[PPT] - PSYCHOTHERAPY AND PSYCHOTHERAPY AND COUNSELLING IN THE AGE OF THE PowerPoint Presentation

SLIDE 1

PSYCHOTHERAPY AND COUNSELLING IN THE AGE OF THE INTERNET

Onlinevents – A Reflective Introduction to Working Online Mondays 11th & 18th May 2020

PSYCHOTHERAPY AND COUNSELLING IN THE AGE OF THE INTERNET

Onlinevents - A Reflective Introduction to Working Online Mondays 11th & 18th May 2020

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WHAT IS YOUR STARTING POINT FOR TODAY’S WORKSHOP?

Some questions to consider before we start:

1. How do you feel about the impact of digital technology on your
wn life in general?
2. What is your ‘gut response’ when you hear the words ‘online

therapy’? You may have begun to this in your break-out group. At some stage in the day you can take a few moments to discuss this with others and find out whether their starting point is similar to, or different from your own.

WHAT IS YOUR STARTING POINT FOR TODAY'S WORKSHOP?

Some questions to consider before we start: How do you feel about the impact of digital technology on your

wn life in general?

What is your 'gut response' when you hear the words 'online therapy'? You may have begun to this in your break-out group. At some stage in the day you can take a few moments to discuss this with others and find out whether their starting point is similar to, or different from your own.

SLIDE 3

THEMES

What exactly do we mean by ‘digital technology’?
Attitudes/responses to DT
Online identity and ‘presence’
Assessment and contracting for online therapy
Ethical issues, boundaries and containers, security
Disclosure and disinhibition (benign and toxic)
Therapeutic relationships online
Equipping, training and supporting the digital therapist
What lies ahead?

What exactly do we mean by `digital technology'? Attitudes/responses to DT Online identity and `presence' Assessment and contracting for online therapy Ethical issues, boundaries and containers, security Disclosure and disinhibition (benign and toxic) Therapeutic relationships online

Equipping, training and supporting the digital therapist

What lies ahead?

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HISTORICALLY SPEAKING

“A.. problem with the net is that it’s still ‘technology’, and ‘technology’…is ‘stuff that doesn’t work yet.’ We no longer think

f chairs as technology, we just think of them as chairs.”

(Adams, 1999)

HISTORICALLY SPEAKING "A.. problem with the net is that it's still 'technology', and `technology'...is 'stuff that doesn't work yet.' We no longer think

f chairs as technology, we just think of them as chairs."

(Adams, 1999)

SLIDE 5

“Technology is nothing. What’s important is that you have a faith in people, that they’re basically good and smart, and if you give them tools, they’ll do wonderful things with them.” Steve Jobs (1994)

"Technology is nothing. What's important is that you have a faith in people, that they're basically good and smart, and if you give them tools, they'll do wonderful things with them." Steve Jobs (1994)

SLIDE 6

HISTORICALLY SPEAKING

“The medium is the message”

Marshall McLuhan, 1964 A Canadian philosopher born 1911

He suggested that the form of a medium embeds itself in any message it would transmit or convey, creating a symbiotic relationship by which the medium influences how the message is perceived.

HISTORICALLY SPEAKING I

"The medium is the message" Marshall McLuhan, 1964 A Canadian philosopher born 1911 He suggested that the form of a medium embeds itself in any message it would transmit or convey, creating a symbiotic relationship by which the medium influences how the message is perceived.

SLIDE 7

WHICH ARE YOU?

A digital native

(born around 1980 or later)

A digital immigrant

(the rest of us!)

Prensky, M. 2001a. Digital natives, digital immigrants. On the Horizon 9 (5): 1-6. http://www.scribd.com/doc/9799/Prensky-Digital-Natives- Digital-Immigrants-Part1

WHICH ARE YOU?

A digital native (born around 1980 or later) A digital immigrant (the rest of us!)

Prensky, M. 2001a. Digital natives, digital immigrants. On the Horizon 9 (5): 1-6. http://www.scribd.com/doc/9799/Prensky-Digital-Natives- Digital-Immigrants-Partl

SLIDE 8

THE IMPACT OF DIGITAL TECHNOLOGY ON HUMAN INTERACTION

Some questions to consider: How much of your time each day do you spend engaging with

thers via a device and/or screen?

How much of your time do you spend engaging with others in person? How much has this changed over the last 6-8 weeks? Take a few minutes to consider this? Are you comfortable with both the extent and quality of your digital interactions?

THE IMPACT OF DIGITAL TECHNOLOGY ON HUMAN INTERACTION

Some questions to consider: How much of your time each day do you spend engaging with

thers via a device and/or screen?

How much of your time do you spend engaging with others in person? How much has this changed over the last 6-8 weeks? Take a few minutes to consider this? Are you comfortable with both the extent and quality of your digital interactions?

SLIDE 9

In the social jungle of human existence, there is no feeling of being alive without a sense of identity. Erik

Erikson(1968)

What kind of identity are we creating? (Suler J.R

“Psychology of the Digital Age” 2016)

Reality vs fantasy?
Authenticity vs illusion?
Impoverished or enriched?
Restrictive or freeing?
True self/false self/many selves?
Considered or spontaneous?

ONLINE IDENTITY

In the social jungle of human existence, there is no feeling of being alive without a sense of identity. Erik

Erikson(1968)

What kind of identity are we creating? (Suler J.R

"Psychology of the Digital Age" 2016)

Reality vs fantasy? Authenticity vs illusion? Impoverished or enriched? Restrictive or freeing? True self/false self/many selves? Considered or spontaneous?

ONLINE IDENTITY

SLIDE 10

ONLINE PRESENCE

John Suler (2016) proposes that the following conditions are necessary for a sense of presence:

Environmental presence

I see, hear, feel it
It moves and changes around me
It interacts with me
It looks familiar to me

Interpersonal presence

I see, hear, feel you
You move and change right in front of me
You interact with me
You look familiar

ONLINE PRESENCE

John Suler (2016) proposes that the following conditions are necessary for a sense of presence:

Environmental presence I see, hear, feel it It moves and changes around me

It interacts with me

It looks familiar to me Interpersonal presence I see, hear, feel you

You move and change right in front of me
You interact with me

You look familiar

SLIDE 11

WHAT DO WE MEAN BY ONLINE THERAPY?

1. Text-based therapy where client and named therapist meet

according to a contracted arrangement

The original ‘computerised therapy’. This can be delivered either:

Synchronously – this means that it is in ‘real time’ and ‘immediate’ involves the use of

some form of Instant Messaging (IM). Originally delivered only via the computer, it could now also involve smartphone messaging via an App or messaging service

r
Asynchronously – this involves the exchange of complete messages, not in real time.

It is also sometimes known as ‘email counselling’ as the messages are composed and sent via a secure email service. The counsellor and client agree when the messages will be exchanged but do not have to be present at the same time. Other kinds of files may also be attached to the email, such as pictures, audio-files, web-links etc.

WHAT DO WE MEAN BY ONLINE THERAPY?

Text-based therapy where client and named therapist meet according to a contracted arrangement

The original 'computerised therapy'. This can be delivered either:

Synchronously - this means that it is in 'real time' and 'immediate' involves the use of some form of Instant Messaging (IM). Originally delivered only via the computer, it could now also involve smartphone messaging via an App or messaging service

r

Asynchronously - this involves the exchange of complete messages, not in real time. It is also sometimes known as 'email counselling' as the messages are composed and sent via a secure email service. The counsellor and client agree when the messages will be exchanged but do not have to be present at the same time. Other kinds of files may also be attached to the email, such as pictures, audio-files, web-links etc.

SLIDE 12

WHAT DO WE MEAN BY ONLINE THERAPY?

2. Video-therapy where client and named therapist

meet together for contracted therapy sessions in real time via a computerised video link.

Involving the use of a web-cam and video-conferencing software (similar to Skype). The session is scheduled and constructed similarly to a face-to-face session but the counsellor and client are in separate locations (and perhaps even different time-zones).

WHAT DO WE MEAN BY ONLINE THERAPY?

Video-therapy where client and named therapist meet together for contracted therapy sessions in real time via a computerised video link.

Involving the use of a web-cam and video-conferencing software (similar to Skype). The session is scheduled and constructed similarly to a face-to-face session but the counsellor and client are in separate locations (and perhaps even different time-zones).

SLIDE 13

VIDEO OR WEB-CAM THERAPY

Can this really replicate the experience for counsellor and client of being in a room together?

Counsellor and client are in 2 different places. Where

do they actually meet – ‘my place’, ‘your place’ or somewhere out in cyberspace?

Can the counsellor continue to establish and manage

the frame when the client is in his/her own space?

What about visual cues (missing in text therapy)? Do

we receive them in the same way via webcam?

Eye contact – this may depend on where the camera

is positioned (on many devices this is fixed)…

Are we ‘in sync’?
What about internet connections – are they good

enough? What happens if the connection is lost?

Can this really replicate the experience for counsellor and client of being in a room together?

Counsellor and client are in 2 different places. Where

do they actually meet - 'my place', 'your place' or somewhere out in cyberspace?

Can the counsellor continue to establish and manage

the frame when the client is in his/her own space?

What about visual cues (missing in text therapy)? Do

we receive them in the same way via webcam?

Eye contact - this may depend on where the camera

is positioned (on many devices this is fixed)...

Are we 'in sync'?
What about internet connections - are they good

enough? What happens if the connection is lost?

VIDEO OR WEB-CAM THERAPY

SLIDE 14

BLENDED APPROACHES

Either face-to-face treatments which include a digital intervention or component, or digital interventions that include opportunities to interact directly with a therapist at certain stages in the process, sometimes referred to as ‘supported self-help’. There is a growing body of evidence demonstrating that the inclusion of some form (even if minimal) of direct therapist/client interaction during the course of any therapeutic treatment increases its efficacy

BLENDED APPROACHES I

Either face-to-face treatments which include a digital intervention or component, or digital interventions that include opportunities to interact directly with a therapist at certain stages in the process, sometimes referred to as `supported self-help'. There is a growing body of evidence demonstrating that the inclusion of some form (even if minimal) of direct therapist/client interaction during the course of any therapeutic treatment increases its efficacy

SLIDE 15

THE ONLINE RELATIONSHIP 1

Transference/countertransference?

(Can computers create ‘transitional space’? (Suler, 2016 following on from Winnicott, 1971)

Online identity/presence

Telepresence (Fink, 1999): “the feeling (or illusion) of being in someone’s presence without sharing any immediate physical space”

THE ONLINE RELATIONSHIP

Transference/countertransference? (Can computers create 'transitional space'? (Suler, 2016 following on from Winnicott, 1971) Online identity/presence Telepresence (Fink, 1999): "the feeling (or illusion) of being in someone's presence without sharing any immediate physical space"

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THE ONLINE RELATIONSHIP 2

Who am I? Where am I? Who are you? Where are you? Where do we meet? How do I envisage you? How do I feel about you?

[ T H E ONLINE RELATIONSHIP 2

Who am I? Who are you? Where am I? Where do we meet? Where are you? How do I envisage you? H o w do I feel about you?

SLIDE 17

ONLINE DISINHIBITION – SULER 2004 “While online, some people self-disclose or act out more frequently or intensely than they would in person…” “Rather than thinking of disinhibition as the revealing of an underlying ‘true self’, we can conceptualize it as a shift to a constellation within self-structure, involving clusters of affect and cognition that differ from the in-person constellation.” (Suler, 2004)

ONLINE DISINHIBITION - SULER 2004 1 "While online, some people self-disclose or act out more frequently or intensely than they would in person..." "Rather than thinking of disinhibition as the revealing of an underlying 'true self', we can conceptualize it as a shift to a constellation within self-structure, involving clusters of affect and cognition that differ from the in-person constellation." (Suler, 2004)

SLIDE 18

THE ONLINE DISINHIBITION EFFECT SULER, J (2004)

Benign disinhibition: where “people share very personal things about themselves, reveal secret emotions, fears and wishes and show unusual acts of kindness and generosity, going

ut of their way to help others”

Benign disinhibition: where "people share very personal things about themselves, reveal secret emotions, fears and wishes and show unusual acts of kindness and generosity, going

ut of their way to help others"

SLIDE 19

THE ONLINE DISINHIBITION EFFECT SULER, J (2004)

Toxic disinhibition: where “we witness rude language, harsh criticisms, anger, hatred, even

threats. Or people visit the dark world of the

Internet – places… they would never explore in the real world”

Toxic disinhibition: where "we witness rude language, harsh criticisms, anger, hatred, even

threats. Or people visit the dark world of the

Internet - places... they would never explore in the real world"

SLIDE 20

BACP ETHICAL CODES AND GUIDELINES

BACP Ethical Framework for the Counselling Professions

2018

Good Practice In Action 040: Social media (audio and

video) and the counselling profession Dr Nicola Davies Updated February 2019

Good Practice in Action 047: Working online Updated

March 2019

BACP Telephone and E-Counselling Competencies and

Curricula

BACP ETHICAL CODES AND GUIDELINES BACP Ethical Framework for the Counselling Professions 2018 Good Practice In Action 040: Social media (audio and video) and the counselling profession Dr Nicola Davies Updated February 2019 Good Practice in Action 047: Working online Updated March 2019 BACP Telephone and E-Counselling Competencies and Curricula

SLIDE 21

BACP TELEPHONE AND E-COUNSELLING COMPETENCIES (2016)

1. Underpinning knowledge – Ensuring knowledge of psychological processes relevant to offering therapy at a distance 2. Metacompetencies – what overall competencies are necessary for providing safe and reliable therapy at a distance? 3. Core Competencies

Ability to assess suitability for telephone and e-counselling
Ability to identify and manage risk when telephone & e-counselling
Ability to communicate with clients at a distance
Ability to establish ‘ground rules’ and boundaries for therapy at a distance
Ability to direct clients to supplementary online therapeutic resources
Ability to conclude the therapeutic relationship
Supervision of therapy at a distance

BACP TELEPHONE AND E-COUNSELLING COMPETENCIES (2016)

Underpinning knowledge - Ensuring knowledge of psychological processes relevant to offering therapy at a distance Metacompetencies - what overall competencies are necessary for providing safe and reliable therapy at a distance? Core Competencies

Ability to assess suitability for telephone and e-counselling Ability to identify and manage risk when telephone & e-counselling Ability to communicate with clients at a distance Ability to establish 'ground rules' and boundaries for therapy at a distance Ability to direct clients to supplementary online therapeutic resources Ability to conclude the therapeutic relationship Supervision of therapy at a distance

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SAFETY AND CONTRACTING

SAFETY:

Assessing therapist and client suitability
Assessing risk
Encryption/security and online safety
Physical safety of computer vs external hacking
Informed consent vs anonymity
Choosing a secure communication platform
Engaging in appropriate and well-informed supervision

SAFETY: Assessing therapist and client suitability Assessing risk Encryption/security and online safety Physical safety of computer vs external hacking Informed consent vs anonymity Choosing a secure communication platform Engaging in appropriate and well-informed supervision

SAFETY AND CONTRACTING

SLIDE 23

SAFETY AND CONTRACTING

CONTRACTING:

Limitations to availability
Careful contracting around security of devices and

confidentiality etc. for both parties

Contracting on both sides re confidentiality of any stored

material

Agreement about what approaches/platforms will be

used and how to negotiate any changes to this

What to do in the event of a technology breakdown

(back up plan)

Jurisdiction – for clients away from the UK
Crisis planning
Is this a continuation of existing f2f work or is this a new

kind of commitment together. Ongoing support or therapy?

CONTRACTING: Limitations to availability Careful contracting around security of devices and confidentiality etc. for both parties Contracting on both sides re confidentiality of any stored material Agreement about what approaches/platforms will be used and how to negotiate any changes to this What to do in the event of a technology breakdown (back up plan) Jurisdiction - for clients away from the UK Crisis planning I s this a continuation of existing f2f work or is this a new kind of commitment together. Ongoing support or therapy?

SLIDE 24

COMPARING F2F AND ONLINE COUNSELLING

Possible benefits to meeting online

Enables access for those who may be

geographically isolated

Reaches those with physical constraints/

family obligations/ illness

Offers greater choice of therapists
Offers flexibility of time and place
May help lessen impact of shame and guilt
Enabling for those who are socially phobic
Levelling in terms of ‘power’
Increases mutuality and collaboration
Disinhibition effect can be liberating
Offers a permanent record

Potential challenges if meeting online

Complexities of identity management
Enduring mental health conditions - may be

more difficult to assess and contain

Additional challenges to risk assessment and

monitoring of safety

Fewer/different cues may lead to

misinterpretation

Text-based interventions assume certain literacy

skills and different kinds of reflective skills

Reliable hardware and software needed plus

some technological expertise

Disinhibition effect can threaten effective

containment

Permanent record may feel challenging

COMPARING F2F AND ONLINE COUNSELLING

Possible benefits to meeting online Enables access for those who may be geographically isolated Reaches those with physical constraints/ family obligations/ illness Offers greater choice of therapists Offers flexibility of time and place May help lessen impact of shame and guilt Enabling for those who are socially phobic Levelling in terms of 'power' Increases mutuality and collaboration Disinhibition effect can be liberating Offers a permanent record Potential challenges if meeting online Complexities of identity management Enduring mental health conditions - may be more difficult to assess and contain Additional challenges to risk assessment and monitoring of safety Fewer/different cues may lead to misinterpretation Text-based interventions assume certain literacy skills and different kinds of reflective skills Reliable hardware and software needed plus some technological expertise Disinhibition effect can threaten effective containment Permanent record may feel challenging

SLIDE 25

A helpful guide to finding balance in how we manage our work – are we attending to each of these systems as they interact within us? (With thanks to Paul Gilbert)

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SLIDE 26

Hopefully we will optimize our use of technology for our collective well-being. Because cyberspace acts as our mirror, we must realize that what we do with it merely reflects how we decide to express and develop the human psyche, for better or for worse.

John Suler (2016): Psychology of the Digital Age

Hopefully we will optimize our use of technology for our collective well-being. Because cyberspace acts as our mirror, we must realize that what we do with it merely reflects how we decide to express and develop the human psyche, for better or for worse.

John Suler (2016): Psychology of the Digital Age

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