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Article Excerpt
During the past 3 decades, computer technology and the Internet have evolved at an extraordinary pace. Currently, over 1.4 billion people use the Internet worldwide (International Telecommunications Union, 2007). In the United States, more than half the population (54%) uses the Internet, with an average increase of 2 million users each month (U.S. Department of Commerce, 2002, 2004). This growing Internet population affords counselors many opportunities to deliver online services to a majority of the public. In responding to this practice, some scholars have posed concerns related to counselors establishing therapeutic relationships online (Lebow, 1998; Mallen, Vogel, & Rochlen, 2005; Robson & Robson, 1998). In contrast, other researchers have found that counselors and clients can successfully create and maintain an online therapeutic alliance (Cook & Doyle, 2002; Leibert, Archer, Munson, & York, 2006).
Because of the evolving nature of technology and online counseling practice, researchers have recommended ongoing investigation into this electronic therapeutic medium (Barnett, 2005; Belcher & Holdcraft, 2001; Chester & Glass, 2006; Heinlen, Reynolds-Welfel, Richmond, & Rak, 2003; Laszlo, Esterman, & Zabko, 1999; Mallen et al., 2005). Through the current study, we supplement the literature with an in-depth, qualitative analysis of the experiences of counselors-in-training who facilitated synchronous, online, one-on-one counseling using secure chat rooms. The main focus of this study was to describe the facilitation of online counseling and to generate inductive propositions (Strauss & Corbin, 1994) about this contemporary therapeutic avenue. Specifically, we sought to (a) investigate and uncover factors that impeded and facilitated online counseling and (b) illustrate and describe the clinical, personal, and environmental processes specifically related to facilitating online counseling. Thus, our central and guiding research question (Creswell, 2002, 2007) was "What is the experience of facilitating online counseling for counselors?" The perspectives of the participants and the implications for clinical and ethical practice discussed in this article outline the basic themes embedded in the delivery of online counseling.
* The Growth of the Internet and the Counseling Profession
As computer-processing technology rapidly progressed in the late 1980s and 1990s, the Internet evolved from relative obscurity to ubiquity. The Internet originated as a small U.S. Department of Defense computer network named ARPANET [Advanced Research Projects Agency Network] that was commissioned in 1969, grew to approximately 1 million hosts in 1992, and expanded again to 18 million sites by 1997 (Bowman & Bowman, 1998). This phenomenal growth continues, as evidenced by the establishment of more than 540 million Internet hosts worldwide (Internet Systems Consortium, 2008). In April 1996, Sampson, Kolodinsky, and Greeno (1997) found nearly 4,000 Web locations incorporating the term counseling. Between April and August 1996, those authors reported a 15% increase in the number of Web sites related to counseling (Sampson et al., 1997). In their analysis, Sampson et al. estimated that the amount of Web sites featuring the word counseling would grow 55% annually. To discover the number of Web sites currently featuring the term counseling, we used the same search criteria used by Sampson et al. In October 2007, we entered the term counseling into the Google search engine, which subsequently returned links to over 66 million Web pages. A cursory review of the first 20 sites yielded a Wikipedia definition of counseling listed first and a mix of sites offering information about professional organizations related to counseling and psychology (n = 8), online clinical and psychoeducational services (n = 6), links for counseling services (n = 3), and counselor education programs (n = 3). Undoubtedly, this follow-up exploration illustrated the phenomenal growth of counseling-related Web sites.
Beginning in the 1990s, the counseling profession has been active in establishing guidelines and ethical codes to direct the practice of online counseling. In 1998, the National Board for Certified Counselors (NBCC) developed Web counseling guidelines (Bloom, 1998) and published updated versions of these guidelines in 2001 and 2007 (NBCC, 2007). Similarly, in 1999, the American Counseling Association (ACA) published ethical guidelines to direct the practice of Internet counseling and has included best practices for Internet counseling in the newest ACA Code of Ethics (ACA, 2005). Generally, the NBCC and ACA guidelines addressed the ethical, technical, and informed consent issues inherent in the use of technology to deliver counseling services; however, findings of recent research (Heinlen et al., 2003) have revealed that very few practitioners have adhered to these guidelines when providing online services. In their study of online counseling, Heinlen et al. reported that conformity to the NBCC guidelines was often dismal, with noncompliance rates ranging between 23% and 100%. More recently, the Center for Credentialing and Education, an affiliate of NBCC, offered a Distance Certified Counselor credential, providing national visibility and certification for counselors delivering online services (Center for Credentialing and Education, n.d.).
Maheu and Gordon (2000) surveyed 56 practitioners offering online counseling and found that most of the respondents (63%) provided only education or advice on their Web sites, and 18% provided therapy or counseling. Of those practicing, 93% reported holding a current license; however, 74% were unsure about their respective state laws regarding Internet counseling. Respondents indicated that they treated the following clinical issues through online methods: mood, anxiety, sexual or adjustment disorders (41%); relationship problems (22%); and "other" problems (37%). In discussing the legal and ethical implications of the results of their survey, these authors recommended that national and state credentialing agencies address the issue of interstate provision of services. Furthermore, they questioned the efficacy of online interventions because of the paucity of outcome data.
In another recent survey of online counseling services, evidence indicated that a slight majority (36%) of persons claiming to provide Web counseling had no credentials or formal training in professional counseling. According to the survey, other professionals delivering online counseling were either counselors with a master's degree (31%) or doctoral-level psychologists (29%; Heinlen et al., 2003). Most counselors on the Web provided counseling using asynchronous methods, primarily through e-mail. However, a quarter of the online counseling sites offered synchronous chat sessions with a clinician. Heinlen et al. discussed concern about the ethics of Web counseling and speculated that a majority of online professionals practiced outside the realm of the established NBCC guidelines. In summary, these authors expressed the need for ongoing examination of interactions in asynchronous and synchronous Internet counseling sessions.
* Internet-Based Clinical Interventions
An increasing number of studies have examined the role of the Internet as a therapeutic medium for individuals who have a variety of mental health concerns. Early research described the Internet as a channel for delivering suicide intervention, and researchers found that this medium was generally helpful in screening for and intervening with suicidal clients. It is interesting that suicidal males used e-mail as a means of contacting counselors at twice the rate of females (Wilson & Lester, 1998). Jencius and Sager (2001) analyzed online marriage and family therapy and reported that online therapy could facilitate convenience, reflection, and narrative interventions. Furthermore, the Internet has been an effective medium for delivering interventions related to weight loss (Tate, Wing, & Winett, 2001) and in intervening with persons diagnosed with eating disorders (Zabinski, Celio, Wilfley, & Taylor, 2003; Zabinski et al., 2001). In a randomized comparative study, Cook and Doyle (2002) concluded that clients experienced a therapeutic alliance in online counseling that was comparable with that established in face-to-face sessions. Another randomized, controlled study demonstrated that techniques delivered via the Internet reduced client's frequency and severity of recurrent headaches (Strom, Pettersson, & Andersson, 2000). Cohen and Kerr (1998) compared outcomes between face-to-face and computer-mediated interventions for 24 undergraduate students seeking counseling for anxiety. They reported that computer-mediated interventions fared no worse than face-to-face sessions in reducing the students' anxiety. Other studies have reported that interventions delivered through the Internet for panic disorder (Richards, Klein, & Carlbring, 2003) and posttraumatic stress disorder (Lange, van de Ven, & Schrieken, 2003) were effective. Likewise, investigators found that Internet-based cognitive behavior therapy and educational interventions were effective in reducing clients' depressive symptoms (Christensen, Griffiths, & Jorm, 2004). In sum, a moderate amount of literature supports Internet-based approaches for a handful of specific disorders and concerns. However, there is little evidence examining the experience, from the perspective of counselors, of providing online synchronous counseling. This study provides the counseling profession with an overview of the processes and experiences related to delivering synchronous counseling through secure chat rooms.
Given that the literature recommends ongoing study of online counseling and...
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