32 Current trends in counseling, E-Counseling

G. Padma Priya

1.    Introduction

Counseling skills are an integral part of everyday communication, both in a personal and professional context. They are necessary competence for practitioners whether working in a face-to-face context or when conversing in an online environment. 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. There might be circumstances preventing clients in have access to the personal counseling sessions in such cases the availability of online support is an invaluable resource. Seeking online support can often be the first step for those lacking in confidence or who have personal barriers in accessing a more traditional entry route to receiving personal support. It is a direct medium between the counselor and the client. The social taboo, the stigma of mental health and the reluctance to visit a mental health professional, the use of technology to provide web-based counseling, e-therapy, online counseling and cyber counseling; are excellent opportunities that bridge the gap between the need and the availability of solutions to problems.

2.   Objectives:

•  To understand once own problem clearly.
• To realize what he is able to do and what he should do that means to accept abilities and weakness.
• Decide a course of action by making his own decision.
• Improve personal effectiveness.
• Develop insight & understanding in relation to self & environment, opportunities open to improve in respect to his potentials & goals he has chosen.

3.   Current trends in counseling

Telemedicine is becoming more prevalent as technological advancement continues to influence how we deliver services and treat our clients. In increasing numbers and frequency our clients are emailing and text messaging us, requesting sessions by phone, and requesting therapy that is exclusively delivered via the Internet. Some of the most cited concerns in regard to e-therapy and email communications are issues of confidentiality, privacy, informing clients about the vulnerability of email and other Web-based communication in regard to privacy so they can make informed consent about treatment, discovering clients’ identity, making proper assessment of client suitability for e-therapy, application of reporting laws, and crisis interventions. Some of the most important, however unresolved, issues are practicing across state lines, Skype compatibility with HIPAA, reimbursement, and treating clients in different countries.

3.1. Arenas

Arenas-also sometimes referred to as arrangements or modalities – may include the constellations of people receiving therapy (individuals, peers, couples, groups, families) and the media through which therapy is delivered (telephone or email counseling, art therapy, dance therapy, writing therapy, etc). The former group is the one most commonly included under the arena. Strictly speaking, forms of self-help such as self-analysis, therapeutic writing and meditation might be included here. The interpersonal arenas are all, usually, face-to-face, verbally mediated therapies.

3.2. Peer counseling

This refers to any kind of counseling or therapy provided on an egalitarian basis, with each party agreeing temporarily to take the role of counselor with the other as client and then reversing roles. Its benefits include mutually, egalitarianism, economy and avoidance of professional intrusion; its potential problems include boundary issues, compromised ability to ‘hold’ and transferential dynamics.

3.3.Individual therapy

Individual therapy clearly replicates the original relationship of infant and caregiver and professional relationships such as the doctor-patient one this arena offers optimal confidentiality, privacy, attention, containment, intimacy and safety. The assumption that it is necessarily the best arena for each client should, however, be balanced by considerations which include the therapist’s expertise (or lack of it) in various areas; potential for dependency, manipulation, acting-out and abuse. The usefulness of other arenas should always be considered instead of or in conjunction with individual therapy.

3.4.Counseling/therapy via other media

Face-to-face, individual therapy based on talking is the most common format, increasingly therapy is offered using alternative media and arenas. Child psychotherapy is a special media and arenas. Child psychotherapy is a specialism in its own right, requiring particular training. The expressive arts therapies, which include art therapy, drama therapy, psychodrama, dance and movement therapy, therapeutic writing and use of other media (e.g. phototgraphy) are increasing in their extent, availability and professionalism. For certain groups (e.g. children, older people, those who dislike primarily intense verbal communication), one or another form of expressive therapy may be the arena or modality of choice. Bodywork may or may not fit here, but obviously is an alternative means of providing therapy; where there are clearly problems expressed somatically, therapeutic massage, breathing or other techniques may be considered viable alternatives.

Differences between counseling and psychotherapy and the use of counseling and psychotherapy and the use of counseling skills have already been discussed. Here it is important to point out that people often receive sufficient help from alternative professionals or para-professionals who may use counseling skills. Social workers, probation officers, guidance workers, welfare officers, nurses, teachers, mentors, coaches and others, often become involve in a helping or therapeutic role and many have specific training in therapeutic knowledge and skill. It is quite likely that many people are helped by such professionals (either incidentally and by brief contact or by formal arrangement) who might not otherwise approach, trust or have access to helpers designated ‘counsellors’ or ‘psychotherapists’.

3.5.Voluntary agencies

These included those with national coverage such as Victim Support, Mind Turning Point, etc. provision of local women’s therapy centre’s, rape crisis centre’s, HIV/AIDS agencies, and family-oriented, drug-and alcohol-related services is widespread. Many of these rely on a mixture of statutory funding. Voluntary fundraising and donations, most concentrate on a specific client group and some may offer paid positions. The work is not always purely or solely counseling or psychotherapy, but may include telephone help lines, befriending, advocacy, information and advice giving, awareness raising and so on.

3.6.Residential care

Residential cares projects may be based within statutory or voluntary services and obviously focus on clients whose needs involve more than talking therapy. Client groups include children at risk, vulnerable young people, the homeless, those with often multiple problems of poverty, domestic violence, alcohol and drug abuse, criminal behavior, mental health problems disabilities and special needs, illness and frailty. Quite typically such work involves degrees of physical care, welfare issues and liaison with multiple agencies (e.g. social services, probation and medical and legal services). Clients are often helped by ‘key workers’, part of whose work may be to provide counseling or to refer elsewhere for counseling. Some kinds of intensive residential care are highly specialized for example with victims of torture, those emerging from hostage or damaging cult experiences. There are many projects offering residential rehabilitation programmes following drug addiction and alcoholism and which look for experience and/or qualifications in general and psychiatric nursing, social work, counseling and group-work. Often this kind of work offers in-house training and may be regarded as a route towards further professional training.

3.7.Education

School, further and higher education and special educational projects are some of the longest established settings in which forms of counseling and therapy take place. While some schools offer specific counseling services (and the need is still frequently alluded to ), therapeutic work is probably still more commonly carried out by educational psychologists, behavior support workers, mentors, and by teachers with a pastoral brief, with referrals being made where necessary (and possible) to child psychotherapists. Colleges of further and higher education and universities, although not providing uniform national therapeutic services for students, are no example of a setting in which counseling has been offered successfully for decades. In the transitional and vulnerable period between adolescence and adulthood, issues of career uncertainly, susceptibility to emotional, interpersonal and sexual problems, drugs and alcohol, homesickness and educational pressures, require sensitive help. Student counselors may have relative high caseloads of self-referred clients presenting a wide range of personal concerns. Turnover is often high since the work is often crisis oriented and determined by the pressures of the academic calendar. Student counselor (and those with psychotherapy training may be found as much as those from a counseling background) work in one of the few area with a relatively good, clear structure of pay, conditions and progression prospects.

3.8.The workplace

Today, counseling is a regular feature of many diverse workplace and often a service that most human resources/personnel departments are familiar with and have access to, or they will know how to access psychological help for employees. Workplace counseling is usually accessible to employees through employee counseling services or Employee Assistance Programmes (EAPs). Workplace counseling as a regular source of income and often counselors will e contracted to an EAP to provide short-term work. With more people spending more of their lives in their working environments, some employers have had to adapt to provide what employees need in order to keep them at work. Counseling can keep an employee functioning, on tasks and as part of the workforce. It can also enable employees to leave abusive working environments, or challenge the hostile and sometimes ‘alien’ experiences of being an employee.

Prevention of absenteeism is a motive behind employee counseling services. Employer’s concerns include drug and alcohol abuse, stress at work, employee relations, management of change, redundancy, accidents in the workplace, etc. many large companies provide their own in-house counseling provision, sometimes as part of occupational health; some refer out to individual counselors or group practices; many contract the services of external employee assistance programme (EAP) providers.

3.9.Primary health care

Counselors and psychotherapists are also sometimes to be found in specialized roles in hospitals (E.g. providing debriefing and counseling after road traffic accidents; counseling in obstetrics, infertility cinics, etc.) depending on local policies in NHS settings.

4. E- Counseling – Electronically Delivered Therapies

The first aspect of working with text that may seem obvious but bears clarifying is that it is a distance method of communication. There are obvious benefits to those who cannot access therapy, for example, because of disability or geographical reasons, but apart from practical reasons it is important to understand the disinhibition effect that makes for a more open and honest relationship. The ability for the client to reveal much more when working at a certain perceived distance (the one with which they feel comfortable) is significant. It also means that the level of disclosure occurs at a much faster pace than it usually does in a face-to-face relationship or even within other methods of distance therapy, such as the telephone.

Since 1995, there has been a growing body of individual practitioners, organizations and dedicated services providers who have turned to new methods of communication to deliver counseling and psychotherapy. More desirable from the client and practitioner point of view.

As well as the work of international experts in the field, publishing literature and collaborating on research projects, the area of electronically delivered therapy has been addressed by mental health organizations worldwide. Professional bodies such as the British Association for Counseling and Psychotherapy and the National Board of Certified Counselors (2001), and the American Counseling Association (1999) have addressed and published guidelines for their members who wish to offer an online presence. In addition, a dedicated body for online practitioners, the International Society for Mental Health Online, was formed in 1997 ‘to promote the understanding, use and development of online communication, information and technology for the international mental health community’.

This section describes the most essential elements that practitioners need to be aware of before considering an online presence, from a theoretical stance. It will concentrate on the use of text, via email, IRC /9chatrooms), forums (Also known as Bulletin or Message Boards) and mobile phone texting (SMS), for conducting an individual client-practitioner therapeutic relationship.

4.1. Using block-text email (Asynchronous) for therapy

This is most people’s perception of using email for therapeutic use-the exchanging back and forth of emails between two people within a contract, which is (usually) short-term, (usually) weekly, and which (hopefully) utilizes encryption software for privacy and confidentiality.

4.2. Using narrative dynamic email (asynchronous) for therapy

This type of email is where the practitioner inserts his/her responses within the client’s email using different fonts and/or colours, and the client reciprocates in the same way, usually for a small number of exchanges before the dynamic text becomes two unwieldy and a new narrative is required. Again, it is (usually) short-term, (usually) weekly, and (hopefully) utilizes encryption software for privacy and confidentiality.

4.3.Using Internet Relay Chat (synchronous) for therapy

This method involves a dialogue between client and practitioner in real time, using an Internet chat room or Instant Messaging software (AIM, ICQ, etc). The contracted sessions are usually weekly, and often incorporate a weekly exchange of asynchronous email (this is a useful function to allow the client to expand upon actual descriptive situations that would otherwise take up valuable time within the IRC sessions). They are also (hopefully) password protected.

4.4. Using forums (asynchronous) for therapy

More secure than any other from of electronically delivered therapy within this context, forums are held on the internet itself behind a password protected access system so that client and therapists visit a website to view and post responses to each other.

4.5. Using mobile phone texting (Asynchronous) for therapy

An extremely recent method for therapeutic use, mobile phone texting (SMS or Short Message Service) is usually reserved for making and cancelling face-to-face appointments. Its use has, however been documented as a facility for clients to end face-to-face relationship (Walker, 2004) and as follow-up for patients who have been treated for drug and alcohol addiction. The use of texting within therapy is anticipated to become more common in the near future.

4.5.1. Ethical Considerations

• Confidentialilty and data protection
• Limitations of the method
• Contracting and informed consent
• Encryption
• Fee structure
• Assessment skills, suitability of client and referring on verification of parties (identity management)
• Practitioner competence (both within IT and online work)
• Boundaries
• Licensing, regulation and quality control
• Virus, worm and Trojan management
• Crisis intervention and the suicidal client
•  Cultural differences
• Technical breakdown.

The world of technological development is one that moves developed extremely quickly, and it is well known that the counseling and psychotherapy profession in particular has been playing catch-up with the arrival of technology for therapeutic use over the last ten years what is certain, however, is that the profession has had to come to terms with the idea that sometimes the client is in a situation that means that they not only cannot sit with us face to tace, but also that they don’t want to. It is these clients that practitioners can now stop excluding from our services, ensuring that the world of counseling and psychotherapy becomes more accessible to ur potential clients worldwide.

4.6. Telephone counseling

A few counselors had used the telephone for the occasional session when a client was unable to attend a face-to-face session, but conducting all counseling sessions by telephone. Fortunately those counselors who were willing to explore new concepts and broaden their horizons persevered and telephone counseling became an accepted mode of counseling. The intensity of the interaction, because there I sless opportunity for distractions during the session, since both parties are focused on words and voice tone alone, further enhances the development of the relationship. This usually enables a deeper therapeutic relation sip to become established sooner than occurs in much face-to-face work.

Telephone counseling is an excellent example of an integrative approach to counseling. It can utilize aspects of psychodynamic orientations, person-centered approaches, brief therapeutic interventions and other humanistic methods of working. Cognitive-behavioral techniques may be used alongside interpretive psychotherapeutic disciplines. Telephone counseling is an excellent way of equalizing the power relationship between the counselor and the client.

4.6.1. Contracting and ethics

Some of the issues to be considered for contracting have already been addressed, such as location and time.

• Terms of reference for both parties, outlining the goals or aims of the sessions;
• The length of each sessions, which should be fixed at no longer than an hour and no less than 45 minutes;
• The time interval between sessions, ideally a week;
• The number of sessions before a review-a block of six with a review during the fifth is suggested. Further blocks of four to six sessions can be agreed as desired;
• The location, to ensure privacy and no interruptions;
• Who calls whom and therefore pays for the cost of the calls;
• What is considered a late start or no-show and what happens in these instances;

   The telephone is an excellent medium for enabling the client to feel free to talk about anything. It is also an excellent way of broadening the counsellor’s horizons. It is one of very few counseling techniques that enable an equalizing of power in the client counselor relationship. Further, it constantly reminds the counselor of the skills of listening and really hearing.

5. Conclusion

Finally, we must consider how all this building of the therapeutic relationship can occur without the gestures, vocal interventions and eye contact that make up the traditional face-to-face relationship. The quality of the practitioner’s written communication and their ability to convey the nuances of body language that facilitate the client’s growth (empathic facial gestures, for example) is paramount when working online. However, it should be noted that respect for the client means that their ability to communicate in this way need not be expert (although the practitioner’s work is made much easier if it is). The use of text to replicate body language takes many forms online, as does the use of netiquette (a combination of ‘net’ and ‘etiquette’), but both aspects are integral to the success of the communication and therefore the client’s recovery.

Web links

• https://www.theguardian.com/society/2017/feb/12/online-therapy-thousands-but-does-it-work
• https://familycounselling.co.in/