Rabu, 28 September 2011

Researching the Cybercounseling Process: A Study of the Client and Counselor Experience




                                    Chapter Sixteen

               Researching the Cybercounseling Process:
                               A Study of the Client
                           and Counselor Experience
                Jacqueline  Lewis, Diane Coursol, and Kay Herting Wahl
  

                 Few professions  remain  untouched  by recent  technological
            advancements (U. S. Department of Labor [DOL], 2000) and this cybernetic
           trend is also apparent in the mental health profession (Bowlsbey, 2000).
           There are increasing attempts to harness the potential of technology to
           provide mental health services online (Boynton, 2001; Collie, Mitchell, &
           Murphy, 2000; Haas, 2000; Jerome, DeLeon, James, Folen, Earles &
           Gedney, 2000; Sampson, Kolodinsky & Greeno, 1997). From Australia,
   
           Canada and Czechoslovakia to the United States, cybercounseling is an
           increasing presence on the Internet. The American Counseling Association
           (ACA) and the National Board of Certified Counselors (NBCC) predict
           that with society's increased comfort with technology,cybercounseling will
           continue to expand (Bloom, 1998). With more counselors attempting to
           offer services over the Internet (Boynton, 2001; Jerome, et aI., 2000;
           Sampson, et aI., 1997), it is imperative that counselors understand what is
           involved in the use of this emerging modality. However, there is little
           research to guide the implementation of training efforts or to identify
           appropriate cybercounseling strategies (Bloom, 1998; Guterman & Kirk,
           1999; Stamm, 1998; Sussman, 2000). In addition, there is a need to
           investigate the cybercounseling experience from the perspective of clients
           and counselors.
                The literature on cybercounseling is primarily theoretical and contains
           numerous recommendations for research in this area (Bloom, 1998; Lewis,
           Coursol, Khan, & Wilson, 2001; Sussman, 2000). This indicates an urgent
           need for empirical investigations to inform practice and guide policy
           development in cybercounseling. Jerome, et ai. (2000) emphasize that
           developing guidelines for this treatment modality is an immediate necessity.
                This chapter describes a brief counseling interaction that used Internet
           videoconferencing technology to provide cybercounseling. In this study,
           cybercounseling    refers   to  counseling   over  the  Internet   via
          videoconferencing. The experience of the counselor and client during the
  

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                     cybercounseling  process was analyzed using qualitative  methodology. In
                     addition,  the chapter  describes  the skills and competencies   used in the
                     practice of cybercounseling.  Suggestions to guide practice and implications
                     associated with cybercounseling  are discussed.

                                                     Methodology

                     Participants
                          The participants  included  two female graduate  students who were
                     enrolled  in a counseling  graduate program at a public university  in the
                     Midwest.  Participant  selection  was based upon the following  criteria:
                     Counselor:  (a) had completed  core classes such as the introductory  and
                     advanced counseling skills courses and was in a supervised internship and
                     (b) had some knowledge  of technology;  Client:  (a) had completed  the
                    introductory   counseling   skills  class and (b) had some knowledge  of
                    technology.
                          The counselor was a 58-year-old Caucasian  woman who was in the
                    second year of a Community  Counseling  master's  degree program. The
                    client was a 29-year-old  African American  woman who was in the first
                    year of a Community Counseling master's degree program. In a self-report
                    of their level of technological   competence,   the counselor  indicated  a
                    beginner level of computer expertise and the client indicated an intermediate
                    level of computer expertise.
                          Prior to the project, participants  were briefed on the purpose of the
                    study and on their role in the project. Both participants  agreed to maintain
                    confidentiality  about information acquired during the process. Participants
                    were informed that they could withdraw at any time during the progress of
                    the project. In addition, participants  agreed that if they experienced  any
                    negative  feelings  during  the project,  they would  inform  the principal
                    investigators and seek assistance with a helping professional of their choice.

                    Procedure
                          Prior to the commencement   of the study, the participants  received
                    training in the use of videoconferencing  until they were comfortable using
                    the technology. The training was provided to ensure that technology was
                    not a mediating   variable   during  the cybercounseling    process.   The
                    participants  also completed  a demographic sheet that included information
                    about their age, gender, ethnicity and comfort with technology.
                          The second year graduate student was the counselor in a session similar
                    to a counseling  skills training class. The first year graduate student, who
                    was the client, presented  with a career problem  similar to the problems



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presented  in a counseling  skills class. A private  counseling  room was
established in cyberspace and the counselor and client met for three sessions
of brief counseling  at pre-arranged   times for 45 minutes  a week. The
cyberroom  was established  prior to the first counseling  session and at the
assigned time the client and counselor entered the room using a password.

Analysis
      At the end of each counseling  session the principal  investigators
interviewed  both the counselor  and client to document  their experience
during the counseling process. The first two authors of this article conducted
the interviews.  A list of topics with sample questions  was developed  to
avoid the use of leading questions  by the interviewers.  The interviewers
used probes, follow-up questions, feedback, and reinforcement  techniques
during the interview  process as suggested  by Patton (2002). Participant
responses to the questions were not restricted in any way during the interview
process. The interviews continued until each participant indicated that they
did not have additional  information  to offer. Each interview  averaged
between 60 to 75 minutes in length.
      The first author  of this article  transcribed   all of the interviews
conducted   with  the participants.    Patton  (2002)  suggests   that  such
transcription  enables the researcher to acquire a better understanding  of the
experience  of the participants. The three authors of the study reviewed the
transcripts  independently   to identify the main themes in the interviews.
Once the independent analyses were completed, the findings were compared
and the themes identified by all three researchers were retained. To validate
these findings, the themes were shared with the participants.  Based on the
feedback from the participants  information was added, deleted or modified
as necessary.

                                    Results

      To provide a clearer picture of the experience of the participants during
the cybercounseling  process, the themes that emerged from the interviews
are discussed separately for counselor and client.

Counselor Experience
      Theme  1: A Two-Dimensional  Experience
      The counselor  described  cybercounseling   as a "two-dimensional
process"  where she could see and hear the client, but could not sense or
feel her presence. The counselor noted that the counseling experience  felt
"flat".  While it was possible  for the counselor  to experience  the client



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      through audio and visual cues, she could not sense the energy that is typically
      generated when in close physical proximity with a client.
            The cybercounseling  experience was described as having a "surreal"
      quality that was characterized  by a "lack of depth". The counselor reported
      experiencing an underlying feeling of physical and emotional distance. Even
      though cybercounseling  was in real-time, the counselor's  experience in the
      interaction did not feel real. The counselor's  experience  is captured in the
      following comment:
               ...what  hit me was its two-dimensions...sort     of that
               realization  [etc.]

            Theme 2: Acceptin& Cybercounselin~  as a Different Experience
            When the counselor  recognized  and accepted that cybercounseling
      was not going to be like traditional face-to-face counseling, there was greater
      comfort  with the experience.  The acceptance  of cybercounseling   as a
      different  type of experience  from face-to-face  counseling  allowed the
      counselor to feel more relaxed about the interaction. The more the counselor
      was involved with the cybercounseling  process, the greater was her comfort
      with the experience. The following quote reflects the counselor's experience.
            Well, I certainly felt a lot more comfortable and maybe she felt a little
      uncomfortable.  It worked for me this time and I said, 'Maybe it worked last
      time but I felt more comfortable  with it.'  I think part of this is accepting
      that it is going to be different.

            Theme 3: Increased Focus on the Cybercounseling  Process
           As the cybercounseling  sessions progressed, the counselor found that
     she was more focused on the counseling process. The counselor began to
     concentrate  more on her interactions with the client and the progress of the
     sessions. The counselor expressed that she was concerned about the client's
     perceptions  of her and whether the client felt understood.  The following
     quotes reflect the counselor's  experience.
              I thought, 'No, that's more of a counseling question' ...Then,
              I found myself wondering,  'Hmmm, should I have done
              that?   Should  I have said that?   More of a counseling
              question of my skills than it is the technology, the process
              of cybercounseling.'

              I mean... 'OK, there were two issues that came out of the
              first session and we would work on those andO see how
              things were going.'




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      Theme 4: Counseling Relationship  Lacks Emotional Connection
      The counselor  described a "good" counseling  relationship  that was
based on the participants'  abilities to communicate  with each other. The
counselor  felt that she connected with the client on a cognitive level and
that they were able to understand each other. The counselor  was able to
comprehend the client's issues. However, the counselor also noted that there
was no connection on an emotional level with the client; that there was no
sense of intimacy between them. The counselor reported that although it
was possible  to see, hear and even understand  the client, the emotional
connection between them was missing. The counselor felt that the emotional
closeness that comes from physical proximity was absent in this experience.
Though  the counselor  related well to the client on a cognitive  level, the
emotional  connection  was not present.  The following  comment  by the
counselor  illustrates this point.
         Well, I felt that the relationship  was good. But, you know,
         there is that kind of two-dimensional   thing.  There is a
         lack of...connectedness...l    call it the lack of intimacy
         because you can't see the whole body and today all I really
         saw was her head.


      Theme 5. Need to Modify Counseling  Skills
      The counselor  reported that while she employed  basic counseling
skills, they had to be adapted to suit the cybercounseling   process. The
counselor described modifying her counseling skills because she found they
did not have the same effect in cybercounseling  as they did in face-to-face
counseling. The counselor reported having to modify two skills in particular,
silence and listening, during the cybercounseling  process. This comment
by the counselor illustrates her experience.
         Yes, the skills that one has to learn for counseling face-to-
         face I've still used, but because it was cybercounseling,
         they had to maybe be adjusted or I had to be aware of them
         in a different way.
      The need that the counselor felt to modify her counseling  skills was
particularly  true for the skill of silence. The counselor's  perception  was
that silence did not seem to work in the same way as it did in face-to-face
counseling.  The counselor reported that it was difficult to read the silences
that occurred during the cybercounseling  process because of the time lag in
the audio  and video transmissions.   The counselor  found it difficult  to
distinguish between client silence and a transmission lag time. Consequently,
the counselor  felt that there were some instances  when she may have


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 interrupted the client. The counselor noted that she had to learn how to use
 silence during the cybercounseling  process.  The counselor described her
 experience  as follows.
          Oh, I knew it was going to be different, but I didn't know
          how different it was going to be. And, I didn't know how I
          would feel about the differences. So, I think as I get into
          this...    silence    doesn't    work   the   same   way   in
          cybercounseling  as maybe it does in a one-on-one,  in the
          same way during emotions.

      Another  skill that the counselor  described  modifying  during the
cybercounseling  process was listening. Even though cybercounseling  was
an audio-visual  experience  the counselor felt that she had to listen very
intently. In fact, the counselor noted that her listening skills were heightened
during the cybercounseling  process. The counselor explained that she had
to listen attentively  because the non-verbal  cues were not always easily
visually accessible. This made it difficult for the counselor to become aware
of the subtle nuances in communication that facilitate the counseling process.
The lack of audio  clarity  and the time lag that  occurred  during  the
transmissions  forced the counselor to listen more intently. The following
counselor comments illustrate this theme.

         I think I said last time. It really heightens, in that I found
         that I had to really listen, I had to really focus. There was...
         some, how do I put this, some time lag with the audio,
         which I think could be distracting,  but you have to pace
         yourself with that and adjust for that.
      Theme 6. Technology Affects the Process
      The counselor noted specific aspects of technology  that affected the
cybercounseling  process. One aspect of technology  was the time lag that
occurred during the audio-video transmissions.  The counselor had to learn
to manage the delay that was evident between the time when the client
spoke and when the counselor heard her. The following statement illustrates
this theme.

        There is a lag in this. In the transmission.  I felt there were
        times when I wanted to summarize something and I think
        that in [an] actual session I wouldn't,  I wondered if! was
        being very intrusive  and interfering,  I mean...because   it
        was like I wanted to summarize and I thought there was a
        pause and then she was "'"




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      Another effect of technology was that it was not always easy for the
counselor to read the non-verbal cues of the client. Because the video image
of the client only included the shoulders upwards, the counselor found it
difficult to read the non-verbal behaviors of the client. In addition, the visuals
were not very clear and this added to the difficulty of reading the body
language  of the client. The following  quotes explain  the counselor's
perspective.
         Well, when you are doing cybercounseling   you don't
         always see all the little nonverbal sort of nuances. This
         time I just accepted that.

         Because I think that I became so aware of not being able to
         [see] the nonverbals not coming across as clearly, and some
         of them you wouldn't see them at all.

Client Experience

      Theme 1: More Comfortable  than Face-to-Face Counseling
       The client described cybercounseling  as a less awkward  and less
intimidating  experience than face-to-face counseling. The client felt that it
was less threatening because the counselor was not physically present. In
cybercounseling  the client did not experience the pressure that is generated
by sharing the same physical space with the counselor. The client felt that
she was not under pressure to respond in the same way she did when she
was in close physical proximity  with a counselor. The client expressed
having   more  freedom   not to share  information    when  she was  in
cybercounseling.   The following quote illustrates the client's experience.
         From my experience, the uncomfortableness  of going into
         a room  where  when  you  are doing  the face-to-face
         counseling,  the power aspect of the fact that, I feel that
         when you walk into the room the counselor definitely has
         that  [power]  when its face-to-face.   Whereas,  with the
         technology, it didn't seem to be the case for me. And, the
         comfort level was much more there than it was in face-to-
         face.

      Theme 2: Unexpected Depth of Emotions
      The client reported some surprise about the feelings she experienced
as part of the cybercounseling  process. The client was astonished  that she
experienced such depth and intensity of emotion while addressing her issues
in cyberspace.  The client felt that the counselor  was able to facilitate  a



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deeper   emotional    experience    than  she  expeered.    The  client   had  not  conceiVed     
                                                                                                             
that this couldpossibly occur in cybercounseling. The surprise of the client
                 at the strong emotions that were experienced during the cybercounseling
                 process is embodied in the following comments.
                           Because I've talked to people in class before today. It's
                          like... [it] is somewhatof a moving experience or something
                          compared to...the other times when I've done counseling.
                          And I'm pretty straightforward and honest when I'm in
                          those counseling sessions. I talk to them about whatever is
                          going on at the time, and so I think that that surprises me
                          that we are doing this with this technology and I would
                          really have these feelings.

                          I keep reflecting on other sessions I've done and where its
                          been... with people within the room with me, and we are
                          doing counseling, and I can't say that I've felt that before.
                                                                                                              
                          And I keep trying to think back to... make sure before I
                          make that statement, but I can't say that I felt that                        
                                                                                                              
                          before...even with having someone in the room.
                                                                                                              
                                                                                                             
                       Theme 3: Immersed in the Counseling Process
                                                                                                              
                       The client described becoming more involved in the counseling process
                                                                                                               
                 as her issues became the focus of the sessions. The client's perspective of
                                                                                                      
                 the cybercounseling  process was that it gradually came to feel like face-to-
                                                                                                        
                 face counseling. By the third session, when the novelty of cybercounseling
                                                                                                               
                 had disappeared,  the client began to think of the experience  as counseling.          
                 In fact, she described  "feeling more like a client". The following  quote
                                                                                                               
                 explains the client's perception of the process.
                       Because initially...it was...the excitement of doing this new stuff and
                                                                                                        
                                                                                                        
                 then...the  next time it was as it was still new, but I was able to totally get
                 into the counseling session once we got started. But this time we just went
                 into counseling.  I went into counseling.
                                                                                                        
                                                                                                        
                       Theme 4: Empowerment                                                       
                       The client described feeling a sense of empowerment during the         
                 cybercounseling process that she did not experience during face-to-face         
                 counseling. The client reported that the counselor "directed the session but
                                                                                                        
                 was not in charge of it" The client felt that in cybercounseling she had the         
                 power to decide how to respond to the counselor. The technology that         
                 allowed the client and counselor to meet in a neutral place like cyberspace          .
                                                                                                               
                 gave the client a sense of being in control of the process. Having a sense of
                                                                                                       


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     her own space also made the client feel in command of the experience. The
    following statements illustrate the client's experience.

         Like I said before, it gives me choice. I'm allowed to make
                some decisions in this, in this session before it even starts.
                Yeah, I'm empowered to do some things; I'm empowered
               to set up my things the way I want them and to basically
                start the session when I'm ready.

               I didn't feel that the counselor was totally in charge and I
               think it has to do with, and I used this before, coming into
               her office. I don't come into her office. She actually comes
               into [mine] because I'm already sitting there and I'm
               comfortable where I am and then she comes in.


        Theme 5: Equal Relationship. Different Connection
            The client reported that she had developed an egalitarian relationship
       with the counselor during the cybercounseling  process. The client
       characterized the client-counselor relationship as an "equal" one in which
       there was freedom to make choices and where she was in control of the
     counseling experience. The client felt that the counselor listened to her and

       understood her perspective. Despite considering the client-counselor
       relationship as "equal," the client did not feel a strong emotional bond with
       the counselor. The client explained that she did not feel the kind of

      connection that one has when the counselor is physically present in the
     same room. She described the cybercounseling client-counselor relationship
     as similar to the connection experienced with a person on the telephone.
     The following quote expresses the relationship that the client had with the
       counselor.
               The only way I could explain it is just that we have that,
               the human being, person looking right at you... I don't feel
               the...! guess it's the connection. I don't feel the connection
               that you feel when the person is in the room, or it's just
               when I think about something when I'm online and if I'm,
               you know, I have, I'm using the web camera and I can talk
               and e-mail and all of that, its not the same as if that person
               were right here in front of me talking to me.

            Theme 6: Skills that Facilitate
            The client experienced the cybercounseling interaction as more than
      just the use of listening skills. The client noted that the counselor used a


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 variety of skills to facilitate the cybercounseling  process. Some of the skills
                                                                                                 
 that the client identified included attending skills, empathy, summarization
                                                                                                 
 reflective  listening, and probes. For instance, the client commented  that
                                                                                      
 when the counselor reviewed the previous session she felt that the counselor
                                                                                                  
 had paid attention. The experience of the client is expressed in the following
 quote.

          It's more than just listening, its, I mean, the thing is that
          she's able to see past the specific issue that I'm sharing
          with her, and I guess go a little forward. She does, she
          probes to see, ok, is it this, is it just this or is... it something
          else.  Because,   we initially   started  out talking  about
          something totally different than what we ended up talking
          about.

       Theme 7: Listening is Key
                                                                                                    
      The client reported that she used the skill of listening  extensively
                                                                                                    
during the cybercounseling  process. The client observed that she was more
                                                                                                    
concerned with listening to what the counselor said than to the counselor's
non-verbal behaviors. The client described being more absorbed in listening
to the counselor as she wanted to hear what was said. By listening closely
the client reported that she could hear concern in the counselor's  voice.
The client indicated that although some of the non-verbal  behavior of the
counselor was visible on the screen, she did not focus closely on them. The
only time the client described attending to non-verbal behavior was when
the counselor engaged in some action that attracted attention. The experience
of the client is illustrated in the following quote.
         But for some reason,  the technology   I, I was paying
         attention to what she was asking me, but it was more like I
         was, you know, listening  with my ears rather than, you
         know, I didn't do a whole [lot] of just the eye-to-eye contact
         when she asked questions.


      Theme 8: Technology is Secondary to Process
      The client explained that she was less aware of the technology as the
cybercounseling  process progressed. In fact, the client found that once she
was immersed in the counseling process she did not attend to the technology.
The client stated that she paid limited attention to the technology  in the
second  and third  sessions.  By the third session  the client  described
technology  as "a non-issue"  and more as a vehicle by which to reach the
counselor.




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         The client reported that the only time that she noticed the technology
      was when there was a technical glitch that caught her attention. This point
      is illustrated in the client's observation after the final session where she
      notes that she was more focused on the counseling process than on the
      technology.
               For me, after two sessions, it was totally a non-issue. The
               second one was still a little new to me, but by the third
               session we just started the session and I went there to, and
               I set up the computer just to start my session and that's
               that was it, until the end, when it was time to close it out.

                                        Discussion

            The results  of this study  have implications   for the practice   of
      cybercounseling   and for counselors  who contemplate   engaging  in this
      emerging  modality. In this study both the counselor  and client observed
      that cybercounseling   was a different type of experience  from traditional
      face-to- face counseling. The counselor described cybercounseling  as a two-
     dimensional   process  where it was possible  to see and hear the client.
     Meanwhile, the client indicated that cybercounseling  was a less threatening
     experience  than face-to-face  counseling  as she felt that there was less
     pressure to respond because the counselor was not physically present.
            Such findings suggest that counselors are more likely to feel greater
     comfort with this modality when they accept cybercounseling  as a distinct
     experience  from traditional  face-to-face  counseling.  Given  the unique
     features   of cybercounseling,    counselors   cannot  expect  to transition
     effortlessly  into cybercounseling  merely because they are trained  in face-
     to-face counseling. In fact, the counselor in this study indicated a desire for
     more opportunities  to practice cybercounseling before she actually engaged
     in the process.
           A related implication  is that counseling  techniques  may need to be
     adapted  to the unique  features  of the cybercounseling   process.  To be
     effective,  counselors  will need to adjust their counseling  skills,  such as
     silence, summarization,  and immediacy to the cybercounseling   situation.
     One of the skills that both the counselor and client in this study emphasized
     was that of listening.  The counselor  indicated  that the ability  to listen
     carefully was a key element in cybercounseling  especially  as it was often
     not easy to read the non-verbals of the client.
           Another skill that manifested itself differently in cybercounseling  was
     that of silence.  The counselor  described  silence as not facilitating   the



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          cybercounseling  process in the same way as it does in face-to-face        
             counseling. In addition, the counselor had to learn to distinguish between
             silence on the part of the clientand a time lag duringtransmission.             

                  Given these results, one strategy that can facilitate and enhance the              
                cybercounseling  process is the more frequent use of immediacy. As
                counselors inquire more frequently with clients about the process, this        
                                                                                                     

                approachwill allow themto better assess the progressof the sessionand         
                the experience of the client. Counselors can also employ the skill of                
                summarization more often to let clients know that they have heard and       
                understood their perspective. This will allow clients to feel that they are         
                active participants in the cybercounseling process.                                 
                      Obviously, it is to the advantage of counselors to receive some form                
                of training in cybercounseling so that they are comfortable with the process                
                                                                                                  
                and develop a comprehensive understanding of cybercounseling. Such               
                training would allow counselors to recognize that counseling skills have a                
                different effect when cybercounseling than when being traditional face-to-
                                                                                                            
                face counseling. It would also allow them to learn to troubleshoot effectively
                                                                                                         
                when there is a technical difficulty.
                     The results of this study also suggest that clients are likely to react         
                more positively about the cybercounseling process than their counselors,
                                                                                                            
             as it allows clients to address their concerns in a less threatening
                environment. Such perspectives are probably reflective of broader societal
                                                                                                  
                attitudes  where clients may be more interested in participating  in        
                                                                                                  
                cybercounseling than previously thought (Boynton, 2001). Haas (2000)                  
                                                                                                            
                suggests that because cybercounseling does not contain all the elements
                that counselors have come to expect in face-to-face counseling such as the         
                presence of non-verbals, it does not mean that cybercounseling cannot be          
                effective. In fact, Powell(1998) suggests that the advantagesof uninterrupted         
                                                                                                            
                care or the longer relationship between the client and counselor that is
                                                                                                             
                possible in less costly cybercounseling may outweigh the initial lack of
                                                                                                              
                intensity in the client-counselor alliance.
                                                                                                             
                     Another interesting finding of this study was that both the client and
                                                                                                     
                counselor indicated that though they had a working relationship, they did

            not experience  a strong emotional  connection  with each other. In
                cybercounseling, the client and counselor have a relationship that is based
                upon the participants'  abilities to understand the goals and tasks of
                counseling. Therefore, counselors who engage in cybercounseling may find
                that though they can see and hear the client, the emotional connection that
                is an integral part of face-to-face counseling is not apparent. The lack of
                emotional connection appeared to have interesting ramifications for the
                counseling process. The client reported a greater sense of control over the



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 counseling  process in that she had the freedom to make choices.  While the
 client acknowledged  that the counselor  directed the process, she did not
 perceive  the counselor  as "in charge"  of the session.  Thus,  the client
 perceived   an equal relationship   and was more empowered   during the
 counseling  process.
       Conversely, the lack of connection in the client -counselor relationship
 was uncomfortable  for the counselor as it made it difficult for her to assess
 the progress  and effectiveness  of the counseling  process. The counselor
 also reported that she felt less in control over the counseling  process. For
 counselors   trained  in face-to-face   counseling,   this lack of emotional
 connection  is one aspect that will require adjustment.  Given the difficulty
 in establishing  an emotional bond with the client during cybercounseling,
 counselors  may need to focus on other aspects of the working alliance such
 as the goals and tasks of counseling  in order to strengthen  the existing
working connection they have with their clients.
       The results of this study have important implications  for the manner
in which the counseling profession addresses the issue of cybercounseling.
It is impossible  to tell when technology  will arrive at a point where it will
capture the elements of face-to-face  counseling.  However, it is important
to note that some of the technological  problems that were identified in this
study may become less of an issue with Internet2 and its related applications.
Offering  greater bandwidth,  latency, Quality of Service (QoS) protocols
(Salpeter, 2002; Van Horn, 1998) and such applications  as full-size video
(Salpeter, 2002; Van Horn, 2002) and tele-immersion  (Ditlea, 2001; Lanier,
2001),  these Internet2  initiatives  will address  many of the challenges
associated with cybercounseling.  Optimistically,  when tele-immersion, with
its three dimensional  quality (Lanier, 2001), becomes affordable  for the
general populations, the client and counselor are likely to experience greater
authenticity  in their interaction.   Ditlea  (2001) suggests  that with tele-
immersion,   participants   may finally  have the ability  to interact  more
realistically   with each other, giving  new meaning  in counseling  to the
concept of "high tech, high touch."
      Until then, the counseling  profession  will need to determine  how to
incorporate   the practice  of cybercounseling   to best serve clients.  One
possibility  is to consider  cybercounseling   as a mechanism  for follow-up
contacts or for contacts between sessions.
      Another option is to develop a hybrid counseling experience for clients
who lack easy access to mental health  services. Instead of an extended
interlude  between sessions, counselors  and clients can alternate between
face-to-face   and cybercounseling   sessions.  Such an approach  has the




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advantage  of allowing  the client-counselor   relationship   to develop the
emotional bond that is not apparent in cybercounseling.                                     
      With the limited investigation into the application of videoconferencing
to the cybercounseling  process, it is premature to conclude whether it is an
appropriate form of counseling. However, as a number of counselors offering
services online increases (Bloom, 1998; Hughes, 2000), there is an urgent
need for further investigation into the process and outcome of this modality.

                          Implications  for Practice

      At the moment, cybercounseling  is new and largely uncharted territory
and there are practical implications  that require serious consideration  by
counselors.  Based on the results of this exploratory  investigation,  initial
recommendations    are provided   for the set-up  and for the process  of
cybercounseling.  It is important to recognize that these suggestions are based
on the results of this study and are not all-inclusive.

Cybercounseling  Set-Up
      The recommendations   for the set-up of cybercounseling   address
technical and non-technical  issues. Among the technical issues that require
consideration   in cybercounseling   are those related  to the selection  of
technology  software and hardware. A variety of software packages, web
cameras,  microphones  and Internet connection  options  are available. In
videoconferencing,   the quality of audio and video reception  will depend
upon the hardware and software selected. In addition, the mode of Internet
connection (cable modem, satellite modem, digital subscriber lines, or dial-
up modem) will greatly impact the quality of the sound and picture.
      Not surprising,   counselors   can expect  to sometimes   experience
technological  difficulties  with audio and video quality. Common  audio
problems include sound distortions that, at times, make it difficult for the
participants   to hear each  other. Proactively,   counselors   may want to
emphasize  that clients should ask them for clarification  whenever there is
an audio distortion.  In addition, clients should be aware that they might
have to repeat information when the counselor is unable to hear them.
      Another  technical   concern  is the time  lag in audio  and video
transmission.  If cybercounseling  is a new experience  for participants,  the
counselor  and client may need to adjust to the digital quality of the audio
and the time lag. Depending upon the hardware, the audio can be limited in
its ability to capture subtle voice inflections of the participants.  In addition,
the participants have to learn to distinguish between a transmission  lag and
a moment of silence during the cybercounseling interaction. Such conditions



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may not always make it possible to identify the emotions  that the client
experiences during the cybercounseling  process.
      While the video allows the participants  to see each other, it provides
a restricted picture that often extends from the shoulders upward. Therefore,
it is difficult for participants to read non-verbal behaviors that are essential
for better communication  between the client and counselor. Consequently,
the counselor  may find it more challenging  to get an accurate read of the
counseling process and the experience  of the client.
      Another  practical  issue is the inability  to guarantee   security  of
information in cybercounseling.  A common suggestion for addressing  this
problem is the use of encryption software to protect the information that is
transmitted over the Internet (Bowman & Bowman, 1999; Sampson, et aI.,
1997; Sussman,  2000). While these programs  provide  some degree  of
protection, they cannot guarantee complete security. It is important to note
that this may be less of an issue with videoconferencing  that involves point-
to-point communication,  than with other forms of cybercounseling. Another
suggestion    is  that   when   using   videoconferencing      to  conduct
cybercounseling,  counselors can establish a private cyberroom that can only
be accessed with a password.
      Given the possible  technological  challenges,  proactive  approaches
include  addressing   the procedures   for managing  these  issues  on the
counselor's   website and also in the initial cybercounseling   session. The
website can describe the technology required for the cybercounseling process
including  hardware,  software, and connection  requirements.  Suggestions
for setting videoconferencing  software preferences, ensuring the computer
is not in sleep mode, and a description of the cybercounseling  process can
also be provided.
      An important  non-technical  issue that deserves consideration  is the
limited research  about cybercounseling.   Given the limited investigation
into cybercounseling,  it is critical that counselors are aware of the ethical,
legal and practical issues related to its practice. These issues are addressed
by various professional  bodies including ACA (www.counseling  .org) and
NBCC (www.nbcc.org)  and are available on the Web.
      Relatedly, counselors may want to carefully consider the kind of issues
that are appropriate  for cybercounseling.  Again, there is limited research
that identifies   the problems  that  are appropriate   for cybercounseling
interactions. The NBCC (1997) recommends that mental health issues such
as relationships  that involve violence  and psychological  conditions  that
include   problems   with  reality   distortions    are not  appropriate    for
cybercounseling.  Cybercounselors  should specify the problems that can be
appropriately  managed through their Internet practice and those problems



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               that are not suitable for this modality (Manhal-Baugus, 2001). Prior to the
               initiation of the cybercounseling sessions, counselors may want to gather
               pertinent information about their clients. Such information should be
               collected before the first session through an intake procedure such as an
               online intake form, a telephone intake or preferably a videoconferencing
               intake session. The counselor can solicit information such as age, gender,
               presenting concern, client experience with counseling and the location of
               the client.
                     Another issue to consider before counselors begin cybercounseling is
               whether counselor licensure is required for treating clients in certain states.
               For instance, California recently passed legislation that mandates that only
               clinical psychologists and medical practitioners licensed in California can
               provide cybercounseling to state residents.
                                                                                                       
               Cybercounseling  Process                                                            
                     Counselors also need to be aware of several issues about the process          
                                                                                                       
               of cybercounseling.   One aspect  that may require  modification   is the
               structuring of the cybercounseling experience. In addition to what is typically
               addressed    in face-to-face    counseling,    structuring    of the  initial
                                                                                                       
               cybercounseling  session should address security, confidentiality,  informed
               consent, billing procedures,  client contact between sessions, the protocol
               for managing technical problems, policies for session cancellation and post-
              counseling   contacts.  In the final session,  counselors  can review  post-
              counseling  and follow-up contact procedures.
                    Another  challenge  of Internet  videoconferencing   is that the video
              feature may distract some counselors.  The ability to see themselves on the
              screen can initially divert the attention of neophyte cybercounselors  from
              their clients. To prevent focusing on their image rather than on their client,
              counselors  may want to consider  closing  their video window  to avoid
              distraction.
                    While the audiovisual properties of cybercounseling  are an advantage,
              neophyte cybercounselors should note that their behaviors are clearly visible
              to the client even though they are physically  separated.   Consequently,
              counselors   may want to avoid  engaging  in any behavior  that is not
              appropriate  for face-to-face counseling.
                    No discussion of cybercounseling  is complete without some reference
              to the ethical and legal issues that pertain to this process. The ethical and
              legal issues associated with the practice of cybercounseling  are consistently
              documented  in the literature. While an in-depth discussion  is beyond the
              scope of this article, readers should note that several examinations (Attridge,
              2000; Bloom, 1998; Hughes, 2000; Manhal-Baugus,  2001; Sussman, 2000)



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of the ethical and legal issues related to cybercounseling are available.
Professionals considering counseling on the Internet may want to acquaint
themselves with these discussions as the information gleaned from them
can inform practice and prevent problems in the future.

                                Conclusion

     It is apparent  that the practice  of cybercounseling   through
videoconferencing  is a different experience compared to face-to-face
counseling. Evidently, cybercounseling entails more than just access to
technology and the ability to use it. Rather, cybercounseling involves
adapting the technology to the counseling process and the needs of the
mental health field so that it serves as a vehicle to expand services for
clients.
     As this form of cybercounseling is in the initial stages, there is a need
for further investigation into this process. Such investigations can provide
greater understanding about the process, practice and effectiveness of this
modality.As Sampson, et al. (1997) suggest, the counseling profession needs
to proactively address the application of cybercounseling to mental health
concerns. If and when cybercounseling becomes an acceptable form of
counseling, it will not be because counselors have necessarily embraced
the concept, but rather because there is an increasing demand for this new
and different modality from clients.

The authors thank Audie Willis and Wendy Firven for their assistance with
this project.

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