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To Skype or Not to Skype

To Skype or Not to Skype. Dan L. Mitchell, MA, CCC & Dawn Schell, MA, CCC, CCDP Worldwide Therapy Online Inc. TherapyOnline.ca. Overview. Introduction, History, the Present Literature Overview Recent LinkedIn Conversations Preparing to Offer Cybercounselling

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To Skype or Not to Skype

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  1. To Skype or Not to Skype Dan L. Mitchell, MA, CCC & Dawn Schell, MA, CCC, CCDP Worldwide Therapy Online Inc. TherapyOnline.ca

  2. Overview • Introduction, History, the Present • Literature Overview • Recent LinkedIn Conversations • Preparing to Offer Cybercounselling • Ethical, Technical, & Clinical Considerations • Real Life Experience • Worth It? • Next steps

  3. A Brief History of Therapy Online • founded 1994 by two counsellor members of CCPA • ethical codes: 1998 NBCC, 2011 BCACC • 1998 - “When Writing Helps to Heal” • 2003 Cybercounselling training - U of Torontohttp://www.cybercounselling.com • 2009 - British Journal of Social Work article compares F2F and online

  4. The Present • Team of 8 online counsellors • Dawn’s Blog on Counselling Connect • Yet to be published research: Competency Scale • Privacemail 3.0: multi-lingual web based platform for cybercounselling • “Private Conversations” Chat, & Videocounselling • Ethics/practical guidelines - update

  5. Videocounselling: the Literature • 68 peer-reviewed journal articles from 1970–200063 new published reports by 2003 148 new publications from April 2003 to July 2008 Richardson et. al. (2009)In 2012 - http://clinicaltrials.gov/ indicates over 340 studies are currently underway or have recently been completed.

  6. The Literature - 2 • Case studies, novel clinical applications, program descriptions/evaluations, assessment studies and randomized, controlled studies. Videocounselling was used with rural and remote populations, children and adolescents, older adults, veterans, deployed personnel, cancer patients and incarcerated patients.

  7. The Literature - 3 “Outcome findings..include high patient satisfaction,...and positive clinical outcomes....The clinical effectiveness of tele-mental health interventions in children, nonelderly adults, and elderly adults has been demonstrated via case studies, program evaluations, and some controlled trials...research in this area is still ‘underdeveloped’” Richardson, et. al. (2009)

  8. The Literature - 4 “Research demonstrates that important process and client-counselor relationship variables are similar to equivalent face-to-face-therapy” i.e. therapeutic alliance and session impact factors Barak & Grohol, (2011)

  9. The Literature - 5 “Videoconferencing has been successfully used to treat, social anxiety disorder, panic disorder with agoraphobia, obsessive–compulsive disorder, anxiety in cancer patients, and depression in adolescents and children. Randomized controlled trials have found that videoconferencing treatment is as effective as in-person treatment for childhood depression..” Yuen et. al. (2012)

  10. Besides Counsellors... • Other professional groups/fields using Videoconferencing technology • Health Care Professionals, Music Therapists, Speech Pathologists, Elder caregivers, Rehab Professionals, Corrections (to name a few)

  11. LinkedIn: Recent Conversations • LinkedIn Groups - Online Counselling Network, Online Therapy Institute, Online Counseling • Counsellors in many countries are using Skype - UK, USA, Canada, New Zealand, etc. • USA - concerns about HIPAA, insurance payments and cross-state legalities

  12. Preparing to Offer Cybercounselling • Four areas to consider • Ethics • Clinical competency in the modality • Sound knowledge of the technology • Adapting clinical work flow

  13. Skype and “Videocounselling”

  14. Alternatives to Skype • WebEx • CounSol • Mootu - UK site - 128 Therapists using Skype • Google Hangout • ovoo.com

  15. Webcam Technology • “Videocounselling” = Integration of Openmeetings into PrivacEmail • System Requirements • How the technology works • peer to peer vs. server-based

  16. Webcam Technical Issues • Software issues/updates • Router/modem connectivity/ Router configuration • Wireless connection • Firewall configurations • Internet filtering and parental control software • Resource Issues: RAM, CPU, Bandwidth • Additional Hardware: headsets, camera, mic

  17. Technical Issues Manifested • Unable to connect • Loss of connection • Loss of audio • Loss of video • Degraded sound/pixelation • Delay • Echo

  18. General Ethical Considerations • Counsellor Preparation • Secure technology - transit and storage • Appropriate training • Insurance

  19. Specific Ethical Considerations • Counsellor Preparation • Privacy laws • Plan for crisis management (registration data) • Plan for technological failure/interruption • Counsellor Setting

  20. Specific Ethical Considerations • Screening criteria to determine appropriateness/eligibility • Client setting • Client technology & computer skill • Orientation & informed consent • Identity confirmation

  21. Ethical, Technical, Clinical Issues

  22. Practical/Clinical Considerations • Pre-counselling process (online? phone?) • How to ensure proper client tech setup • First time pre-session orientation/test

  23. Practical/Clinical Considerations • TV interview skills are relevant • Where to look; steadiness of gaze • Clothes, setting, background (auditory and visual), lighting

  24. Professional appearance

  25. Lighting

  26. Camera Height (laptop on desk)

  27. Camera Height (eye level); Gaze - Looking at my own eyes

  28. Gaze - Looking at camera

  29. Jotting Notes

  30. What a large nose!

  31. Distance

  32. Our Launch Plans • Online registration and screening • include questions about system requirements • Additional telephone screening if necessary • If eligible/appropriate, first session begins on phone + video • Chat or Private Conversations backup

  33. Real Life Experience • Dawn’s client feedback • frustration with call-dropping - loses train of thought • likes flexibility • pauses led to her “trying to fill blank spaces” • “felt a tad bit like there wasn’t a full connection when we used Skype...but this might be one of those necessary cons to the system which has lots of pros”

  34. Real Life Experience • Interviews with two experienced Videocounsellors • about 20% of practice is Skype • usually meet client first in person • no issues re: therapeutic alliance • work on camera angles, eye contact, etc. • have even used it for EMDR

  35. Is It All Worth It? • Outcomes of 98,609 U.S. Department of Veterans Affairs Patients Enrolled in Telemental Health Services, 2006–2010 • psychiatric admissions decreased 24% • days of hospitalization decreased 27%

  36. Resources:Moving Forward • Personal study and competency • Bibliography with links to online articles/info • Cybercounselling Levels 1 & 2 • Agency & Private Practice • Consultation • PrivacEmail 3.0 software

  37. We’re just an email away Dan L. Mitchell dmitchell@therapyonline.ca Dawn Schell dmschell@me.com Worldwide Therapy Online Inc. www.TherapyOnline.ca (778) 838-6824

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