Does the research justify the use of video for delivering counselling?  Is it clinically effective?  Excellent questions!  

I would like to direct your attention to an excellent review of the literature.  This review written in 2009[1] builds on a previous review written in 2003, consolidates the information available up to 2008 and suggests future research avenues.

The review discusses an exponential increase in articles from 1970 – 2008.  “From an initial review of 68 peer-reviewed journal articles in the period 1970–2000, there were 63 new published reports three years later and 148 new publications from April 2003 to July 2008”. A quick search of http://clinicaltrials.gov/ indicates over 340 studies are currently underway or have recently been completed.  And I bet that’s not all!

Richardson et. al. (2009)  point out that the bulk of the published reports on videocounselling are case studies, novel clinical applications, program descriptions/evaluations and assessment studies with a “handful” of randomized, controlled studies.  Videocounselling was used with rural and remote populations, children and adolescents, older adults, veterans, deployed personnel, cancer patients and incarcerated patients. 

What types of results were reported in Richardson et. al. (2009)?

Continue reading →

Just as my client was telling me something important I lost the Skype connection.  Bam. The screen went black. It took a few precious minutes to get back online and back in touch with the client.  The client seemed to be okay with it and picked up the story where she had left off.  Me?  Well, it took me a moment longer to take off my ‘technical problem-solving hat’ and put my ‘counsellor’ hat back on. 

When you are using videoconferencing these moments happen.  The technology fails.  It’s one thing to have this happen in a conversation with a friend.  It’s another thing altogether when it happens with a client in a moment of vulnerable sharing.

How about this scenario – a client Skypes with you and as part of that Skype session you have sent each other written messages.  The client shares a computer and Skype address with her spouse and she hasn’t told her spouse she is having counselling.  While Skype calls are themselves encrypted the history of calls, contacts and messaging history stays on the computer.

So what can we as ethically responsible counsellors do?  

Continue reading →

Skype and other forms of videoconferencing have been around for quite a while.  As I periodically surf the internet I have noticed an ever-increasing number of counsellors list Skype as an alternate method of delivering counselling.  

Why do so many counsellors use Skype as opposed to any other videoconferencing software?  Hmmm, could it be because it’s free?  And easy to use?  But is it the best platform to use for every counselling situation?  (see Brian Dosenberger’s Feb. 10, 2012 blog post “Choosing a Platform for Online Counselling”)

Some counsellors only use this technology as an adjunct with clients they have met face-to-face and others use it exclusively – only ever “meeting” their clients online. Which clients use it?  Clients who have moved, are travelling, have caregiving responsibilities or disabilities that make it difficult to get to a counsellor’s office, live in areas where resources are limited and who prefer talk therapy to writing. 

Continue reading →

If you google the phrase “online support groups” you will find over 60 million hits. And you can find an online support group for everything from Abstinence to Zellweger Syndrome [yes, literally A to Z].  There are mutual help groups (peer to peer) and groups that are moderated by mental health professionals or trained volunteers.  How to select from amongst them? First, we need to educate ourselves and then we need to educate our clients.   

At times I have referred clients to online support groups.  In order to make an informed referral I search for and review the groups.   Questions I have asked as I am researching support groups:

Continue reading →

There are several factors to consider when deciding which web conferencing to use for online counselling.  Today I want to highlight I will focus on choosing a web-conferencing platform that fits how you practice counselling. As someone that practices both traditional and online counselling I want to ensure the web conferencing platform I choose allows me to offer my clients online the same, or as close to the same experience as I would give a client in my own office.

Choose a platform that allows you to perform counselling in the same manner as you would in a traditional face to face session.

In order to effectively perform online counselling I need the ability to perform counselling in the same manner that I conduct an in person session. For example, if you are a therapist that utilizes a white board, illustrate psycho-educational material, draws diagrams, or gives homework assignments then you want to choose a platform that allows you to perform those tasks.

Continue reading →

As I mentioned last time a number of crisis lines have added online services such as real-time chats and e-counselling.  It’s not just Canada. A 2007 report from Child Helpline International[1] lists 13 other countries that make use of web-based support in addition to their phone-based support.  Given the shifts in help-seeking behaviour in youth it makes sense.

While web-based support is being widely used researchers and crisis line counsellors are still determining what makes for the most effective and appropriate ways to use this medium.  Research has been focussed on outcomes, session impacts, building rapport, assessing therapeutic alliance, comparisons of telephone versus chat, motivations for choosing chatting versus calling and client feedback.

Continue reading →

As an online counselling session begins I welcome them to my office and familiarize the client with my office and environment that is not visible via the VoIP technologies. Licensing bodies in Canada have a daunting task in front of them determining counsellors’ use of online counselling. Where does the counselling session occur?

My insurance stipulates that I am covered to conduct therapy that occurs within the provincial boundaries of which I am registered. So this leads to the question, where does online counselling occur?  I could argue that the internet is the taxi, train, or jet plane that brings the client to my office. Others could argue that if my client is in Ontario and I (the therapist) am in Alberta, the therapy occurs in Ontario.  The third argument, suggests that the counselling session occurs in neither the counsellors office nor the client’s home but rather a virtual space where counsellor and client meet in the middle. I know for a fact that I would be in big trouble with my licensing body if I flew to Ontario and conducted a counselling session. Having stated this fact, I have to truly believe that the counselling session I conduct occur in my own province to ethically see clients outside of my province. What is the evidence and how can we determine that the appointment occurs at the counsellor’s office? Basically, because the client schedules an appointment with the counsellor, determines that the client is coming to the appointment as opposed to the counsellor coming to their residence.

Continue reading →

Over the past several years Crisis lines across have begun to add online components to their crisis services.  Based on conversations with people involved and research I have read — after years of successfully running crisis lines a pattern emerged of a significant drop in phone calls from the under 25s.  

As Robin Shantz noted in a 2006 article “We knew the problems youth are facing weren’t going away.  And it’s not like youth don’t have access to phones…”[1].  What became apparent is that youth’s help-seeking behaviour had changed.  They wanted to be able to access crisis services online.  As one messaging software company put it “…Increasingly people are not using the phone to seek help. Instead they turn to the tools they use elsewhere in their daily life: websites, live chat and text messaging”.[2] 

Continue reading →

As 2011 winds down I wanted to share with you some of the top online mental health sites I have used with clients (both in-person and online) in the past year.   

Before I recommend a site to a client I check that the URL is still active and I review the site.  I inform clients that referring them to a website is not a wholesale endorsement of everything on the site.  I also encourage my clients to use their own judgment about what they read.  

And now…here they are! 

Continue reading →

It’s a question I’ve heard many times. From colleagues as they try to understand how online counselling works and from parents as they puzzle over the amount of time their child spends on facebook (and other social media).   Of course, they don’t often define “real” – just express this vague sense that somehow an online relationship is not valid.

Let’s look at some anecdotal reports from this past week in my life. 

A counsellor I know is taking the Cybercounselling Level 1[1] course.  She said she had learned it was possible to feel connected to people she had only met online. That she had “warm feelings” for the others in her course.  This experiential learning was a pleasant surprise to her and enabled her to understand how a client and therapist might be able to establish a positive working relationship in an online format.

Continue reading →