Literature Review<br />Does Cyber-Counseling Make Sense? <br />
Introduction<br />The past decade has brought with it the advent of a communication medium that had never before existed. Increasing with it, the extent those individuals across the globe can communicate constantly, consistently, and effectively no matter the time or distance. This infant medium of communication has changed the face of many facets of everyday life and occupations, as “1.4 billion people use the Internet worldwide (International Telecommunications Union, 2007). In the United States, “more than half the population (54%) uses the Internet, with an average increase of 2 million users each month” (Haberstroh, S., et al, 2008, Journal of Counseling and Development). This being the case, we have seen transitions within most all occupations in advertising, facilitating work-loads, communication within the business or organization, and in keeping and maintaining clients. The globe, in effect, has shrunk to a manageable size and we are now able to work even more closely within this medium with specialists across the all over the world. This transition in communication has not missed the science of psychology. The programs that have developed to assist clinicians and clients alike, researchers, and program developers in becoming more effective in their given fields are extensive and utilized consistently.<br />
Introduction Continued<br />We now have e-mail, forums, video conferencing, instant messaging, and chat sessions that are available through the advent of the Internet and its many components. There also exist the social networking groups in which the professionals within the field of psychology can exchange information increasing potential initiatives that have the ability to advance the field and assist its professionals in being effective. Within this medium there are many advantages; however with these advantages come new potentially negative consequences and ethical issues that have to be addressed. This literature review will discuss the positive aspects that come with utilizing this communication medium as well as the issues that can be potentially negative within this framework. How effective is the use of this communication medium and how do we address the issues that this form of communication presents while ensuring that psychologists and professionals in this field are able to maintain integrity and be effective?<br />
Positive Effects of this Communication Medium<br />Distance has always been a potential issue for individuals in need of psychological assistance. There are often times issues with scheduling appointments and especially with transportation in reaching a face to face meeting with a clinician or counselor. Due to this hindrance, many people do not feel they have an option to seeking assistance and instead use this as an excuse for neglecting their need for help. With the technological advances in communication and especially via the internet, individuals are able to schedule meetings i.e. video conferences or chat sessions with a clinician and do not have to leave the comfort of their home. Within this cyber-counseling medium “client concerns and issues are dealt with immediately, instead of waiting for a scheduled appointment, which is one of the most serious problems in providing face-to-face counseling.” (Maples, M.F. & Han, S., 2008, Journal for Counselingand Development). The excuse of lack of time or the ability to get to a meeting with a counselor has been undermined substantially with the advances that technology has provided for communication across the globe. Waiting for an appointment also increases the risk that the individual in need of assistance will choose to avoid seeking help and choose other means of handling their situation; often negative means such as self-medicating with drugs and alcohol.<br />
Positive Effects Continued<br />Communicating via the Internet allows “a degree of anonymity that encourages clients to be more forthright with their issues.” (Haberstroh, S. et al, 2008, Journal of Counseling and Development). In a plethora of situations, people feel more comfortable communicating with others, especially when the subject is themselves and of a sensitive nature, via a non-confrontational medium. Writing a letter or even communicating over the phone allows the individual the ability to feel that they are not being dissected, unlike a face to face meeting which can quickly become uncomfortable. Clinicians spend a lot of time, especially in the beginning of a client/clinician relationship, establishing rapport and trust with a client. This rapport building is important, however utilizing Internet or e-mail mediums for communication decreases the time needed to establish this trust, and thus the issues can be addressed more expediently. Also, self-disclosure is more extensive within this form of communication because “in cyber counseling, clients usually do not see the counselor face-to-face, thus improving communication by making the clients feel less defensive and vulnerable. (Maples, M.F. & Han, S., 2008, Journal for Counseling and Psychological Development).This medium reminds you of confession within the Catholic faith, where an individual is in a box talking to a priest who can only hear their voice, thus they are able to unload all that is on their minds without feeling put on the spot or feeling any additional guilt.<br />
Positive Effects Continued<br />. By allowing for a more extensive self-disclosure, this medium allows the clinician to get to the heart of the issue at hand in a shorter period of time and in effect assist an individual in making positive changes as expediently as possible. This can be especially important for individuals who are facing issues that can cause serious bodily harm if they stay in the situation they are currently in. <br /> Another positive effect of utilizing this mode of communication is the ability to track conversations with the client. Especially through e-mail, a clinician has the ability to note the progress of the sessions and keep the sessions moving along, instead of dealing with potential regression that can be difficult to control in a face to face environment. The messages that have been sent and received are saved and can be located and recalled with minimal effort. This not only allows a clinician to keep track of what the client has shared but allows the clinician “to contemplate their responses without the interpersonal pressure that is typical in face-to-face settings (Haberstroh, S. et al., 2008, Journal of Counseling and Development). The ability to think through responses allows the clinician to share information and give advice that they possibly would have not thought of if they were in a face to face situation. This can give the clinician an ability to give more positive input and viable techniques needed in order to assist their client. <br />
Potential Negative Effects of this Communication Medium<br /> There are often times deficiencies within the clinician’s ability to have the know-how or technical abilities needed to assist their clients via Internet. Knowing and being proficient in all the technological advances that are available to themselves and their clients allows the clinician to be even more effective, however there are many who lack these skills and these deficiencies only undermine the clinician’s ability to have a positive effect. There are many ways that lack of technical knowledge within this medium that can be detrimental to a client/clinician relationship, “for example, one needs to have proficient typing skill, speed, and accuracy; be familiar with various computer and Internet technologies, particularly those related to data security and clinical record confidentiality; and be able to understand and use emoticons or a host of expressions created to facilitate text-based communication in the online world. (Maples, M.F. & Han, S., 2008, Journal for Counseling and Development). Just as in typical interpersonal communication, it is necessary for the clinician to have a working knowledge of web based communication methods to facilitate understanding of where their client is coming from, where they are at present, and what needs to be said or done to assist them. <br />
Negative Effects Continued<br />Another potential negative effect of utilizing cyber-counseling in assisting clients is the lack of non-verbal cues that are presented in this medium of communication. In a face to face meeting, which has been the standard until recently, “the counselor usually uses nonverbal cues from clients to interpret what they maybe feeling or thinking, thereby helping clients to become<br />aware of their own feelings and thoughts. The absence of verbal and nonverbal cues in cyber counseling makes miscommunication between counselor and clients more common. (Maples, M.F. & Han, S., 2008, Journal for Counseling and Development). When you have these potential misunderstandings it can be difficult to move beyond them, and can even cause a break in the relationship. Non-verbal cues are extremely important in most communication mediums, and even on the phone you have tome of voice to assist you in assessing a client’s emotions. Thus, via the Internet clinicians have to take a clients word for what they say is going on, and it becomes increasingly difficult to make a thorough and accurate assessment of the clients mind frame and needs. <br />
Negative Effects Continued<br />Technology is not always a hundred percent reliable and glitches, power outages, website malfunction, and the like, can cause problems within this medium of communication. Thus, there is a need to communicate these potential problems with the client prior to beginning the sessions and agree on a form of re-establishing communication when these situations arise. If this fail safe is not discussed prior to beginning any type of therapy or counseling, technical difficulties can potentially cause additional negative assumptions that can be detrimental to the client/clinician relationship. For example, “if the cause of the interruption is on the psychotherapist’s end, such an experience is likely to be confusing and upsetting to the client, and could even cause damage to the therapeutic relationship. In addition, when the interruption is on the client’s end, it could be difficult for the psychotherapist to judge whether the client is disconnecting due to technology failure, because he or she is upset about something the clinician said, or because he or she is in some kind of crisis (Rummell, Christina & Joyce, Nicholas, 2010, Ethics and Behavior). Outside this mode of communication there is no need to worry about these unsubstantiated assumptions because there will be few interruptions for which the cause is unknown to one party or the other. <br />
Ethical Issues that Arise Within This Medium of Communication<br />One of the main ethical issues with using this form of communication in counseling is the potential risk for clients and clinicians alike to false represent themselves. In other words, a client can be who they want to be, or present false information about themselves or their environment and thus their situation. This also applies to the clinician, as research on this issue has shown that there are situations where “evidence indicated that a slight majority (36%) of persons claiming to provide Web counseling had no credentials or formal training in professional counseling. According to the survey, other professionals delivering online counseling were either counselors with a master’s degree (31%) or doctoral level psychologists (29%) (Haberstroh, S., et al., 2008, Journal for Counseling and Development). There is potential for not only the client, but the clinician to use false information to induce counseling sessions, and there is a need to set up a safe guard for this infringement on both the client and clinicians behalf. <br />
Ethical Issues Continued<br />Client confidentiality can be another issue if the clinician and the client themselves is not excessively careful in guarding the information exchanged during sessions. There is always a potential risk for accidental breech in confidential information between client and clinician, however using a web based service to facilitate counseling sessions can increase the number of potential eyes that can come across the information. There are in fact ways to limit these potential threats, for example “password protection, data encryption, use of secure socket layer encryption for Internet traffic between psychotherapist and client computers, and use of a firewall. However, even these methods cannot protect against certain mishaps, such as accidental interception, e-mail snooping, unauthorized e-mail access, and so on (Rummell, Christina & Joyce, Nicholas, 2010, Ethics and Behavior). It is imperative that the client is aware that they are just as responsible for the protection of these private transactions as the counselor. This being the case, there is a need to develop a specific informed consent form for the client, explaining “the novelty of Internet counseling, the unknowns, limits to confidentiality, technology issues, and so on, are all important for potential clients to understand before treatment (Rumell, Christina & Joyce, Nicholas, 2010, Ethics and Behavior). <br />
Recommendations for Utilizing This Medium of Communication<br />It is evident that the world has become smaller with the advent of computers, the internet, and now cyber-chat systems such as web-cams. With the correct technology, you can be almost anywhere in the world and have a positive effect on an individual and their life. However, with this ability come great responsibility and a completely new framework with regards to the structure in which this medium is used to guide and mentor. There needs to be significant research done on the effectiveness of this means counseling, and where the line is drawn in regards to severity of the situation being discussed, basically when does a face-to-face intervention need to be implemented instead of continuing with the “faceless” counselor. There also needs to be significant research and reframing done on the client/clinician agreement with regards to confidentiality and expectations. I believe with the proper research and restructuring this medium can be used efficiently and effectively in the world of psychology. <br />
References: <br />Devi, Sharmila.(2011-04-02). Facebook friend request from a patient? The Lancet Medical Journal.v.337, 1141-1142. ISSN: 01406736. <br />Danaher, Brian G. & Seeley, John R. (2009). Methodological Issues in Research on Web-Based Behavioral Interventions. Annals of Behavioral Medicine. 38:1, 28(12). ISSN: 08836612.<br />Goss, S. & Anthony, K. (2009). Developments in the use of technology in counselling and psychotherapy. British Journal of Guidance & Counseling. 0837:3, 223(8). ISSN: 03069885.<br />Haberstroh, Shane., Parr, Gerald., Bradley, Loretta., Morgan-Fleming, Barbara & Gee, Robert. (2008). Facilitating Online Counseling: Perspectives From Counselors in Training. Journal of Counseling & Development. 1086:4, 460(11). ISSN: 07489633.<br />Lewis, Jacqueline & Coursol, Diane. (2007). Addressing career issues online: perceptions of counselor education professionals. Journal of Employment Counseling . 146.8, 1244:4.ISSN: 00220787.<br />Maples, Mary Finn & Han, Sumi. (2008). Cybercounseling in the United States and South Korea: Implications for Counseling College Students of the Millennial Generation and the Networked Generation. Journal of Counseling & Development . 0486:2, 178(6). ISSN: 07489633.<br />
References Continued:<br />Ramseyer, Fabian & Tschacher, Wolfgang. (2011). Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome. Journal of Consulting and Clinical Psychology. 06-0179:3, 284. ISSN: 0022-006X.<br />Rummell, Christina M. & Joyce, Nicholas R. (2010). So what do u want to wrkon 2day? : The Ethical Implications of Online Counseling. Ethics & Behavior . 1220:6, 482(15). ISSN: 10508422. <br />Seidman, Daniel F., Westmaas, J. Lee., Goldband, Steve., Rabius, Vance., Katkin, Edward S., Pike, K. Joanne., Wiatrek, Dawn., & Sloan, Richard P. (2010). Randomized Controlled Trial of an Interactive Internet Smoking Cessation Program with Long-Term Follow-up. Annals of Behavioral Medicine. 0239:1, 48(13). ISSN: 08836612. <br />Williams, Robert., Bambling, Matthew., King, Robert., & Abbott, Quentin. (2009). In-session processes in online counseling with young people: An exploratory approach. Counseling & Psychotherapy Research. 069:2, 93(8). ISSN: 14733145. <br />
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