To Skype or Not to Skype
Dan L. Mitchell, MA, CCC & Dawn Schell, MA, CCC, CCDP
Worldwide Therapy Online Inc.
is a trademark of Worldwide Therapy
Online Inc.
• 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
• founded 1994 by two counsellor
members of CCPA
• ethical codes: 1998 NBCC, 2011
• 1998 - “When Writing Helps to Heal”
• 2003 Cybercounselling training - U of
• 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, &
• Ethics/practical guidelines - update
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 -
indicates over 340 studies are currently
underway or have recently been
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,
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)
Recent Conversations
• LinkedIn Groups - Online Counselling
Network, Online Therapy Institute,
Online Counseling
Counsellors in many countries are using
Skype - UK, USA, Canada, New Zealand,
USA - concerns about HIPAA, insurance
payments and cross-state legalities
Preparing to Offer
• 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
Google Hangout
Mootu - UK site - 128 Therapists using
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
• Router/modem connectivity/ Router
• Wireless connection
• Firewall configurations
• Internet filtering and parental control
• Resource Issues: RAM, CPU,
• Additional Hardware: headsets,
Technical Issues
• 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
Plan for technological failure/interruption
Counsellor Setting
Specific Ethical Considerations
•Screening criteria to determine
Client setting
Client technology & computer skill
•Orientation & informed consent
•Identity confirmation
Ethical, Technical, Clinical Issues
Skype knows your
How to conduct
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
Chat/call interruptions
Isolated call
Skype apps
Single purpose
Integrated screening
• Pre-counselling process (online?
• How to ensure proper client tech setup
• First time pre-session orientation/test
• TV interview skills are relevant
• Where to look; steadiness of gaze
• Clothes, setting, background (auditory
and visual), lighting
Professional appearance
Camera Height (laptop on
Camera Height (eye level); Gaze - Looking at my own
Gaze - Looking at camera
Jotting Notes
What a large nose!
Our Launch Plans
• Online registration and screening
include questions about system
• Additional telephone screening if
• 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
“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
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%
Moving Forward
•Personal study and competency
•Bibliography with links to online articles/info
•Cybercounselling Levels 1 & 2
• Agency & Private Practice
•PrivacEmail 3.0 software
We’re just an email away
Dan L. Mitchell
[email protected]
Dawn Schell
[email protected]
Worldwide Therapy Online Inc.
(778) 838-6824
is a trademark of Worldwide Therapy
Online Inc.

To Skype or not to Skype?