Tag Archives: Technology

The pros and cons of contracting with online counseling companies

By Melanie Person January 15, 2019

The day I decided to close my private practice and move to another state was one of both excitement and remorse. I knew that I would be starting from scratch in building a practice in a new region, yet I did not have the time and energy to devote to the marketing and networking that are essential to building a practice. As I scrolled Facebook trying to avoid my grief and frustration, I repeatedly saw ads for online therapy platforms: iCouch, Talkspace, BetterHelp and so on. My interest was piqued. I had a desire to start working with clients again, but I wanted to exert minimal effort in obtaining them. So, I ultimately decided to attempt to supplement my practice by contracting with online counseling providers.

In the 21st century, technology has become a regular and expected part of our daily lives. The convenience it affords can be overwhelming to consider. As a counselor educator and professor in a graduate training program, it is essential that I keep my finger on the pulse of the counseling world, and I believe that technology will continue to be integrated into our work as helping professionals.

I have used technology in my private practice over the years for tasks such as managing client files, sending out reminder texts, recommending apps for mindfulness and other coping strategies, and assessing client satisfaction. Technology has become more integrated into the counseling profession over the past few years, and I cannot envision a future in which this trend does not continue.

But even setting aside our society’s propensity toward all things technological, I decided that contracting with online counseling providers would be the most hassle-free way for me to build up my practice. Here is what I learned.

Selecting a company

Several companies currently provide clients with access to counselors through online chatrooms, messaging forums, and video and phone sessions for a monthly subscription fee. Frequently, these companies will advertise a service that provides subscribers with unlimited access to a counselor for one low monthly charge.

Intrigued by the direction this field is moving, I decided to contact three of the most well-known providers of this service. All of these companies followed up with me immediately, but each had a very different process and focus. One company simply wanted information from me so that I could be registered with its agency, whereas the other two companies provided a screening process and were interested in my competence with providing counseling, both in general and over the internet. I have no desire to make this my full-time practice, so I decided to focus on the company that provided the most rigorous professional assessment process.

One particular piece of screening that I appreciated from the company I chose was the statement that my application would become inactive if I did not respond to homework assignments or provide the required information proving my status as a licensed counseling professional within one week. From my perspective, there was something reassuring and professional about the company taking this stance. Online counseling agencies frequently post job advertisements because they want prospective clients to have a wide variety of clinicians to choose from. This screening statement was one of the first hints I received that this online company valued the client and the integrity of the counseling profession and was not merely trying to add clinician names to its roster.

The ‘interview’ process

Once I settled on going with the company that I felt was most knowledgeable and invested, I began following through on the requests put forth by its management. For example, I answered homework assignments to demonstrate my potential responses to clients. I defended my theoretical orientation and discussed flexibility in that orientation to allow for meeting client needs. I quickly responded to these inquiries and somewhat enjoyed the guided exploration of my values and skills in counseling.

I shouldn’t have been surprised when the company contacted me with the final step of its process: an interview. However, the “interview,” which took place in the virtual space provided by the company, was not what I had been expecting based on my previous interactions. It consisted of a member of the administrative team asking to see my driver’s license, then describing to me how the company complies with the Health Insurance Portability and Accountability Act (HIPAA) and the ACA Code of Ethics, and avoids working with clients who have intense needs or are actively suicidal. He then proceeded to tell me that if a client were actively suicidal, the company would handle the transition of the client to a modality that would allow the client to access crisis services.

The interviewer had no desire to hear about why I was interested in this modality of counseling, didn’t care about my experiences and, admittedly, was not a clinician himself. After he finished explaining the process of client selection and screening, he asked me to fix a few minor details on my online profile that clients would access and requested that I reupload the photo of my counseling license. Once the video interview ended and we were disconnected, I was reminded that I was joining a business as much as I was joining a service.

Aside from the vetting process that this company requires, I was drawn to this company because it offers scholarships for clients who are struggling financially. As someone who is passionate about client care, I liked this focus on and care for those who are less privileged. So, I assuaged my concerns and continued on.

Getting going

After completing the minor changes and uploading my license for a second time, I received an email indicating that the company was giving my information a final look and would be in contact with me in the next 10 business days to confirm my contractual relationship. So, I was surprised when, three hours later, I received an email welcoming me to the company and asking me to pick a shirt that would later be shipped to me. The email also provided step-by-step directions for opening my profile online so that I could be assigned new clients.

Excited to start this process, I followed the directions and moved my cursor to indicate that I was “open” for new clients. Within three minutes, I was assigned my first new client — an individual struggling with a divorce that was not his choice. I immediately responded to his message, and the messages for that day began to flow. Within 10 minutes of obtaining my first client, I was assigned my second. Within 30 minutes of the second, the third appeared. By the end of the day, I had nine new clients and was sufficiently overwhelmed with the relational requirements of connecting with each of these individuals.

It would be difficult enough to establish therapeutic alliances with nine new clients as they sat directly across from me, but trying to remember details about and establish relationships with these online clients, including some who didn’t provide a name, proved almost too much for me to manage. These clients were able to use initials or pseudonyms instead of their real names, and only one of the nine clients had a picture associated with their profile. I consider myself to have an excellent memory, but I was struggling to connect issues to the names (or, sometimes, just a single initial) provided by the clients.

Suffice it to say, my first day of contracting with this service was exhausting. Of course, I must acknowledge that I am someone who likes to take care of communication with others as soon as possible. As a professor, I have received several rounds of applause over the course of my career for being a faculty member who immediately answers student emails. I gain a sense of accomplishment from an empty inbox and like to keep myself organized. If I can respond to an inquiry quickly, that is one less task nagging me when I slip into bed. I was not prepared for how this personality trait would translate to online counseling. I was going to need to reassess my boundaries and become comfortable with leaving a message unanswered at the end of the day if I was going to survive providing online counseling.

At the start of the second day, I considered quitting, but I weighed the pros and cons of continuing and found that my desire to learn this evolving form of counseling outweighed my desire to throw in the towel. This discernment led to a renewed commitment and a plan of action to create manageable expectations for myself and my clients.

Establishing boundaries

The first boundary I enacted for myself was switching off my “available to new clients” sign. After giving it much consideration, I determined that I could not successfully provide quality counseling services to more than five clients through the online service while also trying to get tenure and maintain my small in-person private practice (let alone raise my two young children). As soon as I switched off my availability, a wave of relief washed over me.

Now I had the task of managing the nine clients I had already been assigned. Three of those clients have not sent me any messages, meaning they have not required my attention (they remain on my roster though, indicating that they are still paying the monthly subscription fee). So, my job boiled down to managing the six clients who were actively engaged.

In attempting to find my footing, I inquired about the willingness of each client to meet for a video session. This was one of the smartest moves I could have made. I found that five of the six were excited and desired to meet through video. The other client had signed up for this service specifically to avoid the face-to-face contact. She remained content with message counseling.

Meeting the five clients individually through the use of video sessions allowed me to connect information to a face rather than just to a name or an initial. In turn, this solidified my conceptualization and understanding of each client. Plus, it was far easier and more time efficient to collaborate via voice and video rather than the pingpong of written words. Once I met with my clients through video, I was more comfortable and relaxed in this new format.

After limiting the number of clients I was willing to work with through this medium, I next needed to identify a schedule for checking and responding to messages. I looked at some of the online forums the company offered and read how their different providers were managing their schedules. I learned quickly that most of these providers had set hours and times that they would check messages and respond to clients. Some providers chose to check twice a day, whereas others indicated that they checked and responded every two to three days. This variability of schedules increases the need for any prospective provider to communicate upfront with their clients about what they can expect from the provider and the online service. This approach allows clients to find an online counselor who is available to the degree that they want. It also helps to prevent against a provider not meeting client expectations.

One of the hardest parts of learning this system for me has been receiving an email that a client has shared a message and not being immediately drawn to check and respond to that message. I was made aware from the outset that this is not a crisis service and that clients know that each counselor has his or her own method of responding to clients. Honoring this and not having unrealistic expectations of your ability to communicate with clients is imperative to being successful with these companies.

Six months after sending my first message to my first client, I am very thankful that I joined the site I selected. I have been able to engage with clients again and have made a fair amount of money working at my own pace and time. I would recommend this avenue for counselors looking to take on new clients and who have the freedom and flexibility to work with these contracting companies. Although the pay is poor and the process new, the experience has been more than I had hoped for.

Take-home lessons

1) Research and read reviews of the companies you are considering joining. There is a wide range of understanding and dedication to the field of counseling among these online services. Finding one that aligns with your view of the counseling profession is essential to successful practice.

2) Know your limits. Before accepting new clients, decide how much time you would like to devote to this type of counseling and have a manageable schedule and plan for responding to messages.

3) Find new ways to develop relationships. It was helpful for me to use the video sessions as a bridge in learning this new modality while holding on to a form of counseling that is comfortable for me.

4) Figure out how you will relay your commitment to the site to your clients so they will have realistic expectations of how available and responsive you will be.

5) Use the support systems found in many of these companies. Often, these companies will provide forums and discussion boards so that providers can connect and consult with one another. Embrace this new online professional community that you are joining and allow yourself to learn from others who have been providing these services for a while.

6) Be realistic about how much you will receive in reimbursement from these companies. The company I joined paid $10 for every 1,000 words communicated by me or my client (video and phone sessions are counted as 50 words per minute). It is also imperative that you identify the company’s monthly maximum reimbursement per client. The company I joined stop reimbursing after 12,000 words a month. If you are not mindful of these limits, you will be providing a lot of support and counseling without receiving any reimbursement.

7) Don’t forget that counseling is counseling, whether it is happening live or through some form of technology. Although the essential skills of counseling are still relevant in this form of counseling, they need to be modified and conceptualized slightly differently to be successful with this modality. For example, I learned to withhold confrontations until the clients demonstrated a willingness to be challenged. Because the therapeutic relationship can be more difficult to monitor through messaging, it is imperative that you learn how to check your clients’ readiness to be challenged. In this form of counseling, it is very easy for your clients to click a button and find a new counselor. This can be great for clients, but it can leave many counselors with unanswered questions about what happened and where their clients went.

 

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Melanie Person is an assistant professor in the Department of Counselor Education at Gonzaga University. She is a licensed clinical professional counselor and a licensed mental health counselor. Contact her at person@gonzaga.edu.

 

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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.

 

Superheroes and play therapy: The perfect imaginary combination

By Jetaun Bailey and Tonya Davis July 9, 2018

Superheroes have a profound influence on American culture. Recently, Marvel Comics’ Black Panther came to life on the movie screen. It appears the movie had a twofold impact.

First, it brought heroic life to a seemingly little-known character. Second, unlike most other big-screen superhero movies, Black Panther placed value on social consciousness, awareness, community, family and pride. It broke boundaries that went beyond simply box-office sales, introducing a male of presumably African descent as the superhero. During the movie’s opening weekend, many news outlets showed young African American children wearing their dashikis as a symbol of pride in the African ancestry depicted in the movie.

As a culture, we hold our superheroes in high esteem, even if they are fictional characters. Thanks to Black Panther, many African American boys can identify with a superhero for the first time. This experience has likely heightened the imaginations of many African American boys as they imitate characters from Black Panther in their play.

Escaping to the imaginary worlds of our superheroes seemingly has therapeutic powers. Author and blogger Remez Sasson describes imagination as the mental ability to formulate an image that is not tangible through our five senses. For young children, an even deeper escape possibly occurs when watching these types of movies. The imagination is a powerful tool for children, as reported by Patti Teel in Pathways to Family Wellness magazine. When children imagine, they can visualize their heart’s desire, thus welcoming it into their reality.

 

Reaching beyond traditional play therapy

The therapeutic power of imagination is also evident in various therapy practices, specifically play therapy. According to “Helping a Child Through Play Therapy” by Jane Framingham, adults mistakenly think that child’s play is solely for fun and games or to occupy time. Unbeknownst to these adults, through creative and imaginative play, children are developing cognitively and emotionally while improving their self-worth, positive self-image, and communication and coping skills. For those reasons, play can be therapeutic in helping children overcome challenges that might inhibit developmental growth.

To tap into children’s imaginations and gain deeper understanding of their problems, play therapists are reaching beyond traditional play therapy tools such as sand trays, crayons, paints, animals, toys and dolls. Technology appears to have revolutionized the art of play therapy, thus making it easily accessible to counselors. This can be especially important for school counselors, who work in settings in which the counseling process is often limited because of the other administrative duties assigned to them.

Technology-based programs such as Marvel’s Superhero Avatar Creator and DC Super Friends Super Hero Creator represent the infusion of electronic media into play therapy. Based on “The iPad Playroom: A Therapeutic Technique” by Marilyn Snow and colleagues, the infusion of technology increases the imagination and creativity of the child by allowing the child to create media, pictures and other artwork while the therapist is present, either in conjunction with or separate from the therapist. For example, many applications are available to aid children in fueling their imaginations to create family dynamics or events through drawing and colors that possibly hold symbolism to their presenting problems. This invites the opportunity for metaphors to help solve real-world problems.

 

An ideal therapeutic method

This method of integrating superheroes through a technology approach in play therapy potentially could be an ideal therapeutic method of working with children, especially African American males, in the school setting. It appears to offer a nonintrusive approach for getting students involved in counseling because it integrates technology and play without asking probing questions.

As former school counselors, we have been disturbed by the alarming rates of African American boys being suspended because of perceived aggressive behaviors. Through our lenses, we have seen many of these students struggling with low-self-esteem or low self-worth. Ironically, sometimes these issues are not apparent through traditional presentations such as withdrawing or isolating.

The adjustment between school and family cultures has proved problematic for African American males regarding understanding their importance and worth. This likely causes tension in the school setting, resulting in aggression. These adjustment issues, or inability to navigate from one situation to another, is better known as code-switching.

Eric Deggans, in “Learning How to Code-Switch: Humbling, But Necessary,” describes code-switching as beyond the exchange of two languages in a conversation. But in today’s diverse society, the term’s deeper meaning is shifting between different cultures to move through life’s conversations. Deggans, an African American man, implies that code-switching is an essential tool for African Americans to adjust culturally. Therefore, African American males are expected to recognize one set of rules in one setting and understand another set of rules in another setting while maintaining their identity.

 

Uses with a student

We have sought to address these adjustment issues with our African American male clients through the use of play therapy methods. Using the power of imagination in play therapy allows them to foster development and problem-solve issues that have been hindering their overall academic and emotional growth. In one case, Marvel’s Superhero Avatar Creator  was used with an African American male student who was having adjustment issues at school that produced aggressive behaviors both at school and at home. Although the nature of the school setting did not permit long-term therapy, this short-term approach showed significant positive results.

This student created a superhero avatar over the course of four sessions. During the creating phase, the student used his imagination to create a creature that had similar features and skin color to his own, thus solidifying the importance of identity and connection to the creature. Allowing the student autonomy in creating his creature aided in establishing the therapeutic relationship.

The student was able to arrange the way therapy was directed as the therapeutic relationship was established. Through the various stages of play therapy, from gaining insight to reorientation or reeducation, the therapeutic process became a playground in which the student could live out his imagination through his superhero in a way that was vivid and emotionally alive. This experience paved the way for deeper understanding of how the student perceived his school family in relation to his peers, faculty and staff, and his actual family. Through incorporation of a client-centered approach to play therapy, this student showed significant growth in his overall development and was thus able to transfer those skills (i.e., code-switching) between school and family relationships.

Once significant progress was made with the student, his parents were incorporated in one play therapy session. The student’s father decided to create a superhero avatar to bring life to his perceived role as the family protector. In retrospect, through this play therapy family activity, the father could see how his family viewed his role and their individual roles within the family.

The play therapy sessions, infused with the technology of creating superheroes, helped the student use his imagination to bring to life his own unique story and identity. In superhero stories, superheroes conquer their adversaries while overcoming their adversities. The ending of this student’s story depicted similar results.

This form of play therapy is a nonintrusive method that renders promising results by not asking direct questions, but rather allowing students to self-express through play. As such, we do not believe that the traditional mode of counseling would have achieved the same impact on this child’s growth and development. This lends support to the importance of expressive therapy for children, particularly African American boys. Expressive therapies can help children find their voices, especially through play-based techniques using superhero avatars.

 

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Jetaun Bailey, a former school counselor, is a certified school counselor, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University. Contact Jetaun at Jetaun.bailey@aamu.edu or baileyjetaun@hotmail.com.

 

Tonya Davis, a former school counselor, is a nationally certified school psychologist, a licensed professional counselor supervisor and an assistant professor at Alabama A&M University.

 

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Related reading: See the upcoming September issue of Counseling Today magazine for an in-depth cover article on play therapy.

 

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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.

Counseling Connoisseur: Thanatechnology – Grief and loss in a digital world

By Cheryl Fisher June 8, 2018

Thanatechnology: Any kind of technology that can be used to deal with death, dying, grief, loss and illness.

 

Kelly (an alias), an eighth-grader, sits with her friends in the school auditorium as her principal calls out the names of each of her classmates who were killed in the recent shooting. To honor the lives of these young people, the school is hosting a remembrance ceremony. As tears run down her face, Kelly huddles close to her schoolmates and clicks away on her phone posting messages on several social network sites and a memorial site that she and her friends created. A text message pops up from a boy she met on one of the sites. He is a survivor of a school shooting that happened a couple of years ago — he understands.

Tony’s (alias) phone vibrates, rousing him from his slumber. He looks at the clock – it’s 2 a.m. He has to be up for school in just a few hours. He squints, trying to read the alert on his phone. Another teenager has died from drug overdose. He heaves a mournful sigh and turns on the bedside lamp. His phone begins to blow up with social media posts. The deceased didn’t attend his school but is related to his girlfriend’s best friend. Tony attempts to return to sleep, but he keeps thinking about the teenager [and] wondering why it happened.

Without a doubt, the youth of today are often exposed to significant and traumatic losses. Traditionally, we have marked death with rituals such as funerals and memorials and grieved with the support of counseling, faith communities and neighbors. In more recent years, technology has provided additional ways to remember and mourn, such as creating online memorials, seeking distant or virtual grief counseling and connecting with family, friends and even strangers without geographical limitations. It erases time and distance and allows for virtual experiences and expressions that promote a narrative that lives forever.

Digital Presence and Youth

In Dying, Death, and Grief in an Online Universe, researchers Kathleen R. Gilbert and Michael Massimi observe that digital technology can “bring people together for social support, provide information, and offer a venue for conducting grief work such as telling stories or building digital memorials.”

In another section of the book, researcher Carla Sofka writes that young people are even more likely to seek grief support online. Sofka explains that the internet, social media and other digital platforms are where younger generations are most comfortable because they provide opportunities for social interaction; a sense of independence and privacy; the ability to express and form their own identity; a sense of community that includes those that are marginalized; and instant alerts and communication. All of these elements allow youth to seek and find like-minded communities that can provide immediate support and strategies for coping with myriad life issues — including death and dying, and grief and loss.

 

Social Interaction

Online bereavement forums and chat rooms provide a sense of social connection with users. Sites such as Caring Bridge allow multiple users to maintain a virtual journal offering information and capturing narratives that are accessible to members. Tumblr, Facebook and Instagram create spaces where youth can just “hang out.” Video calling technology such as FaceTime and Skype bridge the distance between users and promote interaction and communication. Additionally, grief counseling may be offered via video, phone, chat or email formats.

Independence and Sense of Privacy

Teens turn to technology to carve out a private space for self-expression. However, research indicates that internet use often provides the illusion of anonymity, which may encourage a false sense of privacy. The struggle for privacy is nothing new: The tension between privacy and personal expression has existed between teens and parents for decades. In It’s Complicated: The Social Lives of Networked Teens, danah boyd*, principal researcher at Microsoft Research notes that social media introduced a new dimension to this age-old power struggle. Instead of worrying about what teens wear outside, parents are concerned about what pictures teens are posting about what they wear outside.

[*boyd prefers to spell her name with lowercase letters.]

“Although teens grapple with managing their identity and navigating youth-centric communities while simultaneously maintaining spaces for intimacy, they do so under the spotlight of a media ecosystem designed to publicize every teen fad, moral panic, and new hyped technology,” writes boyd.

Yet, online spaces allow for exploration of feelings and thoughts, examination of death anxiety, and expression of grief and loss. For example, a 14 year- old client crafted an entire mix of music and prose around the complicated emotions she experienced related to the death of her estranged father who had abused her as a little girl. Using an alias, she posted the eulogy online and watched as strangers connected with her, validating her feelings and experience.

Expression and Influence of Identity Formation

The internet provides creative space for expressing grief and honoring loved ones. Sites such as KIDSAID.com, offer children the opportunity to connect, interact and creatively express their grief. In addition to expressive sites and online memorial services such as Legacy, Remembered.com and Your Tribute provide an unfettered opportunity to honor loss, especially for those who are marginalized or disenfranchised. The use of letters, photos and sound provide rich and detailed memorials that allow users to express their grief, absorb their loss and ultimately move forward.

Sense of Community

Blogs provide a venue to capture experiences and to cultivate topic-based virtual communities. Boyd suggests that these constructed networks serve as a public place to interact with real and imagined communities, thus satisfying a desire to be part of a broader world.

Instant Alerts

Online communication is often in real time. Twitter, Snapchat and a variety of other digital sites offer instant notifications and ongoing engagement. Technology allows users to gather multiple streams of almost instantaneous information from afar. For example, recently I was at a social gathering where a young woman, glued to her phone, was continuously texting. At one point I interjected, “Is everything alright?” She looked up and shook her head. “No, I have a friend who was just in a car accident and the medics are transporting her to shock trauma. Her parents are on their way to the hospital — but no one thinks she’s going to make it.”

The accident occurred in another state, yet this young woman was experiencing the event minute by minute via her phone messaging.

There are numerous attractive features to thanatechnology. Information is persistent and endures. There is a sense of immortality and legacy when a person’s comments, photos and work is posted in cyberspace. It is visible to infinite numbers of individuals. It is spreadable, and with one repost or share, hundreds more are invited into our experience. It is searchable. Just yesterday someone emailed me after reading my article on pet loss and grief. She had been Googling information about pet loss and my article popped up. I was able to provide her with additional support resources.

While there are many helpful aspects of using technology for grief support, there are some serious causes for pause. Are the online interactions healthy? Who is actually participating in the network communities? Are youth oversharing personal information while in a vulnerable state? How pervasive are social divisions and are they perpetuated in the participating forums?

Clinicians, parents and educators must be digitally literate and provide opportunities for genuine face to face connection while acknowledging the cyberworld of teens. Using technology during this very vulnerable time can provide tremendous support and healing, but it may pose risks. Counselors have the responsibility to help youth develop the skills to navigate technology in a way that creates a safe environment for their grief experience and promotes bereavement support.

 

 

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Cheryl Fisher

Cheryl Fisher is a licensed clinical professional counselor in private practice in Annapolis, Maryland. She is director and assistant professor for Alliant International University California School of Professional Psychology’s online MA in Clinical Counseling.  Her research interests include examining sexuality and spirituality in young women with advanced breast cancer; nature-informed therapy: and geek therapy. She may be contacted at cyfisherphd@gmail.com.

 

 

 

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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.

#disconnected: Why counselors can no longer ignore social media

By Laurie Meyers April 30, 2018

As humans, we are wired to fear the unknown. A case in point: We often look askance at new technology, suspicious that it will completely upend our lives and perhaps even destroy society as we know it. These dire predictions have greeted every new technology, going back (in all likelihood) to Gutenberg and his printing press. Radio, the telephone, television and now the Internet and social media have all changed not just how we communicate but, to varying degrees, society itself. And each technology has been scrutinized in turn.

Thus, it may not come as a shock to read the current flurry of panicked headlines, such as “Smartphones are destroying a generation” and “Social media use tied to depression.” Counselors are well aware that depression, anxiety, alienation and even social isolation are tied to myriad factors, but most counselors also make their living talking to people face-to-face. So, although many counselors have embraced and are regular users of social media, it’s not surprising that others are skeptical about “faceless” interaction.

Regardless of personal viewpoint, however, the genie is out of the bottle. It’s too late to go back. Social media and other digital platforms are now the primary means through which adolescents and young adults socialize, form relationships and stay informed. But it’s not just for kids. People of all ages are staying in touch, pursuing interests and making new connections online. Digital personal interaction is here to stay, and counselors who shun any mention or understanding of social media risk not just failing to connect with clients, but actually alienating them, says Laura Gallo, a licensed professional counselor and former school counselor who studies adolescent social media use.

A matter of cultural competence

Given the role that face-to-face communication has traditionally played in counselors’ training and work, it can be difficult for practitioners to view digital communication as an effective way to form a therapeutic bond with clients, says American Counseling Association member Martin Jencius, a professor and the doctoral internship coordinator for counselor education and supervision at Kent State University. His research interests include the use of technology in counseling. Counselors are trained to garner information not just from speech but also from facial expressions and body language, he points out. “Unfortunately, that [in-person conversation] is only one way in which people communicate and form relationships,” he says.

Counselors may not want to engage in serious interactions on a virtual platform, Jencius says, but they should understand that many people — including many clients — are forming relationships in this way. Furthermore, these relationships are just as meaningful to people as those formed in the traditional manner, he adds.

Gallo, an ACA member, agrees. “We often ask ourselves, are people missing out on something by not looking at one another? But is this just a difference in values? And, as counselors, should we acknowledge that this may be our own bias?”

“Counselors must work to recognize this new culture — a culture with its own language, values and customs,” Gallo continues. “If a counselor does not identify as a ‘digital native,’ they may not be aware of the complexities of this culture and struggle to accept its importance in clients’ lives. Yet as counselors work to understand this cultural group, they are more likely to be able to empathize and make connections, strengthening the counselor-client relationship. I believe most counselors can understand how technology has become immersed in all of our lives. Whether it’s welcomed or valued may not be as important as accepting the significance it has for a client.”

ACA member Everett Painter, a former college counselor whose areas of research include technology, believes that understanding the role that social media and technology play in clients’ lives is a matter of cultural competence and ethical practice. As with other areas of cultural competence, counselors should do a self-inventory to determine what opinions and biases might be influencing their views on social media, he says.

Painter, an assistant professor of counseling at Edinboro University of Pennsylvania, recommends that counselors develop basic literacy, at minimum, in social media and other online platforms. Ultimately, counselors should learn enough about online activity to understand the part it plays in clients’ lives, he says.

“Our role as counselors is to meet our clients where they are, to communicate unconditional positive regard and to recognize how they view the world,” agrees Gallo, an assistant professor of counselor education at Boise State University. “If interacting online is a focus and priority for a client and we fail to acknowledge this, the client may feel misunderstood by the counselor or, worse, ignored. I believe this could be said for clients of all ages [but] especially young people who spend more time online. If a teen client has to spend 10 minutes to describe what Tinder is, they might not think it’s worth it. It’s impossible to keep up with everything in the technology world, but counselors can strive to understand more about the common social platforms being used, as it may help create common ground between counselor and client. Just as we work to become culturally competent counselors in relation to gender, race, ethnicity [and] sexual orientation, we must recognize that there is a new culture surrounding technology.”

Giving guidance

The reality is that digital culture is just “culture” for younger generations. Online interaction is inextricable from how they socialize.

Teenagers are still going through the normal developmental phases of defining themselves and figuring out who they are. It’s just that the cliques and the gossip and everything else that used to take place in the hallways at school are now occurring online, says ACA member Tracy Steele, the director of counseling for Stanford University’s online high school.

As comfortable as teenagers may feel in the digital world, however, there are still important aspects that they don’t understand, Steele continues. Counselors can play an important role in teaching adolescents to guard their safety by being careful about where they post personal information, being wary of people they don’t yet know and recognizing that people aren’t always who they say they are online, she explains. Teenagers — and many adults — also need to remember that the internet is forever. Once posted, impulsive remarks and photos cannot be taken back, Steele points out.

“The internet is relatively unmonitored, and teens often have more knowledge of its intricacies than the adults in their lives,” agrees Gallo. “Developmentally, we know teens place a lot of importance on peer groups, are developing their identity, can be more impulsive and are asserting their independence — all of which can factor into their online behavior.

“There is also the opportunity to interact 24/7, something different from past generations. This could lead to extra support from peers, but it could also lead to a higher probability of negative or risky behaviors. Counselors, especially those who work with teens, may be wise to learn as much as they can about different platforms, social media sites and popular apps that young people use. But more importantly, counselors may want to strengthen their relationships with young people, especially those displaying risky behaviors, in order to intervene and provide support when appropriate.”

Gallo recommends the website Common Sense Media, which maintains a variety of resources on children and technology, including a frequently updated list of popular social media platforms, for counselors, educators and parents.

Express and connect

The potential perils of social media use and other digital platforms tend to dominate coverage of today’s technology culture. Indeed, safety issues and the indelible nature of the “digital footprints” that all online users leave behind are important considerations to dissect and discuss. Often overlooked or discounted, however, are the positive aspects, including people of all ages who find that the digital world provides them with outlets unavailable in their offline lives.

In a survey that Gallo and her colleagues conducted, “School Counselors’ Experiences Working With Digital Natives: A Qualitative Study,” published in Professional School Counseling, school counselors reported that students often use technology as an expressive outlet. This outlet was especially helpful for shy or withdrawn students, but students of varying personality types also found expressing themselves online therapeutic, Gallo says.

“The ability to connect with others who have similar experiences, even from afar, may create much-needed companionship and help eliminate isolation,” she says. “Interacting with others online does not simulate ‘group counseling’ exactly, but it may contain some of the same therapeutic factors such as universality, altruism and, in some cases, instillation of hope and group cohesiveness. Some may also find opportunities for deep reflection, something they may not have felt comfortable with prior to the advent of technology.”

Painter notes that the ability to connect despite geographical limitations is not just useful for students. Finding online connection can be vital in areas such as rural communities, where resources such as support groups may be limited, he says. For example, when Painter was practicing in Tennessee, he had a transgender client who wanted to interact and receive support from other transgender people, but no local resources were available. Painter suggested that they look for an online group. He and the client found one that put the client in touch with other transgender people from all over the country, but they also discovered group members who lived in different areas of Tennessee, making it possible to meet in person.

Both Gallo and Painter acknowledge that there are some negative aspects of social media’s “always on” culture that warrant further attention. In this age of FOMO (fear of missing out), some people may be spending too much time online, and Painter urges counselors to educate themselves about overuse.

Gallo notes that online bullying continues to be a devastating force, fed by the inherent anonymity of online communication.

“Another important point to mention is the increase in anxiety we see today,” she says. “Many have asked, are the individuals who interact more online doing so because they have social anxiety, or does being online continuously create the anxiety they now experience? These are important questions researchers are studying, and the answers may influence the future work we do as counselors.”

Gallo believes that counselors can help clients strike a healthy balance between their online and offline worlds. “Through our discussions with clients, we may be able to help them understand both the positive and negative effects that technology has on their lives,” she says, “and we can provide the space for them to explore this phenomenon.”

 

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Facts and Figures

According to a Pew Center research study, “Social Media Use in 2018”:

  • 88 percent of 18- to 29-year-olds report using some form of social media
  • 78 percent of 30- to 49-year-olds use social media
  • 64 percent of 50- to 64-year-olds use social media
  • 37 percent of people 65 and older use social media

Across all age groups:

  • 68 percent use Facebook
  • 73 percent use YouTube
  • 24 percent use Twitter
  • 35 percent use Instagram
  • 27 percent use Snapchat

Americans ages 18-24 are substantially more likely to use platforms such as Snapchat, Instagram and Twitter.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Podcasts (counseling.org/knowledge-center/podcasts)

  • “Ethics and Social Media” with Michelle Wade

Counseling Today (ct.counseling.org)

ACA Code of Ethics (counseling.org/resources/aca-code-of-ethics)

  • Section H: Distance Counseling, Technology and Social Media

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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.

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.