Further Adventures: Supplementing my "Day Job"

[Art Matthews, MA LPC DCC]

Working on a university campus, I have different ebbs and flows of client need than community counselors and private practice therapists. The beginning of the year, testing schedules, Holiday Breaks and of course end of year and graduation all influence how full my calendar can get. Lately, I've seen an expected jump in my appointments.

My campus has roughly 750 residential students, meaning they physically attend classes on-site during their academic program. Attending a graduate school of health sciences, the students often are required to have practical experiences and clinical rotations away from their home-campus, some to far flung locations in other states or even countries. I'm using eTherapy to connect with students for whom the local drive time is extremely inconvenient to those in the islands of the South Pacific. Although the demand has not been high for eTherapy yet, since I began advertising distance counseling at no charge to students, I have seen an increase in distance clientele.

Before opening the online "doors," I made a survey of a group of students to see what their attitudes, opinions and needs were regarding online counseling. I was more than pleasantly surprised. The typical respondent was in their late to mid twenties to early thirties and was to engage in a large portion of their study at rotation sites "out of pocket."

Not unexpectedly, many of the respondents were experiencing symptoms of anxiety, depression or stress. While face-to-face counseling was still preferred, 41% reported they would consider video chat and 35% would consider telephone sessions. Twenty-three percent were willing to consider email as the main method of therapeutic communication. Nearly 6% of the respondents actually stated they would prefer online sessions to face-to-face and 32% said they were very comfortable with the idea. Only 12% reported they were "Not At All Comfortable" with electronic provision of services.

When asked about their reservations, 63% stated a concern over how eTherapy would work, while 48% reported equal concerns over 1) the confidentiality and 2) privacy/security of shared information. Proper development of electronic resources/methods and education of clients on the eTherapy process may change the opinions of those expressing reservations to indicate an even higher number of those willing to utilize online services.

The eTherapy methods I have utilized thus far are: video-chat using Skype and tele-sessions via phone. I have developed a "HushMail" account off the institution's web servers to address concerns over privacy and confidentiality. Students will frequently email me directly at my institutional email and provide too much information (I use a disclaimer regarding the email's limited confidentiality and security, but that hasn't diminished the emailed requests for appointments to that address). Plans in the works are for a new institutional webpage for online therapy with instructions on contacting me for an appointment as well as access to downloadable forms, process and expectations.

For those of you who think it's very difficult or impossible to develop a therapeutic relationship with a client online, consider that the culture of clients is changing and with it their expectations. I probably see younger clients, more educated and more computer savvy than the average counselor. The Millennial Student has high expectations of college student services and low tolerance for delay in receiving services. In many ways, eTherapy helps me to meet their expectations. I am available when (within limits) and where they want me. Following one session this week with a continuing client, "she" expressed her gratitude that my services were available this way and said she found it very helpful in resolving her concerns.

I'm convinced that eTherapy is here to stay, but I'm equally convinced that counseling and counselors must adapt. I believe changes are afoot related to client's expectations of counselors, what treatment looks like, when treatment occurs, and how long clients stay in treatment (both in a session and length of overall treatment).

Stay tuned (to use a dated reference) for more...

[Catherine Drennan]

This is such an interesting topic. My kids are 21 and 23 and virtually cut their teeth on a mouse pad. They have an intuitive grasp on technology. When I asked my younger son if he has been in touch with his brother lately, his answer was "In the real world?" "I beg your pardon?" was my reply. "Well, Mom; if you mean in the real world, I don't know what he's doing, but in 'World of War Crafts', he's fighting wild boars on the Hellfire Peninsula." I am not exactly fossil matter, I am not ashamed to say I have 55 years of rich life experience to look back on, and I hope many good years ahead of me as well. So, you could say I cut my teeth on a slide rule, and I have to think in a very focused way, on everything I do at the computer. In fact, I struggle with this website sometimes, and I am sure it is one of the most user friendly I use with any degree of regularity. Your topic, as I see it is a double edged sword. First; there will probably not be a huge population of seniors signing on to this modality of treatment. Don't count us out; there is a reason we are called "baby boomers" because our numbers are huge. Most of the people I trained with are planning to retire and have zero interest in becoming tech savvy. They like the personal intimacy of a face to face contact with white noise at the door; whether they are the therapist or the client/patient, or in peer supervision. Second; that leaves a younger, (intuitively) technologically wise patient/client population. When you say, "Students will frequently email me directly at my institutional email and provide too much information " perhaps it is our job as therapists to integrate this into therapy. I would wonder about the impulsivity judgment, and maturational level of sending information which can be easily disseminated to the wrong eyes (e.g. sext messaging with trust and confidence to a 'significant other', only to be betrayed with the most devastating consequences.) You also say, "The Millennial Student has high expectations of college student services and low tolerance for delay in receiving services." to which I would say, delayed gratification is a life skill without which, one is setting him or herself up for painful disappointment. Unless of course you have determined the person is a danger to self or others, waiting is something we all have to deal with and manage to regulate our emotions. Even in a true emergency, you might not be immediately available, in which case the ER is the next stop. What about the therapeutic value of skyping vs. chatting, vs. emailing? 1- How do I know who the person really is writing the text or email? Recall the Mom who impersonated a fictitious "boyfriend" of her daughter's rival and later broke up with her online resulting in the child's suicide. What is a mother doing, meddling in her daughter's social life? If you've been around long enough you know exactly what I mean. My opinion of telephone therapy is that it's okay in a pinch; bad weather, a sick child, some other reason to be home bound, the phone keeps you connecting and maintains continuity in the process. I think Skyping is here to stay as is the phone. We know there is so much more that the written word; body language, voice inflection, bizarre attire and so on. Without the visual component appearance is eliminated from the mental status exam. I have gone on long enough about this, but have given this topic lots of thought. Could go on, but one of my fantastic sons decided to come see good old Mom for the weekend. So, bye for now.

[Carroll McGrath Hood]

Dear Art,
Tank you so much for your thoughtful and insightful posts. This is exactly the kind of "conversation" I was hoping to find here.