Tag Archives: Technology

Counseling with artificial intelligence

By Russell Fulmer January 16, 2018

Welcome to tomorrow. Artificial intelligence (AI) is now actual science, not science fiction. Although its formal inception took place in 1956, the idea of AI is known to most people only through imaginative movies such as The Terminator or the 2013 flick Her. However, right here and now, AI is real and maturing at a near exponential rate. Signs point to AI soon infiltrating society at large, which means that the counseling profession is not immune. The future of counseling likely involves virtual assistants, virtual counselors, chatterbots and, for the inclined, robots dubbing as animals to help comfort clients.

AI equates to machine learning. Current AI assistants such as Siri and Echo have limited capabilities. The holy grail of AI is artificial general intelligence — machines with humanlike, versatile abilities. AI can be contrasted with organic intelligence, or, put another way, human, biological intelligence. Many factors contribute to human intelligence, chief among them being our ability to process information, solve problems, adapt and learn. All of this happens in the brain, and in many ways, our brains are like computers. AI researchers apply the findings of neuroscience to computer programming to make computers more like us.

The goal of AI, then, is not just the production of an ordinary computer, but one that learns and can become autonomous. And guess what? Computers can learn much faster than us. Their intelligence is off the charts. Plot typical human intelligence quotients on a normal curve, situate Einstein’s a couple of standard deviations to the right, and try to imagine the placement of a conscious artificial intelligence (CAI). Now, envisage what a CAI is capable of doing, inventing, discovering and revolutionizing. The prospect is equal parts bewildering, intriguing and nerve-wracking.

Computers have already beat the best humans at chess, Jeopardy! and, more recently and impressively, the board game Go. Played copiously in Asia, Go is a strategic, intuitive game with a mind-blowing number of possible moves (researcher John Tromp finds that number on a 19-by-19-inch board to be ~2.082 × 10^170, which equals a 2 followed by 170 zeros). Garry Kasparov (chess), Ken Jennings (Jeopardy!) and Lee Sedol (Go) are all very smart, and each fell to AI in his respective specialty.

But those are games. AI can’t “beat” the best counselor, can it? Surely not …

Relevance to counselors

Asking if AI has significance to the counseling community is like asking if counselors should be concerned with global warming or if social media has an impact on the lives of our clients. AI is originating within the hard sciences but promises to touch the emotional lives of clients in untold ways. The magnitude of AI’s impact remains unknown. Some individuals are excited by the vast reach of AI, whereas others are cautious. Consider the following quotes:

“It would take off on its own and redesign itself at an ever-increasing rate. Humans, who are limited by slow biological evolution, couldn’t compete and would be superseded. … [AI will be] either the best, or the worst thing, ever to happen to humanity” — Stephen Hawking

“We need to be super careful with AI. Potentially more dangerous than nukes.” — Tweet by Elon Musk, Tesla and SpaceX CEO and co-founder of Paypal

“I am in the camp that is concerned about superintelligence. [At] first, the machines will do a lot of jobs for us and not be superintelligent. That should be positive if we manage it well. A few decades after that though, the intelligence is strong enough to be a concern. I agree with Elon Musk and some others on this and don’t understand why some people are not concerned.” — Bill Gates

Should counselors be concerned? They should at the very least be educated about the subject. Knowledge is power. In the short term, the consensus is that AI will rapidly expand automation. When this occurs, the jobs of your clients who are employed in, for example, the fast-food industry might be threatened. Perhaps new jobs will be created, however. After all, people originally feared that the Industrial Revolution would lead to massive unemployment. In fact, the opposite happened.

Unlike a century ago, however, things are changing at a faster pace. The modern age is quickly morphing into a future of omnipresent technology. Change management may become an overarching theme of therapy in the near future. Change is coming fast because algorithms are being written that enable AI to expand its abilities into the realms of creativity, cooperation and emotional intelligence. It is here that AI directly converges with counseling.

Computers that care

In his book, Thinking Machines: The Quest for Artificial Intelligence and Where It’s Taking Us Next, Luke Dormehl writes about how advances in facial recognition enable AI assistants to read the emotional states of users. The company Affectiva broadcasts on its website that its “emotion AI humanizes how people and technology interact.” Affectiva is at the forefront of bridging this gap by … let’s call it providing a corpus callosum between traditional computer acumen, with its mathematical and logical abilities, and the realm of emotional intelligence.

Facial recognition software is getting better. “Ellie” is an example. A virtual reality AI, Ellie was created by the Institute for Creative Technologies at the University of Southern California to help treat people with depression and posttraumatic stress disorder. On the computer screen, there sits Ellie, whose body language mirrors that of an actual therapist. She responds to emotional cues, nods affirmatively when appropriate and adjusts in her seat. She does all of this because her algorithm permits her to perceive 66 points on a person’s face and read his or her emotional state accordingly.

It’s obvious that Ellie is not “real,” and therein lies the secret to her success — people feel less judged talking to Ellie. She provides the ultimate in unconditional positive regard. Although Ellie looks like a therapist, she doesn’t claim to be one, telling people from the outset, “I’m just here to listen.”

Ellie has company in “Tess.” The developer, X2AI Inc., says Tess is a “psychological AI that administers highly personalized psychotherapy, psycho-education and health-related reminders, on-demand, when and where the mental health professional isn’t.”
This slogan speaks volumes about the future interplay of technology and mental health counseling. Counselors have families and need to sleep. Some even like to take vacations. AI has no need for any of the above.

As therapeutic AI becomes more mainstream, it is likely that some people will forgo seeing living, breathing counselors altogether in favor of their favorite virtual therapist. Others will see an actual counselor plus their online “listener.”

Of course, ethical questions abound. Nevertheless, like it or not, AI promises to play a greater role — either directly or indirectly — in the counseling sessions of the future.

A client’s truth

Skeptics may point to the obvious — that no machine is truly human; that humans need humans; that a machine can fake, say, empathy but not actually deliver it; and that clients will see through the façade.

The counterpoint to this criticism resides in a question: Who determines clinical truth? Rather than ask whether machines can be empathic, a more pragmatic question for counselors may be, will clients perceive them to be empathic? If so, what are the ramifications?

The evidence suggests that in some cases, people do indeed emotionally connect to computer programs. It has been happening since the 1960s, when “Eliza” was created. Created by a computer scientist to demonstrate the blurry threshold between man and machine communication, Eliza was a computer program that reflected statements typed to her via text. Programmers were astounded when people began ascribing human emotions and feelings to a computer program, confiding personal information to Eliza and pouring their hearts out. Blurry boundaries indeed.

Eliza is still with us, available on several websites and ready to chat. Programmers declare Eliza a Rogerian therapist open for business. You just have to believe the illusion. That illusion may be a client’s truth.

Music therapy

For the music therapists out there, AI has touched even one of the longest-running human traditions — making music. Sony Computer Science Laboratories is coordinating the Flow Machines project in conjunction with the European Research Council. The goal is to see if AI can autonomously create music.

Currently, AI still needs some human assistance. Your favorite singer undoubtedly has a better voice than your favorite robot. However, AI is helping and making great strides. Check out “Daddy’s Car” and “Mr. Shadow,” two pop songs created with the help of AI. The first is in the style of the Beatles, circa late 1960s. As for “Mr. Shadow,” listen and judge for yourself. Both songs are available on YouTube. Neither song may be suitable for music therapy, but their mere existence suggests that this is only the beginning of music created by sentient machinery.

The question is, if AI can help produce music today, will it find a place in the music therapy of tomorrow? Will the act of music production itself — between a counselor, client and AI — prove therapeutic?

Counselors aren’t the only ones interested in how far AI creativity will expand. For more information about how AI is being used to create both art and music, research Magenta, a project from Google Brain.

Animal-assisted therapy

Meet Paro, a therapeutic robot. You may know a lot of robotic baby seals (who doesn’t?), but none is like Paro, because this cuddly seal is interactive. Paro (known as a “carebot”) makes eye contact, has five senses, responds to its name and, like any good AI seal, learns. Paro’s website (parorobots.com) indicates that research has shown that the carebot aids in reducing stress, improves relaxation, motivation and socialization, and helps people who have dementia. Paro certification classes are even available. If you are wondering whether Paro runs on batteries, rest assured that Paro charges by sucking on an electric pacifier.

Even our animal compatriots will be affected by AI. It won’t be the first time that technology has altered the function of an animal, or its numbers. The advent of the internal combustion engine spelled the end of the horse-drawn carriage. The number of horses in the United States plummeted as a result. It’s easy to predict that therapeutic robots will play larger roles in counseling. On the bright side, they create fewer messes.

Looking ahead

Currently, counseling is chemistry, an interaction between two or more carbon-based life forms, albeit a special interaction marked by active listening. The therapeutic alliance is the emergent property that stems from this interaction. Chemistry and counseling — who said the social and hard sciences were disparate? This is counseling at an elemental level.

But what about counseling not at the basic level but at a technologically advanced level? What form does that take? AI offers an answer. Machines that can think and learn, that even look and act like a human counselor, could revolutionize the field.

The future is unwritten, but the counseling community would be wise to anticipate and plan ahead. Here are some pointers for doing just that.

1) Educate yourself about emerging AI technologies. Advancements happen quickly, so staying updated on everything might be impossible, but keeping an eye out for major breakthroughs, themes and patterns is advisable.

2) As AI infiltrates society at large, be on the alert for clients who are growing aware of the technology and feeling excited or fearful of it as a result.

3) Don’t be surprised when some clients start viewing a chatbot, carebot or — potentially — therapistbot as their other counselor. Likewise, clients may anthropomorphize their robotic pets. Start thinking about how you will respond when clients speak of computers as if they are people.

4) Advocate for your profession. Tech companies are producing everything from apps to robots, and they are hiring mental health professionals to help humanize their creations. The company mentioned earlier that developed Tess is currently looking for — you guessed it — clinical psychologists. Perhaps the people at this company simply don’t realize that counselors are distinct and have a lot to offer. Advocate.

5) Be proactive and address the ethics surrounding the coming AI movement. The choice is clear: Anticipate and plan accordingly or wait, be reactive and deal with issues after they have arisen. Prevention is good medicine. At the national level, the American Counseling Association’s Ethics Committee could keep AI on its radar screen.

Predictions about world-altering technology are usually premature, but AI shows no signs of slowing down. Sooner or later, AI will bring changes — perhaps significant changes — to the counseling field. The key is to adapt and evolve. Remember, no AI is better than the best counselor … yet.

 

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Russell Fulmer is core faculty with the Counseling@Northwestern program with The Family Institute at Northwestern University, where he specializes in the psychodynamic approach. He has written “conversations” used in AI algorithms for chatbots. Contact him at russell.fulmer@northwestern.edu.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

@TechCounselor: There’s no escaping technology

By Adria S. Dunbar and Beth A. Vincent November 13, 2017

Do you pay for your drive-through latte with your iPhone app while streaming Spotify through your Bluetooth speakers and double-checking your GPS for traffic notifications? Or are you the stalwart who prefers to park and go inside to order your coffee because drive-throughs seem so impersonal and face-to-face communication is an endangered art? Whether you’re the early adopter who embraces technology usage in every aspect of your life or the skeptical laggard who argues that we would all be better off if we were less plugged in, you can’t escape the question of whether (or how) to integrate technology into your life and work.

For those of us who are counselors, our technology habits in our personal lives likely influence how we use technology in our professional lives, including in our relationships with colleagues and clients. Yet it can be difficult to remain self-aware about our habits and choices surrounding technology use. Constant advances in new technologies ensure that as soon as we have a solid grasp on current technology, a new innovation bursts onto the market and changes everything. This is lifelong learning to the extreme.

Why does it matter which technologies we use and how? If technology is a means to an end — be it increased efficiency, convenience, communication, transparency or organization — then it matters whether those ends are achieved. Email enables us to communicate from the convenience of our smartphones, but not when the messages pile up too fast for us to read and reply to them. Cell phones make us accessible 24/7 from any location, but only until our signal gets dropped. PowerPoint helps us stay on track in meetings, but not when the presenter falls back on reading slide after slide of black bullet point text from a plain white background. When technology fails — when it does not get us to the desired end — we can end up feeling lost, frustrated or even betrayed.

The downsides of technology can arise from our own abuse of technology or be inherent in the technology itself. We see the human tendency to abuse technology every time a co-worker consistently replies to all when they think they are replying to one. Or when we sit in a meeting that is filled with the incessant tapping of keyboard keys as colleagues refuse to unplug long enough to attend a one-hour meeting. Or, perhaps worst of all, when we sit silently while a lunch companion stares at a screen rather than paying attention to the human being seated directly across from them. At times, we may catch ourselves being less present in the company of others, distracted by social media, email or notifications. Some of the ways people use software may even be categorized as addictive or criminal.

In addition to these human failings, other pitfalls are inherent to the technologies themselves. Important emails wind up in spam folders, text messages never make it to their intended audience, and software crashes a moment before we hit save, just as we are entering the final case note of the day. Just as we all benefit from technology, we also struggle to navigate its challenges.

As counselors, our choices around technology use are laden with our professional responsibilities. Federal laws dictate what we can do and say in online and digital formats. Our social media must be monitored carefully to avoid the creation of dual relationships or unintentional self-disclosure to clients. Our behaviors must be models of healthy boundaries in front of those we serve. Ethical standards exist to help guide our professional behaviors, but as counselors, we are confronted with an ever-changing technology landscape that affects our personal and professional lives and the lives of our clients.

In this shifting landscape, how do counselors make decisions about which products to use and which to avoid? How can we leverage technology to make us more efficient and effective without allowing technology to steal the spotlight away from the real work we are doing with clients? We must keep returning to the question: “What is the end goal, and how can technology help us get there?”

Each column in this new monthly series for CT Online will explore this question in the context of a different type of mobile and online software technology that counselors use.

Future column topics will include:

  • Email
  • Productivity software
  • Communication software
  • Site blocking software
  • Record-keeping software
  • Online counseling platforms
  • Chat and texting
  • Mobile devices

 

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Adria S. Dunbar is an assistant professor in the Department of Educational Leadership, Policy and Human Development at North Carolina State University in Raleigh. She has more than 15 years of experience with both efficient and inefficient technology in school settings, private practice and counselor education. Contact her at adria.dunbar@ncsu.edu.

 

Beth A. Vincent is an assistant professor at Campbell University in Buies Creek, North Carolina, in counselor education. She is a counselor educator, licensed school counselor and former career counselor who is driven to learn everything there is to know about innovative productivity software to help counselors be their most present selves. Contact her at evincent@campbell.edu.

 

Our Instagram is @techncounselor.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

Technology Tutor: Revisiting the ethics of discussing clients online

By Rob Reinhardt November 7, 2017

If you have given even a cursory observation to the advertisements that appear on Facebook, during Google searches or on many of the websites that you visit, you will have noticed that these advertisements are targeted at you. The ads might be related to web searches you have performed, the area you live in or something that is generally popular with your age group.

This is how companies such as Facebook and Google make almost all of their money. They gather information about you (and everyone else) and sell advertising to companies that want to target you. They make a lot of money doing this because they are very good at letting those companies get very specific with their targeting. (Google reported revenues of $26 billion in the fourth quarter of 2016 alone.) For a glimpse into the kinds of details that Facebook collects about people, check out the great infographic at bit.ly/FBTargetOptions. That list keeps growing and getting more refined. It is especially important to note this passage from Facebook’s overview of how to target ads: “Behaviors are constructed from both someone’s activity on Facebook and offline activity provided by data from Facebook’s trusted third-party partners.”

In other words, to target advertising to their users, Facebook is collecting data from many different sources about both online and offline activity. So, this is not restricted only to the activity on Facebook.

What does this have to do with our clients (and potential clients)?

I continue to witness counselors engaging in referrals and case consultation in online forums such as Listservs and Facebook groups. This is despite my previous article on this topic last year in Counseling Today (see bit.ly/discussingclients) in which I discussed the difficulty of maintaining confidentiality for clients and the PIT principle (permanence, identity, transferability), and even with American Counseling Association Chief Professional Officer David Kaplan clearly stating that discussing clients online is an ethics no-no. The existence of marketing databases curated by entities such as Facebook and Google adds yet another reason that we need to consider other ways of addressing client needs.

Take this example of a completely fictional situation that could quite easily refer to a real situation:

Johnny Client contacts Susie Counselor about an appointment. He provides some background, and Susie recognizes that she is not a great fit for him. She decides to reach out to her local mailing list or Facebook group of therapists to see if she can provide Johnny with a solid referral. She writes: “Looking for referral for 30-something male dealing with depression. Needs counselor in network with ABC Insurance.”

Although this may seem innocuous at first, it is likely more than enough information for Johnny to be identified. In my previous article, I pointed out the human reasons this is an issue. (For instance, what if someone who knows Johnny or even Johnny himself is in the group? What if someone copies and pastes or screenshots the information?)

Now let’s look at it from a targeted marketing standpoint. Johnny’s call to Susie didn’t happen in a vacuum. Prior to calling her, Johnny did a search for “Counselor MyTown” and visited Susie’s website. These are traceable behaviors tied directly to Johnny, and they likely will end up in the databases used by entities such as Google and Facebook to target advertising. Based on these behaviors, Johnny is likely to start seeing ads on his computer for mental health treatments, counselors in the area and self-help books.

It is important to note that Susie Counselor is now probably connected to Johnny in these databases because he visited her website and placed a call to her. So, when she posts about the 30-something male with depression shortly after receiving Johnny’s call, it’s not a huge leap for database algorithms to figure out that this is the same Johnny Client who recently visited her website and called her — the same Johnny Client whose address, birthday and many other pieces of information already exist in the databases. Except now, thanks to Susie, those databases have learned that Johnny is dealing with depression. They may well have already known what insurance Johnny has, but if not, that’s another bonus that Susie provided for them.

What you can do

I’d like to highlight one of my suggestions from the previous article as well as provide a couple of other suggestions:

  • Make it counselor-centric: When seeking someone to refer to, focus on the counselor’s skills, not the client’s issues. For example, you might say, “I’m looking for a counselor who helps clients dealing with depression.”
  • Keep it offline: Go old school! Keep your own notebook or database of people you can refer to. Note their strengths, location, the insurance they accept, etc. Network and get to know them to elevate the quality of your referrals.
  • Raise awareness: Sometimes, counselors need to be reminded of things that we often tell our clients. For instance, just because others are engaging in a behavior doesn’t make it OK. Make others in your online forums aware of the privacy issues surrounding discussing referrals and cases online. Point them to this article and to my previous article that I referenced earlier. Point them to the pertinent passages in the ACA Code of Ethics (noted below). Even if they aren’t counselors, the ethics codes for social workers, psychologists, marriage and family therapists and psychiatrists contain similar passages, so their concern for client privacy and confidentiality should be just as great. Above all, be kind and compassionate in your approach.

Pertinent standards in the ACA Code of Ethics

B.1.c. Respect for Confidentiality

“Counselors protect the confidential information of prospective and current clients. Counselors disclose information only with appropriate consent or with sound legal or ethical justification.”

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Note the inclusion of “prospective” clients. Do you have the person’s consent before disclosing anything about them online? Can you accomplish your goal without disclosing information about them online? If so, what is your legal or ethical justification for disclosing?

B.2.e. Minimal Disclosure

“To the extent possible, clients are informed before confidential information is disclosed and are involved in the disclosure decision-making process. When circumstances require the disclosure of confidential information, only essential information is revealed.”

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Do clients (or prospective clients) fully understand the ramifications of you disclosing information about them online? Do they understand how few details it might take for computer algorithms to identify them? Are they aware of all the options for accomplishing the goal, and do they approve of online disclosure?

B.3.c. Confidential Settings

“Counselors discuss confidential information only in settings in which they can reasonably ensure client privacy.”

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Is there any way that this standard doesn’t completely rule out using online forums for any disclosure? Based on my experience and expertise, there simply is no way that counselors can reasonably ensure client privacy if they share any details about clients in most online forums.

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For an interesting discussion of this topic, including an interview with social media policy expert Keely Kolmes, check out Episode 104 of the TherapyTech with Rob and Roy podcast.

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Technology Tutor: Speaking your clients’ social app language

By Rob Reinhardt April 28, 2016

During my time as editor of the Technology Tutor column, I have been very focused on how counselors can use technology. This month, I’m breaking from that pattern to give you a look at technology from the client side of things.

Much of our work with clients involves discussing how they express themselves and how they relate to others. With social media use growing, it is important for counselors to stay in touch with the ways that people are connecting and communicating. We’ll be in a much better position to meet clients phonewhere they are if we understand statements such as, “My friend sent me a Snapchat about an Instagram I inadvertently posted. It was a screenshot from my Periscope session, and it was so embarrassing!”

It can be especially important for counselors to understand how these apps work if your clients include children or adolescents because some of these apps can amplify the typical dangers of social interaction. I leave the exploration of that to your imagination. Alternately, you could view an article by Common Sense Media, “16 Apps and Websites Kids Are Heading to After Facebook” (see bit.ly/1LoFdkR), that details concerns about these apps as they relate to minors.

With all of this in mind, I’ll discuss some of the social apps that are currently most popular. Note that I am skipping some big ones — Facebook, Pinterest, Twitter — that I assume everyone is familiar with by now. You may also notice that I do a fair bit of comparing. That’s because it can be challenging to explain many of these applications without relating them to an app that readers may already know. Of course, the best way to understand most of these apps is simply to experience them for yourself.

Instagram

Instagram is like a pictures-and-video-only version of Facebook and is actually owned by that social media giant. Like Facebook, you can share your postings publicly or with a private network of connections. Instagram’s claim to fame is the filters users can apply to their pictures to give them many different looks. It is important to note that Instagram is a mobile-only program. It can only be accessed through an iOS or Android mobile device.

Tumblr

Tumblr is what is referred to as a microblogging platform. Unlike a traditional blog, Tumblr posts typically feature a photo or video with minimal text. It’s akin to a visual sound bite version of a blog. Although many Tumblr users create new content, some opt to simply curate and pass on the content of others. Another way to look at it is that Tumblr is like Pinterest with more options and more interaction.

Snapchat

Snapchat is like a self-destructing Instagram (it’s the content that self-destructs, not the app). Snapchat allows users to enhance pictures with text and doodles that they draw before sending. The resulting image can be viewed for only 10 seconds (or less if you choose) by the recipients, and then it’s gone forever. Snapchat also allows users to create “stories,” which are similar to “snaps,” but they last 24 hours. There is also chat functionality in which chats are cleared once completed. It is important to note that despite the transient intent of Snapchat, screen shots of content can be taken.

Yik Yak

Imagine you could view only the tweets of people within a 10-mile radius of your current location and you’ll have a good idea of what Yik Yak is. Add to that the fact that, until recently, Yik Yak’s users were completely anonymous. Now they have the option of taking on handles (i.e., nicknames/usernames). Yik Yak has been especially popular on college campuses and even embroiled in controversy (see on.mash.to/1LoEccn).

Periscope

Periscope allows anyone with the mobile app to broadcast his or her own live video show, complete with comments and questions posted by anyone watching. Owned by Twitter, and primarily used by businesses, it has spawned the growth of similar services. For example, Facebook has recently launched its own live streaming.

Blab

Whereas Periscope is focused on the broadcaster sharing an experience, Blab is more like a talk show. Similar to Google Hangouts, it allows the person producing the show to have up to three other guests. Those viewing can ask questions and provide feedback.

Tinder

Tinder is a photo-and-location-based dating app. Users view pictures of others within a certain mile radius, swiping right to “like” a photo and left to not like it. If two people both swipe right, they are then able to communicate with one other. Where it goes from there is up to them.

Skout

Skout is similar to Tinder, though generally less well known. It differs in that it attempts to segment users into peer groups on the basis of age and provides moderation for teen groups/communication.

WhatsApp

WhatsApp is a mobile messaging app that can take the place of texting.  It uses the mobile data plan and, therefore, doesn’t incur SMS charges. It is cross-platform, so users can communicate with others regardless of the type of phone they use. Users can also create “chat groups” to message between multiple people at once. Facebook acquired WhatsApp in 2014. Kik is very similar to WhatsApp, although not as prevalent.

 

 

This is not an exhaustive list, and there are always new applications coming out. I encourage counselors to stay up to date on their understanding of these apps and the ways that their clients are communicating and relating with their peers. And don’t forget, if you use social media as part of your work, the ACA Code of Ethics requires that you have a social media policy.

 

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Is there an app your clients talk about a lot that isn’t on this list? If so, I’d love to hear about it. Feel free to drop me an email, or leave a comment below.

 

 

 

 

 

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Rob Reinhardt, a licensed professional counselor supervisor, is a private practice and business consultant who helps counselors create and maintain efficient, successful private practices. Before becoming a professional counselor, he worked as a software developer and director of information technology. Contact him at rob@tameyourpractice.com.

Letters to the editorct@counseling.org

 

Apps4Counseling: What’s in your digital toolbox?

By Maxine L. Rawlins and Elizabeth A. Hughes January 27, 2016

The increase in mobile device ownership and usage — primarily smartphones and tablets, in that order — has been remarkable for all segments and age groups of the U.S. population. The Branding-Images_toolsindependent market research company eMarketer estimated that just under 2 billion people worldwide would own a smartphone by the end of 2015. Although tablet ownership and usage is generally lower than that for smartphones, the figures are still impressive. Worldwide and U.S. tablet sales for 2015 were estimated to reach 1 billion and 156 million, respectively, which represents a doubling of worldwide sales when compared with 2012 figures.

Among some other U.S. trends in mobile device usage and social networking as reported by various sources:

  • Mobile device ownership and social media usage have increased for all age groups (Pew Research Center, 2015).
  • Smartphones and tablets are used more than any other electronic device by children ages 4-14, prompting the toy division president of market research firm NPD to conclude that “technology devices are as much staples for American families as traditional toys” (NPD, 2014)
  • Increased mobile device usage by children has prompted some schools to adopt hybrid learning BYOD (Bring Your Own Device) policies (Ed Tech, 2015).
  • Almost one-third of adult smartphone owners say they couldn’t imagine living without their smartphone (Pew Research Center, 2014, 2015).
  • Young people, “minorities” and those with lower socioeconomic status (SES) levels are likely to be “smartphone dependent” for Internet access (Pew Research Center, 2015).
  • The highest rates of social networking were reported by young adults, African Americans and those with higher levels of SES and/or education (Pew Research Center, 2014, 2015).
  • Approximately 51.5 percent of millennials in higher education settings report using their smartphones to monitor their personal health (Domo, 2015).

Incorporating mobile devices into counseling

Professional usage of mobile devices by counselors has not sufficiently reflected an awareness of or capitalized on the dramatic shifts in the ways in which large numbers of the U.S. population currently communicate, learn, socialize and obtain, manage and share information. Put differently, counseling, counselor education and wellness promotion strategies have not, for the most part, kept pace with the way that people currently live in and interact with their immediate and larger world. The benefits of actively integrating mobile devices into the teaching and practice of counseling are numerous. These benefits include:

  • Portability
  • Flexibility
  • Effectiveness at embracing multiple learning styles and multiple “intelligences” because of the inherent kinesthetic, auditory and visual components of mobile devices
  • Ability to be customized to match the developmental level, culture, etc., of the target group
  • Range of standard accessibility features
  • Effectiveness with a wide range of cohorts, not only “digital natives”
  • Engaging and interactive nature
  • Potential to enhance brain neuroplasticity and neurogenesis
  • Ability to use a single device with an individual or group of clients/students
  • The ever-increasing plethora of high-quality apps that are free or low cost, many of which can be used across same-system mobile devices

Put another way, an informed use of mobile devices in counseling, counselor education and wellness promotion can significantly increase the size, creativity and effectiveness of our intervention toolboxes. The importance of meeting our clients and students where they are should not be minimized.

Despite the multiple potential benefits of incorporating mobile devices into our work as counselors, there are some primary challenges regarding their use. These include:

  • Reduced counselor experience, confidence and competence, as well as limited research on the use of technology (especially mobile devices) that might enhance our work as counselors
  • The less robust nature of mobile devices compared with computer-based software applications
  • The general “functional fixedness” of counselors
  • Concerns regarding confidentiality
  • Concerns that technology will depersonalize the counseling experience
  • Privacy concerns
  • The “digital divide”

Current project: Goals, genesis and focus

The goal of our current multiyear mobile device and app curation project is to explore ways in which iOS and Android mobile devices and related apps can be used to enhance counseling and therapy, counselor education, training and wellness promotion. Initial emphasis was on the iPad. The hope is that the results of the project will significantly streamline the app search process for counselors, human service and other allied health providers, counselor educators, trainers and counselor education students, and increase the ways and frequency in which mobile devices are purposively integrated into our work. We also hope project results might be useful to and accessed by laypeople to increase their overall well-being.

At the onset of the project in fall 2013, it was estimated that there were more than 1 million apps in Apple’s App Store, with approximately 500,000 of these apps developed specifically for the iPad. Identifying counseling and wellness-related uses of mobile devices and related apps proved to be an arduous and time-consuming process, even when the literature of related fields such as education, special education and communication was considered.

Because the initial project focus was on wellness promotion, an important early step was to identify a wellness model to provide the conceptual foundation for app exploration and selection. After reviewing a variety of models, we adopted the landmark multilayered Indivisible Self Model developed by Jane Myers and Thomas Sweeney (2004).

This Adlerian-compatible, holistic, three-tiered factor structural model includes the unified indivisible self, representing a person’s overall well-being, as its first factor. This is followed by five second-order factors: the creative self, the coping self, the social self, the essential self and the physical self. Finally, these second-order factors are composed of a combined total of 17 third-order factors. For example, the creative self is composed of the following five third-order factors: thinking, emotions, control, work and positive humor.

The current project enthusiastically adopted this model, with minor revisions, because of its evidence-based foundation, its holistic, broad-based definition of wellness and its contextual perspective.

In revisiting the Indivisible Self Model, however, it became clear that some adjustments were needed to reflect current counseling practice and literature. More specifically, this entailed a more inclusive definition of gender identity and the addition of brain health, sleep and sexual orientation as third-order factors. Finally, all third-order factors were further operationalized into a set of “fourth order” categories. Although these factors were not empirically identified, they provided a much-needed structural rubric for the project’s selection of counseling/wellness-enhancing apps and tablet-specific tools. Toward this end, we made every effort for the project to be guided by and to remain as true as possible to the writings and concepts put forth by the architects of the Indivisible Self Model, while simultaneously reflecting current practice and knowledge.

InfographicApp selection process

It became clear at the outset that a structured four-stage discovery and vetting process was required to cull through the plethora of App Store apps and ultimately identify counseling/wellness-enhancing apps for inclusion in the project.

The first stage, Identification, consisted of app searches within counseling and related fields. The procedure entailed arduously culling through the App Store using related keywords, categories and leads obtained from our literature and online searches, monitoring “best new app” listings and exploring other apps offered by the developers of apps we had already identified as promising.

After an app was identified, the Discovery process began, which involved taking several factors into consideration before the potential app progressed to the next stage. Factors included app reviews and user ratings, App Store developer descriptions, price, file size, in-app purchasing, free version restrictions, user suitability ratings (e.g., age), whether the app was accessible on the iPhone, iPad or Apple Watch, the app’s version history and the developer’s attentiveness to required fixes. If these features were deemed to be satisfactory, the app was determined to be ready for further examination in the Analysis stage.

During the Analysis stage, surviving apps were subjected to more robust scrutiny, as we “checked under the hood and kicked the tires.” The apps’ user friendliness and intuitiveness came to be of utmost importance. Relevance and quality of fit with the Indivisible Self Model also came into play, as did the apps’ level of versatility, customizable options and value-added features such as trend analysis, syncing/interfacing with other devices, integrated cloud storage and note-taking/journaling elements. If the app was for children, the degree of available parental control became important, as did the inclusion of follow-up questions, activities, resources or tips for parents.

Exclusionary factors included apps that focused on self-diagnosis, hypnosis or “hookups”; were sexualized; contained an excessive amount of grammatical or spelling errors; appeared to be pushing an agenda or product; cost more than $10; or contained excessive in-app purchasing or excessively intrusive ads. At the end of this stage, we determined whether an app provided sufficient value to warrant downloading or purchasing it to be tested in the project’s fourth and final stage.

In the Selection stage, we test drove downloaded and purchased apps by using actual or hypothetical data to make an informed recommendation about each app’s inclusion or exclusion in the project. For example, we considered ease and reliability of operation, usage restrictions, customizability and information saving/syncing. In this final stage, we raised the bar to reassess each app’s relative value by conducting an informal cost-benefit analysis and determining the extent to which its concept, design, functionality and operation were unique in comparison with similar apps in its category.

The hundreds of hours spent identifying and vetting apps have thus far yielded more than 350 high-quality apps — and counting — that enhance counseling and wellness. It is important to note that the majority of apps that survived the rigorous four-stage evaluation process and ultimately received the project’s stamp of approval were originally developed for purposes unrelated to counseling. It quickly became apparent to us that it was important not to be dissuaded by an app’s stated or intended purpose. To be maximally effective, this necessitated holding any tendencies toward app-specific functional fixedness in check so that each app could be creatively evaluated through an objective and unbiased lens. Put differently, it was critical for the project investigators to deconstruct each potential app, peeling off the layers to highlight its bare-bones core components. This careful mining process was critical in revealing multiple gems.

Case vignette and app-related interventions 

To demonstrate how mobile devices and related apps can be utilized in many ways during the counseling process, consider “John,” a hypothetical case study created to demonstrate app-related counseling and wellness promotion interventions and their potential effectiveness.

John is a talented budding lawyer who is determined to become the youngest partner in his firm. He often heads to work early and leaves late, sacrificing quality sleep and nonwork-related social activities to achieve his goal. John presents to counseling with several areas of concern. Specifically, he states that his lack of “real friends,” absence of nonwork interests and neglect of his overall health and wellness have significantly contributed to his life feeling out of balance.

John says that he:

  • Spends the majority of his time working at the office or at home
  • Eats on the go, typically consuming fast food on a regular basis at his desk, picking up something on his way home from work or skipping meals entirely
  • Has no time to exercise, although he has a gym located in his apartment building
  • Consumes caffeine regularly to keep up with his job demands and increasingly consumes alcohol to help him relax
  • Can’t recall the last time he had fun since moving to this area

John and several of his presenting concerns are good candidates for mobile/app-related interventions, particularly because he offers that he never leaves home without his smartphone and prides himself on being the most tech-savvy employee at his firm. Additionally, he consistently mentions his overall lack of time to address many of his highlighted areas of concern.

John acknowledges that he has neglected his health and put the rest of his life “on hold” in his pursuit of making partner and achieving career success. At several points, he also brings up his overall lack of discretionary time and his perceived inability to attend to his overall wellness. John agrees to give OWAVES (a free app for iPhone, iPad and Apple Watch) a try to evaluate, track and change his current habits.

In response to John’s specific requests for assistance in expanding his social world and interests, he is introduced to the Meetup app (a free app for iPhone, Apple Watch and Android). This app provides users with a community-based way to nurture existing interests, rekindle old passions and explore new locally based activities through its listing of various social and interest groups in the area. John is particularly drawn to this app because he has mentioned an old love of ballroom dancing, a desire to reconnect with this “community” and an increased willingness to meet new people outside of his work environment.

Additionally, John has expressed a wish to reduce his alcohol consumption and explore other ways of relaxing that are compatible with his busy lifestyle. For this, he downloads and agrees to experiment with several mindfulness strategies, especially those that don’t require a large time investment. He is especially drawn to the bite-size mindfulness practices of the Smiling Mind app (free for iPhone, iPad and Android).

John’s insights and positive outcomes

In response to the counselor’s request that John track his daily activities using OWAVES and make efforts to use Smiling Mind and Meetup over the next two weeks, John achieves some insights and realizes some positive outcomes. First, he recognizes that taking time for lunch and eating mindfully actually increases his productivity in the afternoons. He begins to increase his sleep, waking refreshed in the morning. This results in time for exercise before work, decreased stress and less perceived need to use alcohol as a relaxant.

After four weeks, John takes small daily breaks dedicated to relaxation strategies, often using one of the bite-size Smiling Mind meditations. In the process, he increases his alertness during the day, decreases his need for caffeine and frees up some evening hours for social activities. John also uses his newly available time in the evenings (due in part to his increased daytime work productivity) to begin testing the waters with the Meetup app, searching for local groups that pique his interest.

Special considerations 

This hypothetical case was designed to highlight the app selection and implementation processes and the potential impact of app-related counseling interventions. Additionally, our intention is to encourage counselors to take a “blended” approach to incorporating technology into their work.

The incorporation of technology in general, and mobile devices in particular, into our counseling practice does not have to be an all-or-nothing proposition. Such interventions can enhance and supplement — not necessarily replace — traditional counseling.

It is important to note that, first and foremost, John’s goals and fit for technology-incorporated counseling practice were considered. John was an ideal candidate for this type of intervention because of his age, presenting issues, comfort and access to technology, openness to its utilization and perceived lack of time to incorporate other strategies to improve his level of wellness.

App selection 101: Practical applications for counselors

Given the limited body of literature on the use of technology in general and mobile devices in particular in the counseling process, the following recommendations are offered to facilitate informed decision-making by counselors and other allied health providers when assessing the selection and incorporation of mobile devices and apps into their practice.

First and foremost, the provider should take into consideration the needs and goals of the client or student. As with any intervention, intentionality should be the driving force that guides the decision-making process. The app under consideration should be in the best interests of the client or student, taking into account his or her presenting issues and goals. Other factors such as developmental level, age suitability, cultural identification (broadly defined) and client degree of familiarity, experience and confidence in using technology should also be considered.

Although we live in a technological age that is constantly changing, the digital divide has become increasingly important. Client or student access to the considered app, as well as to the technology required to support use of the app, both inside and outside of the counseling session, are important factors that need to be considered. In addition, because confidentiality and privacy of the information generated within most apps cannot be guaranteed, this should be discussed prior to use. Any counselor who intends to utilize apps or other technology-related resources within the counseling process should strongly consider delineating such information in his or her informed consent.

Finally, counselors interested in integrating mobile devices, apps or other technologies into their work are advised to examine clients and students through the lens of their current stage in the counseling relationship and process. The Stages of Change Model (1994) developed by James Prochaska, John Norcross and Carlo DiClemente can also be useful in this regard. These factors may be critical in determining whether the individual will be responsive to and is appropriate for the technology-based intervention being considered.

We invite you to join our growing Twitter and Facebook communities
@Apps4Wellness, @Apps4Counseling and online at apps4counseling.com to access our App of the Month tweets and related online postings, which provide counseling/wellness-related usage ideas, app tips, case studies and sample products using the spotlighted app. We also encourage you to share with us your favorite counseling/therapy, training or wellness-enhancing apps or specific mobile device uses. Please be advised that by submitting your app or mobile device use recommendations, you are giving us permission to post your submitted information on one or all of the Apps4Counseling sites (Twitter/Facebook/website) in the way that it was submitted.

Finally, we invite you to contribute to our international research in this area by taking our brief survey at surveymonkey.com/s/N7339P6. Requests to receive project updates by email can be made at the end of the survey or by going to surveymonkey.com/r/2GFY8BZ. Alternatively, the survey or request for project updates can be accessed by scanning the QR codes on page 58 of the February issue of Counseling Today.

 

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Maxine L. Rawlins is a professor and coordinator of the Counseling Technology Center in the Department of Counselor Education at Bridgewater State University in Massachusetts. Contact her at mrawlins@bridgew.edu.

Elizabeth A. Hughes is a recent graduate from the CACREP-accredited mental health counseling program at Bridgewater State University. She is currently working as a mental health clinician.

Letters to the editor: ct@counseling.org