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
321
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)
322
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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