Technology and Treatment

Technology provides tools to help counselors accomplish their work more effectively and efficiently beyond what they can do without it. Counselors now have high-tech methods for better managing, supporting, conducting, delivering, and describing their work as before never imagined. Such power, however, comes with great responsibility. Counselors must work diligently to make certain that technological literacy and implementation is an important part of their ongoing professional development. They must identify and plan for overcoming barriers that technology can pose, such as intrusions into personal lives. Finally, counselors must recognize how the very same technology that helps them can hurt themselves and their clients. Thus, important parts of counselors’ technological literacy and implementation are understanding potentials and opportunities that technology affords counselors, evaluating how technology is used, and considering the impact that technology has on their lives.

Technology is having a profound impact on every aspect of life, including how people work, how they play, and even how they view the world. The introduction of technology into counseling is an evolutionary process that is happening quickly, if not always easily. Those who grew up at a time when there were no computers have struggled to gain the skills necessary to function in a rapidly changing, technologically literate society, while those of younger generations use technology almost effortlessly, because they were introduced to it at a very early age. The most recent advances in assessment and diagnosis, counseling techniques, and career development utilize technology in one fashion or another. From Internet-based counseling to telecounseling, the range of human services provided in schools, agencies, and private practice is changing and advancing.

The Nature of Counselor Technological Literacy

So what is technological literacy as it pertains to counselors? Many people have written on the subject of technological literacy. Technological literacy may be seen as having knowledge and abilities to select and apply appropriate technologies in a given context. There are three components to technological literacy: the technology of making things, the technology of organization, and, the technology of using information. Applying a Delphi technique to opinions expressed by experts, Croft evolved a panel of characteristics of a technologically literate student. Those are abilities to make decisions about technology; possession of basic literacy skills required to solve technology problems; ability to make wise decisions about uses of technology; ability to apply knowledge, tools, and skills for the benefit of society; and ability to describe the basic technology systems of society.

A theme among various attempts to define technological literacy is that technology has evolved to become a powerful medium—not only a set of high-tech tools. If technology functioned merely as a set of tools, the problem of advancing technological literacy would not be so challenging. But technology has become more than a set of devices to be picked up and used when a person decides he or she needs them.

It has become a required medium that mediates experience in most aspects of peoples’ lives. Broadly speaking, technological literacy, then, can be described as the intellectual processes, abilities, and dispositions needed for individuals to understand the link between technology, themselves, and society in general. Technological literacy is concerned with developing one’s awareness of how technology is related to the broader social system and how technological systems cannot be fully separated from the political, cultural, and economic frameworks that shape them.

This means that counselors who have adequate levels of technological literacy are able to understand the nature and role of technology in both their personal and professional lives; understand how technological systems are designed, used, and controlled; value the benefits and assess the risks associated with technology; respond rationally to ethical dilemmas caused by technology; assess the effectiveness of technological solutions; feel comfortable learning about and using systems and tools of technology in the home, in leisure activities, and in the workplace; and critically examine and question technological progress and innovation.

How Counselors Use Technology in Their Work

Counselors use technology to help them be more effective and efficient in their work, ultimately maximizing positive counseling outcomes, in one or more of the following four areas:

  1. Information/Resource. In the form of words, graphics, video, and even three-dimensional virtual environments, technology affords counselors a dynamic and rapidly growing library of information and knowledge.
  2. Communication/Collaboration. Chat rooms, bulletin boards, virtual shared environments, video conferencing, online conferences, electronic meeting services, e-mail—technology now enables people to connect, exchange information, collaborate, and make shared decisions.
  3. Interaction/Productivity. The maturing of software and Web-based programming has launched a new level of available tools, both off the shelf and customized for the counseling professional. These high-tech tools can help counselors build and create anything ranging from a personalized business card to a set of personalized Web site links. For example, interactive tools help counselors to process data and manipulate information, convert text to speech, create a graph, or even determine the interactive effects of popular prescription drugs.
  4. Delivery of Services. Most controversial, yet growing in popularity, is counselors’ use of technology to meet with clients and deliver counseling services in an online or virtual environment (i.e., at a distance).

Across these four areas, counselors are incorporating technology in their work in many different ways. Following is a cross-section of examples:

A therapist recorded an in-session relaxation session as well as specific exchanges between the clinician and client focusing on specific client difficulties such as mastering a breathing technique. This custom-made tape then becomes a review for the client in the following days as he or she works on relaxation at home. The same therapist used recording technology with another client whom he instructed to tape “conversations with yourself to better identify irrational, unrealistic, or illogical thinking patterns.

Susan, a community counselor, needed to provide periodic reports to a funding agency regarding the nature of clients served by her counseling group over several months as part of a grant. Counselors where she worked used a software program shared over a network for record keeping, so that demographic data, diagnostic information, treatment plans, and insurance information—among other types of information—were uniformly stored for each client. The system allowed Susan to choose data of interest and then add several basic formulas to aggregate the data to display descriptive statistics (e.g., average client age, percentages of clients with certain diagnoses, changes in GAF scores over time). Finally, she merged relevant information into a report template provided by the funding agency. After she generated the first report, subsequent reports required only that she repeat the procedure for exporting the data from the system and then copy and paste the existing formulas instead of recreating them.

One school counselor conducted a psychoeducation group for all students at the same time by creating a multimedia presentation, transferring it to video, and then broadcasting it on the school’s television network. For classes that had computers, the counselor used the Internet to conduct a live chat about the topic. For classes that did not have computers, the counselor followed up that day and conducted live discussions.

Online Counseling

One area of technology that seems to be receiving the greatest amount of attention is online counseling. This type of counseling goes by names such as e-therapy, e-counseling, cybertherapy, and telecounseling. Specifically, online counseling refers to counseling that occurs across some distance instead of in an office setting with both counselor and client in the same room or office. According to Sabella, the continued evolution of the Internet offers many future possibilities and much potential for this type of counseling.

Delivery of Services

Counseling over the Internet may be a useful medium for those with physical disabilities who find traveling even a short distance to be a significant obstacle. For others who are reticent to meet with a counselor or who have difficulty with self-disclosing, the Internet may foster the counseling process. Similarly, the Net is a convenient and quick way to deliver important information. In cybercounseling, information might be in the form of a homework assignment between sessions or bibliocounseling. Also, electronic file transfer of client records, including intake data, case notes, assessment reports, and selected key audio and video recordings of client sessions, could be used as preparation for individual supervision, group supervision, case conferences, and research.

Assessment and Evaluation

Access to a wide variety of assessment, instructional, and information resources in formats appropriate in a wide variety of ethnic, gender, and age contexts could be accomplished via the World Wide Web.

Communications

Especially via e-mail, counselors and clients can exchange messages throughout the counseling process. Messages may inform both counselor and client of pertinent changes or progress. E-mail can provide an excellent forum for answering simple questions, providing social support, or scheduling actual or virtual meeting times.

Marriage and Family Counseling

If face-to-face interaction is not possible on a regular basis, marriage counseling might be delivered via video conferencing, in which each couple and the counselor (or counselors) are in different geographic locations. After independent use of multimedia-based computer-assisted instruction on communication skills, spouses could use video conferencing to complete assigned homework (e.g., communication exercises).

Supervision

Anecdotal evidence has shown that e-mail is an enhancing tool in the process of counselor supervision and consultation. It provides an immediate and ongoing channel of communication between and among as many people as the counselor or supervisor chooses.

Credentials

Because cybercounseling can occur anytime and anywhere, it may pressure the profession and governance to formulate a national, or perhaps international, counseling licensure or certification. Definitely an enormous undertaking, this measure would facilitate uniform standards of training and practice while expediting reciprocity among states and countries. Cybercounseling may very well become the impetus for the ultimate in counselor credential portability.

Potential Pitfalls

Confidentiality

Although encryption and security methods have become highly sophisticated, unauthorized access to online communications remains a possibility without special attention to security measures. Counselors who practice online must ethically and legally protect their clients, their profession, and themselves by using all known and reasonable security measures.

Computer Competency

Both the counselor and client must be adequately computer literate for the computer/network environment to be a viable interactive medium. From typing skills to electronic data transfer, both the counselor and client must effectively harness the power and function of both hardware and software. As in face-to-face counseling, cybercounselors must not attempt to perform services outside the limitations of their technological competence.

Location-Specific Factors

A lack of appreciation on the part of geographically remote counselors of location-specific conditions, events, and cultural issues that affect clients may limit counselor credibility or lead to inappropriate counseling interventions. For example, a geographically remote counselor may be unaware of recent traumatic events at the local level exacerbating a client’s reaction to work and family stressors. It may also be possible that differences in local or regional cultural norms between the client’s community and the counselor’s could lead a counselor to misinterpret the thoughts, feelings, or behavior of the client. Counselors need to prepare for counseling a client in a remote location by becoming familiar with the client’s recent local events and local cultural norms. If a counselor encounters an unanticipated reaction on the part of the client, the counselor needs to proceed slowly, clarifying clients’ perceptions of their own thoughts, feelings, and behavior.

Equity

Web counseling has the potential to exacerbate equity issues already confronting live counseling. If counseling online is a viable alternative, steps need to be taken to ensure that costs do not create another obstacle for some clients. As well, if some service providers view cybercounseling as an inexpensive alternative, then it may inappropriately become the tool for those who cannot afford more traditional approaches. Alternatively, if cost issues are addressed and access is available equally for everyone, cyber-counseling may further alienate potential clients who have less technological expertise, creating a different type of equity gap.

High Tech versus High Touch

How can counselors foster the development of trusting, caring, and genuine working relationships in cyberspace? Until virtual reality is realized for individuals and small institutions, cybercounseling relies on a process limited in nonverbal or extraverbal behavior. Questions remain about whether counseling can be effectively conducted without an actual human presence—a presence that includes a holistic experience greater than the sum of its parts.

Impersonation

Many people hide behind the Net’s veil of anonymity to communicate messages they ordinarily would not communicate in real life. The reality is that it is almost impossible to know who a cyberclient really is. A client who is a minor may depict himself or herself as an adult. Other clients may disguise their gender, race, or other personal distinctions in a manner that threatens the validity or integrity of the counselor’s efforts.

Credentials

One of the counseling profession’s main concerns will be those who are unlicensed persons promoting themselves as competent Internet counselors. When a counselor is unlicensed, a state has no regulatory authority, unless there is a law in that state that will allow prosecution for practicing counseling without a license as a criminal act or that gives the state’s licensing board regulatory authority. According to Hughes, unlicensed cybercounselors are legally almost untouchable, especially when they display a disclaimer stating that what they are doing is not therapy.

More than ever before, cybercounseling may have created a need for the profession to educate consumers about choosing an appropriately trained and credential counselor. Many questions regarding cybercounseling and credentials need to be answered: How will insurance companies handle requests from cybercounselors interested in purchasing professional liability insurance specifically to conduct cybercounseling? How will certification and licensure laws apply to the Internet as state and national borders are crossed electronically? Will cybercounselors be forced to maintain licensure or certification in the states in which their clients reside, or must counselors only obtain licensure or certification in the state from which they practice? Similarly, who will monitor service complaints out-of-state or internationally?

Ethics

How do current ethical statements for counselors apply or adapt to situations encountered online? For the most part, counselors can make the leap into cyberspace and use current ethical guidelines to conduct themselves in an ethical fashion. However, problems exist. The future will inevitably see a change in what it means to be ethical as we learn the exact nature of counseling online.

References:

  1. Sabella, R. A., & Booker, B. (2003). Using technology to promote your guidance and counseling program among stake holders. Professional School Counseling, 6, 206-213.
  2. Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling & Development. 84, 41-53.
  3. Sussman, R. J. (2002) Counseling over the Internet: Benefits and challenges in the use of new technologies. Retrieved February 7, 2016, from http://files.eric.ed.gov/fulltext/ED478216.pdf
  4. Tyler, J. M., & Sabella, R. A. (2004). Using technology to improve counseling practice: A primer for the 21st century. Alexandria, VA: American Counseling Association.

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