ONLINE COUNSELING
Encyclopedia of
Cyber Behavior
Zheng Yan
University at Albany, USA
Volume I
698
ONLINE COUNSELING
699
Chapter 59
Online Counseling
Derek Richards
University of Dublin, Trinity College Dublin, Ireland
Noemi Viganò
Alliance Counseling: Professional Psychological and Counseling Services, Ireland.
ABSTRACT
Online counseling is defined as the delivery of therapeutic interventions in cyberspace
where communication between a trained professional counselor and client(s) is
facilitated using computer-mediated communication (CMC) technologies. Research
considers aspects of delivering therapeutic interventions online, including process and
outcome research, the therapeutic relationship online, the potential benefits and
challenges in working online, client suitability for online counseling, therapists’ and
clients’ attitudes and experiences of online counseling, professional training for working
online with clients, and its very nature and definition as a therapeutic intervention.
Understanding the psychology of online behavior as it applies to online counseling
includes the effects of apparent anonymity and distance, disinhibition, identity and
impression management, writing and emotional expression, presence, and ethical
behavior in cyberspace.
KEY TERMS
Therapeutic relationship online, ethics of online counseling, experience and attitudes
about online counseling, expression in cyberspace, suitability, cyberbehaviors.
ONLINE COUNSELING
INTRODUCTION
The field of cyberpsychology involves
the study of human experiences
(cognitive, emotional, and behavioral)
that are related to or impacted by
developing technologies, in other
words, the psychological study of
human-technology interaction. Subject
areas, for example, include identity
online, online addiction, and online
relationships. Online counseling, also
referred to as e-therapy or cybertherapy,
is another area of study. Online
counseling is the delivery of therapeutic
interventions in cyberspace where the
communication between a trained
professional counselor and client(s) is
facilitated using computer-mediated
communication (CMC) technologies.
The phenomenon of online counseling
has a brief history but, aided by
technological developments, has grown
exponentially in recent years. Research
considers
aspects
of
delivering
therapeutic interventions online. These
include, but are not limited to, the
potential effectiveness of online
counseling, establishing a therapeutic
relationship in cyberspace, potential
benefits
and
challenges,
client
suitability for online counseling,
therapists’ and clients’ attitudes and
experiences of online counseling,
professional training for working online
with clients, and its very nature and
definition as a therapeutic intervention.
Research has also been exploring newly
observed phenomena that form part of
understanding the psychology of online
behavior as it applies to online
counseling. Areas of interest include the
effects of apparent anonymity and
distance, disinhibition, identity and
impression management, writing and
emotional expression, presence, and
ethical behavior in cyberspace.
OVERVIEW
698
History and Current Empirical
Knowledge
While we have provided a definition of
online counseling, the exact definitions
of interventions involving therapists and
clients online are very much in flux and
a continued source of debate. A recent
paper (Barak, Klein, & Proudfoot,
2009) has brought some clarity, yet the
terms are not specific to any theoretical
or technical approach, nor do they
underscore professionals with certain
levels of training (Rochlen, Zack, &
Speyer, 2004). Synchronous (chat and
video conferencing) and more popularly
asynchronous (e-mail) communication
have
been
used
by
client(s).
Additionally, online counseling has
been provided as a stand-alone service
and as an adjunct to other services.
Virtual reality environments, allowing
both synchronous and asynchronous
communication, have also been used to
conduct counseling (Nagel & Anthony,
2011).
Some
web-based
selfadministered treatments for a variety of
disorders
have
included
online
counseling support, usually in the form
of asynchronous post-sessions feedback,
which appears to increase adherence
and
yield
enhanced
outcomes
(Newman,
Szkodny,
Llera,
&
Przeworski, 2011).
It has been argued (Castelnuovo,
Gaggioli, Mantovani & Riva, 2003) that
online counseling is a transposition of
face-to-face counseling online, with
technologies mediating the therapeutic
communication and impacting the
process with their associated advantages
and limitations. From this perspective
online counseling is not perceived as a
new and distinct way of engaging
therapeutically and is therefore not seen
as necessitating a different theoretical
framework
from
face-to-face
counseling.
Conversely, it is argued (Fenichel et al.
2002; Grohol, 1999, 2001) that online
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counseling should be considered a new
type of therapeutic intervention,
characterised
by
fundamentally
distinctive
features.
From
this
perspective online counseling is not
seen as a substitute to face-to-face
interventions but rather as a versatile
and flexible resource with the potential
to complement and support other types
of interventions
From its beginning online counseling
has been criticized by professionals and
laypeople alike (Barak, Hen, BonielNissim, & Shapira, 2008). The roots of
the criticisms have largely concerned a
number of key areas that have populated
the literature since. Firstly, concerns
have been voiced regarding the impact
of the loss of cues on the process of
therapy. Secondly, ethical issues and
their legal implications regarding all
aspects of the construction and delivery
of online counselling feature. Thirdly, a
variety of practical issues have arisen
concerning training for conducting
online counseling and concerns about
relying
on
technology.
Our
understanding of these issues, while
they still exist, has developed through
research, the development of advanced
technologies, the development of ethical
codes of practice, and specialized
training for professionals.
The goal of counseling is to alleviate
the concerns that clients can present.
Counseling attempts to foster clients’
well-being, building on clients’
strengths, and improving overall
functioning (Mallen, Vogel, Rochlen, &
Day, 2005). Online counseling must
also adhere to the same objectives. The
findings from research studies in the
area of synchronous and asynchronous
online counseling have positively
evaluated outcomes, working alliance,
helpfulness and impact and report client
improvement and satisfaction (e.g.:
Barak & Bloch, 2006; Cook & Doyle,
2002; Efstathiou, 2009; Hanley, 2009;
699
Knaevelsrud & Maercker, 2006;
Richards, 2009; Barak et al., 2008).
An early study by Cohen and Kerr
(1998) assigned 24 students to one
session of either face-to-face or online
synchronous (chat) counseling. Both
groups showed a decrease in anxiety
outcomes post-treatment. Although the
study is a sure beginning in showing the
potential of online counseling, it
screened out participants with high
levels of distress and had a small
sample.
Another series of studies (Glueckauf et
al., 2002) randomized teenagers and
their parents for family counseling
among video counseling, audio
counseling, and face-to-face counseling.
Participants in each of the three
treatment groups report positive posttreatment
outcomes
involving
reductions in the frequency of family
problems.
Day and Schneider (2002) compared
face-to-face, telephone and video
psychotherapy.
No
statistically
significant difference was found
between the three treatments for either
working alliance ratings or outcomes. A
statistically significant difference was
found with clients participating more
actively in distance therapy than in faceto-face therapy.
Students using online asynchronous
counseling noted the advantages,
namely, ease of use, speed and
anonymity, followed by ambivalence
about traditional counseling (Efstathiou,
2009). Online counseling seems to
reduce the traditional social stigma
toward seeking help and counteract
social factors that may hinder people in
seeking help such as gender and
physical appearance (Efstathiou, 2009).
Richards (2009) investigating online
counseling with students, highlights the
potential for single session online
contact. He advances reasons such as
apparent anonymity and distance, the
therapeutic benefits of writing, the
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cultivating of a zone of reflection, and
the resourcefulness of young adult
students, as supporting the success of
single session online counseling. The
model employed also allows content to
become a resource for all users
(Efstathiou, 2009; Michaud & Colom,
2003).
Online counseling has demonstrated its
value for users in accessing services on
time and on demand, including acting as
a gateway to face-to-face counseling,
and clients reported satisfaction with the
service (Richards, 2009). Efstathiou
(2009) reports that users of their service
were satisfied with the answers they
received. Similarly, Michaud and
Colom (2003) report that 92% of
teenagers felt the professionals had
clearly understood them and were
satisfied with the answer they received.
Several randomized controlled trials
that have included a treatment condition
using synchronous or asynchronous
online counseling have reported
significant post-treatment and follow-up
effects (Kessler et al., 2009; Vernmark
et al., 2010), demonstrating the efficacy
of delivering structured, manualized
online CBT counseling for depression
treatment.
Barak & Bloch (2006) found no
significant difference in clients’
perceived session helpfulness for online
compared with that for face-to-face
services, despite what they refer to as
meaningful differences in these two
modalities.
They
have
also
demonstrated that perceived helpfulness
correlated highly with impact from both
client and therapist perspectives
indicating
that
deep,
smooth
conversations that yield positive
responses and arouse clients’ emotions
are helpful. Their findings have been
confirmed in another study (Reynolds,
Stiles, & Grohol, 2006) that found
session impact and alliances were
similar in online and face-to-face
counseling.
700
Leibert et al. (2006) reported that clients
are reporting satisfaction with online
counseling but less so than in face-toface counseling. The authors found that
the more time respondents spent online,
the more likely they were to make use
of online counseling. Noted advantages
in using such a service include
convenience, anonymity and privacy. It
can be speculated that some individuals
with, for example, shame based
problems may need to communicate
without the fear of the listener’s
reactions. In a more recent survey
(Murphy et al., 2009) the authors
reported
that
satisfaction
scores of face-to-face and online clients
showed no statistically significant
difference.
Process and outcome data to date are
positive, but inconclusive and further
research is needed. A recent metaanalysis (Barak et al., 2008) reported an
overall weighted mean pre-post effect
size of d = 0.53 for internet-based
psychotherapeutic interventions. More
precisely, the effects achieved for
studies (n = 27) that represent work
conducted synchronously (d = 0.49) and
asynchronously (d = 0.44) were not
statistically different, although chat and
e-mail modes were statistically superior
to forum, audio, or webcam. The study
provides evidence for the use of online
interventions, concluding that online
interventions are as efficacious or
nearly as efficacious as face-to-face
ones. However, the meta-analysis only
included peer-reviewed journal papers,
did not discriminate on the basis of
quality, and was based on a wide variety
of studies with mixed methods,
approaches and objectives.
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Research Areas
In many cases the contributions by
researchers and clinicians to the
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historical work and the current status of
empirical knowledge have led the way
in different areas of understanding the
psychology
of
human-technology
interaction with respect to online
counseling, paving the way for others to
build upon. Many pioneers have been
referenced throughout this chapter.
However, in many cases no systematic
line of research is occurring and
therefore efforts have been largely
individual, or in some cases, such as
with the development of ethical codes,
organization-led.
In terms of research, Professor Azy
Barak, University of Hafia, Israel,
deserves mention. He has pursued
research in this area for many years,
advocating the benefits of advanced
technologies and their role in extending
the possibilities for the helping
professions. Currently, he teaches
courses in research issues in counseling,
counseling applications on the internet,
the psychology of the internet and
counseling skills development.
The therapeutic relationship
At the heart of the therapeutic
endeavour is a belief that the systematic
use of a responsive relationship
produces changes in cognition, feelings
and behaviours (Holmes, 1989). A
significant
challenge
for
online
counseling is establishing the possibility
to
create
equally
meaningful
relationships through CMC.
In an early study (Hufford, Glueckauf,
& Webb, 1999) that compared the
alliance in video conferencing and faceto-face counseling for teenagers, clients
reported significantly higher levels of
alliance in face-to-face. Yet, despite the
lack of social signalling, another early
study (Cohen & Kerr, 1998) reported
similar ratings between CMC and faceto-face counseling regarding clients’
perceptions of therapists’ expertness,
attractiveness, and trustworthiness.
701
Additionally, while clients rated higher
levels of arousal in face-to-face
encounters, there were no differences
found regarding ratings of depth,
smoothness or positivity between online
and face-to-face clients.
A study by Cook and Doyle (2002)
found equivalent alliance scores for the
online and face-to-face conditions.
Qualitatively online clients reported
experiencing strong bonds with their
therapists. However the study did not
include a face-to-face comparison group
and the sample was small. Prado and
Meyer (2004) reported that clients and
therapists created solid working
alliances in online counseling. Mallen et
al. (2005) found that face-to-face
contact was superior to online
communication in establishing a
relationship,
yet
no
significant
difference was found in emotional
understanding. McKenna and Bargh
(2000) found that individuals who were
socially isolated and anxious and who
had difficulties forming relationships
were more likely to form deep and
lasting relationships online than in
person.
A review of the literature concluded that
studies concerning the therapeutic
alliance in online counseling were
scarce, yielding mixed results (Mallen
et al., 2005). Subsequent research seems
to increasingly support the feasibility of
developing therapeutic relationships
online with modest to high alliance
scores being consistently found
(Hanley, 2009; Leibert, Archer,
Munson, & York, 2006; Reynolds et al.,
2006). Alliance online appears to be
capable of being equivalent to face-toface.
A fundamental question remains as to
whether the same process variables that
are strong predictors of success in faceto-face interventions play the same
facilitative role in online interventions.
King et al. (2006) found session impact
to be a stronger mediator in online
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702
counseling than the working alliance. In
a study on the impact of the working
alliance on outcome Knaevelsrud and
Maercker (2006) found that high
alliance scores correlated weakly with
outcome.
While the research to date is largely
positive further research is needed to
understand the nature and dynamics of
online
therapeutic
relationships.
Whether the therapeutic relationship is
or is not a key facilitative element in
online counseling still needs to be
established. However it would seem that
for an interaction to have therapeutic
value the basic principles of providing a
supportive, empathic, empowering
relationship need to be present.
Behavioural characteristics
online counseling
of
The many features and cyberbehaviors
characteristic of online counseling bring
with them associated benefits and
challenges. These have appeared in the
online counseling literature from the
early days (Childress, 1998) and many
have been addressed adequately for the
ethical and professional practice of
online counseling.
Dr. John Suler, a clinical psychologist at
Rider
University,
has
written
extensively on features and behaviors
that characterize online counseling,
notably disinhibition, self-disclosure
and the zone for reflection. He is one of
the founders of the ISMHO and, with
his colleague Dr. Michael Fenichel,
moderated the ISMHO clinical case
study group.
Additionally, John M. Grohol, Psy.D is
a pioneer in online mental health,
publishing one of the first commercial
mental health portals in 1995 and
becoming one of the largest mental
health and online health support
communities. He is a recognized expert
on online behavior and internet
addiction. He was one of the founding
members and the first president of the
ISMHO. In 2001, he created the world's
first mental health social networking
community at Psych Central.
Anonymity and disinhibition
In the online environment users are
often apparently anonymous, using a
fictitious username and not disclosing
identifying information. However, this
is becoming less the case in the
professional
practice
of
online
counseling as ethical standards are
bringing about change in how clients
are recruited, assessed and identified.
Features of apparent anonymity and
geographical
distance
in
online
interactions have been theorized to
facilitate
psychological
safety,
disinhibition and increased selfdisclosure (Suler, 2000, 2004).
The disinhibition effect is believed to be
a key element in reducing social stigma
and anxieties that some experience in
meeting a professional (Suler, 2004).
This powerful distinctive factor is
believed to have the potential of
reaching individuals who would
otherwise not access traditional face-toface therapy. A qualitative analysis of
clients’
experiences
of
online
counseling found that clients typically
reported experiencing disinhibition,
which helped them express themselves
more openly and honestly (Cook &
Doyle, 2002).
While disinhibition is believed to lead
to higher rates of self-disclosure and
honesty, it has also been noted that it
could lead to acting out behaviours
(Suler, 2000), including identity and
impression management on behalf of
the client. However, Joinson (2001)
examined self-disclosure by comparing
dyads interacting face-to-face and
online and found that instances of
negative self-disclosure were rare and
that participants in the CMC condition
had significantly higher levels of self-
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disclosure. The author argues that the
decrease in external focus and the
process of having to express oneself
through writing may facilitate and
increase self-awareness.
Convenience
A frequently reported advantage of
online counseling is that it can be
accessed anywhere at any suitable time,
is believed to reach individuals who
encounter both psychological and
physical
barriers
to
accessing
counseling services (Mallen et al.,
2005). The nature of these obstacles can
range from limited mobility due to
geographical isolation or physical
disability, to language barriers, fear of
stigma or time availability (Rochlen,
Zack et al., 2004). Several research
studies have highlighted that both
clients and therapists identify factors
associated with convenience as reasons
for choosing online counseling (Chester
& Glass, 2006; Haberstroh, Duffey,
Evans, Gee, & Trepal, 2007; Young,
2005).
Another facet that has been highlighted
is the potential for online counseling to
increase the accessibility of specialised
expertise that might otherwise be
beyond the reach of clients (Young,
2005). Simpson et al. (2005)
exemplifies this in treating eating
disorders using video conferencing:
clients were geographically isolated
from specialist treatment and clients had
complete control over whether they
were seen by the therapist.
Time delay
In synchronous communication modes
clients and therapists can check, clarify
and understand in the immediacy of the
interaction. However, in asynchronous
communication a time delay is built into
the counseling process. Clients and
therapists can wonder about and
703
interpret the unexplained delays in
messages. This can potentially increase
anxieties; leading to what Suler (2004)
calls the “black hole phenomenon”, i.e.
the ambiguity in the no-reply can
become a blank screen where easily we
can project our own expectations,
emotions, and anxieties. (Suler, 2004).
However, because each party can attend
and respond to the other’s message in
their own time, without the urgency of
thinking and responding in the
immediacy, a zone for reflection can
develop; a space for both parties to
reflect on what they want to say (Suler,
2000). This can facilitate the processing
of experiences and emotions as well as
promoting self-observation, awareness
and reducing impulsivity. Because the
recipient of communication is not
present in real time and awaiting a
response the pressure that can be
experienced in a synchronous context is
reduced.
Time delay is a potential advantage for
the therapists as it can help with better
observation and management of
counter-transference reactions. Several
qualitative
studies
found
that
participants reported feeling less
pressurized and that the relief from this
pressure enabled them to engage in
deeper reflection and expression
(Haberstroh et al., 2007; Hanley, 2009).
Loss of cues
One of the main criticisms and
perceived main limitations of online
counseling is that individuals often do
not know much about each other and all
the visual and verbal cues that convey
subtle information about the person and
their affect in face-to-face interactions
are missing (Suler, 2000). However,
Suler (2004) argues that this invisibility
can lead to disinhibition by removing
any concerns about the other person’s
reaction to one’s narrative and presence.
ONLINE COUNSELING
Practitioners have speculated that this
invisibility and the consequent feelings
of
psychological
safety
and
disinhibition have the potential of
reaching clients who are particularly
sensitive to the physical presence of
another person and to cues indicating
disapproval or judgment (Fenichel et
al., 2002; Leibert et al., 2006).
A qualitative study of clients’ and
therapists’ experiences of online
synchronous counseling found that the
lack of visual feedback led to a
disinnhibition of self-expression and
also facilitated disclosure of more
embarrassing subjects (Haberstroh et
al., 2007). Leibert et al. (2006)
concluded that the disinhibition effect
reported by participants seemed to be
stronger and off-set the impact of the
lack of cues.
Another derivate of the absence of cues
and invisibility is an increased sense of
control by clients over what they
disclose (Cohen & Kerr, 1998; King et
al., 2006; Simpson et al., 2005). For
instance, young clients using online
counseling reported that they liked
having the choice of whether to disclose
that they were crying to their counsellor
(Hanley, 2009).
While text-based communication may
reduce
the
possibility
of
misunderstandings by allowing time to
formulate the question and the answer,
some clients may find not having the
reassurance of non-verbal visual and
auditory cues distressing (Alleman,
2002).
Presence is the feeling of being in
someone’s presence without sharing
immediate physical space (Fink, 1999).
Riva et al. (2011) considers presence as
an intuitive perception of oneself in
whatever environment one may be in.
Consequently our ability to feel present
in a virtual reality system does not
fundamentally differ from the ability to
feel present in our surrounding physical
environment. It is a powerful concept in
704
terms of its potential implications for
the delivery of online counseling, and
especially the development of a
therapeutic relationship online.
Writing behavior and expression
A distinctive feature of online
counseling is that the bulk of
communication is occurring in writing.
The benefits of writing, impacting
positively on psychological and
physical health, have been widely
documented and have been employed in
therapeutic practice in different forms
well before the advent of online
counselling
(Pennebaker,
KiecoltGlaser, & Glaser, 1988). The process of
writing can, for instance, be cathartic in
translating emotional experience into
words and this has also been found to be
the case in the use of e-mail (Sheese,
Brown, & Graziano, 2004).
Wright and Chung (2001) point out that
in writing the writer is in control of the
content as well as the pace and depth of
the written material, which can foster a
sense of psychological safety; also the
permanency of the written record can
facilitate the benefits deriving from the
process of writing to continue in time.
Cook and Doyle (2002) found that
client participants appreciated the
opportunity to re-read the responses
received from the therapist, feeling this
allowed them more time to process the
content than verbal communication
would have. Beattie et al. (2009)
reported that online clients were
particularly impacted by seeing their
thoughts and emotions in writing, which
also facilitated further self-reflection.
Suler (2000) notes how the use of text,
similar to narrative approaches to
therapy and journal writing, can also
facilitate the therapeutic construction of
a personal narrative. He also argues that
writing may be a preferred or more
suitable modality of self-expression for
some individuals who are less
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comfortable in face-to-face interactions,
while being unsuitable for individuals
with limited writing skills.
Ethics
Many of the debating ethical issues such
as confidentiality, validity of the data
delivered via computer networks,
inadequacy of counselor interventions,
misuse of computer applications, lack of
awareness of location-specific factors,
digital divide, privacy concerns,
credentialing,
and
relationship
development issues were identified
early in the literature (Sampson,
Kolodinsky, & Greeno, 1997). Another
early paper raised many of the potential
legal issues regarding duty of care
arising from the ethical concerns of
online
counseling
(Shapiro
&
Schulman, 1996).
Apprehension regarding anonymity,
distance, and the lack of cues in online
counseling raised serious concerns
regarding issues of informed consent,
contracting, confidentiality of records,
privacy, diagnosis, and duty of care
(Bloom, 1998; Childress, 1998; Shapiro
& Schulman, 1996). How was it going
to be possible for professionals to
practice ethically online regarding such
issues? Skinner and Zack (2004)
maintain that the many issues that are
posed
online
are
no
more
insurmountable than those faced in
traditional practices.
Early attempts to address the ethical
concerns were the delivery of a general
statement by the American Psychology
Association Ethics Board in 1995 that
described the ethics code applicable to
therapists
using
telephone,
teleconferencing, and internet services
(Shapiro & Schulman, 1996). Another
was the development of standards for
online practice by the National Board
for Certified Counselors (NBCC)
(Bloom, 1998).
705
A
further
response
was
the
establishment in 1997 of the ISMHO,
formed with a clear mission to promote
the understanding, use and development
of online communication in mental
health. They too have produced guiding
principles for the ethical practice of
online counseling (ISMHO, 2000).
Other professional accrediting bodies
have followed suit and produced
guidelines for online clinical practice
that are regularly revised as the
evidence-base from practice and
research grows (Anthony & Jamieson,
2005; Anthony & Goss, 2009). These
ethical
frameworks
have
been
significant steps in addressing the
important ethical issues of online
practice.
However, several studies have surveyed
online counseling websites (Chester &
Glass,
2006;
Heinlen,
Welfel,
Richmond, & Rak, 2003; Shaw &
Shaw, 2006) and reported that
credentials varied widely among
practitioners, only 32% of practitioners
requested that clients sign an informed
consent form, that 42% of participants
did not use any encryption to protect
confidentiality, and they reported very
low compliance with established ethical
standards for online counseling.
However,
a
high
number
of
practitioners provided information
about the limitations of online
counseling.
Dr. Kate Anthony is a leading expert on
the use of technology in therapy. She
has co-authored the British Association
for Counseling and Psychotherapy
(BACP) guidelines for online work
(including supervision) through its three
editions. She is a fellow of BACP, pastpresident and fellow of ISMHO and a
co-founder of the Online Therapy
Institute (OTI). She was awarded a
DPsych via public works for her
doctorate: Developing counseling and
psychotherapy in the age of technology
and the internet. Kate Anthony has also
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been involved in training mental health
professionals to work online since 2002.
Attitudes and experience
Mallen et al. (2005) reported that clients
seem more accepting of online
counseling than are professionals.
Hanley (2006) found that the concerns
expressed by practitioners in developing
an online counseling service for young
people mainly echoed those that would
be considered when establishing a faceto-face
practice,
for
instance,
contracting,
confidentiality,
and
informed consent.
A Norwegian study found that the
majority of psychologists held a neutral
attitude and only 3% viewed the use of
the online medium for therapeutic
interventions
as
unacceptable
(Wangberg, Gammon, & Spitznogle,
2007). The study highlighted that those
who frequently use the internet or had
experience using e-mail in clinical
practice were more favourable towards
online counseling. Chester and Glass
(2006) in a survey of therapists’
attitudes reported that 57% of
respondents believed that online
counseling is as effective as face-to-face
counseling while 42% believed it to be
less effective.
Therapists have reported concerns
including technological barriers, the
challenges of counseling without verbal
and visual cues, clinical concerns
regarding the suitability of the medium
for certain clients, and the difficulty
with accurately assessing the clients’
state (Haberstroh, Parr, Bradley,
Morgan-Fleming, & Gee, 2008).
Therapists
have
also
reported
advantages: lower emotional intensity,
more time to think, the power balance
being more equal, and clients being
more focused, expressive and less
resistant (Bambling, King, Reid, &
Wegner, 2008). In relation to records
being verbatim and permanent, while
706
potentially useful in supervisory
consultations, it also increases the level
of accountability for therapists (Murphy
& Mitchell, 1998).
Clients appear to have embraced online
counseling with more ease, although an
early study that assessed attitudes
towards online and face-to-face
counseling noted that respondents had
significantly more positive attitudes
towards face-to-face than online
counseling (Rochlen, Beretvas, & Zack,
2004). Unlike traditional gender divide
in attitudes they found no differences
between men’s and women’s attitudes
towards online counseling, with an
overall neutral to slightly positive
attitude.
Young (2005) reported that the main
reasons clients seek online counseling
were
anonymity,
convenience,
counsellor credentials, access, and cost.
Conversely, the study outlines some
concerns highlighted by clients such as
lack of privacy associated with the use
of technology including the security of
the technology being used, and being
caught. Several qualitative studies of
clients’
experiences
of
online
counseling found that most participants
believed it was effective and
advantageous in enhancing freedom of
expression through writing, reducing
costs, and convenient (Bambling et al.,
2008; Beattie et al., 2009; Cook &
Doyle, 2002).
In their study looking at clients’ and
therapists’ experiences Haberstroh et al.
(2007) found mixed results with some
clients reporting having experienced a
supportive and helpful relationship with
their therapist while others did not.
Attitudes and experiences toward online
counseling seem to be impacted by the
level of comfort and use of internet
technology (Leibert et al., 2006;
Wangberg et al., 2007). Skinner and
Latchford (2006) found that members of
an online support group expressed
significantly more positive views about
ONLINE COUNSELING
the idea of engaging in
counseling
compared
to
attending face-to-face therapy.
707
online
clients
Suitability
It has been noted that the use of the
medium, as is true for other types of
communication, may not suit everybody
and that individual factors may be
important in determining the success of
online counseling (Fenichel et al.,
2002). Factors that constitute suitability
for online counseling, for clients and
therapists, are ability for written
expression and reading, as well
computer-literacy (Fenichel et al., 2002;
Rochlen, Zack et al., 2004). Therapists
should also have an openness and belief
in the therapeutic benefits of online
counseling (Fenichel et al., 2002).
The debate continues regarding the
suitability of individuals and the types
of presenting issues that are appropriate
for
online
counseling.
Some
practitioners advocate for this to be
restricted to less serious issues
(Haberstroh et al., 2008), some note
specific advantages for specific
populations and presentations (Simpson
et al., 2005), while others advocate that
the medium is adequate to address most
issues at any level of severity (Fenichel
et al., 2002).
Very limited empirical research exists
about the issues presented by online
clients. Most services have dealt with a
broad range of presenting issues, few
have targeted specific issues (Abroms,
Gill, Windsor, & Simons-Morton, 2009;
Alemi et al., 2007). Apparently there
exists no difference between the
presenting issues in online compared to
face-to-face counseling (Leibert et al.,
2006; Richards, 2009).
Barack et al. (2008) reported that while
all age-groups showed benefits in online
interventions individuals in the 19-39
age range appeared to benefit the most.
Training
Alongside practitioner guidebooks (see
additional readings) there are now
training programs that offer certification
in
online
counseling.
Training
programmes were developed to raise the
awareness of ethical issues and promote
the development of specialized skills for
the effective provision of online
counseling (Anthony & Goss, 2003).
Typically, participants are brought
through a variety of theoretical and
experiential modules, learning about the
ethics of practice, establishing a
relationship online, communicating
effectively using CMC, and establishing
an online practice.
Dan Mitchell and Lawrence Murphy,
Canadian counsellors who co-founded
Worldwide Therapy Online Inc., have
since 1994 been pioneers in the field of
online counseling training and have
authored
several
professional
publications on the subject. They
developed
and
instruct
online
counseling
certification
programs
delivered in collaboration with the
University of Toronto.
FUTURE RESEARCH
The research to date is largely
supportive of online cousneling, yet
more is needed to further explore and
form an empirical knowledge-base
regarding the processes and features
characterizing online counseling as well
as its effectiveness and appropriateness.
These include understand the nature and
dynamics
of
online
therapeutic
relationships, the type of client or
presenting issues most suitable for
online counseling, and whether it is as
effective as face-to-face counseling for
client(s). Professional training also
needs to evolve as technology develops.
A pertinent example is the use of virtual
worlds for online counseling, still
requiring
empirical
investigation.
ONLINE COUNSELING
Further exploration the features and
cyberbehaviors associated with online
counseling,
including
apparent
anonymity and distance, disinhibition,
identity and impression management,
708
writing and emotional expression, and
presence, are needed to strengthen
empirical knowledge and inform
clinical practice.
ONLINE COUNSELING
699
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ADDITIONAL READINGS
Anthony, K., Merz-Nagel, D. & Goss, S. (2010). The Use of Technology in Mental
Health: Applications, Ethics and Practice. US: Charles Thomas Publishers Ltd.
Goss, S., & Anthony, K. (Eds.). (2003). Technology in Counseling and Psychotherapy.
UK: Palgrave Macmillan.
Grohol, J. D. (2003). The Insider's Guide to Mental Health Resources Online. Guilford
Publications, Inc.
Jones, J. & Stokes, A. (2009) Online Counseling: A Handbook for Practitioners. UK:
Palgrave Macmillan Ltd.
Kraus, R., Stricker, G. & Zack, J. (2010). Online counseling: A handbook for mental
health professionals (2 ed.). San Diego, CA: Elsevier
Maheu, M., Pulier, M., Wilhelm, F., McMenamin, J. (2004). The mental health
professional and the new technologies: A handbook for practice today. NJ:
Lawrence Erlbaum Associates