Online Counselling and Guidance Skills: A Resource for Trainees and Practitioners

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Jane Evans

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  • Praise

    ‘A very practical text that provides professionals new to this arena with a good introduction to what they can expect to encounter in online work. The book contains numerous thought-provoking examples and exercises for those contemplating work in virtual arenas.’

    Terry Hanley, Lecturer in Counselling, University of Manchester

    ‘Thinking about counselling online? It may seem like the best way of getting clients; and you can work from your home computer. Are you trained to do this? It's tempting to think that face-to-face experience translates straightforwardly to online work. But it doesn't. Jane Evans shows how many different aspects there are to counselling online. This comprehensive text is well illustrated with examples, and encourages the prospective counsellor to use well-thought-out exercises to examine just how thought out the practitioner's plans are to use this particular medium. My advice would be, don't attempt it until you have worked through this book.’

    Professor Michael Jacobs, author of Psycho dynamic Counselling in Action

    ‘This practical, skills-focused book makes an important contribution to the growing literature on online counselling and guidance. It will provide a very current and valuable resource for practitioners interested in setting up and maintaining good practice online.’

    Jeannie Wright, pioneer of online therapeutic practice in the UK and Associate Professor in Counselling, Massey University

    Copyright

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    Foreword

    Gary S.Stofle, LISW, LICDC, Columbus, Ohio, USA

    I began providing online counselling in 1997 using a chat room in response to a request for help from a young woman who was experiencing some very significant difficulties. No books or articles existed at that time to inform my online practice; no training opportunities were available. Myself and a growing number of providers cautiously provided counselling using the computer, being mindful of potential ethical quandaries that could arise but at the same time committed to providing help to those who, for a number of distinct reasons, were unable to access therapy and counselling in a more traditional venue.

    Since that time, we have learned to adapt and adjust face-to-face counselling skills into effective work online. This book acquaints the reader with that knowledge. Written as a handbook for the new counsellor as well as a reference for those more experienced, Jane Evans addresses the full continuum of issues related to online counselling from philosophy and ethics to practical, ‘nuts and bolts’ skills. This book is also useful to allied professionals (health providers and university/college personnel), more and more of whom are interacting with patients and students over the Internet and through email.

    Jane Evans uses practical examples throughout the book to assist the reader in developing the needed skills to work successfully online. The reader can clearly see a simulated client express issues and problems through email or chat, and then see a therapeutic, empathetic response by the counsellor. Through these examples, Evans demonstrates what the research is bearing out: that a therapeutic, empathetic, healing relationship can be formed using only text.

    Jane Evans also uses worksheets, exercises and assignments to help the reader learn about what is needed to do effective counselling and communicating online as well as to tune into potential issues and problems in online counselling. Significant learning about online counselling and communication can occur through active participation during the reading of this book.

    Jane Evans predicts, and I agree, that online counselling and computer-related personal services will continue to grow. More and more people across the globe are ‘connected’ and are becoming more comfortable purchasing both goods and services over the Internet. Evans notes that the Federal Government in the United States is currently sponsoring a series of e-therapy demonstration projects for a total grant award of six million dollars divided up between four providers. This shows significant confidence in online counselling and therapy. We are consistently finding that using the computer to counsel is a viable alternative to traditional face-to-face counselling for clients. Jane Evans has written an important book that will be useful in both the initial and further training of online counsellors and other helpers.

    Preface

    The movement towards expanding online counselling, mental health, support, and guidance to clients via online computer-mediated resources is experiencing a dramatic increase. Professionals and support organisations are seeking to expand and diversify the context of their resources in a manner to accommodate the identified needs of their client groups, whilst also utilising available staffing resources and modern technology to provide the most beneficial, cost-effective services, and competitive practice. This movement is driven by the need to optimise the accessibility of support to service users, whilst also providing flexibility in the nature of technology resources which are available to assist in such spheres of practice. Providing a service or resource through online communication is convenient, as well as being easy to facilitate, as computer literacy and competency are skills that are broadly commonplace across all generations. Such flexibility and the potential for immediacy in responses to client needs can be of particular importance, specifically in the area of addiction treatments (Zelvin, 2003).

    The domains of counselling, mental health, academia, and support services are particularly active in introducing a wide variety of online services for their client groups. Pergament (1998) defines online therapy as an outgrowth of four important elements within the history of psychoanalysis and psychotherapy, with particular emphasis on the work of Freud as a contributing influence. In this relatively new field of working with clients, there are publications available to practitioners that can provide a generalised insight into the practicalities of engaging with clients and offer guidance on the technology variations and requirements. There is an apparent lack of published material on a broader scale which directs trainees and practitioners in a variety of contexts requiring guidance towards the development and application of online counselling skills with their service users.

    Previous published material has focused on utilising a variety of computer-mediated approaches within counselling and therapy practices without consideration being given to its potential adaptability to additional professional contexts.

    This book focuses on supporting trainees and practitioners by illustrating the necessary skills required to improve service delivery in an innovative and professional manner alongside ethical considerations which are not limited to a specific area of professional practice.

    Why Elect to Work Online with Service Users?

    Counselling skills are an integral part of everyday communication, both in a personal and professional context. They are a necessary competence for practitioners whether working in a face-to-face context or when conversing in an online environment. They are skills which are beneficial to developing relationships, whilst also enhancing the empathy, understanding, and needs of fellow human beings. In a therapeutic context, they are the essential tools required of a professional to facilitate personal growth, personal awareness, and the alleviation of the impact of mental health difficulties. Online Counselling and Guidance Skills: A Resource for Trainees and Practitioners offers direction in this area of work whilst also illustrating the general use of online counselling skills. This in turn may open up opportunities for other related professionals to consider where they may be able to expand their service delivery into working online with clients. Literary techniques have been successfully utilised within face-to-face therapeutic encounters since the evolution of counselling and psychotherapy practice and are also relevant to online therapy (Murphy and Mitchell, 1998).

    Having competence and experience in face-to-face counselling skills does not automatically translate into holding competence in an online context without adaptation and the development of existing skills.

    For some professionals, their work will lead them to a combination of face-to-face and online working with service users. An example of this might be where a client moves away from the locality but wishes to continue with accessing support for the individual or service beyond a face-to-face relationship. There might be circumstances preventing clients in having access to services due to physical restrictions, financial resources, being demographically distanced from accessing local services, personal inhibitions, and social stigma. These circumstances might arise in a wide variety of service provisions. Where it does occur, it is extremely beneficial that professionals are familiar and confident in making the transition from using face-to-face counselling skills to applying them within computer-mediated technology.

    Growth in this area is further promoted by clients seeking counselling and support via an electronic medium which is accessible and can be arranged at a mutually convenient time and in the privacy of their own home. This is particularly relevant when considering current working patterns as online services can be asynchronous and planned flexibly around personal schedules. For clients who are limited in their mobility, or who have a disability which restricts their access and inclusion to face-to-face contact, the availability of online support is an invaluable resource. Seeking online support can often be a first step for those lacking in confidence or who have personal barriers in accessing a more traditional entry route to receiving personal support.

    The current development is strongly influenced by a need to move the traditional focus of counselling, guidance, and support into a position where modern technology is used to provide a resource which is available and flexible in relation to accessibility for client groups and professionals who offer an online service. This is currently evident within a broad variety of counselling, health and social care, and educational contexts providing online support with availability over a 24-hour, seven days a week timespan.

    I anticipate that within the next five years, the provision of online counselling and other related personal support services will be more prevalent. Interest and awareness of online working and support will continue to develop and grow. This book will provide a valuable resource for all professionals who wish to familiarise themselves with online working and who seek the option of extending their professional work to include online practice. The publication is also a useful supplementary reading and research resource for tutors and students involved in general counselling training modules and programmes, as there is currently a deficit in the subject area of online counselling being acknowledged and validated within graduate training programmes (Trepal et al., 2007). Practitioners studying at this level of qualification should be provided with insight and skills training in online counselling as this field of therapy is currently accepted as falling within the spectrum of helping relationships in a global context.

    The book will also be a general interest resource for counsellors who wish to keep themselves up to date with advancements in the field of counselling. In addition, there is considerable growth in organisations that are offering welfare and support resources for their employees in conjunction with voluntary or charitable organisations offering online support resources for their clients. The book will illustrate how such services can be professionally serviced from an online perspective, in addition to a more traditional face-to-face service.

    This book illustrates the practicalities of developing an online counselling and emotional support service, whilst also encompassing areas where online counselling skills can assist allied professionals to develop a service which has greater flexibility and accessibility for their service users. The field of student and peer mentoring can be particularly enhanced by computer-mediated communication (Sampson et al., 1997).

    Terminology Used within the Book

    As this book is intended as a resource for professionals and trainees working and studying across a diverse range of helping and support activities, I have elected to use the term ‘client’ to identify the person(s) accessing a service provision and the term ‘practitioner’ to identify the professional who uses counselling skills in their online professional practice. This terminology provides generic terms which do not restrict the scope of trainees and practitioners across a diverse range of services in seeking an informative and detailed illustration of the skills required when working online with clients. Where simulated examples of client work are included in chapters to illustrate online skills in practice, I have endeavoured to include examples which are not biased towards a specific gender or other related personal differences or circumstances. Such examples are not based upon actual client material and any similarities that may occur are purely conjured.

    The book is also intended as a practical guide for practitioners who are engaged in online interactions with service users, or trainees who are considering the potential to include online working as an adjunct to their face-to-face practice. Therefore, I have included references which will illustrate research in this field of work, whilst also reinforcing experience based upon my online clinical practice. Further resources, skill development activities, and other invaluable aids to assist professional practice are available through the companion website to this book.

    The book is divided into two parts. Part I consists of five chapters which focus on providing the reader with a clear outline of the practical skills required to develop and maintain an online relationship. This includes both brief interactions or longer-term associations. The necessary skills for effective online communication are further highlighted with the use of simulated service user examples illustrating the skills in practice. The reader is also encouraged to undertake exercises on their own, or as a shared activity, in order to gain deeper insight into the skills in practice and explore further considerations relating to the chapter subject and their specific area of professional practice. Part I also discusses the process for trainees and practitioners to establish their suitability for working online with clients and highlights the importance of online counselling training, skills experience, and technology know-how.

    Part II contains four chapters where guidance and thought to professional and ethical considerations promote further thinking around the necessary requirements for professional practice. The reader is encouraged, through the use of questions and suggested exercises, to assess/reflect upon how the subject of professional and ethical considerations can be developed within their own related client work, whilst also consolidating the direction of practical guidance and skill acquirement provided within Part I.

    References
    Murphy, L. and Mitchell, D. (1998) ‘When writing helps to heal: e-mail as therapy’, British Journal of Guidance & Counselling, 26 (1): 12–21.
    Pergament, D. (1998) ‘Internet psychotherapy: current status and future regulation’, Health Matrix: Journal of Law Medicine, 8 (2): 233.
    Sampson, J.P. Jr., Kolodinsky, R.W. and Greeno, B.P. (1997) ‘Counseling on the information highway: future possibilities and the potential problems’, Journal of Counseling & Development, 75 (3): 10. http://dx.doi.org/10.1002/j.1556-6676.1997.tb02334.x
    Trepal, H.Haberstroh, S., Duffey, T. and Evans, M. (2007) ‘Considerations and strategies for teaching online counseling skills: establishing a relationship in cyber-space’, Counselor Education & Supervision, 46: 266. http://dx.doi.org/10.1002/j.1556-6978.2007.tb00031.x
    Zelvin, E. (2003) ‘Treating addictions in cyberspace’, Journal of Social Work Practice in the Addictions, 3 (3): 105–112. http://dx.doi.org/10.1300/J160v03n03_07

    Acknowledgements

    Gaining the knowledge, clinical experience, and time required to write this book would not have been possible without the support of professional colleagues, online clients and supervisees, and my dear husband, Paul.

    I would like to extend my thanks to all who have contributed both directly and indirectly to the completion of this piece of work.

  • Conclusion

    There were many aspects that I would like to have discussed within the conclusion of this book, in the anticipation that I might promote further consideration and encouragement to readers on the subject of online counselling and guidance skills. However, I've had to limit both my enthusiasm for the subject and the content presented to focus on points that I hope will provide further insight to readers on how they might engage with the current and future developments in this field of practice. I have also included some ‘food for thought’ on the immediate issues applicable to the process of promoting a wider understanding, and the apparent significance of computer-mediated engagement with clients.

    Computer-Mediated Technology as a Viable Resource and Support for Clients

    ‘Ask uncle Ezra’, the world's first online advice column, was launched in 1986 and is the earliest recorded instance of a computer-mediated client resource. It was established by Cornell University as a support facility for their student population. Issues relating to confidentiality may be a contributing factor in the noticeable limitations when seeking to establish the extent of additional areas of activity, either prior to or subsequent to this point in time. Due to the evident restrictions in publicising client activity and engagement with such resources, this may limit aspects of research data that could assist in ascertaining the many variations and outcomes of service delivery where computer-mediated technology has been adopted to sustain supportive practitioner and client relationships. It is highly likely that, from an historical perspective, all fields of professional activity where practitioners provide supportive interaction to clients in a face-to-face context have utilised computer-mediated resources at varying stages to communicate and sustain contact with potential or actual clients. This may have included email, with such contact being informal or ad hoc, and based upon convenience to both parties in the process of maintaining engagement, or providing information, in between face-to-face meetings. Without doubt, the resulting outcomes from both formal and informal computer-mediated client and practitioner exchanges will have contributed to the current developments where computer-mediated resources are deployed as a vehicle for providing client services. At the point of concluding research for their book, Marks et al. (2007) had identified up to 100 differing computer-mediated treatment packages in use across a global context, whilst also forecasting a continuing increase in developments and application in such resources. This feature of practitioner support and guidance, in conjunction with self-help guided programmes, is stated as being significant to successful client outcomes.

    During the writing of this chapter, I conducted an Internet search using the key words ‘online counselling, guidance, and support’. This produced 1,950,000 associated results. The willingness for clients to engage with practitioners using computer-mediated communication, either on a formal or informal basis, has to be acknowledged as reinforcement to the relevance and potential for this to fulfil a significant niche in the wide range of supportive resources available at this time, and also within future advancements in this field. Smith (2005) discusses a Canadian computer-mediated support service for young people called ‘Ask a Counsellor’, where postings have increased from 74 to 2,267 per month during the 12-month period between February 2004 to March 2005. Female postings outnumbered those by males on a 4:1 ratio.

    There may be some professionals or ‘observers’ of this relatively new and developing field of practice who might argue that clients are actively engaging with computer-mediated supportive services where their needs could be more aptly met within the more traditional scope of face-to-face practice. It is not my intention here to attempt to dismiss or allay concerns and reservations that others may hold regarding the viability and professionalism in this area of supportive practice. I consider the content of the book has provided thought and guidance on how such concerns can be addressed in the process of securing a professional and ethical service for clients. I hope that the simulated case study material and exercises included with each chapter have provided readers with insightful opportunities to attain greater understanding of the value of supporting clients in this manner and the necessary skills required to achieve this. I would also like to emphasise that I do not envisage that engaging with clients in this manner holds a higher regard or will supersede the relevance and benefits of face-to-face engagement with clients. Nonetheless, I would hope that online support can achieve its relevant place in being a recognised and valued resource for supporting clients and service users.

    The advent of the Internet and the development of computer-mediated technology and resources will continue to be a feature which holds the potential to influence how individuals form supportive interactions across a global canvas. Professionals have a choice in how and at what level they choose to engage in such developments. The continuing points of consideration throughout future developments in this area will be a requirement for those practitioners and organisations that do elect to provide computer-mediated resources for clients, to ensure their compliance with professional, legal, and ethical guidelines, whilst also demonstrating a commitment to continuous review regarding the maintenance and improvement of their service delivery.

    The Relevance of Research

    The field of research, using randomised control groups and contexts of service delivery, will no doubt prove to highlight areas where computer-mediated outcomes and appropriate service delivery are proving to meet client needs, whilst also conforming to the requirements of legal, ethical and professional boundaries. Amongst others, the specialised field of computer-mediated treatment programmes is an area where research evidence is being undertaken and providing some insight to the potential benefits for clients (Marks et al., 2007). An overriding outcome from such research indicates that there is difficulty in defining whether these are more beneficial than other traditional forms of treatment, as the emphasis lies in what works best for each individual, the presenting issues, and their circumstances, as opposed to generalised outcomes. This may be similar to the dilemma where research has sought to identify which of all available modalities of face-to-face counselling and psychotherapy hold the potential for greater client outcomes. There is always the feature of individual client needs and differences which affect how a client engages with such evident variation in theoretical approaches and in turn influences the resulting outcomes. An additional consideration, in either a face-to-face or alternative context, is how effectively a client engages with their practitioner. Within computer-mediated supportive and therapeutic interventions, a significant factor in determining the potential for successful client outcomes lies in a client's willingness and ability to engage with a practitioner and the specific intent of the service delivery.

    Currently, there are a range of guidelines which indicate what specific client issues and presenting mental health features would be considered as unsuitable for therapeutic support or treatment using computer-mediated technology (Anthony and Jamieson, 2005; ISMHO, 2000; Suler, 2000). There may be distinct benefits for other fields of computer-mediated professional practice, where issues relating to mental health and supportive interactions feature within their client relationships, to identify criteria for establishing suitability of this media for their client groups. As growth in this field of practice progresses, there is a requirement for continuous review and research in this area.

    At present, there is a dramatic increase and diverse range of service providers who are seeking to engage clients through this medium. As would be apparent in face-to-face service provision, it is pertinent for individuals and organisations to include the feature of continuous research and evaluation within the short- and longer-term structure and planning of these resources. The inclusion of such features will:

    • assist in securing a platform for benchmarking and regulation in all manners of computer-mediated client resources
    • assist in ascertaining the effectiveness of computer-mediated client support within a diverse range of service delivery contexts
    • provide reliable and consistent sources of research which influence future development activities in this field of practice
    • serve to improve the overall standards of service delivery across the spectrum of computer-mediated client support
    • assist in clarifying aspects of service structure, client outcomes, and so on, which in turn may serve to allay areas of the apparent anxiety and scepticism regarding the relevance and future scope within this context of client support
    • provide the potential for clients to express their opinions regarding the efficacy and professional viability of computer-mediated support, in conjunction with providing a voice for clients in the forging of future developments. This will be particularly relevant in areas where specific client groups have been under-represented within traditional forms of face-to-face supportive relationships, yet have found inclusion through computer-mediated technology resources
    • provide an opportunity to continuously monitor and review the nature of client presenting issues which can be appropriately supported by adopting the use of computer-mediated software and technology.
    An Example of How Research Might Provide Greater Insight to the Benefits/Disadvantages of Computer-Mediated Relationships with Clients

    There is considerable material available which refers to the potential dynamics that are initiated within computer-mediated relationships. The following points highlight where appropriate research may assist in providing insight to such influences and the resulting outcomes.

    Suler (2004) identifies the aspect of visual cues being absent within text-only communication as a point of criticism from those who believe this form of communication induces an ambiguous and depleted relationship. The absence of visual and physical characteristics is proposed as a distinct advantage due to the potential for clients to engage with practitioners without aspects of transference dynamics which may be evident within face-to-face exchanges. This may therefore provide opportunities for individuals to be released from preoccupations relating to gender, race, culture, general appearance, and so on. Thus, this offers a unique occasion for individuals to experience a release from personal factors and inhibitions which induce a negative impact in other areas of their life, including participation in study, when seeking support or therapeutic assistance, within business or personal relationships, and so on.

    From an opposing viewpoint, this may not be evident in all instances, and the absence of a client's physical presence may restrict a practitioner's ability to secure the desired levels of empathy. An online practitioner colleague has consented to my inclusion of their encountering an asynchronous online client where aspects of negative transference had impacted upon them being able to secure the desired level of empathy. When the client subsequently approached the counselling service for face-to-face support after a few months from completion of their computer-mediated exchanges, the client was offered the opportunity to meet with the same practitioner or an alternative face-to-face counsellor: the client elected to meet with their former online counsellor due to feeling that they were already familiar with the presenting issues. The previous transference responses were not apparent during the face-to-face meeting, and this resulted in the practitioner experiencing a more enhanced and positive empathy with the client and their presenting issues.

    Training and Additional Opportunities for the Sharing of Good Practice for Those Professionals Engaged in Computer-Mediated Supportive Relationships with Clients

    At the time of writing, there were limited training opportunities for practitioners that offered guidance relating to engaging with client groups using computer-mediated technology. Where available, the training content does not encompass the full diversity of circumstances and professional duties where practitioners currently engage with clients and the specific considerations which are pertinent to each. There would be distinct advantages in a broader range of training opportunities being made available, including the inclusion of a specific focus and direction for practitioners on the technology forms which will be adopted within the intended client practice (Kraus et al., 2004). It would be considered inappropriate for face-to-face practitioners to have acquired certificated competency as an endorsement for engaging with clients without having undertaken training and assessment in face-to-face training activities. Equally, the nature of distance engagement with clients should be reflected by training programmes for online practitioners holding a strong emphasis on remote learning activities (Anthony and Jamieson, 2005).

    Case discussion groups and peer support forums are a valued resource within the field of therapeutic computer-mediated client practice. Such arenas exemplify the sharing of good practice and provide support for new areas of development. All practitioners who engage with clients, regardless of specialism, may benefit from developing or participating in such activities, as they hold the potential to provide an equally valid and worthwhile experience. I have previously referred to the potential benefits in securing affiliation to professional organisations that offer support to online practitioners within their area of specialism. At the time of writing, there are a number of such organisations who provide a service to online therapeutic and mental health practitioners, but there is a deficit of resources available to those practitioners engaged in activities with clients outside of this remit. This is a matter which, if addressed, could enhance the support and guidance for practitioners across a broad canvas of computer-mediated client activities.

    There is a requirement for those who oversee the professional standards of practitioners across the range of professional occupations, where there is movement towards engaging with clients using computer-mediated technologies, to encourage the introduction of forums where specific considerations can be discussed and offer guidance which is specific to practitioners' field of practice.

    I find it encouraging that there is evidence to support a developing awareness of counsellor training programmes realising the significance in encouraging students to learn and conduct research into the subject of online counselling and supervision. Within the last year, I have frequently received email requests, via my website, where face-to-face counselling students have been directed by tutors to seek information or brief interviews where practitioners provide insight into their professional online counselling or supervision practice.

    Attitudes of Society Towards Computer-Mediated Engagement with Clients

    It is logical to acknowledge that there may be evidence of caution on behalf of some members of society regarding the potential for online and computer-mediated activity with clients to provide appropriate care, service level requirements, and outcomes. There are frequent publicised accounts of the Internet introducing an arena where charlatans establish themselves in online practice and compromise the well-being and financial resources of individuals, groups, and organisations. Prior to and in conjunction with the advent of the Internet, there is evidence of reports where similar activity has occurred within face-to-face engagement with service providers. The increased wariness or scepticism regarding adopting the use of computer-based technologies may lie in individuals holding the belief that face-to-face encounters provide additional reassurances due to being based in a physical locality with the service provider. Computer-mediated supportive interactions cannot offer the same reassurances. This book has provided discussion in areas where practitioners can seek to enhance the scope for clients to gain a sense of the validity and professionalism of their service, whilst also offering guidance relating to the provision of continuous features of reassurance in the form of explicit contracting and service guidelines, and adopting the use of secure and encrypted communication facilities, data storage, and so on.

    The attitudes of society will form an important aspect of computer mediated approaches to client support achieving increased credibility and value. The securing of such a position places responsibility upon individual practitioners to conduct their practice in a manner that promotes confidence in all areas of their professional activities, but also calls upon professional bodies and organisations aligned to all facets within this field of practice to:

    • actively encourage research projects which assist in gaining insight and understanding of the advantages and drawbacks of supporting clients using computer-mediated technology
    • increase the instances where practitioners are actively encouraged to submit articles for professional journals and provide insight to their online activities with clients
    • encourage the development of focused training opportunities which are allied to specific areas of online practitioner specialisms
    • support existing training providers to include modules relating to computer-mediated supportive relationships with clients where there is the likelihood of this subject featuring within practitioners' fields of practice
    • promote opportunities for focus groups to explore the potential for developing or introducing a broader range of diversification within computer-mediated resources and facilities for clients.
    Consideration to the Potential for Computer-Mediated Supportive Relationships to Harmoniously Sit Alongside Face-to-Face Services

    Discussions and research relating to the effectiveness and place of computer-mediated supportive relationships will no doubt continue far beyond the publication of this book. Currently, there is continuing debate relating to computer-mediated client support being able to firmly secure a place where it is valued and acknowledged as credible within its own right, and find appropriate acceptance in relation to face-to-face alternatives.

    In addition to the lack of research evidence to promote greater understanding of the potential for computer-mediated support and therapeutic interventions to hold its place alongside face-to-face practice, there may also be a lack of understanding and interest from practitioners and professional bodies regarding the value within this field of specialism. There is also the possibility that elements of resistance may emanate from individuals not holding sufficient confidence to utilise computer-mediated technology within their client practice, whilst also anticipating that aspects of them as unique individuals may be lost during computer-mediated exchanges with clients. Currently, I deploy the use of counselling skills within both face-to-face and computer-mediated therapeutic interventions with clients. I also use these skills in both contexts when participating and facilitating forums, training programmes, case discussion groups, or conversing through email exchanges, and so on. I value the benefits, dynamics, and the potential available within both perspectives. Each hold specific values relating to the focus of the interaction and desired outcomes. I regularly receive email contact from clients who openly express that they have chosen online counselling due to feeling inhibited in disclosing the nature of their presenting issues within face-to-face therapeutic support, or who wish to ‘test the water’ in this manner prior to considering approaching a face-to-face service. Many of the presenting issues are related to shame and guilt inhibitors. Online supportive interactions can provide a platform to discuss such feelings and related experiences in a manner that may not be evident when meeting a practitioner within face-to-face exchanges.

    It is pertinent to consider that a combination of face-to-face and computer-mediated exchanges could have a significant impact upon the overall content and outcomes of practitioners' engagement with individual clients. This would form a very interesting and insightful basis for research activity.

    Computer-Mediated Supportive Exchanges as a Tool for Increasing Access for Clients with Disabilities or Geographical and Personal Restricting Influences

    I consider it relevant to conclude this chapter by reiterating points made throughout this book which refer to the potential benefits that computer-mediated services and technologies can offer in assisting those clients who are restricted in securing access to face-to-face services. There are wide ranges of contributing factors which result in individuals and groups across a global canvas being excluded from supportive engagement with practitioners. This is often due to many factors which can be alleviated by organisations offering alternative features, including computer-mediated resources. A brief summary of such restricting factors includes:

    • The geographical location of clients and available services within their locality.
    • Health and physical mobility restricting influences which prevent the potential to access face-to-face services.
    • Within higher and further education organisations, students may be engaged in distance learning or placement activity which restricts access to face-to-face service provision.
    • Within the area of employment, individuals may be deployed to locations or countries where suitable face-to-face services are unavailable. Language barriers may also be a significant inhibiting factor within such circumstances.
    • Individual personal and work schedules may prevent opportunities to engage with routine support services as these are not usually available beyond limited opening hours.
    • Clients who suffer with anxiety or phobia-based disorders may be unable to consider approaching routine and therapeutic face-to-face support services.
    • There may be restrictions on potential clients being able to seek support from face-to-face services due to their age or physical/mental health issues. Such issues may prevent or inhibit opportunities to leave the home unaccompanied. This may be particularly pertinent to young people and adolescents, dementia sufferers, and so on.
    • Fear of stigmatisation.
    • Cultural, gender, sexuality issues, and so on which may influence an individual in being able to consider approaching face-to-face support.
    • In locations where clients are members of a close-knit community, there may be an internalised or explicit rationale for electing not to access locally based support networks due to an anticipated negative response if others became aware of their engagement with a service provision.

    This list is not exhaustive, but does offer insight to areas where potential clients are restricted in accessing support due to variations within their personal circumstances and external influences. It is therefore relevant for organisations to consider how they might introduce a wider inclusion for those clients who are unable to secure or are restricted in securing support and resources which are currently only available via face-to-face exchanges with practitioners.

    I hope that the variety of discussion subjects within this book have offered readers the opportunity to reflect upon their existing online or computer-mediated practice with clients, whilst also serving to encourage those practitioners who are considering adapting their existing face-to-face counselling and guidance skills into a position where they proceed to engage with clients in this manner. Part II has focused on supporting practitioners in the professional, legal, and ethical issues which are apparent within this field of practice, and I anticipate that the subject matter discussed may provide material which serves as a continuing reference point in the planning stages and conducting of supportive activities with clients.

    References
    Anthony, K. and Jamieson, A. (2005) Guidelines for Online Counselling and Psychotherapy,
    2nd edition
    . Lutterworth: British Association for Counselling and Psychotherapy. p. 4.
    ISMHO (2000) Assessing a Person's Suitability for Online Therapy. Available at http://www.ismho.org/builder//?ppage&id222.
    Kraus, R., Zack, J. and Stricker, G. (2004) Online Counselling: A Handbook for Mental Health Practitioners. London: Elsevier/Academic Press. p. 95.
    Marks, I.M., Cavanagh, K. and Gega, L. (2007) Hands-on-Help: Computer Aided Psychotherapy. Maudsley Monographs, no 49. Hove: Psychology Press.
    Smith, E. (2005) Online Counselling Comes of Age: Young People being Drawn to Use Web-based Facility due to Anonymity. News @OFT. Toronto: Social Sciences, Business and Law, University of Toronto. Available at http://www.news.utoronto.ca/bin6/051011–1731.asp.
    Suler, J. (2000) Ethics in Cyberspace Research. Available at http://www.usnrider.edu/~suler/psycyber/ethics.html.
    Suler, J. (2004) Psychology of Cyberspace: In-Person versus Cyberspace Relationships. Available at http://users.rider.edu/~suler/psycyber/showdown.html.

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