The Changing Trend in Counselling Psychology: Internet Counselling as a Psychotherapy Practice
The emergence of counselling psychology as a distinct profession in the United Kingdom two decades ago was a significant pointer that the field’s practitioners, represented by the British Psychological Society, had finally recognised that the field is unique in terms of identity and practicing philosophy. This recognition is captured in the definition by the Society that counselling psychology is a value based approach to counselling as a profession, and puts emphasis on the counselling primacy or relationship-oriented approach based on therapeutic observation (Milton, 2010). However, amidst the recognition are challenges, both present and potential, affects and will continue to challenge the effectiveness of counselling psychology as a noble profession.
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The challenges, as a matter of fact, are based on the modes of delivery of delivery of counselling psychology. Presently, scholars and practitioners have identified issues, such as technological revolution challenges, ethical dilemmas in relation to health maintenance organisations, psychologists facing certain challenges including prescription delivery services, and challenges with empirical research based support system among many other issues. Although these issues are no doubt a big concern currently, the biggest debate has revolved around the role of technology in counselling psychology, considering that the literature about this area is hard to come by. The growing dilemmas are based on the impact of technology on the growth of counselling psychology and, at the same time, the challenges that come with its increased use, given the nature of counselling psychology services modes (Gackenbach, 2011).
Technology has become part of almost every household, and is predicted to continue having tremendous impact on the lives of families and households, particularly in the spheres of economic, socio-political and cultural aspects. In fact, internet technology has not only affected how families and households buy or sell things online through ecommerce trading platforms, but has also had a tremendous impact on physical and mental health of many people around the world. Health professional practitioners have, therefore, incorporated internet into one of their modes of transferring services to the care receivers or clients. In turn, the general public, including those in need of counselling services, can access these services from home within minutes, and cost effectively. However, the inherent challenges when delivering counselling services via internet cannot be assumed, and has attracted unending debate not only on its viability but also its effectiveness as compared to the traditional in-person mode of counselling (Reamer, 2013). The question would therefore be on whether advantages of internet counselling supersede its disadvantages.
The British Psychological Society established a “Division of Counselling Psychology: Professional Practice Guidelines” in 2006 (Reamer, 2013), which emphasised the need to have a balanced approach to counselling psychology service delivery methods. For instance, they state that the practitioners should not assume any form of automatic superiority over any one in terms of experience, feeling, value, and know-how. They also state that any practitioners should be ready to challenge the views of persons who pathologise on the basis of “sexual orientation, disability, class origin, or racial identity and religious and spiritual views” among other critical aspects of the society (British Psychological Practice, 2006, cited in Reamer, 2013, p.169). The concept of not assuming one-way knowledge in counselling psychology has led to a number of challenges, particularly with the increasingly growing technology-laden population, including those in need of counselling and psychological support. In certain cases, the client may not have the adequate mental capacity to interpret certain information, thus leading to miscommunication. In other words, the client may wrongly interpret a message as critical or not friendly, thus end up feeling hurt or injured. After all, online interaction sessions do provide neither counselling psychologist nor client with shared environment.
Internet psychotherapy sessions may suffer from miscommunication between the psychotherapist and client. In any case, studies have shown that miscommunication may inadvertently harm the client and possibly increase trauma after the disclosure of important facts about them (Gackenbach, 2011). For example, text or email based communication is prone to miscommunication since the more important non-verbal cues are missing. Moreover, most counselling psychologists are mainly trained on in-person techniques. The counselling psychologist may, thus, lack the writing skills necessary to adequately express meanings in written words. (Patrick, 2006)
As technology pushes people o the brink of being an entirely online society, the viability of internet counselling will remain a thorny issue as it is apparent that certain aspects of counselling psychology could be more difficult to deal with than others. Most professional organisations unanimously recommend that counselling therapists practicing online counselling sessions should continue using the basic ethical standards applied in the in-person psychotherapy sessions (Luepker, 2012). Some of the recommendations are based on the need to adhere to the informed consent used in in-person counselling, including informing the clients about risks, benefits, available safeguards, limitations, and exceptions to confidentiality and privacy, identity verification, limiting practice to the scope of one’s qualification, accurately representing themselves and their licensure status, finding solutions to the potential harm that may arise from dual roles, and establishing emergency response for clients in different geographical locations (Gackenbach, 2011). However, the question that has never been answered is how to deal with clients coming from different jurisdiction locations with varied laws and legal procedures. In addition, a therapist may find it extremely difficult to handle a case where a client threatens to commit suicide.
Informed consent, Disclosure and Confidentiality
The introduction of diverse digital versions in the counselling psychology practice has brought with it diverse problems related to informed consent, disclosure and confidentiality. However, like any other internet usage, the concept of informed consent, disclosure and confidentiality still lingers as serious sources of dilemma. The lack of physical presence may make it difficult to verify identity, thus may lead to psychotherapist treating a minor without parental knowledge, and this consent (Gackenbach, 2011). When such occurrence become rampant, there is likely to be more actions from policy makers to protect the majority from the possible breach of informed consent in the context of internet counselling.
Within the context of informed consent is the issue of confidentiality, a critical aspect of counselling psychology. Studies have shown that internet is not a secure platform to assure the preservation of confidentiality (Barak, 2008). Although psychotherapists are advised to inform the clients of the potential dangers and risks associated with modes of service delivery, including breach of confidentiality and experimental nature of the process, this kind of advice still leaves gaps in better ways in which confidentiality can be maintained, a concern that is unlikely to end any time soon.
Accuracy in assessment and monitoring effectiveness of interventions
One of the first steps in the counselling process is to assess and monitor the client (Milton, 2010) However, with barriers in the virtual world, it is may be difficult to accurately assess and monitor the patients during service delivery sessions. It is important to note that virtual interaction means lost contact, which is an integral part of achieving the goals of counselling psychology as outlined by the British Psychological Society. Moreover, one of the perspectives that were present during the formative periods of counselling psychology is the need for psychologist to understand people as relational beings.
In the process of fostering collaborations with people as well as contexts that draw on a range of perspectives, including the traditional views of people as independent entities, counselling psychology has always recognised that relational perspectives have significant contribution to make on not only understanding people but also help the clients work towards bettering their wellbeing (Patrick, 2006). However, this relationship is lost through lack of physical interaction between the psychologist and the client. Moreover, the psychologist’s inability to focus on other family members and intimate partners obviously jeopardises any chance of learning the relationship between the clients and their significant others. As Barnett (2005) states, failure to understand the relationship between clients and people close to them may make it difficult to assess the former’s self-esteem, likes, cultural upbringing and socio-political background.
The controversy that is likely to extend over a long period of time is the criteria in which internet psychotherapy sessions can be evaluated. While the traditional in-person counselling therapy has elaborate theoretical frameworksand models that support its use, internet counselling psychotherapy does not have any historical frameworks and models that guide its use. Although most psychotherapists have solely relied on relational counselling, they still run short because of the inability to establish therapeutic relationships with clients. At present, the main concern is how the traditional models can be interpreted into online models. Barak et al (2008) observed that internet-based interventions in the field of counselling psychology have been used for over a decade. However, no clear analysis of its effectiveness has been forthcoming. They, however, recommend adoption of online counselling as a legitimate option in offering psychotherapeutic counselling sessions. Still, they warn that the psychotherapists must be willing to use online counselling with strong ethical issues in mind.
The other challenge is the ethical issues that emerge from counselling psychology practice. In the field of practice of counselling psychology, one of the potential current issues is how to enforce ethical code of conducts, including ensuring psychologists only practice within their areas of competence based on qualifications in terms of training as well as experience (Patrick, 2006). In addition, the psychologists are expected to take reasonable steps in ensuring their work follow necessary procedures that protect clients from any possible harm. However, this challenge still poses serious challenges to the regulatory authorities as it is difficult to weed out unqualified persons from assuming counselling responsibilities at the detriment of the clients. In essence, professional accountability is still considered far from being managed. Furthermore, laws governing counselling psychology practices may be different from one geographical jurisdiction to another, with questions as to how the two persons; client and psychologist, can operate (Luepker, 2012). It has been observed that many practicing counselling psychologists have attempted to navigate through the legal and professional barriers in internet counselling by defining their online counselling services as psycho-education (Patrick, 2006). Although some online counselling may be legitimately offering purely therapeutic education services, some therapists cross the boundary and treat clients within multiple sessions, which clearly suggest therapeutic counselling sessions rather than claimed educational. This is a serious ethical breach that, although may be tamed by stricter regulatory laws and policies, may be difficult to interpret for appropriate actions to be taken.
Despite the advancement in technology and the desire to build long-standing strategies to effectively deliver appropriate services to clients in the field of counselling psychology, there are inherent challenges that remain controversial to date. Confronting the complexity of electronic media to deliver counselling sessions in the most professional manner has is one area that remains a challenge, and is expected to continue dominating this comparatively new profession. Moreover, virtual interactions are limited in the sense that the psychotherapist and the client are not connected beyond internet, hence are not able to experience the common advantages that come with physical interactions, such as nonverbal cue interpretations. Issues that have arisen, and will continue to generate debate in the foreseeable future are: miscommunication, inability to stick to professional code of ethics by some counselling psychologists, inability to assess and measure the success of online counselling sessions, and difficulty in keeping internet communications secure. In fact, these issues have been discussed and continue to dominate the profession’s sphere of influence. It may be important to state that counselling psychologists may need to participate in developing thoughtful policies and procedures related to technology use in the field of counselling psychology by involving clients in the process. Lastly, it must be important to state that whenever technological intervention affects therapeutic relationship, either positively or negatively, the impact becomes part of the profession, hence must remain in the record.
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