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Article Excerpt
Using a survey measuring 21 factors proposed in recent literature to be advantages or disadvantages of distance counseling, with a sample of 854 mental health professionals, we investigated perceptions and use of counseling by telephone, e-mail, text chat, and videoconference. Most participants reported using distance counseling in some form, but they perceived more disadvantages than advantages. Recommendations are provided for professionals considering the practice of distance counseling.
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Counseling relationships have historically developed through a series of in-person communications between counselor and client. However, today telephone and online modalities offer an alternative for forming those relationships. This change has a plethora of both advantages and disadvantages that mental health professionals might perceive. Though several studies have addressed the perceptions of clients (Young, 2005; Reese, Conoley, & Brossart, 2006; Leibert, Archer, Munson, & York, 2006) and students (Finn, 2002; Rochlen, Beretvas, & Zack, 2004) about distance counseling (the provision of counseling services by telephone or Internet modalities), there is a dearth of studies of how mental health professionals view and use it.
TELEPHONE COUNSELING
Telephone counseling is a professional relationship between a counselor and a client carried out entirely by telephone; it has existed in some form since the Samaritans started a suicide prevention hotline in London in 1953. Today telephone counseling services fill many roles, among them health assessment, education, crisis intervention, consultation, client referral, and counselor supervision (Cruz, SanMartin, Guitierrez, Farias, & Mora, 2001; Boucher, Pronk, & Gahling, 2003). Services range from treating disorders one-on-one to group counseling to the related fields of psycho-education and life coaching.
In a recent survey of American Psychological Association (APA) members, 98% affirmed that they have provided counseling services over the phone, and 69% that they provide psychotherapy by phone at least on occasion (VandenBos & Williams, 2000). Similarly, a survey of psychiatrists found 45% use the telephone as an adjunct to in-person sessions and 19% as their primary medium for providing treatment (Lester, 2002).
ONLINE COUNSELING
Online counseling is recognized by many names, such as "webcounseling," "etherapy," "ecounseling," and "cybercounseling." Nearly 1,000 professionals offer counseling services online, and even more have Internet dimensions to their practices that include advertising, information, and the ability to e-mail the clinician (Manhal-Baugus, 2001; Heinlen, Reynolds, Richmond, & Rak, 2003).
RECOGNITION BY PROFESSIONAL ORGANIZATIONS
In response to the expanding use of technology in counseling, ethical statements or codes have been written by the APA (1997), the American Counseling Association (1999), the National Board for Certified Counselors (2001), and the American Mental Health Counselors Association (2000). The AMHCA code states:
Mental health counselors engaged in delivery of services that involve the telephone, teleconferencing and the Internet ... take responsible steps to ensure the competence of their work and protect patients, clients, students, research participants, and others from harm (Principle 14).
The sentiment of nearly every organization that has addressed the issue is the same: one can practice online counseling if it can be provided with competence and if counselors can fulfill their ethical duties.
FACTORS IN DISTANCE COUNSELING
Distance counseling may have several advantages over in-person counseling. Among them might be, for clients, increased safety and anonymity, reduced social stigma, greater counselor selection and accessibility, and service affordability. In contrast, providers see factors that raise concerns, such as whether distance counseling is ethical and legal, clinically effective, and financially viable. These factors are discussed below.
Safety
Distance counseling may increase the sense of safety, because clients are able to receive help from within their home environment. This may make it easier for them to express themselves more fully. For example, a study investigating Thai women in a coed online discussion found that those who were passive in face-to-face interactions spoke more assertively and frequently online (Panyametheekul & Herring, 2003).
Anonymity
With distance counseling clients can communicate without concern for the bias of race, gender, age, size, or physical appearance (Worona, 2003). One of the first online counseling services was that of Cornell University, begun in 1986 (see http://ezra.cornell.edu). This service allows queries from anonymous students, and a counselor responds in a public Internet post. After 21 years this program is still active; users confirm that if it were not for the anonymous format, they would never have revealed their problems.
Social Stigma
Because it is unlikely for distance counseling clients to encounter the counselor in public or be seen by others near a counseling center, distance counseling may be effective in eliminating social stigma. One study investigating the use of phone counseling services by Arab Israeli callers found the medium may be a culturally appropriate method of providing services to people who underutilize other forms of professional mental health services (Al-Krenawi, Graham, & Fakher-Aldin, 2003).
Selection
Distance counseling may offer clients a greater selection of therapists to choose from. This is beneficial for persons looking for a counselor with specific experience or with a particular language, religious, or ethnic understanding. Similarly, since the 1980s online support groups and forums dedicated to a variety of emotional problems have allowed persons to reach others dealing with similar issues across the world (Grohol, 2004; Anthony, 2003).
Accessibility
Distance counseling is advantageous to individuals residing in areas where counseling services are not available and to those who are unable to leave home. Also, while in-person counseling may be incompatible with a client's work schedule, some distance counseling services are available 24 hours a day. Even if counselors are not available at all hours, e-mail gives the perception that they are. A client can...
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