TILT Magazine Issue 13 by Online Therapy Institute

volume 3, Issue two Winter 2013

The Real Motivation Behind Social Networking PAGE 24

PAGE 14

A Distance Counselor's "Ohanashi": Coming to Work with People in Japan PAGE 37

Ethical Framework for the Use of Technology in Supervision PLUS...

Cybersupervision, Marketing Toolbox and much, much more...

TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a free publication published four times a year online at www.onlinetherapymagazine.com. ISSN 2156-5619 Volume 3, Issue 2,WINTER 2013 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Distribution Coordinator Sophia Zollman Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Jay Ostrowski Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Clinton Power Associate Editor for Film and Culture Jean-Anne Sutherland Resident cartoonist Christine Korol Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute. If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture). If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.

TILT is about envisioning therapeutic interventions in a new way. While Kate was visiting DeeAnna on the Jersey Shore, they took a late afternoon boat ride and a display of sail boats tilting against the sunset came within view. It reminded them how, as helping professionals, we should always be willing to tilt our heads a bit to be able to envision which innovations – however seemingly unconventional – may fit our clients’ needs. Our clients are experiencing issues in new ways in light of the presence of technology in their lives. As helping professionals, so are we. TILT and the Online Therapy Institute is about embracing the changes technology brings to the profession, keeping you informed and aware of those developments, and entertaining you along the way.

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Features 14 A Distance Counselor's

"Ohanashi": Coming to Work with People in Japan

24 The Real Motivation

Behind Social Networking

37 Ethical Framework for

the Use of Technology in Supervision

Issue in every

News from the CyberStreet

10 Research Review 22 Wired to Worry 35 Reel Culture 46 Student Spotlight 48 CyberSupervision 50 New Innovations 54 Marketing Toolbox

58 For the Love of Books 60 Advertiserâ&#x20AC;&#x2122;s CyberMarket

A Note from the Managing Editors… Welcome, or welcome back, to TILT – Therapeutic Innovations in Light of Technology, and the second issue of Volume 3. In this issue, our main feature is by Dr Aaron Balick, whose blog Kate discovered recently. Two or three tweets later, she had secured his valuable contribution to TILT in exploring the real motivations we have in our use of social media, and how kate anthony & deeanna merz nagel with the traditional psychodynamic theories are just as online therapy institute in second life relevant today to understanding our behaviour in terms of technological use. Aaron’s forthcoming book about the psychodynamics of social media is a very welcome addition to the literature, and we have already pre-ordered it as a matter of priority! You can read more about it on our Love of Books page. Our next feature article is from Roy Huggins, who gives us a fascinating account into the Japanese culture as a counsellor, having worked there for three years previously. Roy now counsels online with English speaking residents of Japan. Note in particular the concept of having a session in a Karaoke booth, and how he encourages his online clients to show him the room they are in using a webcam – giving a vivid insight into how the Japanese view the importance (or lack of importance) of confidential settings. As Roy points out, “people live close together and privacy is assured by the social contract of "I'll ignore you if you ignore me.” We are also pleased to publish our new Ethical Framework, for the Use of Technology in Online Supervision. Working closely with the lead author LoriAnn Stretch, we have the most up-to-date and comprehensive set of guidelines in conducting the Supervisory relationship online. We hope you find it useful in your work, whatever your mental health practice looks like. Remember, as well as featuring in TILT, all of our seven frameworks are available online, and we are pleased to announce that our first – the Use of Technology in Mental Health – is currently being translated into Albanian! Our aim continues, issue by issue, to keep you up-to-date with developments in innovations in service delivery. In particular, the Cyberstreet is about what is new and noteworthy at the Institutes as well as with our new graduates, supporters and partners. All our other regular columnists are here, with useful and entertaining comment on research; marketing; legalities; innovations and CyberSupervision. In particular this month, we introduce you to what our new future student columns will look like, for both our therapist courses and our coaching courses. Our second run of our Intensive Specialist Certificate is currently in full swing, with students from all over the world including the UK, Australia, the USA, Italy and Kosovo. And of course there is a good dose of humour from our resident cartoonist, Christine Korol. We hope you enjoy this issue, whatever professional world you inhabit. J

Managing Editors

T I L T M A G A Z I N E winter 2 0 1 3

NEWS CyberStreet

TILT â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology

from the

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New Course Opportunities and a DISCOUNT!

INSTITUTE NEWS! WOW! We have recently migrated to a new e-learning platform and we are so excited! Read more about this in our new regularly featured column, Student Spotlight (This issue, page 46). We also blogged about our new learning style here: http://onlinetherapyinstitute.com/2012/12/ learning-style-great-content-face-lift/ Check out our Partners and Supporters! http://onlinetherapyinstitute.com/portfolio_1/ partners/ http://onlinetherapyinstitute.com/portfolio_1/ supporters/

News from the Training Room! Be sure to check out our Course Catalogue for a list of all our course offerings, including Coach Certification and Specialist Certificates! Access the Course Catalogue and speak to an Enrollment Coach LIVE or schedule an appointment for a time convenient for you! Just visit our home page at: http://www.onlinetherapyinstitute.com

We have extended our partnership with the Institute for Life Coach Training (ILCT) and many of our self- directed coach courses are offered through ILCT as well as OCI! See our ILCT offerings! Purchase through ILCT and receive $25.00 off! Use Coupon Code TILT (offer ends Mar 1, 2013). http://lifecoachtraining.com/index.php/ programs/self_directed/

In other training news... Where are we live? Check out our Upcoming Events! http://onlinetherapyinstitute.com/events/

Kate: March 2nd - OCTIA conference Maintaining a Responsible Online Presence (whether sad bad mad or glad) April 12th - Professional Knowledge Seminar for Metanoia Horses to Water: Doctoring the Profession by Taking it Online - the Public and Private Impact of the Doctoral Journey April 25th - Association for Coaching IrelandIntroduction to Online Coaching May 11th â&#x20AC;&#x201C; Transcultural Conference, Edinburgh, OnlinEvents Culture of Cyberspace TILT MAGAZINE WINTER 2013

TILT – Therapeutic Innovations in Light of Technology

DeeAnna: Mar 24th- Psychotherapy Networker Symposium Therapy’s Digital Future, Washington, DC Facilitating Distance Credentialed Counselor trainings Located in Maryland, North Carolina and Arizona! For details check out http://www.readyminds. com/training/dcc_event.asp or email lisa@ readyminds.com

TILT LIVE - COMING SOON Beginning in the spring, we will be offering TILT Live! Join us each month for a webinar with a featured TILT author! Click her for details! http://onlinetherapyinstitute.com/open-officehours/

Media, Publications & Blogs The Bradenton Herald and The Inquistr quoted DeeAnna Nagel and gave a mention to the Online Therapy Institute. Kate Anthony wrote an article for Coaching at Work Magazine entitled Keeping Your Distance. The article is about online coaching. Clara Lang, the fictitious therapist featured in our book, Therapy Online: A Practical Guide, is now featured at www.claralang.com. Her blog features posts by Online Therapy Institute’s Specialist Certificate students. Check out her website and blog!

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Stay tuned! LoriAnn Stretch has joined Kate and DeeAnna (see feature article this issue) in editing a new textbook: The Use of Technology in Clinical Supervision and Training: Mental Health Applications to be published late 2013/ early 2014 by Charles C. Thomas Publishers.

Join our community Find out all the ways to join our community by checking out our community page! http://onlinetherapyinstitute.com/community/

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Research Review

Social Ne Psycholo E

ven three years ago, a long time in the fast moving world of technologically mediated communication, it was reported that more than 60% of adults maintained a profile on at least one social networking site, while 70% read blogs or tweets (Galagan, 2010). Mark Zuckerberg was proudly claiming 500 million people as Facebook users (Zuckerberg, 2010) and that about half of them would log-in on any given day. From something that barely existed less than 10 years previously (Facebook was launched in 2004), social networking continues to grow as a major force in the daily lives of a vast number of people and is here to stay. The following is a brief miscellany of research items, new and old, that have touched on the psychological implications of the tools that turned the Web into Web 2.0. Sun and Wu (2012) found that appearing to be agreeable, the need to belong, selfconsciousness and the need to present oneself as competent were important factors in how we actually present ourselves in social networking sites. However, a growing

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consensus of research has suggested that the way we seem to be – who and what we present ourselves as – may actually be accurately representative of our real selves, meaning that the actual characteristics of the account holder can be more accurately perceived by others than might be supposed, as previously reported in this column. Narcissism and extraversion are, perhaps, traits that one might expect to be noticeable, and indeed they are. Buffardi and Campbell (2008) found that narcissistic self-reports from a sample of Facebook users could be accurately predicted by independent raters. Narcissism was evident not only in raised social activity in social media but also through increased self-promotion, photograph styles and other factors. Extroverted people appear to make greater use of tools such as Facebook although such personality traits do not in themselves dictate whether they are used at all – introverts are likely to find social media something of a level playing field when it comes to social contacts, in other words (e.g. Litman, 2008, Ross et al, 2009).

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Review S t e p h e n G o ss

etworking and the ogical Therapies However, it now appears that even much more internal experiences, such as anxiety, can also be apparent in the way a person uses social media. Social anxiety seems to be just as easily read by viewing a person’s Facebook profile as narcissism and could even be tested for by examining specific aspects of how they use social media and the way in which they present themselves (Fernandez et al, 2012). Not only do studies of these types suggest that reviewing a client’s Facebook page could have useful clinical applications for a range of characteristics, and perhaps therapeutic tools in themselves through modification of social media behaviours, they also suggest that our inner selves are also put on display when using social networking sites and that anyone with access to your profile would therefore be able to work out a good deal about you, and perhaps more than you intend. Most often, of course, that will be largely, if not entirely, benign but could equally be available for those not well disposed to behave in the best interests of the account holder. Moreover, there is a clear link between personality

traits like social anxiety and problematic Internet use with many seeing “online communication as a safer means of interacting, due to greater control over self-presentation, decreased risk of negative evaluation, and improved relationship quality” (Lee and Stapinski, 2011, p197). Putting these bodies of research together, those who choose social media because of its apparent relative social safety may be misled. What might seem to be a more insulated way of interacting is in reality just as vulnerable to the social perceptions and judgements of others as relationships conducted offline. It is also immediately apparent, however, that the simple appearance of relative safety still makes entry into relationships, including therapeutic ones, all the more important for those who would hesitate in the offline world. The same relational processes may occur, but reduced fear of them can be hypothesised as facilitative and likely to increase social connectedness, especially for those who would struggle with relationships offline. These possibilities are underscored by older findings that those seeking information on social anxiety on the Internet tend to be more severely

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Research Review disordered than those seeking treatment offline (e.g. Erwina et al, 2004). Moreover, while social media is indeed considered to be a relatively accessible forum for self-disclosure for those with low self-esteem, Forest and Wood (2012, p295) reported that “the low positivity and high negativity of their disclosures elicited undesirable responses from other people” which could perhaps be seen as suggesting that it is important that social media be used with care – a point of importance for therapists who operate in the online environment and who want to take account of social media usage by their clients. With a medium that is so new it would be unwise for us to pronounce too strongly on what its impacts may be in the longer term as Aaron Balick notes in this volume. Earlier studies may, in time, prove to have been unreliable or over speculative and we should certainly seek confirmation of their findings before relying on them in so fast evolving a situation. But their potential, their impact and pervasive, nigh inescapable, influence is clear, whether for good or ill. What social networking will come to mean to global and national societies, and what its effects for individuals will be, remains to be seen. ABOUT THE AUTHOR Stephen Goss, Ph.D. is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK (http://about.me/stephengoss).

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continued

REFERENCES Buffardi, L. and Campbell, K. (2008) Narcissism and social networking web sites. Personality and Social Psychology Bulletin. 34(10), 1303-1314. Erwina, B., Turka, C., Heimberga, R., Frescoa, D. and Hantula, D. (2004) The Internet: home to a severe population of individuals with social anxiety disorder? Journal of Anxiety Disorders. 18(5), 629–646. Fernandez, K., Levinson, C. and Rodebaugh, L. (2012) Profiling. Predicting social anxiety from Facebook profiles. Social Psychological and Personality Science. 3(6), 706-713. Forest and Wood (2012) When Social Networking Is Not Working. Individuals with low self-esteem recognize but do not reap the benefits of self-disclosure on Facebook. Psychological Science. 23(3), 295-302. Galagan, P. (2010). Ready or not? Training and Development. 64(5), 29-30. Lee, B.W. and Stapinski L.A. (2011) Seeking safety on the internet: Relationship between social anxiety and problematic internet use. Journal of anxiety disorders. 26(1), 197–205. Litman, T. (2008) The effects of extraversion on the usage of and attitudes towards Facebook. Unpublished Dissertation. University of Edinburgh. Ross, C., Orr, E., Sisic, M., Arseneault, J., Simmering, M. and Orr, R. (2009) Personality and motivations associated with Facebook use. Computers in Human Behavior. 25, 578–586. Sun, T. and Wu, G. (2012) Traits, predictors and consequences of Facebook self-presentation. Social Science Computer Review. 30(4), 419-433. Zuckerberg, M. (2010) 500 Million Stories. The Facebook Blog. 21 July 2010. <http://blog.facebook.com/blog. php?post=409753352130>

Please send reports of research studies, planned, in progress or completed, to the TILT Editor at editor@onlinetherapymagazine.com

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Research Call

SASSI Institute DSM-V Validation Study The SASSI Institute is conducting a DSM-5 validation study and for a limited time both adult and adolescent SASSI substance use screening questionnaires are available at no charge to professional clinicians. You can use the online questionnaires for free if you are willing to complete a substance use disorder symptom checklist for any client who completes a free screening questionnaire. Once you have completed the symptom checklist you will be provided with a full report on your client’s screening results. FOR MORE INFORMATION AND TO GET STARTED, VISIT: www.SASSIOnline.com

Seeking therapists to participate in research regarding young people's experience of self and relationship online. • Are you a therapist with experience of working with young people aged 18-25? • Have you had experience of young clients bringing issues relating to their internet use to therapy sessions? • Are you interested in the role that the internet has to play in young people's self-development? If you have answered yes to the above questions, would you be willing to take part in an interview, either online or face-to-face, about your experiences in this area? If so, Please contact Felicity Runchman EMAIL: felicityrunchman@hotmail.com PHONE: 07811404669 Felicity Runchman is an MA student at Regent's College School of Psychotherapy and Counselling Psychology, and a BACP accredited counsellor/psychotherapist.

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A Distance Counselor's Ohanashi* Coming to Work with People in Japan

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BY ROY HUGGINS

My name is Roy, and I practice distance counseling with English speakers in Japan. Yep, I do speak Japanese, but I work in English. I could also do online counseling here in my home state of Oregon, but Oregon isn't part of the story behind my distance practice. TILT MAGAZINE WINTER 2013

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I lived in Sapporo, Japan for three years from 2007 to 2010. My day job was teaching English to middle and elementary school kiddos as a member of the JET Program. Teaching was great, but it wasn't the profession I trained for. I wanted to get practicing counseling, even if it was an all-volunteer deal. That's when the legwork began.

"Ohanashi" means "story ." "Oh," he said with strange calm, "we don't do that." I asked him, "So what would you do if you saw someone about to commit suicide?" He thought about the words for a few seconds. "Of course, I will save his life." "And then what?" "Well, I will talk to him and try to help him before he leaves." Wait. What?

Finding My Way He was a gentle-looking young man, a cop in the coastal town of Otaru. His name was Hideki. He looked genuinely shocked. I – well, our mutual friend Rosemary, really – had just explained to him what police in America do when a mental health clinician calls and reports that they believe someone may be about to commit suicide. It took several efforts, as he kept thinking he must be misunderstanding our English. When it got through to him, he couldn't believe it.

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"Leave? They just leave?" Rosemary chimed in. "Police here don't do the same things that police in the States do. They can only arrest someone who is accused of a crime. They can't hold people for safety." "Yes," Hideki added, "I wish I could." *

I was grateful for Hideki's help, but I wanted to know more about what to do if a client was in crisis. Graduate school didn't prepare me for this Wild West situation I was in. With some

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guidance, I found a Tokyo-based American psychiatrist who had this to say: “Put yourself on the witness stand answering the lawyer who is representing the family of a suicided client who asks you: Did you have medical backup? Did they speak English? How can you see clients if you are a language teacher? What is your surrounding support system? You don’t work in a larger organization? You have to decide where your personal comfort zone is with this.” It took me a while to realize the implied cultural values here. Japanese don't put much truck in a young guy with no doctoral degree operating on his own outside of a large organization. And there are few well-recognized mental health services besides psychiatry. Also, I would get little sympathy for moonlighting on my day job, although I had the blessings of my supervisors! Unsurprisingly, the solution lay in doing as the Romans do. If Japan doesn't have the kinds of public mental health support networks I'm used to, how do Japanese people get that support? It turns out it's usually provided by families and, in some cases, employers or other larger social groups. The JET Program has a network of support people called Prefectural Advisors. They have a little bit of counseling training and a lot of resources for interfacing with the Japanese government when a JET participant is in need of help. I worked with Hokkaido's wonderful PA on several occasions during my time there, and most of my referrals now come from JET

Program PAs, who can act as local champions for our mutual clients. It's great to have a support system. The next step was finding a place to practice.

Karaoke Therapy My friend Chieko is a California LMFT who maintains her California license, although she lives and practices in Sapporo. To earn it, she finished a huge portion of her required 3,000 client contact hours in just 1 year, because that's all the time that the US government allows those on student visas to remain in the country after completing school. Japan has no regulation or licensure, so she was in a now or never situation after graduation. "If you're in a pinch, you can use a karaoke booth." She told me over Starbucks one day. "Umm, how would that work?" I was understandably skeptical. "Well, you both go in and get a karaoke booth. Then you do a session instead of singing. Or I guess you could do karaoke therapy!" "I wouldn't object to that." Really. Honestly. I wouldn't. "How is that private, though? Is that ethical?" "Like I said, you can do it in a pinch. Karaoke booths are quite private, though. No one will bother you at all." Chieko was, and still is, a great resource. I could turn to her for consultation and referral then and I still do in my distance practice.

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I've referred several distance counseling clients to her for things like couple therapy or consultations around getting Somatic Experiencing treatments. She's another great person to have on the ground. The final savior in my search for practice space, however, was my Japanese teacher, Sagarasensei. No surprise there. She got me out of a lot of rough situations during my time abroad, even so far as lending me the money to buy the computer I'm typing this article on. She wasn't using her lesson space on Sunday nights, and so for those evenings it would become my private counseling office. For the record, I did end up doing a counseling session in a karaoke booth at one point. It worked just fine. I have, over the years, learned that Japan has a different idea of confidentiality than we do, however.

Paper Walls, Close Neighbors I opened the door to my borrowed office, which would be my working space for the next two hours. There were already shoes in the genkan (the entry space where you take off your shoes.) They were dainty and feminine, although my scheduled client was male. A voice came from inside. "Hello! Are you Roy?" A woman, probably one of the assistant teachers, was washing dishes. "Yes, I'm Roy. Umm…" I trailed off, which was a way to express that something is wrong

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without actually saying so, Japanese style, and happened to also cover for the poor Japanese language skills I had at the time. She beamed at me. "Ah! You're counseling tonight, right?" "Yes. Yes, I am." "Oh, that's splendid!" She continued washing dishes. "Umm… so… Ya, I'm always busy at this time. I don't have much time to prepare before patients come, you know?" I'm pretty sure I said something like that. I was trying to imply that she should make like a tree and leaf, of course. "Oh, really?" Dishes. Dishes. She wasn't budging. "Go ahead and start preparing. I don't mind." "Yes." Giving up, I sat down and commenced fretting. Luckily, my client was a little late and she finished up and left before he arrived. *

When I start a distance counseling session, I ask my client to pick up their computer or camera and scan the room for me, so I can see if doors are closed and do other confidentiality checks. My clients want their privacy, of course, and I've not yet had any problems with this policy. It mostly acts as a safety measure. Simply closing doors and shooing other adults out of the room, however, has turned out to be not quite enough. Nearly every Japanese apartment I've been in

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wooden frames and paper, and the walls weren't necessarily much thicker. People live close together and privacy is assured by the social contract of "I'll ignore you if you ignore me." I love the creativity my distance counseling clients employ to solve these problems. One client, who lives further south, took the many box fans she had running to deal with the sweltering summer heat and placed them in a semi-circle next to the wall that separates her from her neighbor. She then sat facing away from the wall, some distance from the fans, so she got both breeze and sufficient white noise for privacy. She somehow protected her microphone from the wind, as well.

has walls that are made out of this material that is kind of bumpy and smooth on the surface, and stops sound the way a tissue stops bullets. If drywall could somehow be more flimsy, it would be this stuff. Doors are a challenge, too. You've probably seen the classic Japanese sliding door. Modern apartments still use them, and they typically don't have locks. Often, a whole wall of a room can consist of just these doors. Did I mention that they don't have locks? Locks that help keep rambunctious kiddos out of the confidential room? None of this is all that strange in Japan. Classically, the sliding doors were made with

Support On the Ground I was sitting across from Sagara-sensei in her classroom, working on pronunciation exercises. As often happened, our conversation got sidetracked into talking about the other English teachers in town and how they're doing at their respective workplaces. Lessons with Sensei were never boring for those who enjoy well-meaning gossip. Sagara-sensei is a retired 35-year veteran of the Sapporo public school system, where she taught middle school Japanese. "Sagarasensei" would usually be translated as "Mrs. Sagara" or perhaps "Sagara-teacher," but for me it's much closer in meaning to "Mom." "Roy," she reached across the table and

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TILT â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology

touched my arm, as if to interrupt our conversation with something emergent. "You are always taking care of everyone else, but no one takes care of you." I smiled, and did my best to express that she's quite wrong about that. Sensei took care of me all the time. She taught me the language and how to behave. She was there for me when I was freaking out from culture shock or someone's xenophobic rudeness. She gave me a counseling space and supported me when things went wrong in my life. She brushed these things off, of course. "Roy, Roy," she changed the subject, "what if you

stayed here when you're done teaching? You would be one of the only counselors in all of Hokkaido. Your practice would be so big!" She was right, of course. Chieko said the same thing. So did Chelle, the JET Program Prefectural Advisor for Hokkaido (our prefecture.) So did Kiku, the medical social worker who happened to go to the same graduate school I did. It was like I would be mad to leave such an opportunity. When I returned to the States and started working on my licensure contact hours, my supervisor expressed a similar sentiment. We talked about the great need for counselors in Japan and the support network I had there. Why couldn't I continue that practice, even though I'm back in Oregon? Isn't that what the Internet is for? A lot of research and due diligence had to be done after that, of course. If you're reading this, you probably know all about it. No need for more stories.

Roy Huggins, MS NCC is a mental health counselor in private practice in Portland, OR, USA. When he's not jawing about Japan, he's jawing about digital ethics, online marketing, and security and privacy issues for mental health clinicians at www.personcenteredtech.com.

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The Use of Technology in Mental Health Applications, Ethics and Practice Edited by

Kate Anthony, MSc, FBACP

Online Therapy Institute

DeeAnna Merz Nagel, LPC, DCC

Online Therapy Institute

Stephen Goss, PH.D., MBACP

Independent Consultant in Counselling, Research, Supervision and Technology in Mental Health 2010, 354 pp., 7 x 10, 6 il., 5 tables • $74.95 hard, $49.95 paper (hard) ISBN 978-0-398-07953-6 • (paper) ISBN 978-0-398-07954-3 • (eBook) ISBN 978-0-398-08447-9

Technology is revolutionizing the delivery of mental health services. In this book, the reader is introduced to the broadest possible sampling of technologies used by mental health professionals today. It contains 30 chapters on different aspects of technological innovation in mental health care from 43 expert contributors from all over the globe, appropriate for a subject that holds such promise for a worldwide clientele and that applies to professionals in every country. A wide range of styles is offered, from the individual practitioner exploring a new technology and writing anecdotally about their personal experience, to some of the world’s most experienced practitioners writing a thorough overview of a technology and its uses in the profession. In each chapter, you will find introductions to the technology and discussion of its application to the therapeutic intervention being discussed, in each case brought to life through vivid case material that shows its use in practice. Each chapter also contains an examination of the ethical implications – and cautions – of the possibilities these technologies offer, now and in the future. Technological terms are explained in each chapter for those not already familiar with the field, while the content should stimulate even the most seasoned and technologically minded practitioner. Psychotherapists, counsellors, psychiatrists, life coaches, social workers, nurses – in fact, every professional in the field of mental health care – can make use of the exciting opportunities technology presents. Whether you have been a therapist for a long time, are a student or are simply new to the field, The Use of Technology in Mental Health will be an important tool for better understanding the psychological struggles of your clients and the impact that technology will have on your practice. Further information on ethics, training and practical exploration of online therapy can be found at: www.onlinetherapyinstitute.com, whose work extends and deepens the resources made available in this volume.

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TILT – Therapeutic Innovations in Light of Technology

WIRED TO WORRY

The Meme of

DREAM Christine Korol

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What could be better than memes? Funny, shareable, and no huge investment in time. However, the reality is that many of us spend an inordinate amount of time sharing these funny, little bits of wisdom! I’ve even heard people complain that they are suffering from pinteroids!

you don’t remember from grad school), the Premack Principle involves making high probability behaviours (e.g., playing video games, spending time on Pinterest) contingent on low probability behaviours (e.g., going to the gym, eating your vegetables).

What is interesting to me to me as a therapist is noticing how people choose to spend their time. I always do my best to leverage that information when I am helping them to make more profound changes in their lives. I learned this in graduate school when we were studying the Premack Principle. If you’re not familiar with it (or

In other words, you can suggest the time that clients usually think of as “wasted time” as their reward for working towards their goals. If you go to the gym, then you get to go on Facebook. If you declutter your closet, then you can tweet as much as you want. These behaviours could also be used as a substitute, or

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replacement behaviour, for a bad habit that your client wants to stop. In this case, when you feel the urge to have a cigarette, then go on Pinterest instead and pin everything you want until the craving passes. The ultimate use of memes and other viral ideas by therapists is to create them ourselves. I think of my cartoons as a way to plant seeds and quickly educate of those who read them and start the desire for positive changes in their own lives. Maybe itâ&#x20AC;&#x2122;s a little naive to hope that cartoons could make the world a better place, but Iâ&#x20AC;&#x2122;m having fun trying.

Humour is, ultimately, inspiring and encouraging. That seems like a great goal for all of us tech savvy therapists to pursue. Life can be hard, but we can approach more lightly and I believe reach more people effectively when we are funny. Maybe we can even make change go viral!

ABOUT THE AUTHOR/ ILLUSTRATOR: Christine Korol, Ph.D. is a cartoonist, psychologist in private practice in Calgary, Canada and the host/producer of a podcast on WiredToWorry. com that provides free online anxiety and stress reduction education videos.

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The Real Motivation Behind Social Networking 24

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Aaron B

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Balick

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Poke beneath the surface and you’ll find that everybody just wants to be liked

It’s one of the simplest of words in the English language; four letters, one syllable. It comes with a nifty blue icon too, a thumbs up. I’m referring to the ‘like’ button on your Facebook page. It is operated with deceptively simple ease, just a click of a mouse, and yet it really packs a punch. You

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see, the ‘like’ button may be the simplest way yet to deploy one of the most important things that one individual can give to another: recognition. The function of intersubjective recognition can be traced right back to infant/mother interaction and is one of the most important psychodynamic functions in the development of selfhood. Given the vital function that recognition serves, its ease of deployment by way of the ‘like’ button begs a simple question to a complex set of psychological events; is clicking the like button too easy? And

just what kind of recognition are we giving?

The ways in which today’s online social networks are constructed create a heady psychological mix that belies the simplicity of its interface and the ease in which one engages with them. Such a concoction can be seen as a sort of recipe for online social interaction, souped-up for ease, convenience and a taste that will have you coming back for more. Just throw in a few cups of distraction and instant satisfaction, mix in some voyeurism with a dash of puerile curiosity, and perhaps add some exhibitionism too,

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if that’s to your taste. Mix together in a large bowl with a generous base of ease and convenience and you’re nearly there. Before you pop it in the oven it needs a good 24 to 48 hours of basting in the most important ingredient: the basic human motivation to relate. Once your social network is fully saturated with this, you can’t help but make it a great success. When Web 1.0 (so called only retrospectively) - that pioneering yet boring and static era of the Internet comprised of a series of linked contentheavy web pages - evolved into Web 2.0 - the glitzier interactive version of its former self - the world changed with it. The main difference was the development of interactivity and humanto-human connectivity (think MySpace, YouTube, Second Life, and now Twitter and Facebook). The World Wide Web was no longer a static entity, but one that regular people could interact with on a daily basis.

The consequences of these developments have been massive, ultimately icing the cake (to carry on a metaphor) that, as Marshall McLuhan (1964) described fully 39 years ago in which, “we have extended our central nervous system itself into a global embrace” (p3). This global embrace is as wide reaching as it is compelling since it combines the extension of our own relational selves through a system of interactivity designed to engage our most addictive vulnerabilities as well. Perhaps Nicholas Carr (2010), author of The Shallows: how the internet is changing the way we think, read and remember puts it best: if, knowing what we know today about the brain’s plasticity, you were to set out to invent a medium that would rewire our mental circuits as quickly and thoroughly as possible, you would probably end up designing something that looks and works a lot like the Internet. It’s not just that we tend to use the Net regularly, even obsessively. It’s that the Net delivers precisely the kind of sensory and cognitive stimuli-

repetitive, intensive, interactive, addictive – that we have been shown to result in strong and rapid alterations in brain circuits and functions . . . the Net may well be the single most powerful mind-altering technology that has ever come into general use (p115-116). As I will be arguing in my upcoming book The Psychodynamics of Social Networking (Balick, in press), the fuel for this utterly compelling development in our modern social lives is, like the ‘like’ button, another seemingly simple concept: recognition. It seems simple because we all know what recognition is, but the way recognition operates is rather more complex. Recognition is a two-way street ideally resulting in an intersubjective state that Jessica Benjamin (1988) calls “mutual recognition”. When online social networking is boiled down to its bare essentials, what do you get but a very efficient and simple technology for deploying recognition? The trouble is, mutual recognition is neither simply deployed nor simply received.

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It’s developmental Benjamin comes from the tradition of Relational Psychoanalysis, a development of Object Relations theory that has been developing since the 1980s from the original work of Greenberg and Mitchell (1983). Relational psychoanalysis has been influenced by a whole variety of disciplines outside psychoanalysis including fields as diverse as attachment theory, feminism, post-modernism, and philosophy; it is a modern and cutting edge iteration of psychoanalysis, reviving a theory and discipline that many have proclaimed anachronistic; this version is anything but. Relational Psychoanalysis, like Object Relations, sees the motivation to relate as absolutely central to human experience and the meanings that individuals make of their lives. It’s difference lies in the fact that it is fundamentally an intersubjective theory; it conceives of human psychological development not just in relation to the infant (as subject) developing in a world of objects (with an emphasis on the infant’s inner world), but rather developing in a world of subjects (other people, particularly the primary 28

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caregiver, with a mind of her own). For Benjamin (1990): The development of the capacity for mutual recognition can be conceived as a separate trajectory from the internalization of object relations. The subject gradually becomes able to recognize the other person’s subjectivity, developing a capacity for attunement and tolerance of difference (p33) The development of a capacity to manage sameness and difference is a fundamental developmental achievement in relational psychoanalysis, and continues to be a challenge throughout life. However, the nature of the individual’s upbringing will have a large part in that person’s ability to tolerate difference. For example, does the primary caretaker wish to really recognise the growing infant as a subject in his own right, or does she see him as an extension of herself? The way in which a subject makes their way through early relational challenges will deeply influence both their selfhood and relational patterns as an adult.

The work of British Psychoanalyst Donald Winnicott occupies an important position in relational thinking due to his concepts of “good enough mothering” and the “facilitating environment”. His famous statement that there is no such thing as a baby (Winnicott, 1964) is a fundamentally intersubjective statement, indicating the mother/infant relationship is an important coconstructed space. His further development of the concept of the “false self” that the infant creates to meet the needs of his mother (where she is unable to meet his “difference”) is another helpful tool in understanding the dynamics of recognition. The false self (and similarly the persona in Jung) develops in the direction of interpersonal or social compliance. The infant seeks to be authentically recognised by

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her primary caretakers, but also seeks and finds enjoyment in the discovery of the subjectivity of the other. The continued operation of seeking and being sought continues throughout life as one of our greatest relational pleasures and difficulties. The pleasures results from these moments of authentic mutual recognition whereas the difficulties revolve around managing narcissistic self-states (of the self and/or the other) and the function of the false self catching most of the attention (recognition) at the expense of the true self; a series of events that leads TILT MAGAZINE WINTER 2013

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to a feeling of alienation from the self, or a sense of being fraudulent.

Seeking and being sought online I have written elsewhere (Balick, 2012) that these days a lot of the seeking and being sought occurs online. In my paper “TMI in the transference LOL” I tell a story about how a client found some information about me in a Google search that fundamentally changed the nature of our therapy together. I came to understand these virtual events that shift the nature of a relationship as “virtual impingements”. A virtual impingement is defined as “any event that happens in relation to a person by way of the virtual world, which is experienced as an intrusion on the self” (p125). We can assume that impingements of this sort occur online all the time between individuals in and out of therapy. Those fortunate enough to experience them while in therapy have the opportunity to explore them at a deeper level. It is important to see the world of online social networking as

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the sin qua non of our online relational selves. It is an arena where the desire to seek and be sought is in full throttle. As online social networks are outward facing, they call upon the facilities our ego has of facing outwards, that is, the false self or persona. Both of these concepts are closely related as they refer to the mask we use to operate in the public realm. It is important, however, not to get caught up in the word “false”. We all develop a false self in relation to our strengths and capacities, so it is not “false” at all, but as real as any other part of us. It is, however, deployed with the aim of social compliance and is therefore not a fully free expression of our authentic selves (which is itself a complex and problematic concept).

When the psychodynamic functions of false/true self and the motivation for mutual recognition are combined with the ease, convenience and architecture of the online social network, you can see how the social network is replete with opportunities and challenges. In one sense, recognition is so easily acquired over the social network (Look! He “liked” my comment; Great, she followed me!) many of these acquisitioned are gained by the persona or false self. Does the true or “real” self get neglected in this transaction? Benjamin (1988) draws our attention to the importance of real authentic recognition:

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It is important to see the world of online social networking....as an arena where the desire to seek and be sought is in full throttle. Recognition is so central to human existence as to often escape notice . . . it appears to us in so many guises that it is seldom grasped as an overarching concept . . . to recognize is to affirm, validate, acknowledge, know, accept, understand, empathize, take in, tolerate, appreciate, see, identify with, find familiar . . . love (p15–16). A cursory glance at Benjamin’s verbs above will show you just how closely these psychic needs align with the functions of your favourite social network. The “like” button on Facebook alone can be used to recognize, affirm, validate, acknowledge, know, accept, understand, appreciate, or find familiar with. A few comments on a wall will fill in the details for the rest. While these functions no doubt do a job, they also beg the question of whether

or not the simplicity and ease of delivering such sought after ego needs “fill the jar” as it were, of good psychological health. Additionally, the ease with which misrecognition can occur over the social network also has to be taken into account. With such dispatch can we deliver virtual impingement too.

The Role of Mental Health Professionals Mental health professionals have a complex role in relation to the fast moving online world of social networking. On the one hand it is imperative that they come to understand the nature of the online social network as a fully psychological phenomenon that needs theorising and understanding more fully. While there is currently a great deal of research in the field on this subject, most of

it is largely quantitative or survey based and does not adequately address the deep psychodynamic meaningmaking that is so central to our experience of social networking: more qualitative work is needed in this area. Research like this is particularly important for children and younger people, those that Palfrey and Gasser (2008) call “Digital Natives”; those who have grown up fully saturated in digital culture and do not make a distinction between online and offline lives. It is the online arena where these young people will be seeking much recognition, and we have yet to fully learn the way in which recognition deployed on social networks fully operates. Another challenge facing mental health professionals is their own use of the social network, and how their presence and accessibility in the virtual world has consequences for their own personal lives, and TILT MAGAZINE WINTER 2013

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the lives of their clients. Where many psychotherapists were once wary of being publically available through online social networks, as these networks have become more and more a regular part of everyday life, this becomes less likely. What does our availability and accessibility as therapists existing online mean to present and future clients? How does one deal with a virtual impingement when it is instigated (purposefully or not) by a therapist towards his or her client? These questions bear serious thinking about by mental health professionals. The computer scientist Kranzberg (1986) famously stated that “Technology is neither good nor bad, nor is it neutral.” Sherry Turkle (2011) pithily informs us that “Technology proposes itself as the architect of our intimacies” (p1). The combination of these two statements makes an important synergy. It puts into perspective the nature of an online world that has an architecture and for this reason is not neutral. Yet this architecture mediates our intimacies. In many ways, the more virtual we become, the more dependent we are on this architecture. We retain, however, the free will with 32

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which to choose how we interact across this architecture. Dini (2009) describes the multitude of ways in which patients utilise the Internet: Patients can use the internet for purposes that actualize or accentuate either adaptive or pathological functioning. Because of the nature of internet interaction, users can be secretive or deceiving, exhibitionistic or voyeuristic, to a degree and in ways never before possible. For example, the simultaneous increase of shame and of modes for tension regulation around it can lead to conflictual feelings and, often, dissociative defenses. A need of community has always existed, but as the nature of community is changing, the internet may lend a capacity to distorted defenses and methods of relating in ways with which we, as therapists, are familiar (p982). I don’t think that Dini is being hyperbolic here when she states that the very nature

of community is changing. In reference to Kranzberg’s (1986) statement, this change is neither good nor bad, but it is equally not neutral. Psychotherapists and the role of psychotherapy in today’s society cannot avoid the issue from the comfort of the consultation room, which is rightly in many ways, cut off from the high-speed world of online relating. Though readers of this magazine are presumably more familiar with online dynamics than the wider field is likely to be, there is no doubt great mileage to be had in thoughtfully applying developmental psychodynamics to the ways in which we operate and think about our subjectivities within the online world.

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Conclusion John Naughton (2012) compares the development of the Internet (and particularly Web 2.0) to the Gutenberg press and notes that within the first 20 years of its invention society would never have guessed that this invention would challenge the authority of the Catholic church, trigger the Protestant revolution, facilitate the rise of the modern scientific enterprise and create entire new social classes (p13). We too are within the first 20 years of an invention that is bound to challenge aspects of familiar cultural life that we cannot even begin to understand: . . . anyone hoping that the turbulence wrought by the Internet will eventually subside, and that

things will eventually level out, is doomed to disappointment. The complexity of our emerging media ecosystem, together with the ‘permissionless innovation’ that is facilitated by the Internet, make a return to stability is an unlikely prospect. Instead, our future will be one that is characterized by ongoing disruptive innovation. The good news is that we will adjust to this new realty, just as we have always done in the past. Humans are an adaptive species, and we are good at building tools that help us to cope with changing circumstances (Ibid., p182). I concur with Naughton’s hope in the faith in the adaptive

nature of the human species in the face of unknowable change. Psychoanalysis emerged at the frontier of the great unknown of the human unconscious and Freud stood at the precipice and looked forward with great anticipation. He delayed the publication of his first major work of psychoanalysis The Interpretation of Dreams (completed in 1899) to 1900 as he wanted its date of publication to be at the start of the gleaming new century. Few would have guessed that Freud would have the Gutenberg of the unconscious and fundamentally shifting the way the 20th century West would understand individuals, culture and society. Few now would think that the insights of a man born in the middle of the 19th century might have something to tell

The “like” button on Facebook alone can be used to recognize, affirm, validate, acknowledge, know, accept, understand, appreciate, or find familiar with.

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us about a technology that, to him, would have been unfathomable. However, psychoanalysis was born in the face of the unfathomable; and Freud’s heirs are up to the task. ABOUT THE AUTHOR Dr. Aaron Balick is a UKCP registered psychotherapist, supervisor and psychological consultant in London; he is also an honorary lecturer at the Centre for Psychoanalytic Studies at the University of Essex. As a founding and executive member of The Relational School UK he works to develop and promote contemporary relational thinking in the UK and abroad. He is a media spokesperson for the UKCP and resident psychotherapist on BBC Radio 1's phone-in show, The Surgery with Aled. Aaron will have two books published in 2013, The Psychodynamics of Social Networking: connectedup instantaneous culture and the self and a book for children entitled Keep Your Cool: how to deal with life's worries and stress. His blog is here and he can be contacted on Twitter via @ draaronb. 34

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References: Balick, A. (2012). TMI in the transference LOL: psychoanalytic reflections on Google, social networking, and ‘virtual impingement.’ Psychoanalysis, Culture and Society. 17(2): pp. 120 – 136. Balick, A. (in press for 2013). The Psychodynamics of Social Networking: connected up instantaneous culture and the self. London: Karnac. Benjamin, J. (1988). The Bonds of Love: psychoanalysis, feminism, and the problem of domination. New York: Pantheon. Benjamin, J. (1990) An outline of intersubjectivity: The development of recognition. Psychoanalytic Psychology 7S:33–46. Carr, N. (2010). The Shallows: how the Internet is changing the way we think, read and remember. New York: W. W. Norton and Co. Dini, K. (2009). Internet interaction: the effects on patients’ lives and analytic process. Journal of the American Psychoanalytic Association. 59 (4). 979 – 988. Greenberg, J. and Mitchell, S.A. (1983). Object Relations in Psychoanalytic Theory. Cambridge, MASS: Harvard University Press. Kranzberg, M. (1986). Technology and History: Kranzberg’s laws. Technology and Culure. 27(3). 544 – 560. McLuhan, M.(1964): Understanding Media. New York: Mentor Naughton, J. (2012). From Gutenberg to Zuckerberg; what you really neeed to know about the Internet. London: Quercus. Palfrey, J. And Gasser U. (2008). Born Digital; understanding the first generation of digital natives. New York: Basic Books. Turkle, S. (2011). Alone Together: why we expect more from technology and less from each other. New York: Basic Books. Winnicott, D.W. (1960). Ego distortion in terms of true and false self. The Maturational Processes and the Facilitating Environment: studies in the theory of emotional development. Ed. J. Southerland. London: The Hogarth Press. 140-152. (1982). Winnicott, D.W. (1964). The Child, the Family and the Outside World. London: Penguin.

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REEL CULTURE Jean-Anne Sutherland

Tedium: Marriage & Couples Therapy in Hope Springs Back in March there was a New York Times article which asked, “Does Couples Therapy Work?” In this article the author explored the myriad problems that exist for therapists attempting to treat struggling couples. One of the key issues, the author points out, is the lack of empirical and theoretical insights that distinguish couples therapy from individual therapy. Often a therapist can jump in there with the same bag of tools she might bring to individual therapy only to find those tools lacking. Couples therapy, it turns out, is a unique bird that requires unique approaches. You run into anger and volatility, issues of allegiance, and depression and anxiety that might exist separately from the spousal relationship. David Frankel’s new film, Hope Springs takes a close look at a marriage that has been bled dry and the process of plodding through couples therapy. In this film, Kay (Meryl Streep) and Arnold (Tommy Lee Jones) are a middle aged couple, mired in routine and boredom. His back problems led him to a separate bedroom years prior, where he

remains, contributing to the dearth of intimacy in their marriage. Each morning she places his breakfast before him – same thing each day; egg and toast. He eats, reads the paper, kisses her habitually on the cheek and departs for work. Each evening he falls asleep in his recliner, ESPN on the television. Like Sam Sheepdog and Ralph Wolf in the old Bugs Bunny cartoons, Kay and Arnold carry on the proverbial clock-in each day, stepping into their roles as the dutiful husband and wife. The problem is, Kay wants more. And so she insists that the couple attend a week-long therapy session with renowned couples therapist Dr. Feld (Steve Carell). The twist and perhaps the wisdom of this movie is that the process of therapy is portrayed as sluggish and grueling. Rather like real life. Unlike the couples therapy in Couples Retreat (2009), Hope Springs does not depict therapy as a high-jinx adventure with dancing, jet skiing, and a backdrop of tropical Eden. While Couples Retreat did illustrate the array of potential issues that couples face (again, the boredom of routine in particular), it also, ala Hollywood, made the process look silly and then easily resolved. I must admit that I expected something akin to this in Hope Springs when I saw that Steve Carell was cast as the therapist. We usually know Carell as funny so there was a certain expectation that the therapist in this film would be absurd, on some level. Turns out, Carell plays TILT MAGAZINE WINTER 2013

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the entirety of the therapy experience and each nickel that the couple spends on something he deems unnecessary. Yet Kay is no victim in the relationship. She fully recognizes that the life she is living is vacant and devoid of an intimacy that she feels herself capable of. In one telling moment with Dr. Feld, she says of Arnold and the marriage, “He is everything. But I'm... I'm really lonely. And to be with someone, when you're not really with him can... it's... I think I might be less lonely... alone.” With tremendous courage she realizes that life without Arnold might actually be less lonely than the tedium of their status quo. Her bravery eventually snaps her husband’s attention to the fact that she is not a “given.” She does expect more and she will leave if things remain unchanged.

BUY NOW Dr. Feld straight. And he’s not a bad therapist, actually. The process of getting Kay and Arnold to divulge and take chances is slow-moving and careful. Minus any “chase scenes” or bikini-clad extras, Hope Springs focuses on the dialogue and the real pain involved in opening something that has been so long closed. Streep plays Kay as both strong (after all, she insisted on this therapy experience, telling Arnold that she was going with or without him) and at the same time down-trodden after years and years of Arnold’s relentless, cranky complaining. She silently walks beside him in the grocery store when he insists they buy cold-cuts and eat in their hotel room rather than waste money in a restaurant. Arnold berates Dr. Feld’s demeanor,

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Hope Springs can perform as an interesting tool in the process of couples therapy. Asking couples to watch the film together will no-doubt make them uncomfortable. It’s often hard as an audience member to watch Kay and Arnold’s terror and embarrassment as Dr. Feld explores their sexual relationship with them. While the film captures therapy as a difficult process, it also suggests that it is ultimately doable with tremendous courage and a bit of humor. It’s also a good film for therapists to watch as it allows them to step into the shoes of Kay, Arnold, and Dr. Feld. It’s an unusual Hollywood film in that avoids many of the old therapy clichés, instead depicting a process that is wrenching yet in the end rewarding.

Jean-Anne Sutherland, Ph.D. is assistant professor of sociology at University of North Carolina Wilmington, USA with one of her research focuses being sociology through film.

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ETHICAL FRAMEWORK for the Use of Technology in Supervision LoriAnn S. Stretch, DeeAnna Nagel and Kate Anthony TILT MAGAZINE WINTER 2013

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Introduction Distance delivery of mental health services is becoming a norm in the field of mental health (Shallcross, 2012), and the American Counseling Association (ACA, 2005), the National Board of Certified Counselors (NBCC, 1997, 2009, 2013), and the Center for Credentialing and Education (CCE, 2011) have all recognized the need for ethical guidance. NBCC (2013) recognizes that distance services, including distance supervision, create unique ethical challenges. State counseling boards and other credentialing organizations are

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also beginning to recognize the need for distance clinical supervision as a means for providing access to qualified clinical supervisors who can support practitioners providing traditional and distance mental health services. In 2010, McAdams and Wyatt found that 14 states had regulations regarding distance counseling, six states had regulations regarding distance supervision, and many others had regulations in development. As Orr (2010) noted, good supervision should be dependent on the quality of the skills of the supervisor, not upon proximity

to the supervisee. Bernard and Goodyear (2004) note that supervision is a process whereby a counselor with less experience learns how to better provide services with the guidance of a counselor with more experience and skill. Supervision is distinct from teaching in that the curriculum is individually determined by the supervisees and their clients. While some of the existing literature provides some guidance for distance supervision (ACA, 2005; NBCC, 1997, 2009, 2013; CCE, 2009), most of the available guidelines focus on the delivery of

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distance counseling. Anthony and Jamieson (2005) created a set of guidelines for supervisors for the British Association for Counselling & Psychotherapy, updated by Anthony and Goss in 2009. They recognized that supervisors providing distance clinical supervision must understand the unique considerations related to client consent, confidentiality, and data protection/storage when offering online supervision. The following framework is written to consolidate the best practices related to distance supervision which â&#x20AC;&#x153;may include telecounseling (telephone), secure email communication, chat, videoconferencing or computerized stand-alone software programsâ&#x20AC;? (CCE, 2011, Âś 3). Sources reviewed included Anthony and Nagel (2009); Barnett (2011); Burrak (2008); Chapman, Baker, Nassar-McMillian, and Gerler (2011); Dawson, Harpster, Hoffman, and Phelan (2011); Durham (2001); Hurley & Hadden (2009); Lenz, Oliver, and Nelson (2011); Nelson, Nichter, and Henriksen (2010); Orr (2010); and Watson (2003). The goal was to combine best practices from supervision with the realities of using technology.

Ethical and Statutory Considerations

will be maintained in the respective record(s).

Supervisors must demonstrate and promote good practice by the supervisee to ensure supervisees acquire the attitudes, skills, and knowledge necessary to protect clients. Supervisors and supervisees must research and abide by all applicable legal, ethical, and customary requirements of the jurisdiction in which the supervisor and supervisee practice. The supervisor and supervisee must document relevant requirements in the respective record(s). Supervisors and supervisees need to review and abide by requirements and restrictions of liability insurance and accrediting bodies as well.

Supervisor Qualifications

Informed Consent Supervisors will review the purposes, goals, procedures, limitations, potential risks, and benefits of distance services and techniques. All policies and procedures will be provided in writing and reviewed verbally before or during the initial session. Documentation of understanding by all parties

Supervisors will only provide services for which the supervisor is qualified. The supervisor will provide copies of licensure, credentialing, and training upon request. The supervisor will have a minimum of 15 hours of training in distance clinical supervision as well as an active license and authorization to provide supervision within the jurisdiction for which supervision will be provided. Supervisors providing distance supervision should participate in professional organizations related to distance services and develop a network of professional colleagues for peer and supervisory support.

Supervisee and Client Considerations Supervisors will screen supervisees for appropriateness to receive services via distance methods. The supervisor will document objective reasons for the

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supervisee’s appropriateness in the respective record(s). Supervisors will ensure that supervisees screen clients seeking distance services for appropriateness to receive services via distance methods. Supervisors will ensure that the supervisee utilizes objective methods for screening clients and maintains appropriate documentation in the respective record(s). Supervisors will ensure that supervisees inform clients of the supervisory relationship

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and that all clients have written information on how to contact the supervisor. Written documentation of the client acknowledging the supervisory relationship and receipt of the supervisor’s contact information should be maintained in the respective record(s). Supervisors will only advise the supervisee to provide services for which the supervisee is qualified to provide. Clients and supervisees must be informed of

potential hazards of distance communications, including warnings about sharing private information when using a public access or computer that is on a shared network. Clients and supervisees should be discouraged, in writing, from saving passwords and user names when prompted by the computer. Clients and supervisees should be encouraged to review employer’s policies regarding using work computers for distance services.

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Modes of Communication Supervisors will review written procedures for the use of distance communication, including telephone, chat, email, social media, and other distance technology. There will be a clear delineation between professional and personal accounts. Social media and methods of communication that are not encrypted end-to-end should never be used as a means of communicating confidential information. The supervisor and supervisee will document modes of communication that are acceptable, how frequent communication should be, what a reasonable response time is, when to use asynchronous versus synchronous communication, and what to do in emergency/ crisis situations. Supervisors and supervisees are also encouraged to discuss temporal, cultural, and lingual differences that may impact the supervisory process. Supervisors will review written procedures for verifying the identity of the supervisee during each contact. The

supervisor and supervisee may wish to use a code name or password to verify identities and protection of confidential information. Passwords or codes will be generated using a password protocol thereby reducing the opportunities for being compromised. Supervisors will ensure that supervisees utilize identify verification methods with clients receiving distance services. Supervisors and supervisees are encouraged to use asynchronous communication for logistics only and to use synchronous discussions (chats and video discussions) to negotiate professional boundaries and develop therapeutic/supervisory relationship. Emergency/crisis procedures will include a list of qualified professionals in the superviseeâ&#x20AC;&#x2122;s location who have agreed to serve as back up local supervisors on an emergency basis. Supervisors and supervisees are encouraged to write out thoughts and feelings and to use symbols to convey nonverbal communication to reduce opportunities for

miscommunication. Likewise, supervisors and supervisees are encouraged to use common language in text communication rather than shortened online abbreviations and to ask the meaning of any abbreviations that are not understood by either party to increase clarity of communication.

Technological Issues Supervisors and supervisees need to discuss the challenges of using technology and develop an alternative means of communication should technological difficulties be experienced. Time to deal with technological difficulties should be incorporated into the overall supervision scheduling, especially during the initial sessions. Supervisors and supervisees are encouraged to schedule a session prior to the initiation of distance supervision to become familiar with the technology and work out any issues, such as firewalls, low bandwidth, and Internet access.

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Supervisors and supervisees need to develop and implement a written plan for reconnecting should a synchronous meeting experience technical difficulties. There should be a pre-arranged procedure for reconnecting or rescheduling the meeting.

Contract Supervisors and supervisee will negotiate an explicit, written contract outlining 1. full contact information for the supervisor, including telephone numbers, fax number, email, and address; 2. the listing of degrees, credentials, and licenses held by the supervisor; 3. general areas of competence for which the supervisor can provide supervision (e.g. addictions, school, career, distance services); 4. a statement documenting training in supervision and experience in providing supervision; 5. a general statement addressing the model of or approach to supervision,

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including role and responsibilities of the supervisor, objectives and goals of supervision, and modalities (e.g., recordings, live observation);

the benefits and limitations of using distance technology in the supervision process.

Records

6. a description of the specific evaluation criteria and the formative and summative evaluation process that will be used throughout the supervisory relationship;

The supervisor, in collaboration with the supervisee, will maintain a log of clinical supervision hours that includes:

7. a statement defining the limits and scope of confidentiality and privileged communication within the supervisory relationship;

2. supervision start and stop times;

8. a fee schedule and payment arrangements, if applicable; 9. the emergency contact information for the supervisor and a list of back up supervisors local to the supervisee; 10. disclosure, confidentiality breaches, security, and encryption policies; 11. frequency of supervision; 12. dates for review of the contract; and 13. how to address conflict and what the grievance process is for issues that cannot be resolved. Supervisors will also discuss

1. the date of the supervision session;

3. the modality of supervision provided, such as direct (live) observation, cotherapy, audio and video recordings, and live supervision; 4. documentation of all written communication during the supervisory relationship, such as chat histories, texts, instant messages, emails; and 5. notes on recommendations or interventions suggested during the supervision. Supervisors should maintain copies of clinical supervision logs for a minimum of five years or the legally mandated time, whichever is

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longer, beyond termination of supervision and will provide copies to the state counseling boards and other credentialing/professional organizations upon request.

Security, Encryption, and Confidentiality Supervisors need to consider three aspects regarding data related to federal security laws: integrity, availability, and confidentiality. Supervisors and supervisees will need to back up ePHI (electronic protected health information) incrementally, Monday through Thursday, with a full back

up on Friday. Backup media should be stored offsite with a HIPAA complaint (in the USA) cloud or similar encrypted technology. Supervisors and supervisees must have written policies regarding backups as well as training for anyone handling ePHI. The National Institute of Standards and Technology (NIST) 800 series of documents provide guidance for compliance with federally mandated regulations (see http://www.nist.gov). The supervisor and supervisee will implement procedures preventing the disclosure of confidential information. The supervisor and supervisee

must be in a secure and private location while conducting supervisory sessions or consultations. Supervisors and supervisees must identify who might have access to confidential information and take precautions to prevent disclosure of confidential information, such as password protecting computers and profiles. Identifying information about a client should not be used in any form of distance communication. Clients need to be identified by a code name or other means understood only by the supervisor and supervisee.

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TILT – Therapeutic Innovations in Light of Technology

Client information of any sort may not be forwarded, copied, or blind copied to anyone without the explicit consent of the client. Supervisors and supervisees should agree how communications and recordings will be stored. Communications related to the supervisory relationship may not be forwarded, copied, or blind copied to anyone without the explicit consent of all parties, unless in accordance with grievance policy outlined in the supervisory contract or in cases where there is a risk of serious harm. Any communication disclosure must be documented in the respective record(s). Both parties need to agree upon whether or not supervisory sessions are recorded and if so how these will be secured for confidentiality, how long recordings will be archived, and how they may or may not be used. Clients must give written consent to be recorded and be informed in writing how recordings used in supervision will be stored, archived, and destroyed.

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About the authors Loriann Stretch, is a Licensed Professional Counselor Supervisor, a National Certified Counselor and an Approved Clinical Supervisor. She is nearing the completion of her national credential as a Registered Play Therapist and a Distance Credentialed Counselor. She is based in Clayton, NC. DeeAnna Nagel and Kate Anthony are co-CEO’s of the Online Therapy Institute and the Online Coach Institute, and co-Managing Editors of TILT Magazine. They are based in Highlands, NJ and Scotland, UK respectively.

Gatekeeping

Research

Supervisors should utilize objective information about a supervisee’s professional skills and performance to determine if a supervisee should be endorsed academically or professionally. Supervisors will review the specific criteria being used for evaluation during the initial session(s) and will review and document the supervisee’s progress throughout the supervisory relationship through formative and summative evaluation. Supervisors will not endorse any supervisee whom they believe to be impaired professionally. The supervisor will document concerns in writing and review the concerns with the supervisee, when possible.

Research utilizing distance services must adhere to all relevant legal and ethical standards and must take into consideration the unique challenges of distance technology. Supervisors and supervisees seeking to use data collected through distance supervisory relationships must have the relevant training regarding the unique challenges of distance technology. Information gained through distance services may only be used in research with the explicit, written consent of all parties. n

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REFERENCES American Counseling Association. (2005). Code of ethics and standards of practice. Alexandria, VA: Author. Anthony, K., & Goss, S. (2009). Guidelines for online counseling and psychotherapy (3rd ed.) including guidelines for online supervision. Lutterworth, U.K.: British Association for Counselling & Psychotherapy Anthony, K., & Jamieson, A. (2005). Guidelines for online counseling and psychotherapy (2nd ed.) including guidelines for online supervision. Rugby, U.K.: British Association for Counselling & Psychotherapy Anthony, K. & Nagel, D.M. (2009). Therapy online: A practical guide. Sage Publishing: London. Barnett, J. E. (2011). Utilizing technological innovations to enhance psychotherapy supervision, training, and outcomes. Psychotherapy, 48(2), 103-108. doi:10.1037/a0023381 Bernard, J. M., & Goodyear, R. K. (2004). Fundamentals of clinical supervision. Boston: Pearson Education. Burrak, F. (2008). Using videoconferencing: Technology to enhance supervision of student teachers. Apple Learning Interchange, Retrieved Edcommunity at apple.com Center for the Credentialing and Education (2011). Distance credentialed counselor (DCC). Greensboro, NC: Author. Chapman, R., Baker, S.B., Nassar-McMillian, S.C, & Gerler, E.R. (2011). Cybersupervision: Further examination of synchronous and asynchronous modalities in counseling practicum supervision. Counselor Education & Supervision, 50(5) 298-313. Dawson, L., Harpster, A., Hoffman, G., & Phelan, K. (2011). A new approach to distance counseling skill development: Applying a discrimination model of supervision. Retrieved from http://counselingoutfitters.com/vistas/ vistas11/Article_46.pdf Durham, T. G. (2001). Clinical supervision of alcohol and drug counselors: An independent study course. East Hartford, CT: ETP, Inc. Hurley, G., & Hadden., K. (2009). Online video supervision: A case study. Retrieved from the National Register of Health Services Providers in Psychology. Lenz, A. S., Oliver, M., & Nelson, K W. (2011). In-person and computer-mediated distance group supervision: A case study. Retrieved from http://counselingoutfitters.com/ vistas/vistas11/Article_67.pdf McAdams III, C. R., & Wyatt, K. (2010). The regulation of technology-assisted distance counseling and supervision in the United States: An analysis of current extent, trends, and implications. Counselor Education & Supervision, 49(3), 179-192. Retrieved from EBSCOhost. National Board of Certified Counselors. (1997). Standards for the ethical practice of webcounseling. Greensboro, NC: Author. National Board of Certified Counselors. (2009). The practice of internet counseling. Retrieved from http://www.nbcc. org/Assets/Ethics/internetCounseling.pdf National Board of Certified Counselors. (2013). NBCC policy regarding the provision of distance professional services. Retrieved from http://www.nbcc.org/Assets/Ethics/NBCC Policy Regarding the Practice of Distance Counseling -Board - Adopted Version - July 2012- PDF. Nelson, J. A., Nichter, M., & Henriksen, R. (2010). On-line supervision and face-to-face supervision in the counseling internship: An exploratory study of similarities and differences. Retrieved from http://counselingoutfitters. com/vistas/vistas10/Article_46.pdf Orr, P.P. (2010). Distance supervision: Research, findings, and considerations for art therapy. The Arts in Psychotherapy, 37, pp. 106-111. Shallcross, L. (2012). Finding technology's role in the counseling relationship. Counseling Today, 54(4), 26-35. Watson, J. C. (2003). Computer-based supervision: Implementing computer technology into the delivery of counseling supervision. Journal of Technology in Counseling, 3(1). Retrieved from http://jtc.colstate.edu/ vol3_1/Watson/Watson.htm

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STUDENT SPOTLIGHT

TILT – Therapeutic Innovations in Light of Technology

TILT MAGAZINE WINTER 2013

This issue introduces a new regular column placing students in the spotlight! Since the premiere issue of TILT Magazine, we have featured Day in the Life Columns spotlighting online therapists and online coaches. Now we are changing up the focus with this regular column featuring a student in-training. The Online Therapy Institute/Online Coach Institute and training partner, The Institute for Life Coach Training will feature a student at either Institute with an article about the use of technology in therapy and/or coaching. Since we recently changed our e-learning format to include more individualized consultation with each student, we have many “Written Assignments” from students that are worthy of publication. We will hand-pick from these written assignments and with permission from the student; we will publish their work here. Each time we receive a completed assignment we have the opportunity to learn ourselves as we coach students to embrace and implement technology into their practices. In addition, the platforms we use both at ILCT and OTI/OCI introduce students to technology during the learning process. Our self-paced courses are taught using an online coaching platform powered by Jigsawbox. Students read articles, view videos, engage in experiential exercises and submit written assignments along the way. We “coach” each student throughout the learning process by commenting on written assignments and dialoguing along the

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way about specifics related to their individual situation. In this way, we can focus down on tailored learning. Students also have access to discussion forums during their learning as well. If the students are enrolled in our Therapy or Coach Specialist Certificate/Certification Programmes they have access to our Supervision Forum while enrolled in the programme and thereafter. The Supervision Forum provides a place to discuss case material with peers and trained supervisors. The learning and supervision take place in a secure and encrypted online environment. During our 16-week Intensives we supplement the self-paced learning with webinars every two weeks. Our webinars are live and interactive with a chat room and audio capability, and most of all, the webinar is easy to access! We chose Scribblar because of the crisp presentation, white board features, clear audio and ease of use. At ILCT, students are enrolled in the Coaches Community powered by JournalEngine where lively discussions and course information is offered. Ellen Neiley Ritter, PhD, Director of Student Development at ILCT has this to say about the use of technology and JournalEngine: “Technology has made a significant difference at ILCT. A few years ago, we were printing and

shipping materials to students in the more than 30 classes which began each month. Now, thanks to JournalEngine, we are not only able to deliver the course manuals to students electronically, but even more importantly, we are able to create an online “room” for each class, giving students and instructors a place to converse, share resources, and “see” each other, and others as part of our schoolwide Coaches Community. The JournalEngine platform offers us the opportunity to develop a library of valuable coaching resources, have forums where students can ask discuss topics of interest, share journal entries with their coaches, and even advertise upcoming events of interest to Coaches Community members. And now with our affiliation with OTI/OCI, ILCT is able to offer high quality coaching courses that are self-directed, especially important for students with busy schedules.” At OTI/OCI we are committed to providing an enriching learning experience. Whether you are on a journey to a new career, or you are taking a class or two to enhance your professional development, we have the tools and resources to help you succeed. n See our Cyberstreet column this issue, pg 7 for a discount offer from OCI/ILCT!

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TILT – Therapeutic Innovations in Light of Technology

Cyber Supervision Anne Stokes

Humans have been weaving for at least the last thirty thousand years to make useful and decorative objects. Originally this was done using hands as a simple loom, but later separate looms were developed. This enabled the hands to weave the weft across the warp, producing more complex designs and objects. Why am I telling you this? What has it got to do with online supervision?

......

Recently during the Diploma in Online Therapeutic Supervision, a student presented a session considering how Holloway’s Systemic Model of Supervision might be used in online

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supervision. I was reminded of the wonderful poem at the end of her book (Holloway, 1995) where she includes the metaphor of weaving. As part of my ‘previous self’ was a textiles teacher and a weaver, I began to play with the idea of what a weaving of online supervision might be. In my mind, the loom is formed by all my previous experience as counsellor and supervisor over the last three decades. So you’ll find my trainings in both fields, models of supervision that I’ve found useful, and research that has underpinned them. Mostly this relates to my face-to-face work, but it’s this structure that enabled me move on and create a new work as an online supervisor.

Without it, I couldn’t have made this weaving. Now that I have, I’m able to put the loom aside; I won’t throw it away, as it will be useful again in the future. The warp threads are those holding my model of online supervision in place, and need to be strong and reliable. In my particular, the most important weaving is the relationship. That’s fundamental and unless I develop this with my online supervisees, the whole weaving will fall to bits fairly quickly. It takes time to put in place but is worth it. Other warp threads are my experience of online supervision as supervisee and supervisor. Some of these are dark and less attractive, while others are bright and colourful.

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The Warp & Weft of Online Supervision There are also a few threads in the warp that are models and research around online supervision. Sadly there aren’t too many of these; hopefully in future weavings, I’ll be able to find more I can use as the warp! Weft threads are ones most seen. Here’s my individuality, my personality. See my supervisees – lines across the weaving, or patches of colour or texture within it; even additions to my weaving, small individual weavings, attached to the main one. There’s the gap in the weft, representing the space in online supervision to ‘play’ with ideas, understandings, hunches etc. I’ve enjoyed weaving my personal model of online

supervision. It’s unique, and first in a set of weavings that will develop over time, since I’m unlikely ever to arrive at a perfect one. Indeed, I don’t want to, as that would imply I’ve reached the end of my useful life as an online supervisor. I invite you to ‘weave’ your own model – in your minds even if not in reality. (with thanks to Rosie for reminding me of the poem!)

Reference Holloway, E. (1995) Clinical Supervision: A systems approach. Sage, California.

ABOUT THE AUTHOR Anne Stokes is based in Hampshire, UK, and is a well-known online therapist, supervisor and trainer and Director of Online Training ltd. She can be contacted at anne.stokes4@ btinternet.com.

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TILT – Therapeutic Innovations in Light of Technology

NewInnovations

Innovative Online Counseling Referral Programs (Part 2) Jay Ostrowski

eferrals are the lifeblood of any online or offline counseling practice. You may have already noticed that the biggest challenges to creating an online practice often do not involve technology, legal issues or even reimbursement. The biggest challenge typically is creating a consistent flow of client referrals. My hope is that the illustrations provided here will either work for you or that the principles will help spark other innovative ideas for you.

A Programmatic Approach. For marketing to be successful,

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it must be consistent. Even poor marketing methods performed consistently generate results due to market exposure. In the same way, great marketing ideas often flop because they are only performed once, poorly executed or performed inconsistently. A referral program is a step-by-step process by which clients go from the referral source’s recommendation to seeing you on the screen in your online counseling venue. It’s a system for generating client referrals and ensuring that they show for their first appointment. Many great therapists start a private practice and soon go out of business just because

they are starved for clients. They didn’t know how to (or didn’t know they needed to) develop a referral program. Lacking local advantages, online practices have an even bigger need for a referral program. Online practices are different from face-to-face ones and require a slightly different marketing approach. Online counselors sometimes come and go because they lack effective and sustained ways to gain new clients. Like many face-to-face counselors who are new to business, they hope that getting referrals would be as easy as creating a website or a blog. In reality, new services take a lot of promotional work

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and perpetual marketing for a period of time to gain traction. However, the definition of “time” can be greatly abbreviated by applying sound marketing principles and a little creativity.

Leverage Local Relationships. Websites are necessary and occasionally generate referrals, but referrals for online counseling will come more quickly and consistently through relationships. Clients want to find a caring person they can trust and websites and blogs often fall short in conveying our relational strengths. With the relationship principle in mind, consider creating programmatic ways to

get current clients to see you online and potential clients to know you. Just because you are going to see clients online doesn’t mean they can’t be local. In my experience, the quickest way to develop an online practice is to leverage your current relationships or find ways to build new ones. In part 1 of this article, we started with an innovative referral scenario from the client’s perspective. A picture was painted of a client using a combination of physical and text-based advertising to generate an online counseling referral. This was only one example of a referral program. As you create your own referral program, keep in mind the main ideas: Start from the client’s perspective, connect offline ads with online resources, combine advertising

methods, connect with offline referral sources, and create an ongoing process that generates online counseling referrals. The beauty of this particular program is that it can be used to generate referrals for an offline practice at the same time and generate a positive reputation as an innovative practice.

Current Clients. If you have a face-to-face practice, develop a new routine of offering the option on the first contact, in the first session, and as an option when there is a schedule change or when the client or therapist has to travel. You might even consider a mix of online and offline counseling with your current clients. A pair of counselors I know see clients face-to-face in the summer up north near their summer home. The other half of the year, they continue

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TILT â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology

seeing the same clients online while the therapists winter in Florida. Their success came from normalizing the expectation of online counseling with the clients.

For my face-to-face clients, the transition to online counseling was easier because they already knew me and trusted me. Initially, some refused online counseling just because they

preferred face-to-face contact. However, when I moved to another state, it forced the issue and many clients chose to continue with me online. I attribute part of this success to developing a very simple onboarding process to help clients transition to online care.

Educate. Whether you already have trusted referral relationships or you are developing new ones, consider spending some time educating referral sources about the process of how clients get started in online counseling. It likely will take several meetings before you get a client. However, these referral sources are basically your front line sales people and they need to be able to trust you, trust the service and trust their own ability to explain online counseling to the client. Be sure to arm them with the necessary talking points and materials to champion your online practice. If their office

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About the Author has a regular meeting, ask if you can present to their group. Of course the best way to do this is to have someone bring a laptop in your place and you show up on screen, just like an online counseling session. You only need to be in the next room to give them a taste of online counseling.

Give Taste Tests. The example of the presentation is a great example of a “Taste test.” Giving clients and referral sources the experience of seeing you online will generate trust and help them feel more comfortable with the idea of online counseling. Webinars are a good way to give clients a taste test without much risk to you or to them. Consider offering a webinar to a local business or church group on a hot topic. It doesn’t have to be more than 30-45 minutes and allow interaction by answering questions. Offer free initial (20 minute) video consultations as a follow up to help webinar attendees decide if they need counseling and if the online

venue will work for them. Be sure to publicize the webinar well in advance and promote it many times.

Jay Ostrowski is a Telemental health and marketing innovator with www. BehavioralHealthInnovation. com. BHI created www. telementalhealthcomparisons. com to help professionals choose technology. He lives in Grand Rapids, Michigan, USA.

Institutions in your state may also be a good place to start. Find group homes, hospitals, schools, colleges or agencies that are looking for a counselors and offer to meet their needs temporarily online. Approaching them as a temporary resource will allow them to pilot the idea of online therapy, without the investment of significant financial or political capital. This could come in the form of a small contract to see a few clients weekly, to handle their overflow, or to fill in for counselors on leave.

Where to Invest. It may seem like a lot of work up front and you may feel out of your element, but finding a way to create an online

referral process will help ensure that you build and sustain your online practice. Referral development looks different for different kinds of practices. Be careful of anyone offering quick fixes or automated systems and programs that lack individualization. It’s helpful to get advice or brief consulting from those who have gone before you, especially if you have not had a previous private practice. Your program will likely need more strategy than cash investment. If you are launching your own practice, especially an online one, referral development is where your investment in time and money will pay off. n

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TILT – Therapeutic Innovations in Light of Technology

Marketing Toolbox

Clinton Power

I don't know about you, but I've recently become very disillusioned with Facebook and its ability to support businesses.

consensus amongst online marketers is that there has been a radical drop in engagement on Facebook business pages.

In case you haven't noticed, recent changes to their algorithm have meant that less than 15% of people that actually follow your business page see your posts.

Why is Facebook making it harder for businesses?

The way the algorithm works is the greater the engagement you get through your followers liking, sharing or commenting on your posts, the greater the reach of people that Facebook shows your post to. Facebook has never been able to show 100% of your posts to people that ‘like’ your page (formerly called ‘fans’.) If they did so, you would never see any of your friends’ posts because your News Feed would be overwhelmed with updates. However, they have made recent changes that have significantly reduced the reach of your posts. For example, I spent some time looking at the stats for some of my old Facebook business posts. I would regularly reach over 300 people with a post- meaning 300+ people actually saw my post in their feed. More recently, however, it seems that the average reach of my post is about 120, based on my last 12 posts. The

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The reason is simple. Since the Facebook IPO, they need to monetize the site for the shareholders. So this push is part of their movement to encourage business owners to pay for what's called a 'promoted post'. When you pay $5-$10 for a promoted post, Facebook will show more people that are already following you, as well as their friends who don't follow you your post. (You can choose to show your post to only your followers or both your followers and their friends.) It sounds kind of crazy right? You have to pay Facebook to show your posts to people that are already following your page? Crazy, but true. My 'Promoted Posts' experiment I wanted to investigate the promoted posts feature a little further, so I promoted some of my posts to see what kind of results I got.

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Is it Time for Therapists and Coaches to Abandon Facebook? To put it simply, the response was incredible. I promoted this humorous post a few days before Christmas. The result after 3 days of promotion was 35 comments, 64 shares and 388 likes. Plus I got 19 new page likes for my Relationship Matters Facebook page. I also initiated a few other experiments with similar results, but this one was the most successful. I believe part of the success of this particular post included: 1. It was humorous and entertaining. 2. It was well timed just before a significant holiday. 3. It was very shareable- meaning it was content that people love to share on Facebook. What does this mean for coaches and therapists on Facebook? I don't see things changing in the near future for us on Facebook. The way I see it, you will need to consider having a Facebook advertising budget in the future if you want to stay on Facebook and actually have people see your posts on a regular basis.

I'm not sure how you feel about this, but I know many therapists and coaches I speak to are unhappy that this is the case. On the one side, I can see that Facebook has been free for users and businesses for a long time, so we don't have much right to complain. On the other side, Facebook does need to continue to attract businesses and promote engagement between consumers and businesses for its revenue-producing models to work. It's a fine balance that they don't seem to be getting right at the moment. So how should therapists and coaches use Facebook? I still think coaches and therapists are positioned to do very well on the Facebook platform. When you think about why people go on Facebook (and there are now upwards of 1 billion members), it's often to connect with family and friends, to be entertained and to share interesting information and content. Therapists and coaches have a lot of interesting and helpful content that is relevant to large audiences on Facebook. Our content is also ripe to be shared amongst very large segments of the community.

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TILT – Therapeutic Innovations in Light of Technology

Should we stay or abandon Facebook? I'm not convinced that it’s time for therapists and coaches to abandon Facebook as a marketing strategy just yet. However, I have been spending more time on Google+ recently and have been impressed with how they manage privacy and the ease at which you can share with different populations and segmented groups (called ‘circles’). I also think that it's imperative you consider being active in some way on Google+ because early indicators are that Google is taking your Google+ activity and influence into account when it ranks your website in its search engine. When I post on Facebook, I try to make sure that my post covers at least one of these three elements:

Whatever the case, what we do know is that nothing is permanent on the Internet and social media is always in a state of flux.

1. Entertaining—something that is funny, inspirational or engaging in a way that appeals to a lot of people.

As long as you use social media to drive traffic to your own website and not base all your efforts on one platform, you can be assured of better long-term marketing results.

2. Empowering-—this can be achieved through asking a question and giving your audience a voice. 3. Educational—something that teaches or shares information about a topic relevant to your ideal client population. If you're covering one or more of these bases when posting on Facebook, you're much more likely to increase your engagement and facilitate more people seeing your posts.

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ABOUT THE AUTHOR Clinton Power is a Gestalt therapist and passionate marketing coach and consultant who provides online marketing and business development ideas for healthcare professionals. Visit his website or follow him on Twitter @ sydneytherapist, Google+ or Facebook.

Online Therapy Institute/Online Coach Institute offers

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online workshop modules! We offer several modules comprising 5-10 clock hours of learning on many topics! Introduction to Cyberspace: A Primer for Helping Professionals Relationships in Cyberspace: An Introduction for Helping Professionals The Online Therapeutic Relationship: Theoretical Considerations Ethical Considerations of Online Therapy Working Therapeutically Using Asynchronous Email Working Therapeutically Using Synchronous Chat Working Therapeutically Using Telephone and Audio Using Video Conferencing to Conduct Online Therapy E-Therapy: Asynchronous Email/Web Board Therapy, Cyber-culture, Ethics

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We have also launched several Specialist Certificates as 16-week Intensives or completely self-paced. These Certificates are 60 clock hour faciliated courses that truly prepare the therapist and coach to utilize technology for service delivery.

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TILT – Therapeutic Innovations in Light of Technology

“The love of learning, the sequestered nooks, And all the sweet serenity of books.” ~Henry Wadsworth Longfellow

Love For the

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The Psychodynamics of Social Networking: Connected-Up Instantaneous Culture and the Self Aaron Balick This is a timely book looking at the enormous impact that social networking has had on our society and how it is profoundly influencing our lives. While there is currently a great deal of thinking about the psychological ramifications of these sorts of changes there has been little work looking at the psychodynamics of individuals who use and depend upon these social networks, and the consequences for themselves and their important relationships. Popular hubs of social networking such as Facebook and Twitter feature centrally in this text, as well as the impact of the ubiquity of access through smartphones; the nature of this impact on interpersonal relationships and the formation of the ‘self’ will be of particular interest..

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Visit the Online Therapy Institute’s Book Store to purchase featured books and more! http://www.onlinetherapyinstitute.com/bookstore/

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• Bryan, Willie V.—THE PROFESSIONAL HELPER: The Fundamentals of Being a Helping Professional. '09, 220 pp. (7 x 10), $51.95, hard, $31.95, paper.

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• Correia, Kevin M.—A HANDBOOK FOR CORRECTIONAL PSYCHOLOGISTS: Guidance for the Prison Practitioner. (2nd Ed.) '09, 202 pp. (7 x 10), 3 tables, $54.95, hard, $34.95, paper.

COMING SOON! • Douglass, Donna—SELF-ESTEEM, RECOVERY AND THE PERFORMING ARTS: A Textbook and Guide for Mental Health Practitioners, Educators and Students. '11, 232 pp. (7 x 10), 6 il., 5 tables.

• Kocsis, Richard N.—APPLIED CRIMINAL PSYCHOLOGY: A Guide to Forensic Behavioral Sciences. '09, 306 pp. (7 x 10), 4 il., 2 tables, $65.95, hard, $45.95, paper.

• Goodman, Karen D.—MUSIC THERAPY EDUCATION AND TRAINING: From Theory to Practice. '11, 296 pp. (7 x 10), 3 tables. • Bernet, William—PARENTAL ALIENATION, DSM-5, AND ICD-11. '10, 264 pp. (7 x 10), 15 il., 4 tables, $63.95, hard, $43.95, paper.

• McNiff, Shaun—INTEGRATING THE ARTS IN THERAPY: History, Theory, and Practice. '09, 280 pp. (7 x 10), 60 il., $59.95, hard, $39.95, paper.

• Ensminger, John J.—SERVICE AND THERAPY DOGS IN AMERICAN SOCIETY: Science, Law and the Evolution of Canine Caregivers. '10, 340 pp. (7 x 10), 25 il., 1 table, $69.95, hard, $47.95, paper.

• Rich ard , Mich ael A., William G. Emen er, & William S. Hutchison, Jr.— EMPLOYEE ASSISTANCE PROG R A M S : Wellness/Enhancement Programming. (4th Ed.) '09, 428 pp. (8 x 10), 8 il., 1 table, $79.95, hard, $57.95, paper. • Thompson, Richard H.— THE HANDBOOK OF CHILD LIFE: A Guide for Pediatric Psychosocial Care. '09, 378 pp. (7 x 10), 5 il., 15 tables, $79.95, hard, $55.95, paper. • Wilkes, Jane K.—THE ROLE OF COMPANION ANIMALS IN COUNSELING AND PSYCHOLOGY: Discovering Their Use in the Therapeutic Process. '09, 168 pp. (7 x 10), 2 tables, $29.95, paper.

NOW AVAILABLE! • Anthony, Kate, DeeAnna Merz Nagel & Stephen Go ss —T HE USE OF TECHNOLOGY IN MENTAL HEALTH: Applications, Ethics and Practice. '10, 354 pp. (7 x 10), 6 il., 5 tables, $74.95, hard, $49.95, paper.

• Bellini, James L. & Phillip D. R umri l l , Jr. —R E SEARCH IN REHABILITATION COUNSELING: A Guide to Design, Methodology, and Utilization. (2nd Ed.) '09, 320 pp. (7 x 10) 3 il., 5 tables, $66.95, hard, $46.95, paper.

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• Marvasti, Jamshid A.— PSYCHO-POLITICAL ASPECTS OF SUICIDE WARRIORS,TERRORI S M A N D M A RT Y RDOM: A Critical View from “Both Sides” in Regard to Cause and Cure. '08, 374 pp. (7 x 10), $73.95, hard, $53.95, paper. • Moon, Bruce L.—INTROD U C T I O N TO A RT THERAPY: Faith in the Product. (2nd Ed.) '08, 226 pp. (7 x 10), 20 il., $53.95, hard, $33.95, paper. • Wiseman, Dennis G.— THE AMERICAN FAMILY: Understanding its Changing Dynamics and Place in Society. '08, 172 pp. (7 x 10), 4 tables, $31.95, paper. • France, Kenneth—CRISIS I N T E RV E N T I O N : A Handbook of Immediate Person-to-Person Help. (5th Ed.) '07, 320 pp. (7 x 10), 3 il., $65.95, hard, $45.95, paper. • Martin, E. Davis, Jr.— PRINCIPLES AND PRACTICES OF CASE MANAGEMENT IN REHABILITATION COUNSELING. (2nd Ed.) '07, 380 pp. (7 x 10), 7 i1., 2 tables, $69.95, hard, $49.95, paper. • Perticone, Eugene X.— T H E A RT O F B E I N G BETTER: An Approach to Personal Growth. '07, 268 pp. (7 x 10), $58.95, hard, $38.95, paper. • Palmo, Artis, J., William J. W e i k e l & D a v i d P. Borsos—FOUNDAT I O N S O F M E N TA L H E A LT H C O U N S E LING. (3rd Ed.) '06, 468 pp. (7 x 10), 5 il., 3 tables, $85.95, hard, $61.95, paper. MAIL:

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Stay tuned next issue for... 99 More great articles about online coaching, online therapy and related topics! 99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology! 99 If you are interested in submitting an article, review our author guidelines at www.onlinetherapymagazine.com 99 If you are interested in advertising in an upcoming issue, email info@onlinetherapyinstitute.com