1. OSCAR MCKNIGHT PSYCHOLOGICAL COUNSELING SERVICES ASHLAND UNIVERSITY GREGORY POLLOCK DOCTORAL INTERN/ADJUNCT FACULTY JOHN CARROLL UNIVERSITY KERRI CARMICHAEL PROFESSIONAL COUNSELOR ASHLAND UNIVERSITY Using Technology and Online Counseling: The Future is Now

2. Prologue There are professional programs and standards addressing the practice of online or distance counseling, though the practice remains in its infancy. There is a paucity of professional literature or workshops available for the professional counselor when using electronic resources in counseling delivery.

3. Overview Historical and future perspectives on online counseling Review the history of F2F counseling and online counseling Discuss who and why people use online counseling Explore the “goodness of fit” between the individual and their online environment Multiple forms of technology in service delivery:  Emailing  Chatting  Skype  Text messaging  Facebook messaging  Google Plus  Proprietary services  record keeping software

4. Overview Background Technology is transforming the world and how we live, communicate and interact. TWO BIG QUESTIONS 1. Should counselors avoid, minimize, maximize or embrace the online environment? 2. How does On-Line Counseling fit with the profession? Professional standards Certifications Putting it all to use in practice Pros and Cons

5. Counseling: A Historical Review

6. Online Counseling: A Review

8. National On-line Counseling (Real Counselor) An Overview 100% Never meet the Client F2F (excluding “Skype”) Most frequent site visitor was a female between the ages of 25 – 34; browsing from home; and, had no children. Purchased session times: 30 – 60 minutes.

9. SURVEY: ON-LINE CLIENTS (University Counseling Center) LOCATION OF SERVICE

10. Online Counseling Services(University Counseling Center) 3 Year Review No significant Difference found between gender and scheduling appointments for online counseling No significant pattern of diagnoses or presenting concern between those scheduling online counseling and those in traditional counseling No significant difference between the overall satisfaction ratings of those receiving counseling online and those in traditional counseling Why Online Counseling? 1. Did not want to be seen coming into the center 2. Convenience Anecdotal Findings TIMEDoes not follow the 50 minute hour DISCLOSURE Disinhibition effect INFORMATIONAbundance – links to blogs, journals, YouTube videos

11. Online Non-Human Counseling

12. ALICE (counseling sample)

13. ROBO (counseling sample)

15. CHRIS: Session Termination

16. Marriage Counseling by Siri

17. Brief Demographics  250 active users  23 States  Male users on Saturdays  Female users on Fridays  Multiple Diagnostic Categories  Multiple Populations  Average Time on site 5.2 minutes; College Education  36% complete the entire counseling process  Counseling Helpfulness/Effectiveness 7.3 (10 point scale)

18. Skype Video

19. Synchronous and Asynchronous Counseling

20. Targeted Software >150 Commercial Software Packages

21. Speech Recognition

22. Proprietary Software for Record Keeping

26. Pros and Cons of Electronic Notes in Counseling Pros: Easy to read, store, transfer or analyze; Structured; Meets legal/billing Codes or Protocols; forced to conceptualize cases; Maintains case focus; great template for novice counselors Cons: Limited by programming options; Counselors in sometimes fear therapy is more about billing or documentation than treatment; Feeling “technology” inhibits the therapeutic relationship; Case file security

27. According to the NBCC: Standards for the Ethical Practice of Internet Counseling http://www.nbcc.org/Assets/ethics/internetCounseling.pdf These standards govern the practice of Internet counseling and are intended for use by counselors, clients, the public, counselor educators, and organizations that examine and deliver Internet counseling. These standards are intended to address practices that are unique to Internet counseling and Internet counselors and do not duplicate principles found in traditional codes of ethics. These Internet counseling standards of practice are based upon the principles of ethical practice embodied in the NBCC Code of Ethics. Therefore, these standards should be used in conjunction with the most recent version of the NBCC ethical code. Related content in the NBCC Code are indicated in parentheses after each standard. Recognizing that significant new technology emerges continuously, these standards should be reviewed frequently. It is also recognized that Internet counseling ethics cases should be reviewed in light of delivery systems existing at the moment rather than at the time the standards were adopted.

28. In addition to following the NBCC® Code of Ethics pertaining to the practice of professional counseling, Internet counselors shall observe the following standards of practice: 1. In situations where it is difficult to verify the identity of the Internet client, steps are taken to address impostor concerns, such as by using code words or numbers. 2. Internet counselors determine if a client is a minor and therefore in need of parental/guardian consent. When parent/guardian consent is required to provide Internet counseling to minors, the identity of the consenting person is verified. 3. As part of the counseling orientation process, the Internet counselor explains to clients the procedures for contacting the Internet counselor when he or she is off-line and, in the case of asynchronous counseling, how often e-mail messages will be checked by the Internet counselor.

29. Standards of Practice continued 4. As part of the counseling orientation process, the Internet counselor explains to clients the possibility of technology failure and discusses alternative modes of communication, if that failure occurs. 5. As part of the counseling orientation process, the Internet counselor explains to clients how to cope with potential misunderstandings when visual cues do not exist. 6. As a part of the counseling orientation process, the Internet counselor collaborates with the Internet client to identify an appropriately trained professional who can provide local assistance, including crisis intervention, if needed. The Internet counselor and Internet client should also collaborate to determine the local crisis hotline telephone number and the local emergency telephone number.

30. Standards of Practice continued 7. The Internet counselor has an obligation, when appropriate, to make clients aware of free public access points to the Internet within the community for accessing Internet counseling or Web-based assessment, information, and instructional resources. 8. Within the limits of readily available technology, Internet counselors have an obligation to make their Web site a barrier-free environment to clients with disabilities. 9. Internet counselors are aware that some clients may communicate in different languages, live in different time zones, and have unique cultural perspectives. Internet counselors are also aware that local conditions and events may impact the client.

31. Confidentiality in Internet Counseling The Internet counselor informs Internet clients of encryption methods being used to help insure the security of client/counselor/supervisor communications. Encryption methods should be used whenever possible. If encryption is not made available to clients, clients must be informed of the potential hazards of unsecured communication on the Internet. Hazards may include unauthorized monitoring of transmissions and/or records of Internet counseling sessions. The Internet counselor informs Internet clients if, how, and how long session data are being preserved. Session data may include Internet counselor/Internet client e- mail, test results, audio/video session recordings, session notes, and counselor/supervisor communications. The likelihood of electronic sessions being preserved is greater because of the ease and decreased costs involved in recording. Thus, its potential use in supervision, research, and legal proceedings increases. Internet counselors follow appropriate procedures regarding the release of information for sharing Internet client information with other electronic sources. Because of the relative ease with which e-mail messages can be forwarded to formal and casual referral sources, Internet counselors must work to insure the confidentiality of the Internet counseling relationship.

32. Legal Considerations, Licensure, and Certification Internet counselors review pertinent legal and ethical codes for guidance on the practice of Internet counseling and supervision. Local, state, provincial, and national statutes as well as codes of professional membership organizations, professional certifying bodies, and state or provincial licensing boards need to be reviewed. Also, as varying state rules and opinions exist on questions pertaining to whether Internet counseling takes place in the Internet counselor's location or the Internet client's location, it is important to review codes in the counselor's home jurisdiction as well as the client's. Internet counselors also consider carefully local customs regarding age of consent and child abuse reporting, and liability insurance policies need to be reviewed to determine if the practice of Internet counseling is a covered activity. The Internet counselor's Web site provides links to websites of all appropriate certification bodies and licensure boards to facilitate consumer protection.

33. Distance Credentialed Counselor CCE has selected ReadyMinds to deliver the DCC Training. Requirements to attend the DCC Training Program include:  1. An earned Master's degree in counseling or an appropriately related field (you do NOT have to possess advanced technology skills). Requirements to attend the DCC Training Program AND obtain the DCC Credential include:  1. An earned Master's degree in counseling or related mental health field from a regionally accredited college or university.  2. Be licensed to practice counseling or a related field in the State or Country in which the candidate resides or works AND/OR be certified in good standing as a National Certified Counselor (NCC).  3. Successful completion of the two-day 15 hour DCC Training Program and the DCC written Training Accountability Requirement (TAR)  To learn more about the DCC Training Workshop, find a training location near you, or to register for a DCC workshop, please visit www.readyminds.com/dcc. Training questions should be directed to Lisa Miller at ReadyMinds at (888) 225-8248 or lisa@readyminds.com.www.readyminds.com/dcc. Training questions should be directed to Lisa Miller at ReadyMinds at (888) 225-8248 or lisa@readyminds.com.

34. Comments, Questions, Ideas?