E-BOOK KONSELING TEKNOLOGI (REFRENSI) Technology in counselling and...

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Stephen Goss and Kate Anthony
Technology in Counselling
and Psychotherapy
A Practitioner’s Guide

Technology in Counselling and Psychotherapy

Also by Stephen Goss:
Evidence-based Counselling and the Psychological Therapies
(with Nancy Rowland)

Technology in
Counselling and
Psychotherapy
A Practitioner’s Guide
STEPHEN GOSS
and
KATE ANTHONY

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Selection, editorial matter, Introduction and Conclusion © Stephen Goss
and Kate Anthony 2003
Individual chapters in order...

To Andrew, Catriona and Lynn and to Nick and Sidonie

vii
Contents
List of screenshots xi
Notes on the contributors xii
Preface xvii
Acknowledgements xx
Introduction Stephen Go...

Example of email therapy 50
Examples of chat room therapy 54
Conclusion 58
References 58
3 Conducting group therapy online...

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6 Video counselling and psychotherapy in
practice Susan Simpson 109
The development of videoconferencing in telehealth
and...

9 The computer plays therapist: the challenges and
opportunities of psychotherapeutic software
Kate Cavanagh, David A. Sha...

List of screenshots
1.1 Example of practitioner’s view of secure client
correspondence mail boxes 23
1.2 Example of online...

Notes on the contributors
Kate Anthony MSc runs www.OnlineCounsellors.co.uk which
provides online and offline consultancy ...

the board of directors for the International Society of Mental Health
Online (www.ismho.org) and is one of the founding me...

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facilitated many online groups. She has written and presented exten-
sively on developing and providing online services.
D...

Dr David A. Shapiro is Hon. Professor at the University of Leeds and
the University of Sheffield. A Clinical Psychologist,...

where he also serves as Associate Chairman and Chief of Adult
Psychiatry. He is the principal author of the first multimed...

Preface
Technology in Counselling and Psychotherapy: A Practitioner’s Guide
is a very welcome addition to the practitioner...

increasing number of students who were contacting their counsellors
via email between sessions and during interruptions to...

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nology available to us today still has deficiencies in the interface and
this book does not flinch or gloss over those dif...

Acknowledgements
The editors would like to acknowledge the help and support during
the development of this book of Alan Ja...

1
Introduction
STEPHEN GOSS AND KATE ANTHONY
The idea of technology intervening in some way in the counselling or
psychoth...

This is despite the relatively long history of the suggestion that tech-
nology might have much to offer the world of psyc...

such as the use of email and Internet chat, the telephone, video links
and computerized therapy in the form of software de...

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telephony, through email and Internet Relay Chat, to fully computer-
ized therapy and videoconferencing. Examples of pract...

private concerns and do so more rapidly than would be expected in
other contexts.
Chapter 3 looks at a different kind of t...

Part II: Telephone and video links
In Chapter 5, Maxine Rosenfield looks at the use of the telephone for
counselling and p...

pists’ initial hesitations, typical of most uses of technology in therapy,
being overcome as their familiarity with the pr...

systems that demonstrably benefit clients with specific problems such
as phobias, depression and anxiety. Some such progra...

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regarding its future. Significant challenges remain before most of the
methods discussed in this book can be accepted and ...

tions that might be considered to fall into the category that such an
assumption suggests can be considered to be included...

tions have generally been referred to as ‘clients’, rather than as
‘patients’, except where a distinct medical relationshi...

Education, and Welfare, Public Health Service, National Center for Health Services
Research: available from NCHSR Publicat...

13
The use and role of
technology in counselling
and psychotherapy
KATE ANTHONY
INTRODUCTION
The use of technology in coun...

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to-speech software. Websites can be available in large type, enlarged
text documents and colour contrasted text, and compu...

Interaction with another person or persons using technology has four
distinct parameters:
1. without any visual or audio e...

has also meant that their impact reaches a far wider community than
those directly involved. Satellite and cable technolog...

vibrations of the air accompanying the said vocal or other sounds. (see
http://www.invent.org)
Telephone communication, an...

arguably be considered unsuitable for actual therapeutic work due to
the unreliability of their signal and possible privac...

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example); a database package (for client or staff information); and
using spreadsheets to manage and study data for both q...

based on traditional methods of mental health assessment, such as the
Beck Depression Inventory scoring system, are very e...

to recognize not only the words provided by the user but also the
context of the words, how they relate to each other and ...

communication). Many thousands of mental health e-groups (where
practitioners can subscribe to an open email discussion fo...

Screenshot1.1Exampleofpractitioner’sviewofsecure
clientcorrespondencemailboxes

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Screenshot1.2Exampleofonlinetrainingprogramme(therapyusingchatroomsmodule)

Internet for specific subject areas and discussion boards. Coursework
can be held on the server and accessed at anytime, c...

1997), the American Counseling Association (ACA, 1999) and the
British Association for Counselling and Psychotherapy (BACP...

Enhancing the text will further minimize chances of misinterpretation
and give the client an opportunity to ‘hear’ the the...

TECHNOLOGY IN COUNSELLING AND PSYCHOTHERAPY
28
Screenshot 1.3 Example of therapeutic email (practitioner response)

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email for conducting a therapeutic transaction suggests the need for
practitioners to have three separate email addresses ...

COMPUTER TECHNOLOGY AND INTERNET
RELAY CHAT (IRC)
At around the same time as email was being applied to mental health
enco...

Screenshot1.4Exampleoftherapeuticchatroomsession

tion to these relationships surfaces (see Young et al., 1999; Maheu,
2000 for examples). The psychological effects of virt...

Fraser, 1995). Since then, many one-way webcams are used for
viewing various live video-streams, mostly for viewing landma...

increased efficiency and improved global communication that tech-
nology gives us also increases our resources and opportu...

Protocolled Treatment of Post-Traumatic Stress and Pathological Grief Through the
Internet.’ Behavioural and Cognitive Psy...

37
Part IEmail and Internet
Relay Chat

Individual therapy online
via email and Internet
Relay Chat
PETER J. CHECHELE AND GARY STOFLE
This chapter discusses the e...

trast, therapists who envision their role as more of a teacher, motivator
and collaborator rather than healer may struggle...

agreed-upon contract. Finally it is imperative that clinicians develop
competence in handling acting-out behaviour and int...

munications. Over time they may begin developing an eye for ‘reading
between the lines’ of these exchanges. On the other h...

Thank you for your email.As I told you last night this weekend was an
emotional roller coaster for me.This morning I cried...

research and training must be done to better address these needs and
prepare clinicians for the challenges ahead.
PRACTICA...

archived clients’ records can be achieved using one of several email
programs. Regularly backing up these records on a rem...

THE WORK
There are numerous methods for developing a therapeutic relation-
ship through text. Mood and personality can be ...

very childish because I don’t just buckle down and get on with my life.
[authors’ emphasis]
That little girl must have fel...

your fingertips. Whether it is used for looking up information to help
in treatment planning, suggesting books or articles...

phone and finally to face-to-face counselling. Clients will sometimes
enter therapy using email and move up the continuum,...

where one cannot take back what one has said. Of course, whatever
the modality of treatment, the therapist works with the ...

you feel the need. Chat does seem to fly bye [sic] and I
wouldn’t want to see you spend that time thinking about
dollars a...

❒ An alternative email address and or phone number to reach
you.
That will be a good start and if you have some questions ...

expect to hear back from me.What I’d like to do now is to cut
and paste bits and pieces of your last few emails and talk a...

seems I’m all good or all bad.And I’m really somewhere in
between.
I don’t understand how or what I’m doing to change the ...

their ideas and beliefs either help them to function adequately in the
world, or impair their functioning. The following b...

Therapist: are some of those circumstances happening now?
Client: I don’t know…I guess so…to a certain degree
Over time, t...

Therapist: and I trust you – we’ve had several conversations about this.
Client: yeah…I’m okay
Therapist: it sounds like y...

CONCLUSION
There are many further issues to be considered in using online text
within the counselling and psychotherapy pr...

59
3 Conducting group
therapy online
YVETTE COLÓN AND BETH FRIEDMAN
INTRODUCTION
With the availability of online forums fo...

isolation, anxiety and depression (Finn, 1995). Another feature of
computer-mediated communication is the idea of relative...

● Mailing lists/listserv: A mailing list is a private email subscription
in which each subscriber receives a separate copy...

the universality of the experience, were present in the electronic
medium. The anonymity of these groups was also helpful ...

isolation as a young cancer patient and maintaining a positive attitude
in moving forward with his life. He agreed to the ...

advantages and disadvantages of computer-mediated communication
is necessary, and the facilitator and group members must b...

not reviewed or rejected before they are posted or sent to the partici-
pants, the facilitator can use the conflict to fur...

written cues as a means to assess the client’s altered emotional status
was an important skill for the facilitator to poss...

is something I should be doing, but I don’t know what it is. I know you
will understand.
Janet, another member, had seen h...

instructions about how to participate, which need to be clear and
simple, explaining the group process and technical issue...

CONFLICT
In online psychotherapy groups, the management of conflict involves
a strong presence and leadership from the fac...

FACILITATOR: I heard back from Jane and after much thought she has decided
not to continue with the group. I expressed my ...

degree of objectivity, make sure that all members are participating at a
relatively similar pace, try to reflect common fe...

The online termination process can continue to be a process for reflec-
tion, exploration and change. As they approached t...

FACILITATOR: Can you comment on the times people did respond
to you?
CAROL: Is this become MY [discussion]? I think any an...

therapist should be cognizant of all the advantages and disadvan-
tages, as well as any legal and ethical concerns, of pro...

75
4 The supervisory relationship
online
MICHAEL FENICHEL
INTRODUCTION
What exactly is meant by ‘online supervision’? The ...

a need for ongoing supervision as does the therapist engaging in
traditional, office-based practice, if not more so. Moreo...

there are many types of counselling and psychotherapy, for many
types of clients and therapists, with many possible presen...

exposition about the diversity of real-life clinical practice, do
encourage supervisors and supervisees to maintain an awa...

training, and professional focus, has spent several years developing
collective skills in evaluating initial ‘calls for he...

data to be highlighted within the ongoing work, but are liable to be
important for those working in a number of other supe...

the supervisor, it is important also to be aware of a number of factors
which impact the process and efficacy of the thera...

Moreover, this peer group included other members who were experi-
enced not only in psychotherapy practice (online and off...

combines both traditional group structure, beginning with a frame-
work emphasizing confidentiality plus ground rules for ...

parent’ environment where one could freely communicate with a
minimum of frustration due to ‘technical difficulties’, an e...

email, while others provided material from message boards and chat
sessions, depending on the therapeutic relationship. So...

often has more direct access to case records and certainly more direct
(face-to-face) contact with the supervisee, imagine...

as it relates to the individual ‘case’ at hand. Increasingly, we live in an
interconnected world, and an ever-expanding co...

possibility of finding ‘unqualified or unscrupulous counselors’. Thus,
one admonition to the would-be supervisor of online...

Fenichel, M. (2000a) ‘Online psychotherapy: Technical difficulties, formulations and
processes’. [Online] Available: http:...

91
Part IITelephone and
video links

Telephone counselling and
psychotherapy in practice
MAXINE ROSENFIELD
HISTORY
It seems incredible that as recently as 1997...

counselling skills in one-off sessions, to support callers as a ‘listening
ear’, perhaps offering information or referrals...

addition, it may be easier to use a telephone than it would be to
type on a computer keyboard.
● The immediacy afforded by...

ASSESSMENT SESSION
During the assessment session both parties can decide if they wish to
work together and then agree to a...

Often the practitioner will send a copy of the contract by post or
email to the client so that both parties can be clear a...

and talk more freely sooner than they might in other settings. This
also enables the practitioner to take risks and use al...

key tools to aiding listening and understanding. Differences in the
client’s speed of talking, the presence of silences, t...

down phrases during the session and add some more detail and
thoughts to them afterwards, if this is what they intend to d...

as may those who cannot hold a handset for a long time, although
there are aids to assist with such problems.
Other factor...

First session
Narelle calls exactly on time and sounds quite excited. She has been
anticipating the session and is curious...

This led to her talking about the sexual relationship with Simone,
which she describes as ‘comfortable’. We also discuss t...

In all my sessions I inform the client when there are five minutes left
and I always end on time. When I did this, Narelle...

received about six weeks after the last session quoting a passage from
Gibran’s The Prophet (1988, p. 10):
Then said Almit...

were simple and she repeated herself often. She thought the coun-
selling was ‘some time to talk about me and only me’ and...

for everyone in the house and no one helps her. Her voice was
agitated and she spoke far less clearly than when she was ca...

My sessions with Dorothea made me aware of how much we expect of
our clients and how articulate they need to be to facilit...

Video counselling and
psychotherapy in practice
SUSAN SIMPSON
THE DEVELOPMENT OF VIDEOCONFERENCING
IN TELEHEALTH AND PSYCH...

Although the greatest area of growth and research into videoconfer-
encing has taken place in industrial countries such as...

lowest cost videoconferencing equipment currently consists of a basic
desktop PC with a camera mounted on top. At the othe...

Clinical efficacy
A number of studies have suggested that therapy conducted via video-
conferencing may be equivalent to f...

of eleven clients felt significantly more confident to deal with their
problems (including insomnia, flight phobia, social...

In another recent study (Simpson et al., 2002), 11 clients attended a
single session of hypnosis via videoconferencing. On...

consciousness and awkwardness reported by a client whilst discussing
sensitive issues were more attributable to her genera...

Therapist satisfaction
Few studies have examined therapist preference for one mode of com-
munication over another. It wil...

rienced users who are already familiar with the equipment. There is
currently little formal training available on the use ...

causing confusion. In addition, hand and arm gestures can become
pixelated (the screen image becoming interrupted by jerki...

THERAPEUTIC PROCESS ISSUES
Although the process of therapy tends to be similar for video therapy as
in face-to-face settin...

● Therapists should allow time to adjust to using the videoconfer-
encing system, and note that in general any initial dis...

sonnel to operate them at both sites (when needed), and also
provides consistency for clients.
● In order to obtain the be...

Peggy was also experiencing clinically significant levels of anxiety and
depression. She believed that she was socially un...

Peggy was easily hypnotized, and in fact became deeply relaxed in a
relatively short time period. Arm levitation was parti...

therapy through an increase in regular healthy eating and physical
exercise. Results from Peggy’s questionnaires and self-...

therapy via videoconferencing at such an early stage, when there is a
lack of controlled trials to show its efficacy. Howe...

in comparison with face-to-face therapy, and a multi-centre approach
may be needed to recruit sufficient numbers to accomp...

communication: implications for advanced telecommunications technologies’, Human
Factors, 37: 228–50.
Gammon, D., Sorlie, ...

Wittson, C.L. and Benschoter, R. (1972) ‘Two-way television: helping the medical center
reach out’, American Journal of Ps...

Video and telephone
technology in supervision and
supervision-in-training
PHILLIP ARMSTRONG AND H. LORI SCHNIEDERS
In 1985...

LIVE SUPERVISION
During the last 30 years, live supervision of practitioners-in-training
has taken many forms, from teleph...

VIDEOCONFERENCING
Currently, access to most supervision is limited by the availability of
qualified supervisors and the di...

supervision (Sampson and Pyle, 1983; Hannon, 1996; Bloom, 1998).
The use of public servers as a supervision resource can v...

intern/supervisee was a technology novice but far from technophobic
and willing to engage in the process. Equipment and it...

barriers may be created. When servers go down, access to the super-
visor is limited. In addition, supervisees must plan f...

suits the practitioner well. Other issues confront counsellors in rural
and regional areas, such as potential threats to c...

that his brother had recently been killed in a car accident. It does not
take long to identify what is normal in relation ...

potentially dangerous. Being based in a city, the supervisor ignorantly
suggested that he simply ring the local adult ment...

clarify the issues therein (Sampson et al., 1997). The question of how
technology impacts on the quality of the counsellor...

the authors of this chapter call on counsellor and therapist educators
and supervisors, to be proactive in thinking about ...

Schnieders, H.L. (2000) From a bug in the ear to a byte in the eye: Implications for
Internet delivered, live counsellor s...

Part IIIComputerized therapy:
stand-alone and
practitioner-supported
software
141

Computer programs
for psychotherapy
KATE CAVANAGH, JASON S. ZACK,
DAVID A. SHAPIRO AND JESSE H. WRIGHT
INTRODUCTION
Comput...

4. cognitive-behavioural (more fully developed programs that contain
a combination of methods typically employed in CBT an...

client-centred, Rogerian techniques featuring restatement and empathic
reflection. He never intended ELIZA to function as ...

lends itself particularly well to computerization, a key principle that
has been seized upon by the authors of therapeutic...

Computerized graded exposure: individualized hierarchies
Expanding on this early work, two groups of researchers (Ghosh et...

received the book Living with Fear (Marks, 1978), or planned their
exposure treatment by interacting with the computer pro...

Marquis convention hotel, rising 49 floors, up to 147 metres at the top.
Desensitization conducted during immersion in the...

Moreover, virtual environments can be used to construct and explore
feared or desired spaces that cannot be encountered in...

intellectually stimulating but relatively unlucrative. The PLATO DCS
presents an overview of the rationale for the dilemma...

3. Clarify the suitability of the new proactive behaviour and identify
the inhibited function that results from the patien...

effectiveness of cognitive therapy for panic. The traditional therapy
group received 12 sessions of individual CBT, whilst...

therapist (Bowers et al., 1993). In this study, subjects had negative
responses to the natural language module (Stuart and...

electronic self-help method. Beating the Blues has been designed
mainly as a stand-alone tool.
Good Days Ahead: The Multim...

point scale (5 ϭ highest rating). The entire program was completed by
78.1 per cent of subjects and 93.4 per cent reached ...

their treatment by cognitive-behavioural therapy, as well as anima-
tions, voice-over and interactive modules.
In a recent...

inpatients and outpatients within the context of psychiatric practices
(Wright et al., 2001, 2002b).
Below we include a ca...

Janet worked at her own pace in using the therapeutic software in ses-
sions typically lasting 25–50 minutes. She also did...

divorce. In the Taking Action segment she learned how to use activity
scheduling, mastery and pleasure ratings and graded ...

Little is known about which patient characteristics predict most engage-
ment or benefit from computerized psychotherapy p...

Burnett, K.F. (1989) ‘Computers for assessment and intervention in psychiatry and
psychology’, Current Opinion in Psychiat...

Muehlberger, A., Herrmann, M.J., Wiedemann, G., Ellgring, H. and Pauli. P. (2001)
‘Repeated exposure of flight phobics to ...

exposure therapy for Vietnam veterans with posttraumatic stress disorder’, Journal
of Clinical Psychiatry, 62: 617–22.
Sel...

The computer plays
therapist: the challenges
and opportunities of
psychotherapeutic software
KATE CAVANAGH, DAVID A. SHAPI...

of human interaction. Thus one way to consider therapeutic software
is along these three dimensions of time, training and ...

Client–software therapeutic training
Software can also be developed to deliver training in therapeutic tech-
niques or kno...

Since by definition a computer program cannot form a person-to-
person relationship with a client, this might be taken to ...

Ethical and political considerations relate to the primacy accorded to
the client or consumer of professional services as ...

and able to manage crisis situations effectively. Second, we must
consider whether these programs represent a ‘second best...

risk issues and may therefore be wary of computerized therapy on
the grounds that clients need to be monitored for risks s...

Where no suicidal ideation is indicated, the program moves on to a
discussion of recent upsets and disappointments. Where ...

Computer (voice-over, screen text and graphic with multiple choice
responses): How seriously have you planned to carry it ...

The client’s responses to the risk interview are indicated in full on his
or her progress report. Where active suicidal id...

with local practice standards. For example, when delivered in
primary care environments, the client’s progress report can ...

Risk-monitoring: homicide risk
To our knowledge no current computerized psychotherapy program is
designed to assess, detec...

Client acceptance and satisfaction
Acceptability and satisfaction with psychotherapeutic interaction is
not measured solel...

including medication and face-to-face counselling or psychotherapy
(Proudfoot et al., 2003a).
A further measure of treatme...

work with clients whose need for face-to-face therapist contact is
greatest, with some reduction in the pressure of sheer ...

Client trust
Whether a client enters a psychotherapeutic encounter with a human
or a computer, trust issues are involved. ...

Healthcare professionals holding clinical responsibility for client well-
being may wish to have access to progress inform...

ders in the UK indicated that 1 in 6 adults aged 16–64 had a neurotic
disorder. This represents more than 7 million people...

The flexible nature of psychotherapeutic software means that it can
be adapted to meet client needs in ways that a human p...

and vocational counselling (see Wagman, 1980; Wagman and Kerber,
1984). Psychotherapeutic software may offer an efficient ...

extraneous factors. As Colby et al. (1979) noted, there are a number
of ways in which the computer might improve upon the ...

the-art multimedia packages for the treatment of anxiety and depres-
sion have each to date entailed development costs in ...

equipped to supervise trainees? As the use of psychotherapeutic soft-
ware becomes a healthcare standard, such processes m...

Third-party insurance reimbursement is a critical component of mental
healthcare in the US and elsewhere. Although insuran...

‘This is not a therapy’
At present there is no guidance or regulation regarding the use of
psychotherapeutic software in m...

However, all the actions of therapists, their trainers and the raters
tasked with assessing their adherence or competence ...

ACKNOWLEDGEMENT
All images in this chapter have been provided courtesy of Ultrasis plc.
REFERENCES
Australian Institute of...

Haaga, D.A.F. (2000) ‘Introduction to the special section on stepped care models in
psychotherapy’, Journal of Consulting ...

Ohayon, M.M., Priest, R.G., Guilleminault, C. and Caulet, M. (1999) ‘The prevalence of
depressive disorders in the United ...

M.B. (2002) ‘Development and initial testing of a multimedia program for computer-
assisted cognitive therapy’, American J...

Conclusion
KATE ANTHONY AND STEPHEN GOSS
During the course of this book, we have seen a number of ways in
which technology...

COMMON ADVANTAGES AND LIMITATIONS
We can distinguish between two uses of technology to conduct a rela-
tionship; the first...

culture other than their own may feel more comfortable in having
access to someone who is based in their country of origin...

will choose a less physical method of interacting with a therapist. As
was stressed in Chapter 1, there are varying degree...

the ability to copy a message to many people) has proliferated to such
an extent (Heylighen, 1999). Being available to our...

2001). Experience in practising face-to-face therapy before attempting
the use of technology to convey or conduct a therap...

world, questions of quality control, professional regulation and client
safety become acute. In different parts of the wor...

their client’s country, as well as their own. However, numerous profes-
sional bodies around the world are yet to adopt a ...

phone’s more modern counterpart: videoconferencing. Email and
IRC-based services are readily available in many parts of th...

Among other topics that are ripe for research attention, we must iden-
tify which client groups are most, and least, likel...

also be essential for online services to accurately represent themselves
to potential clients.
Despite the increasing body...

occupy the same virtual space while many miles apart will offer total
immersion in a virtual environment with tactile feed...

anonymity and genuine safety. Put these avatars into specific relaxing
virtual environments, and we can lose the impersona...

Childress, C. and Williams, J. (2002) ‘Incorporating Email Into Patient Care at Commu-
nity Mental Health Clinics’. Paper ...

Index
209
A
access
to information 20–2, 68
to online group therapy 5
to online therapy xix, 9, 14, 19, 29,
43, 75, 196–7, ...

Bossert, P. 138–9
Botella, C. 148
Bower, P. 169
Bowers,W. 154
Bowman, J.T. 130
Bresee, G. 25
British Association for Behav...

client–software relationship 167–9
client–software therapeutic training
167
desensitization programs 146–50
disclaimers 18...

Elliott, R. 203
email therapy 4, 22, 23, 25–9, 41
anonymity 42, 43
benefits 29, 41, 42, 43
case study 50–4
challenging/pro...

Heylighen, F. 199
Hill, C. 11, 189
Hodges, L.F. 205
Hodges, M. 117
Hodson, P. 15
Holderegger, J. 2
Hollon, S.D. 190
Holmes...

Marks, I.M. 17, 144, 147, 148, 168, 176,
180, 185, 186
Mayers, L.B. 197
McClennan, J. 115, 116
McDevitt, C. xvii–xix
McLar...

P
Palmer, S. xviii
Parkin, R. 152
password access to live therapy 25
password protection
computerized therapy 22, 180
of e...

stand-alone software 18–20, 195, 198,
202
‘stepped care’ approach 178, 184
Stewart, F. 22
Stiles,W.B. 169
Stofle, G. xv, 4...

for therapists in distance therapy
199–200
treatment manuals, advantages 189–90
trust see client trust
Turing Test 19
U
Us...

E-BOOK KONSELING TEKNOLOGI (REFRENSI) Technology in counselling and psychotherapy

E-BOOK KONSELING TEKNOLOGI (REFRENSI) Technology in counselling and psychotherapy

E-BOOK KONSELING TEKNOLOGI (REFRENSI) Technology in counselling and psychotherapy

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