To Skype or Not to Skype Dan L. Mitchell, MA, CCC & Dawn Schell, MA, CCC, CCDP Worldwide Therapy Online Inc. TherapyOnline.ca is a trademark of Worldwide Therapy Online Inc. Overview • Introduction, History, the Present • Literature Overview • Recent LinkedIn Conversations • Ethical, Technical, & Clinical Considerations • Preparing to Offer Cybercounselling • Real Life Experience • Worth It? • Next steps A Brief History of Therapy Online • founded 1994 by two counsellor members of CCPA • ethical codes: 1998 NBCC, 2011 BCACC • 1998 - “When Writing Helps to Heal” • 2003 Cybercounselling training - U of Toronto http://www.cybercounselling.com • 2009 - British Journal of Social Work article compares F2F and online The Present • Team of 8 online counsellors • Dawn’s Blog on Counselling Connect • Yet to be published research: Competency Scale • Privacemail 3.0: multi-lingual web based platform for cybercounselling • “Private Conversations” Chat, & Videocounselling • Ethics/practical guidelines - update Videocounselling: the Literature • 68 peer-reviewed journal articles from 1970–200063 new published reports by 2003 148 new publications from April 2003 to July 2008 Richardson et. al. (2009)In 2012 - http://clinicaltrials.gov/ indicates over 340 studies are currently underway or have recently been completed. The Literature - 2 • Case studies, novel clinical applications, program descriptions/evaluations, assessment studies and randomized, controlled studies. Videocounselling was used with rural and remote populations, children and adolescents, older adults, veterans, deployed personnel, cancer patients and incarcerated patients. The Literature - 3 “Outcome findings..include high patient satisfaction,...and positive clinical outcomes....The clinical effectiveness of tele-mental health interventions in children, nonelderly adults, and elderly adults has been demonstrated via case studies, program evaluations, and some controlled trials...research in this area is still ‘underdeveloped’” Richardson, et. al. (2009) The Literature - 4 “Research demonstrates that important process and client-counselor relationship variables are similar to equivalent face-toface-therapy” i.e. therapeutic alliance and session impact factors Barak & Grohol, (2011) The Literature - 5 “Videoconferencing has been successfully used to treat, social anxiety disorder, panic disorder with agoraphobia, obsessive– compulsive disorder, anxiety in cancer patients, and depression in adolescents and children. Randomized controlled trials have found that videoconferencing treatment is as effective as in-person treatment for childhood depression..” Yuen et. al. (2012) Besides Counsellors... • Other professional groups/fields using Videoconferencing technology • Health Care Professionals, Music Therapists, Speech Pathologists, Elder caregivers, Rehab Professionals, Corrections (to name a few) LinkedIn: Recent Conversations • LinkedIn Groups - Online Counselling Network, Online Therapy Institute, Online Counseling • • Counsellors in many countries are using Skype - UK, USA, Canada, New Zealand, etc. USA - concerns about HIPAA, insurance payments and cross-state legalities Preparing to Offer Cybercounselling • Four areas to consider • Ethics • Clinical competency in the modality • Sound knowledge of the technology • Adapting clinical work flow Skype and “Videocounselling” Alternatives to Skype • • • WebEx • • Google Hangout CounSol Mootu - UK site - 128 Therapists using Skype ovoo.com Webcam Technology • “Videocounselling” = Integration of Openmeetings into PrivacEmail • System Requirements • How the technology works • peer to peer vs. server-based Webcam Technical • Software issues/updates Issues • Router/modem connectivity/ Router configuration • Wireless connection • Firewall configurations • Internet filtering and parental control software • Resource Issues: RAM, CPU, Bandwidth • Additional Hardware: headsets, Technical Issues Manifested • Unable to connect • Loss of connection • Loss of audio • Loss of video • Degraded sound/pixelation • Delay • Echo General Ethical Considerations • Counsellor Preparation • Secure technology - transit and storage • Appropriate training • Insurance Specific Ethical Considerations • Counsellor Preparation • • • • Privacy laws Plan for crisis management (registration data) Plan for technological failure/interruption Counsellor Setting Specific Ethical Considerations •Screening criteria to determine appropriateness/eligibility • • Client setting Client technology & computer skill •Orientation & informed consent •Identity confirmation Ethical, Technical, Clinical Issues Skype Videocounselling Skype knows your location How to conduct screening? Bound by counselling ethics and privacy laws Crisis response plan? Integrated registration Client may leave Skype “on” - chat records Timeout + all records stored on encrypted server Chat/call interruptions Isolated call Skype apps Single purpose Integrated screening Practical/Clinical Considerations • Pre-counselling process (online? phone?) • How to ensure proper client tech setup • First time pre-session orientation/test Practical/Clinical Considerations • TV interview skills are relevant • Where to look; steadiness of gaze • Clothes, setting, background (auditory and visual), lighting Professional appearance Lighting Camera Height (laptop on desk) Camera Height (eye level); Gaze - Looking at my own eyes Gaze - Looking at camera Jotting Notes What a large nose! Distance Our Launch Plans • Online registration and screening • include questions about system requirements • Additional telephone screening if necessary • If eligible/appropriate, first session begins on phone + video • Chat or Private Conversations backup Real Life Experience • Dawn’s client feedback • • • • frustration with call-dropping - loses train of thought likes flexibility pauses led to her “trying to fill blank spaces” “felt a tad bit like there wasn’t a full connection when we used Skype...but this might be one of those necessary cons to the system which has lots of pros” Real Life Experience • Interviews with two experienced Videocounsellors • • • • • about 20% of practice is Skype usually meet client first in person no issues re: therapeutic alliance work on camera angles, eye contact, etc. have even used it for EMDR Is It All Worth It? • Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services, 2006–2010 • • psychiatric admissions decreased 24% days of hospitalization decreased 27% Resources: Moving Forward •Personal study and competency •Bibliography with links to online articles/info •Cybercounselling Levels 1 & 2 • Agency & Private Practice •Consultation •PrivacEmail 3.0 software We’re just an email away Dan L. Mitchell [email protected] Dawn Schell [email protected] Worldwide Therapy Online Inc. www.TherapyOnline.ca (778) 838-6824 is a trademark of Worldwide Therapy Online Inc.