CYBERCOUNSELLING:
The Use of Text Chat and Video to Effect Clinical Change
Lawrence Murphy
Worldwide Therapy Online Inc.
CCPA Conference
May 16, 2013
http://www.therapyonline.ca
http://www.cybercounselling.com
lmurphy@privacemail.com
A Brief History of Therapy Online
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1994 - founded by Lawrence Murphy and Dan Mitchell
1998 - Co-authored the first online ethical code with the
NBCC
1998 - Published seminal work “When Writing Helps to Heal”
2009 - Publication in BJSW compares F2F and online
2013 – COSCE assessment tool published in RSWP
Developed secure encrypted e-mail, chat & video and client
management system (wwto.PrivacEmail.com)
Provide certificate Cybercounselling training in collaboration
with the University of Toronto.
Online Ethics
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The USA PATRIOT Act
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allows federal agents to access routing
information, pages visited, activities online
allows investigation of email routing information
does NOT require proof of wrongdoing
Judge may NOT refuse.
Online Ethics
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Having an email address on your website
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Using email for booking appointments
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Tracing clients in emergencies
Who controls what the client says?
Who is watching you?
What will your insurance company say?
It Just Crept In
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Mishna et. al (2012) Clin Soc Work J
Clients tend to initiate more than social workers
Slippery slope from administrative to “therapeutic”
Privacy issues
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Intercepted email
Sharing on Facebook or via twitter
Boundaries become permeable
A sense of inevitability.
When is Online Counselling Indicated?
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The majority of face-to-face counselling issues are
appropriate for online work
People who are especially sensitive to the presence
or judgment of others and who would not otherwise
connect with mental health services are often very
well served by eCounselling (Leibert et al., 2006).
When is Online Counselling Indicated?
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People with physical, psychological or mental
challenges
Marginalised and disenfranchised people
Those for whom we claim to offer services
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The right to treatment?.
When is Online Counselling
Contraindicated?
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Clients with mental health issues that involve a
serious distortion in reality who are unmedicated
Clients disclosing past sexual abuse for the first time
(text only)
Clients who are suicidal
Risky for clients in a live-in relationship with ongoing
violence.
Theoretical and Practical Issues in
Asynchronous Work
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Anonymity
Reply when you’re ready
A Permanent Record (C)
Power and Empowerment (c)
Lack of Tone and Non-Verbals (C).
Theoretical and Practical Issues in Chat
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Loss of contact (V)
Live communication means higher
expectations for software (V)
Speed of replies
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How long is too long to be typing?
Spelling and grammar
Guiding clients.
Theoretical and Practical Issues in Video
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High bandwidth demands
Hardware and software must be very good
Where do I look?
You are entering the client’s home
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What’s on the wall?
Was that violence on TV or next door?
When does what become a clinical issue?.
Recent Research
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Murphy et al, British Journal of Social Work (2009)
Compared counselling clients engaged in either
face to face or online counselling
Difference in
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scores on Global Assessment of Functioning (0
to 100 pre and post clinical assessment)
and Client Satisfaction Survey.
CSS
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My counsellor helped me feel comfortable in
discussing my problems
My counsellor’s efforts and suggestions helped me
develop a plan for addressing my problems
My counsellor had the skills and expertise to assist
me with my concerns.
Results
• No statistically significant differences between the
two groups for outcome
• No statistically significant differences between the
two groups in terms of client satisfaction.
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Other Research
Barak et. al (2008) Meta Analysis JTHS
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Online interventions showed an overall effect size of
0.53, comparable to F2F
King et. al (2009) Video in opioid addiction treatment JSAT
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Comparable levels of satisfaction and compliance
Online clients indicated a preference for online work
Moessner & Bower (2012) Email and eating disorders JMH
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57.3% first time accessing professional help
half of these reported that they engaged in additional
services
most would have not done so without the online service.
Conclusions from Research
• The therapeutic alliance (TA) can be established in
the media of online counselling
•Online counselling can as impactful as face to face
counselling
• Online counselling may be an alternative or adjunct to
face to face work.