Tag Archives: Technology

Learning to love (or at least leverage) technology

By Lindsey Phillips May 22, 2019

A client suffers from one of the oldest and most common fears: arachnophobia. The mere thought of a spider causes her anxiety, and she often has a friend check a room for spiders before she enters. She wants to get help, but she lives in a remote area without access to a clinical expert. Could the use of augmented reality help the client overcome this phobia and actually touch a tarantula?

Arash Javanbakht, an assistant professor of psychiatry and director of the Stress, Trauma & Anxiety Research Clinic (STARC) at Wayne State University in Michigan, has found that it can. At STARC, Javanbakht uses augmented reality along with telepsychiatry as a method of exposure therapy for clients with phobias.

The client with the spider phobia, for example, would put on the augmented reality device and connect with the therapist through a wireless telepsychiatry platform. The therapist, who has full control of the augmented exposure scenario, sees a map of the client’s environment on a computer monitor. At first, the therapist places a small spider across the room in front of the client. Then, the therapist adds a larger spider that crawls across the wall. The therapist notes what the client sees and asks how she is doing. By the end of the session, several types of spiders — all moving around — and spider webs surround the client. In this safe, controlled environment, the therapist and client work together to help her overcome her fear.

The impressive part is how quickly this method can help clients. For Javanbakht, the ultimate goal is to have clients touch a real-life tarantula (or a tank containing one). Comparing traditional therapy with the augmented experience, Javanbakht discovered that what would take on average six face-to-face sessions could often be accomplished in 40 minutes with the use of augmented reality. He contends that pairing technology such as this with traditional therapy approaches can significantly improve treatment efficacy for other phobias, anxiety disorders, obsessive-compulsive disorder and posttraumatic stress disorder.

Despite the possibilities that new technologies offer, however, counselors are often reluctant to use them. Many prefer face-to-face counseling and question the impact that technology may have on the therapeutic relationship. Others are unsure of what technology to use or how to use it. Most counselors worry about possible ethical implications. For some, the overarching counseling principle of do no harm translates into do not use tech

Olivia Uwamahoro Williams, an assistant professor of counselor education and college student affairs at the University of West Georgia, says this hesitancy to embrace technology is understandable because counseling is a person-centered profession. However, counselors shouldn’t think about technology as a means of removing the person completely, she argues. Instead, they can use technology to enhance mental health and counselor training outcomes, she says.

“There’s a general lack of understanding in the counseling community about high technology such as artificial intelligence [AI] and how it will impact the field,” adds Russell Fulmer, who is part of the core faculty at the Counseling@Northwestern program with the Family Institute at Northwestern University. Some counselors incorrectly assume that they have to be well-versed in the inner workings of technology or must learn how to code, and many counselors even fear losing their jobs to high technology such as AI, he says.

However, Fulmer, a licensed professional counselor (LPC) and a member of the American Counseling Association, doesn’t believe that counselors’ livelihoods are in jeopardy from technology in the short term. The jobs most in danger of becoming obsolete are ones that are repetitive, he says. Thus, occupations such as counseling that involve social and emotional intelligence are better positioned in the long term, he explains.

Holly Scott, an LPC and the owner of Uptown Dallas Counseling in Texas, used to be adamantly against using technology in counseling. Now, however, she is a technology convert, citing at least five ways that counselors can use technology in their practices:

  • Helping clients find mental health practitioners who are a good match for their presenting issues
  • Finding and disseminating evidence-based information
  • Improving clients’ mental health through the use of virtual or augmented reality
  • Encouraging clients to follow up on treatments and the skills they learn in session through the use of mental health apps
  • Reaching a broader range of clients through telehealth 

Meeting clients where they are

Younger generations have a difficult time imagining a world in which libraries and encyclopedias were the only means of researching school projects. Today, they simply pull out a smartphone and Google it — sometimes while still sitting in class. According to the Pew Research Center, in 2018, 95% of teenagers reported having a smartphone or having access to one, and 45% said they were online on a near-constant basis.

Technology is not just for the young, however. Pew also found significant growth in tech adoption in recent years among older generations, particularly Gen Xers and baby boomers. In fact, boomers are significantly more likely to own a smartphone today than they were in 2011 (67% in 2018 versus 25% in 2011), and the majority (57%) now use social media.

James Maiden, the assistant dean of student affairs and an assistant professor of counseling at the University of the District of Columbia (UDC), finds that clients are outpacing counselors in terms of technology. Counselors need to do a better job of meeting clients where they are, he says. “Don’t think [technology] is going to replace you,” he argues. “Think of how [it] can extend the good work that you’re doing.”

In fact, Maiden, an LPC and an ACA member, views technology as “a gateway into seeking a professional [counselor].” Counselors can begin by providing peer-reviewed, factual information and tools online for people who search the internet for help, he says. Making this information readily available to the public will help lessen the stigma around mental health and open the door for more individuals to eventually take the next step of going to see a counselor, he explains.

Scott says most clients find her private practice in Dallas through her website or by Googling “anxiety” and “Dallas.” She acknowledges that this is a more “selfish” use of technology — one that helps counselors get their names out there. However, if counselors share with the public their specialties and what they offer, then it’s a win-win for both the counselor and the client, she says.

Part of the purpose of Scott’s website is to remove as many stressors for potential clients as possible. The information it provides can help address people’s fears and concerns and normalize the counseling experience, she says. For example, a counselor’s website can include pictures of the office and address common questions that first-time clients might have: Where do I sit in session? Are people going to see me in the waiting room? What do I say to people if they see me sitting there? How much does counseling cost? Where do I park?

Of course, the counseling profession has made some strides in meeting clients where they are through the use of technology. For example, distance counseling and telehealth remotely provide services to clients who may not be able to see a counselor in person because of location or limited mobility. 

More widespread use of telehealth has led to a significant decrease in the number of psychiatric admissions among those residing in geographically isolated areas, according to Panagiotis Markopoulos, the clinical lab director and a faculty member in the counselor education program at the University of New Orleans. He touts several benefits to using distance counseling:

  • Safety (clients can express themselves more freely)
  • Less social stigma (clients can avoid public encounters)
  • Accessibility (clients can receive help regardless of their geographical location or daily schedule)
  • Affordability (clients can receive counseling services at a lower cost than with face-to-face counseling and save on transportation costs)

For clients who prefer or need to use distance counseling, Markopoulos, an LPC in private practice in New Orleans, recommends video- and text-based communication tools such as My Clients Plus and Zoom. In addition, Second Life, a 3D virtual game, offers an encrypted way of communicating, Markopoulos says. If clients value anonymity yet want to be present with a counselor, they can create avatars, enter the “virtual session” and talk through a headset or text-based chat, he explains.

Counseling: There’s an app for that

The high cost of some technologies prevents private practitioners from using them, but mental health apps are an affordable way for counselors to incorporate technology into practice. In addition, these apps can allow people who face barriers to traditional mental health services to access help.

According to Psycom.net, health experts predict that apps will play an important role in the future of mental health care. In particular, mobile apps for cognitive behavior therapy (CBT), relaxation and mindfulness interventions are gaining momentum as supplements to in-person therapy.

Scott, who serves on the board of the National Social Anxiety Center, personally knows the power of using CBT apps with clients. When a client comes to Scott, she offers to use either paper handouts of CBT activities or MoodKit, a CBT app developed by two clinical psychologists. She’s noticed that most clients 35 years and younger prefer to use the app. “For a certain population, [the MoodKit app] really increases the speed of the change and the efficacy of the therapy,” she adds.

Scott has also observed that when she asks clients to record their moods between sessions, those who do it manually often wait until the last minute — sometimes in the waiting room — to complete the assignment. Clients generally respond better to the app, she says, perhaps because it lets them easily chart their moods and provides them with a visual diagram.

When Scott introduces MoodKit, both she and the client open the app on their phones, and she walks the client through all the activities such as daily mood tracking, thought records and behavior activation. With thought records, the app guides users through all the important questions and helps them label the cognitive distortion with prompts such as “Is this all-or-nothing thinking?” Scott also thinks the app’s section for behavior activation is brilliant. With a client who has social anxiety, for example, the app provides a choice of therapeutic activities such as introduce yourself to a stranger. After the client selects an activity, the app prompts the individual to select a day and time to complete this activity.   

Incorporating a CBT app with regular counseling also encourages clients to put the CBT skills they are learning in session to use in their everyday lives, Scott continues. The outcome is best if counselors follow up with clients about the app and the progress they are making, she notes. For example, counselors can ask: What do you like about the app? What activity did you complete this week? When you did that activity, what did it feel like? “The therapist’s input … is what will change [the app] from just something [clients] play with on their phones into a real therapeutic, mental-health-changing application,” Scott says.

Scott, who volunteers as a crisis counselor for Crisis Text Line (which provides free crisis intervention via text messaging), has also discovered that several of her clients already use the meditation/mindfulness app Headspace. If clients are using an app, counselors can see if the app works with their therapeutic goals before using it in session with them, she advises.

Before meditation apps, Scott would play a recording (such as background noise at a bar) and have clients focus on the conversation. Then she would tell clients to do the same thing outside of sessions, starting with 10 minutes a day and working up to 30 minutes. Clients often felt too busy to set up a place where they could play a recording and work on meditation, but the app creates the environment for them, increasing the likelihood they will practice the skill outside of session, she says.

Maiden, like Scott, is a technology convert. He started learning more about incorporating technology into counseling while serving as the principal investigator for UDC’s Verizon Innovative Learning program, which provides educational experiences that promote and support the involvement of ethnic minority boys in science, technology, engineering and math. The program included free summer sessions, led by counselors-in-trainings, that discussed how to maintain one’s mental health. Afterward, the boys created apps that featured information on mental health stigma, stress prevention, anxiety, depression, suicide awareness and local mental health resources (such as counseling centers). Participants also received a year of mentoring and follow-up workshops.

Through their involvement in the program, the students learned the importance of seeking help when dealing with issues such as bullying, death and violence. They grew more likely to reach out to mentors or parents or to access the local resources included in the apps, according to Maiden, who presented at the 2019 ACA Conference on using technology to increase mental health awareness.

Through his involvement, Maiden realized the potential apps have for functioning as counseling tools that supplement the face-to-face work. Tech tools such as those created in Maiden’s program also allow people to share information with others who may not be inclined to discuss their mental health, he continues. For example, when the friend of one of the boys who had participated in the program joked on the phone about killing himself, the boy quickly informed his friend that suicide was not a laughing matter and that he was going to tell his mother, who would tell his friend’s parents. The boy also provided his friend with local resources from the app. As a result of his actions, the friend’s parents sought help for their son.

Exposing clients to a virtual world

As Scott points out, exposure therapy can be time-consuming and expensive to do when using real-life props and scenarios. As Javanbakht’s impressive results demonstrate, however, virtual and augmented reality can allow therapists to remotely expose clients to feared objects or situations. This approach is more time- and cost-efficient and provides a safe, effective outcome, Scott says.

Markopoulos finds the immersive quality of virtual reality particularly helpful for clients with autism spectrum disorder (ASD). Research indicates that individuals with ASD are drawn to technology, and they often learn and understand visually, he says, so using virtual reality with this population makes sense. “The higher the immersion, the more likely the child who has been diagnosed with autism will be able to apply the social skills that he or she has been taught in a real-life situation,” Markopoulos explains.

Markopoulos, an ACA member, has received several awards, including the 2018 Graduate Student Research Award from the International Association of Marriage and Family Counselors and the 2017 Make a Difference Grant award from the Association for Humanistic Counseling, for his work with virtual reality in the treatment of children with ASD. He also presented on the topic at the 2018 ACA Conference.

Markopoulos developed a virtual mall for individuals with ASD and for those who present with social anxiety. Both Markopoulos and the client put on the head-mount display (box-shaped glasses that allow the user to see the virtual/augmented scenario) and enter the virtual mall, which is busy and noisy. The client will see and hear coins falling from the ATM and televisions playing, see flashing lights from a photo booth in the center of the mall and see avatars constantly walking past. All of these visual and auditory elements serve as checkpoints to figure out the source of anxiety for the client.

As the client passes by a large television producing a high-pitched frequency, the client pauses and stares at it, and Markopoulos takes note. Markopoulos has attached a heartbeat sensor to the client, and upon hearing the television, the client’s heart rate escalates. At this point, the client says the mall is overwhelming and removes the head-mount display.

Through the use of virtual reality, Markopoulos has identified what is causing the client’s anxiety — the high-pitched frequency he programmed into the television. With this information, he creates a new scenario with checkpoints focused on the same high-pitched frequency, and he allows the client to control the volume. Upon entering the virtual world again, the client reports the sound is loud and overwhelming, so the client lowers the volume. Slowly, with Markopoulos’ help, the client is able to cope with the sound at a low frequency. Then Markopoulos gradually increases the sound, helping the client slowly build capacity for handling more noise.

Scott and Maiden are excited about the possibilities of incorporating virtual reality into counseling practice. In fact, Maiden plans to use virtual reality in the Verizon Innovative Learning program at UDC this summer. He wants the boys who participate to create virtual safe spaces so they can process and cope with all the stressors they experience. He hopes these safe spaces will be tools the boys can use at home until they are able to make it to their next counseling sessions.

Mental health chatbots

Fulmer doesn’t think that AI will eclipse the human need for face-to-face interaction that counseling provides. Instead, he equates AI to a multivitamin — one that will serve as a supplement to counseling.

To learn more about the intersection of AI and mental health, Fulmer reached out to X2AI, an AI startup in Silicon Valley that is, according to language on its website, “building an AI that will … make the lives of people suffering from various forms of mental illness much better.” Fulmer offered his services and now serves as a consultant and on the company’s advisory board.

As Fulmer explains, Tess is X2AI’s largest and most versatile mental health chatbot. She provides psychological support for people using automated chat conversations through text-based messaging apps that are compliant with the Health Insurance Portability and Accountability Act (HIPAA). When a person talks to Tess, she not only analyzes the conversation but also remembers details and learns from what the person says.

Along with X2AI, Fulmer conducted a randomized controlled trial to test the efficacy of using Tess to reduce symptoms of depression and anxiety in college students. Depending on the group, participants received unlimited access to Tess for either two weeks with daily check-ins or four weeks with semiweekly check-ins. The college students used Facebook Messenger (a text-based communication) to interact with Tess. She provided psychoeducation and interventions to help the students cope with their depression or anxiety.

Fulmer and his colleagues found that having access to Tess resulted in a significant reduction in symptoms of anxiety and depression among the students. In addition, the participants said they felt comfortable and satisfied with the therapeutic experience. One student said it felt like talking to a real person and noted the benefits derived from the specific tips Tess provided for ways to improve mental health. Another student reported learning new ideas for making small changes.

Fulmer points out that this study and the students’ feedback suggest that chatbots can help with two of the most common counseling issues — anxiety and depression. Thus, counselors might want to explore the use of mental health chatbots such as Tess, in conjunction with traditional therapy, to see if it improves the mental health of some clients.

Mental health chatbots can also reach a wider, more diverse group of clients, Fulmer says. For example, X2AI has developed a chatbot (Karim) to help Syrian refugees and a chatbot (Sister Hope) designed for clients who are Catholic. Fulmer also notes that rural populations that don’t have much access to mental health care and older adults who often experience loneliness could benefit from mental health chatbots.

“AI is the biggest opportunity that humankind has ever had,” Fulmer says. “When there’s opportunity and the potential of power and influence, it must be monitored. It must be crafted, and it … must evolve appropriately. And counselors can play a role in … the evolution of psychological AI.”

Virtual role-play

In graduate counseling classes, students often engage in role-play, with one student playing the role of the client — including assuming the client’s mannerisms and personal history — and the other student embodying the role of the counselor. This traditional training method offers several benefits, including helping students develop empathy and experience what it takes to be vulnerable in a session, Williams points out.

However, because students would often “break” from their role-playing if they were caught off guard, Williams, an ACA member and LPC at the Healing Center for Change in Georgia, felt the immersion aspect was not as authentic as it could be. To make the experience more immersive, she started using virtual simulation to create these role-playing scenarios — a topic she presented on at the 2019 ACA Conference.

With virtual simulation, students go into a virtual lab and interact with avatars. The scenarios are limited only by counselor educators’ imaginations, she says. It could be a client with bipolar disorder or a family session with two adults and three children. She points out that a virtual space is also less stressful for students because it allows them to focus on the counseling role. 

Another major benefit is that counseling instructors can easily manipulate or alter the student–avatar interactions and virtual scenarios to further challenge students and prepare them for real-world counseling sessions, Williams says. Instructors can also pause the simulations when students are feeling frustrated and process with them, she says.

For example, recently, when an avatar’s voice became low and choked, the counseling student doing the simulation did not pause to address the emotional change but just kept processing the client’s story. Williams wanted to check this, so she stepped over and asked the person managing the equipment to make the avatar cry. When the avatar started crying, the student froze, not knowing how to respond. Williams paused the session to process this issue with the student, who admitted that she didn’t handle it well when people cried. The other students who had been observing and taking notes on the virtual session acknowledged that they wouldn’t have known how to respond either.

This virtual experience made the counselors-in-training realize that they needed to work on handling clients’ emotions and led to a class discussion on strategies. Williams says she wouldn’t have been able to recreate the same scenario in a traditional role-play because she can’t easily walk over to a student and whisper, “Start crying.” That wouldn’t create the same effect, she says. 

Because students know the avatar is not a real client and recognize that the virtual simulation is a safe space, they are also more willing to take risks, Williams adds. A year ago, a student went into the virtual lab and started asking the avatar close-ended questions, which every counseling textbook and instructor advises against. When the student came out 10 minutes later, Williams asked her why she had used those questions. The student replied that she had been curious about what would happen; now she understood that it resulted in the counselor and client going around in circles.

Providing a safe space to role-play often gives counselors-in-training the courage to “mess up,” Williams says. “They can get it wrong — really wrong — and that’s fine because you can stop the simulation, give them feedback, assess how they’re doing, and start it back over and give them an opportunity to practice that skill again.”

Williams still recommends blending traditional role-play with virtual role-play. She uses the traditional method when students are learning the basic counseling skills, such as listening and developing a therapeutic alliance. Then later in the class, she uses virtual simulation to have students practice those skills and experience more complex scenarios such as crisis intervention, a client with psychosis, or couple and family sessions.

Counseling students can also use avatars to learn how to talk with clients’ families and caregivers, she adds. For example, the virtual scenario could involve a school counselor discussing with a child’s parents how the child mentioned having suicidal thoughts. The counselor-in-training can practice having that conversation with the parent and figuring out how to work together to create a safety plan, she explains.

“As educators, we need to be mindful of the students that we’re teaching,” Williams says. “The millennial generation … [is] exposed to a level of technology that is beyond what any of us were exposed to over the course of our lifetime. It’s naïve to think that we can continue to teach effectively these new sets of students and keep their level of excitement and keep their level of enthusiasm without incorporating more exciting technologies in their learning experiences.”

Technologically ethical

Because technologies change so quickly, counselors may find themselves in uncharted waters when debating whether to incorporate things such as virtual reality therapy or mental health apps into their counseling practice.

The first questions Scott typically hears related to counseling and technology revolve around ethics. She acknowledges that a lot of misinformation tends to circulate about using technology within one’s counseling practice, so she advises counselors to continually check the ethics codes of counseling organizations such as ACA and state-level regulations to see if new guidance or rules have been put in place.

The ACA Code of Ethics doesn’t specifically mention chatbots or mental health apps, but as Joy Natwick, ACA’s ethics specialist, points out, the decision to make the code a general set of guidelines and principles for using technology was intentional. “If we were to write a code that specifically names types of technology, it would be out of date before we printed it,” she says.

Natwick encourages counselors to pay special attention to Section H of the ACA ethics code, which discusses distance counseling, technology and social media. “If you feel like you can’t find [an answer in that section], go to the preamble of the code because that’s where the [professional] values are, that’s where the principles [of professional ethical behavior] are,” she advises.

When counselors encounter a new technology or have ethical questions about technology, Natwick suggests they use an ethical decision-making process such as Holly Forester-Miller and Thomas Davis’ “Practitioner’s Guide to Ethical Decision Making.” (ACA members can access both an infographic and a white paper on the seven-step model at counseling.org/knowledge-center/ethics/ethical-decision-making.) ACA is also in the process of creating tip sheets to provide practical guidance regarding social media and distance counseling, she adds.

“Technology becomes more and more ingrained in everyday life and, therefore, we as counselors need to keep up,” Natwick says. “We don’t want our profession to get left behind.” She hopes the practical guidelines provided by ACA will serve dual purposes: 1) Encourage those eager to use technologies in counseling to pause and consider the ethical implications, and 2) encourage reluctant counselors to engage more with technology.

Natwick also stresses the importance of competency, privacy and confidentiality when it comes to technology in counseling. “Technology is another way we are supplementing therapy or interacting with our clients,” she says. “[As with] anything we introduce to our clients, we need to really educate them about the risks and benefits.”

Scott is well aware of privacy concerns online, so her informed consent document explicitly details her online and social media policies and lets clients know appropriate ways to contact her. For example, she will not friend clients on Facebook, but they can follow her on Twitter. Clients can also contact her through a form on her website or by posting comments on her blog (which require her approval). She also addresses these issues during her intake session
with clients.

“Tech privacy means something very different in the tech space than it does in the health care space,” Natwick warns. For this reason, she recommends that counselors use technologies created or informed by mental health professionals because these vendors should share similar values with counselors and understand the HIPAA privacy rule. 

Teaming up with tech

Of course, professional counselors can also benefit from technology apart from using it with clients. Scott often turns to Twitter to find information and to get practical suggestions from fellow mental health practitioners by using hashtags such as #CBTworks and #SoMePsychs. For example, she recently saw a Tweet asking other mental health practitioners for their favorite clinical handouts for doing cognitive restructuring with clients with anxiety or depression. Several people replied with resources, including handouts, infographics and links.

Scott discovered MoodKit, the CBT app she uses with clients, through the Academy of Cognitive Therapy Listserv. A quick search on the Listserv led her to a research study on three CBT apps. The study found that MoodKit was effective in decreasing depression and increasing mood.

All of this reveals that technology is changing the way that clients and counselors communicate and form relationships. This suggests that counselors will need to be open to finding new ways to build relationships, and it may mean that some of the initial relationship building will happen in different ways than they are used to, Natwick points out.

Smartphones already have built-in sensors that record users’ movement patterns, social interactions, behaviors, and vocal tone and speed. According to the National Institute of Mental Health, apps in the future may be able to analyze the data to determine a user’s real-time state of mind and alert mental health professionals that help is needed before a crisis occurs.

In fact, AI has already made great strides in medical diagnoses. New Scientist magazine recently reported that human doctors annotated medical records (including text written by the doctors and lab results) to help train AI. This partnership resulted in AI that could diagnose children’s illnesses in unseen cases with 90% to 97% accuracy. 

Fulmer believes a type of symbiotic relationship could also form between counselors and technology. He sees technology such as AI working alongside counselors in the same way that counselors often work in multidisciplinary treatment teams. For example, a chatbot could detect a person’s emotional or behavioral state and provide the counselor with the client’s data and a possible diagnosis.

“Rather than just one counselor meeting [clients] during their initial interview and having to write down a provisional diagnosis, it might be pretty helpful to also meet with an AI and get their input on the diagnosis,” Fulmer says. “That could probably enhance reliability and even validity.”

The partnership aspect is key. Technology is most likely to assist mental health professionals, not replace them. Fulmer is an optimist about the intersection of technology and counseling and believes “that if done the right way, everyone can benefit.”

 

****

 

Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist living in Northern Virginia. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

 

Letters to the editor: ct@counseling.org

 

****

 

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.

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.

 

****

 

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.

 

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.

 

****

 

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.

 

****

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.

 

****

 

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

 

****

 

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.

 

 

****

 

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.

 

 

 

****

 

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.”

 

****

 

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.

 

****

 

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

 

*****

 

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

Letters to the editor:ct@counseling.org

 

****

 

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.