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Online counseling generally refers to the provision of professional mental health services concerns via internet communication technology. Often called e-therapy, etherapy, e-counseling, online therapy, or coaching, services are typically offered via email, real-time chat, and video conferencing. Some clients use online counseling in conjunction with traditional psychotherapy, and others use it as an occasional check-in tool for their lives.
Clients typically seek out online counseling services for the same reasons that people seek professional help through traditional channels; however, online counseling may be especially appealing for individuals who are unable or unwilling to see a mental health professional in person. For example, it is a potential resource for clients who are home-bound (such as the elderly or infirm) or who reside in rural areas far from a therapist's office. Online counselors also assist those with a fear of exposing their feelings. For example, a person with grief and loss issues, may be fearful of crying in front of another person. Online counseling can also be an option for individuals who suffer from a rare or unique problem and wish to work with a hard-to-find expert in a relevant field.
Convenience is the most-often cited reason why people use online counseling services. It can be convenient for clients and counselors alike, and participants may engage in the counseling process from the comfort of their homes or offices, at times that are most convenient for them. Schedules are often tight. Online therapy allows client to send an email at 3am or schedule a phone conference at 8am. This is very helpful to many clients.
The sense of anonymity provided by internet assisted counseling is another oft-cited benefit. Many people are uncomfortable talking about their personal problems while in the physical presence of another, and may be more likely to disclose when they cannot be seen. This effect is called disinhibition. While online counseling may suggest anonymity, potential clients should understand the differences between anonymity, privacy and confidentiality. See below for cautions regarding privacy and confidentiality.
Online counseling through asynchronous avenues (email) can be less expensive than traditional in-person sessions and allows both client and therapist to take their time in fashioning a response. Online chat sessions may also be priced lower than face-to-face (F2F) work because net-based counselors may not have the overhead costs needed to maintain an office; however, insurance companies rarely cover online counseling sessions. Clients opting for online counseling often must pay the entire cost of therapy. With email therapy however, a client must be able to hold onto their feelings whilst waiting for a response - this can be painful or damaging.
An advantage of using synchronous counselling methods such as instant messengers or IRC, is the fact that paraphrasing and reflection via text is very similar to a verbal exchange. The only disadvantage to this is the loss of facial expression and vocal tone. It may be difficult to express feelings of empathy, positive regard and genuineness in a natural way. However, some clients do seem to be able to develop a significant therapeutic relationship through synchronous therapy.
A major challenge for online counseling and because there are verbal cues (or verbal behavior), signs and signals given by a client to a therapist that are missed in online counseling. Many online counselors offer the option of phone counseling or video conferencing during the chat. This enables both parties to pick up on some of the missed cues.
Some argue that online counseling may, for some individuals, feed into their tendency to avoid "in office" interactions when what would benefit them most would be to be in the actual physical presence of a healing professional. In some instances this "distanced" interaction can be coupled with the presence of a professional who wishes (for whatever reason) to maintain a distance from the intimacy of "in office" interactions. When both of the above situations exist, it is unlikely to result in an effective therapeutic outcome.
Other major challenges are in the areas of professionalism and internet security. Many people can hang a virtual shingle and offer to do online counseling. Potential clients seeking online counseling should look carefully at the web site offering such services. Look to see that counselor credentials are verified and that counselors carry malpractice insurance.
Counselors and web sites offering counseling should ensure that data is maintained on a secure server and that the highest level of encryption is used to prevent interception of information through computer hacking. Clients also must take due care to password protect their own computer hardware, wireless internet access points and site ID and/or password to further protect themselves against identity theft and interception of private information.
Internet counselling such as instant messengers are also disadvantageous because if the client does not cope well with real social interactions then the Internet counselling will enforce, if not increase social isolation. On top of this, Internet connections can be unreliable (not so much now since broadband was introduced). So, if the client is in the middle of explaining a very emotional situation and the Internet connection drops off, it will not only disrupt the flow of the counseling session, but could leave the client feeling hurt and vulnerable if they cannot retrieve the connection.
A 2005 University of Toronto study showed female users of a Canadian online counseling service outnumbered males four to one.
Antonacci, D. J., Bloch, R. M., Saeed, S. A., Yildirim, Y., & Talley, J. (2008). Empirical evidence on the use and effectiveness of telepsychiatry via videoconferencing: Implications for forensic and correctional psychiatry. Behavioral Sciences and the Law, 26, 253-269.
Hailey, D., Roine, R., & Ohinmaa, A. (2008). The effectiveness of telemental health applications: A review. The Canadian Journal of Psychiatry, 53, 769-778.
- Kraus, R.; Zack, J.; Stricker, G. (2004), Online Counseling: A Handbook for Mental Health Professionals, San Diego, California: Elsevier Academic Press