I am going to be completely honest with you. I have never had Facebook or any social media for that matter. I’m aware that may hurt my credibility, but I never really got into any of it. I wanted to avoid having that conversation with students and clients about why we couldn’t or shouldn’t be friends online. I just never got on board.
But when I saw that Facebook was changing its name to Meta, the Macy’s Thanksgiving Day parade was selling non-fungible tokens (i.e., a digital asset that links ownership to unique physical or digital items such as art or music), cryptocurrency was on Saturday Night Live, and my husband walked into our house with pricey Oculus goggles, I started to pay attention. Some influential, smart and wealthy people started to express a really big buy-in for this metaverse thing, and I was seeing more and more evidence for its relevance. But I still wondered: What is it and why should I care?
Before the pandemic, I was a relatively staunch and rigid believer that counseling could not really occur in virtual spaces and counselor education could not be as effective online as it could be in person. It is never really a comfortable place to operate from when you must readily admit that what held you back were your own personal biases about technology, ones that you later learned are inaccurate. From a completely anecdotal perspective, many clients and students have both benefited and grown from relationships that have been created and maintained over Zoom.
Born completely out of necessity, this shift to online counseling, supervision and education in response to the COVID-19 crisis has been met with a healthy dose of suspicion and apprehension. Appropriately so. With so many of us continuing to use virtual platforms with clients, work from home and teach completely online, it’s the perfect time for counselors and other mental health professionals to discuss the potential benefits and dangers of virtual counseling.
Will we be able to help, empower and counsel clients virtually anywhere as the world around us becomes more and more technological? Will we be ready for what the winds of change bring our way? And how well will we be able to adapt and calibrate without losing a sense of who we are and what we are personally driven and ethically bound to do? In short, how can we be counselors in this rapidly changing world?
The metaverse of today and tomorrow
As I began to explore and dabble more with technology-centric disciplines — ones I never thought I would find myself in — I unearthed a growing curiosity in myself about technology. So, like the character Neo from the 1999 science fiction film The Matrix, I decided to take the red pill — the one that offers a glimpse into a world with an uncertain future — and head down the rabbit hole. Please believe that my innate pragmatism, low stress tolerance for cutting-edge technology and counselor professional identity have all acted as a carabiner, hooking me to the safe rock of reason and practicality.
Along this journey, I discovered the metaverse, which is the next iteration of the internet and is referred to as Web 3.0. This term is often conflated or confused with virtual reality (VR). Although VR provides an opportunity to best experience the metaverse, these terms are not synonymous. The metaverse is the swimming pool, and VR is the floaties (yes, I have multiple children) or life vest that you choose to wear or not. The vest (VR) can undoubtedly improve the quality of your experience but is not necessary for you to enjoy the pool (metaverse) or for the pool to exist. VR may be something that many could avoid entirely, but the metaverse will be harder to ignore because it will impact how we live our everyday lives and represents all the technological advances that will undoubtedly permeate our day to day. For example, it is hard for anyone to even apply for a job without accessing the internet; smartphones are easy to find; and most of us use two-factor authentication and are often asked to use CAPTCHA to prove that we are not robots.
Most people know of the metaverse through movies and television shows such as Wreck-It Ralph, Westworld, Ready Player One and Black Mirror. These shows often depict the metaverse as a dystopian reality, with robots taking over the world, a dispersion of wealth that has devastated some and elevated others to extravagant riches, and everything else in between. And although these Hollywood imaginings are a while — potentially years — away from becoming a reality, people do use VR goggles to maximize their enjoyment of the digital world from a 3D perspective through avatars.
There is not one specific metaverse yet, but many large companies are currently working to create one. You do not need a search engine or “middleman” to log on to the metaverse, and it can be assessed from a computer, smartphone or smartwatch. Voice recognition, hands-free operation and artificial intelligence are hallmarks of the metaverse. So anyone who has ever told Siri or Alexa to play their favorite song or received a social media ad for products after talking about that product near their listening device can attest to many aspects of the metaverse that are already available.
The potential benefits
As technology races to catch up to the vision and imagined concept of the metaverse that represents the collision of a physical world and augmented reality, we are given a precious opportunity as counselors to gain our bearings and come up with a frame of reference. What can the confluence of VR and the metaverse do for our clients, our supervision and our education? For me, it is less about a personal love of technology and more about recognizing the changing landscape that is altering how we are collectively interacting.
Regardless of whether counselors choose to engage in this modality or they choose not to pursue it, we as helpers need to be prepared and equipped to handle any of the issues or concerns that will undoubtedly emerge because of its existence. Having difficult conversations and exploring what psychopathologies could potentially be exacerbated by this cultural shift could give us an opportunity to instill a preventive and strengths-based approach. If we as a helping profession had known how access to and popularity of social media would impact our society and how the prevalence of cyberbullying would ravage schools, could we have prevented some of the carnage instead of reacting to it?
VR opens up creative possibilities in technology and counseling, and there is some research to support that it can be helpful to a wide array of clients. In particular, VR has shown effectiveness in the following clinical areas:
- Fear of heights and flying
- Posttraumatic stress disorder
- Eating disorders
- Substance use disorders
- Grief and loss
In addition, counselors can use VR to do the following:
- Engage in role play for social skills interventions with clients
- Help clients improve empathy and increase understanding of complex societal issues
- Reduce unfamiliarity and mitigate discomfort of mental health treatment
- Create spaces for people with disabilities
A few words of hope and caution
As we enter this technological space and begin to have these conversations, I want to offer an opportunity for reflection.
What we have been doing is not good enough long term. It is important that as licensed professionals, supervisors and counselor educators, we are aware that many of the practices and policies that have been used during the COVID-19 crisis are not rigid and evidence based enough to be enacted for long-term care. As the internet expands and we realize that there is no computer system or program that is not at least somewhat susceptible to penetration, we must be continually focused on preserving client information and confidentiality. We have learned so much from our telehealth experiences that may be applied to our journey with VR and into the metaverse. It is our responsibility to cultivate and encourage ourselves, colleagues, counselors-in-training and newly licensed professionals to not get too comfortable in the current state of operation and embrace the ambiguity that comes from striving for better. It is time to establish best practices that are informed by the protocols and suggestions from the Health Insurance Portability and Accountability Act, the Health Information Technology for Economics and Clinical Heath Act, and Section H (Distance Counseling, Technology, and Social Media) of the 2014 ACA Code of Ethics.
We must not be willing to compromise the safety of our clients or their information because we are excited about or see the applicability of these technological advances. Issues surrounding confidentiality, affordability, accessibility, equity, emergency situations and credentialing all need to be addressed. And because no legal precedent regarding telebehavioral health has been set yet, we must continue to execute due diligence. This includes detailed and appropriate documentation about clinical services and clear rationale for decision-making.
Some of the top concerns for counseling in the metaverse include:
- Confidentiality and storage of client information: Can we protect clients’ personal information? Can we ensure that what is said in these virtual spaces will remain protected and be heard and shared only with the intended parties?
- Affordability and accessibility: Can we ensure that all who would benefit from services and resources in the metaverse will be able to use it, especially marginalized and oppressed populations? (See Daniel Pimentel and colleagues’ article “Virtually real, but not quite there: Social and economic barriers to meeting virtual reality’s true potential for mental health,” published in Frontiers in Virtual Reality in 2021, for a more in-depth explanation of potential barriers.)
- Client and counselor identification: Can we always verify the identity and location of people within the metaverse?
- Emergency situations: If a client shares suicidal or homicidal ideations while in the metaverse, will we be able to intervene effectively, keep the client safe and notify the proper authorities?
- Evaluation for appropriateness: Can we effectively screen, evaluate and identify those who would most benefit from incorporating the metaverse into counseling and those who might potentially be harmed?
- Competency: Can we properly train and educate counselors who want to use the metaverse for counseling? (For more on this topic, see Rodney Goodyear and Tony Rousmaniere’s 2019 article, “Introduction: Computer and internet-based technologies for psychotherapy, supervision, and supervision-of-supervision,” published in the Journal of Clinical Psychology.)
- Unforeseen consequences: Can we provide preventive care for those whose existing emotional and mental health disorders may be exacerbated by the use and installation of the metaverse?
Preventive care equates to a pluralistic acceptance of technology. Do all counselors need to “goggle up” and dive headfirst into the metaverse? There is no simple, straightforward answer to this question. Deciding whether we should or shouldn’t embrace the metaverse really comes down to our unique interests, skills, passion and ultimately our scope of competency. Self-awareness should guide each of us to choose whether this is something we would enjoy and, most importantly, effectively execute. Adequate and appropriate clinical training in contemporary topics is difficult to find, so we must create specialized training, continuing education, and thorough research on technology and mental health, as well as develop a decision-making model for determining how to appropriately use technology with clients.
We could use a humanistic/anti-reductionist lens to guide our ability to optimize human growth and development with our clients by offering more education, support and meaning attribution. Viewing our clients and counseling students as holistic, purpose-driven and capable human beings could provide context for our students and clients and help them make sense of this technological world and their desired role in it. Only by leaning into technology can we better understand the connection between the metaverse and mental health and predict if an extended and universal misuse of the metaverse could result in mental health issues such as lower stress tolerance, poor emotional regulations, anxiety disorders, porn addiction, phone addiction, narcissism and psychosis. And then we can work to develop appropriate responses before it becomes a cultural crisis.
We must meet this change with a healthy skepticism. It is my hope that as professional helpers and caring human beings, we keep an open but very guarded heart as we consider new technologies. Change is hard no matter who you are, and we need to be kind and patient with ourselves as much as we are with others. As we hear more and more about avatars, non-fungible tokens, blockchain technology, the Internet of Things (i.e., devices and other physical objects that are connected to the internet) and more other-worldly seeming terms, we must stand fast to our counselor identity and not resent the overtechnological existence we find ourselves in. An overall aversion to and resentment of cellphones being glued to people’s hands, and now wrists, are not the best ways to advocate for our clients, especially those who Marc Prensky in 2001 dubbed “digital natives” — people who were born or grew up during the age of digital technology and therefore do not know a world without the internet and technology. Instead, we need to be practical, passionate and curious.
Accepting this new technological world does not mean that we cannot fight like hell to make it better. We need to have a pluralistic acceptance of technology, accepting the positives that can come from it without losing sight of the inherent dangers. We must be able to disagree, bring alternative viewpoints and find creative solutions to complex problems. As much as the metaverse represents a convergence of a multitude of disciplines, our articulated response needs to represent the art and science of what we do as counselors.
Here are some tips on how to best dip your toes in the metaverse:
- Have fun. Try VR yourself and explore the current metaverse.
- Be practical, passionate and curious.
- Consider multidisciplinary approaches by incorporating and growing the work you are already doing with a technological spin (e.g., using VR goggles with clients for role-plays or mediations). Counseling has always been a creative process, as Samuel Gladding’s book The Creative Arts in Counseling illustrates.
- Educate yourself on current trends. Although some clients may not want to get into the “pool” of the metaverse, we must be ready to see any potential danger and protect our clients who are already swimming in it.
- Have difficult conversations about what this means for us as counselors.
- Advocate for marginalized populations and make technology accessible for all.
How well we can embrace cultural shifts while upholding the values and core professional beliefs outlined by the ACA Code of Ethics to benefit clients and continue to grow as professionals will dictate our longevity and significance in the coming decade. As counselors, we adamantly believe and live our personal and professional lives to promote growth and continued development in both ourselves and our clients. So how can we not embrace, with a reflective and introspective heart, all cultural and technological shifts? We do not have to view technology as the enemy of meaningful and sustainable relationships if we are able to collectively work together to instill preventive care. We can take a strengths-based approach that is focused on constantly improving accessibility to our services and removing obstacles for all.
We have an opportunity to consider how these technological changes will affect both mental health professionals and clients and calibrate how we as a profession are going to respond. Given the chance to rebuild spaces in which people are going to interact, let us advocate for them to focus on diversity, equity and inclusion. Creating a culture that fosters engagement, collaboration and belonging is important because we value individual perspectives and understand that people do not experience the world the same way. We have a chance to help people approach this virtual world with kindness and acceptance and learn to create meaningful and productive lives within it. The metaverse is coming whether we are ready or not, so let’s start the conversation.
Staci Hayes is a licensed professional clinical counselor and was in higher education for five years. She has recently started a nonprofit organization focused on mental health and wellness in the metaverse with a focus on diversity, equity and inclusion. Contact her at firstname.lastname@example.org.
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Thanks Staci. Cool read. Really appreciate the grounding in ethics and equality. I’ve always struggled to launch my professional identity on social media platforms, but I am a 100% telehealth counselor, as I live remotely from Hawaii. I realize a lot of counselors use the efficient/easy method for EHR like Google Workspace. I appreciate in your article the call to shift and accommodate the highest degree of safety and confidentiality and protection. This feels so important. Any suggestions for best EHR and bill pay methods, perhaps Ivy pay? Thank you again.
Thank you for your comment, Danielle! Such a great question- that one might be a bit tricky to answer. HIPPA compliance includes a Business Associate Agreement and the assurance of confidentiality of electronically protected health information (ePHI). Essentially, this means that consumer data cannot be sold or shared with advertisers or parent companies. Unfortunately, many of the most popular payment software and platforms violate this principles. Ivy- of Ivy pay, maintains client credit card information but has got some attention lately as being a trusted source. Like you, I am always a little tentative about client confidentiality and protection. Love your line of reasoning and keep me posted if you find a payment platform!
Excellent article, thank you for introducing the topic from so many vital angles. As a ‘90s pioneer in online counseling who witnessed the “wild west” of virtual counseling developing faster than ethics and policy could keep up, it is exciting to see such thoughtful considerations being addressed before VR takes off much further in the counseling world. I currently use VR to help teach breathing and relaxation techniques to clients as an adjunct to other interventions, but the immersive experience is not for everyone, so caution and focus on the clients’ best interests are essential. I appreciate the timing and thoroughness of this article!
So good to hear Barbara and would love to hear about your thoughts on where you think this is going and how your progress has been. Keep shooting Tex!
Hi Staci, I’m an accredited mental health social worker in the small towns of Stawell and Ararat in Victoria, Australia. I mainly work face-to face, however I have also been working by phone since the Victorian bushfires in 2019 when all the local counsellors that area were booked out. I’ve read your article great interest, particularly as, at 83, and slowing down with my practice, I wonder how long it will be before the metaverse becomes the norm? Best wishes
Judith! I am so inspired to hear about your amazing reliance during a difficult time. That is such a great question, and I can tell you that technology never really moves the way we predict. I remember thinking that by the year 2020 we will all be driving flying cars and using self-propelled sidewalks. Some of the best predictions that I have seen say 5-10 years before we will be fully immersed in web 3.0. We quite frequently have one foot the previous iteration of the internet and one in the upcoming. I am not sure how much of the technology you have experienced firsthand but would love to hear about it!
Hi Staci, this was incredibly helpful. I’m currently working with younger adolescents and many of my clients utilize VR technology as one of their main recreational activities. While I have a personal interest in advancing technology, it great to have professional resources through the lens of counseling.
Hi Staci, this is incredibly insightful. Having practiced in a virtual setting, VR can definitely make a difference in therapy. This article really speaks volumes to how advance technology is becoming and how quickly it might become the new norm. This opens up so many opportunities to learn and explore how VR can benefit clients and counselors in the therapeutic environment as well as with meeting goals. Thank you for this!
Hi Sania! I am glad you enjoyed it. Sounds like you have experience in VR. I would love to hear about how you have used it and what has been working for you!