rate q uality o f
re latio nship as p o sitive as in f2f the rap y.
What ab out e thics and risk in online Lim ite d re se arch b ase o n e thics and risks in o nline the rap y. Mo re
the rapy? re se arch ne e d e d to e xp lo re co nce rns aro und risk asse ssm e nt and
e thically so und o nline the rap y.
What make s for e ffe ctive training in Sp e cific kno wle d g e and skills re q uire d fo r o nline the rap y – skills
online the rapy? can no t just b e transfe rre d fro m f2f the rap y – re se arch is ne e d e d .Re so urce s
BACP
The BACP Te le p ho ne and E-Co unse lling Training Curriculum p ro vid e s a co nsiste nt
m inim um stand ard to which p ractitio ne rs sho uld b e traine d .
http s://www.b acp .co .uk/m e d ia/2046/b acp -te le p ho ne -e co unse lling -training -
curriculum .p d f
Asso cia tio n fo r Co u n se llin g & Th e ra p y O n lin e (ACTO )
Um b re lla o rg anisatio n in the UK fo r the rap ists who p ractice o nline .
• Dire cto ry o f traine d o nline p ractitio ne rs (m inim um le ng th 80 ho urs o f o nline the rap y
training ): http s://acto -o rg .uk/the rap ists/
• List o f training co urse s which are o nly o p e n to traine d and e xp e rie nce d the rap ists:
http s://acto -o rg .uk/o nline -training -p ro vid e rs/
In te rn a tio n a l So cie ty fo r Me n ta l He a lth O n lin e (ISMHO )
No e nd o rse m e nt fo r sp e cific training b ut sup p o rts the im p o rtance o f co m p e te nce .
We b site lists so m e training o rg anisatio ns, tho ug h re co m m e nd s ind e p e nd e nt se arch.
http s://ism ho.o rg /You can also read
