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Happy Birthday Online Therapy – 20 years old!

September 7, 2015 by Kate Anthony

During one of my infrequent bouts of insomnia last night, it occurred to me that in 2015 we ought to be celebrating the 20^th birthday of online counselling and therapy. It now also occurs to me that thinking about such things at 3am is a bit odd, but then those who know me know that the practice and ethics of online work is the thing that keeps me awake at night, so I’ll choose the word passionate rather than odd…

Anyway, as outlined in my 2010 book Online Therapy: A Practical Guide, co-authored with the lovely DeeAnna Nagel (now of Havana Wellness – check it out!), it’s established that the first paid-for online mental health services started appearing in mid-1995, led by pioneers such as Leonard Holmes, John Suler, David Sommers and of course, John Grohol of PsychCentral. There’s a timeline here up to 2002 from the old Metanoia.org site, one of the first websites I came across when starting to look into the emerging field in 1998.

20 years old in 2015 – that means the field is almost an adult! So I am constantly surprised when it is referred to as “new” – it may be young and dashing, but at 20 years old, it’s not exactly new anymore!

In fact, it also now occurs to me that my training programmes first emerged in a face-to-face capacity in 2000, so the sub-field of training for online services is already a teenager (read my recent BJGC paper about that here)! And let’s not forget Supervision and Coaching also taking place online!

So I was pleased to be invited to Switzerland next year to speak at a conference being offered by the University of Basel. The conference theme is “Typing Yourself Healthy…”, and I was reflecting how nice it is to see the original online therapy modality being aired – a part of online therapy which remains robust despite the great technological developments we have seen over the years, particularly with video now being a reliable method of communication with clients (this wasn’t the case back in 1995, trust me!). Even if you picture “online therapy” as “video therapy”, I’m pretty sure that there is a lot of text-based work involved. And if you have joined the excellent free-to-sign-up platform PlusGuidance, you’ll know that text-based work is very much a part of the communication tools you can use with clients.

So, apart from making me feel very old, what can we take from the history of online therapy? Our 20-year old is maturing, no doubt – BACP will shortly publish new Good Practice Guidance for working with both text and audio/video – the latest set of ethical advice from a professional organisation that first looked at the area back in the late 90’s, and first published guidelines in 2001. The number of doctoral-level studies in the field has increased since my own was awarded back in 2010, and I see many on the horizon as trainees with the Online Therapy Institute find their own burning research topics as a result of their studies. The media is less shocked by the concept of using the World Wide Web for mental health support, although they still love a story about it going pear-shaped (and always will, I suspect). Even using avatars and virtual environments for therapy doesn’t raise too many eyebrows these days.

So join me in lighting a candle for the 20^th anniversary of online practice going live! It’s been a thrilling (and sometimes frustrating) journey to adulthood, as the Internet became an everyday part of our lives and more and more clients reached out through their personal devices rather than calling their medical practice. Having an online element to your practice shouldn’t be intimidating – the pioneers of the field have had your back for ages – so maybe it’s time to reach back out to the clients who are trying to find you online!

Omnichannelled Therapy – the Future of the Profession

July 24, 2015 by Kate Anthony

For a while now when describing the rise of using technology to deliver therapeutic services, I’ve found it helpful to include traditional ways of how we work within the definition. This was helped immensely by taking the writing of my hero Douglas Adams into account, and particular his thoughts on technology itself in his seminal 1999 article “How to Stop Worrying and Learn to Love the Internet”:

“We no longer think of chairs as technology, we just think of them as chairs. But there was a time when we hadn’t worked out how many legs chairs should have, how tall they should be, and they would often ‘crash’ when we tried to use them.“

It could be argued that chairs themselves are a necessity of being a therapist – I’m pretty confident in saying we all use them when communicating with clients. So in considering this traditional way of conducting a therapeutic session, we can include face-to-face work as a technology as well. Adams published that article at around the same time that I joined forces with the British Association for Counselling and Psychotherapy to develop the early Guidelines for Online Counselling and Psychotherapy, the backbone of the ethical advice and competencies for online practitioners we have today, and so I think the time is ripe for us to move on as a profession after over 15 years.

I just did a podcast with the lovely people over at counsellorcpd.com (available early September, check back for the link), and it started me thinking again about how we talk about online therapy as a whole. I described during the podcast how only last year I yet again had the debate about what to call services delivered over the Internet – is it e-therapy, is it teletherapy, is it online therapy…?

Well, how about we take the technology out of the description and just go back to not thinking about that too much? How about we go back to the core of what we do – two or more human beings working together with therapeutic intention to improve someone’s mental health and ability to deal with life’s challenges?

How about we just call it, er, therapy?

So I want us to look at this in a new way, taking into account all the many avenues of communication we have available to us now – be that face-to-face, telephone, email, chat, video, virtual environments or smoke signals. It’s a therapeutic interaction, a relationship, two or more people talking intentionally. It really as simple as it’s always been – we just need to recognise that if we take away the need to think about the screens and keyboards and plugs and chargers and on-buttons and pretty flashing lights, we’re left with the therapeutic relationship itself.

We can offer this relationship in a myriad of ways now, and we can be less restrained by factors such as place or time. The client can choose how and when they want to work, and the practitioner can choose how and when to offer their services. Want to work for 50 minutes in a room with two chairs and a box of tissues? Fine! Want to pick up a telephone and call a helpline spontaneously? Also fine! Want to reach out to your therapist via instant message but not book an entire session? Very fine! Want to journey through a virtual world as an avatar on an epic journey with your counsellor, seeking self-enlightenment? Awesome! That’s just omnichannelling, a word already widely used by marketers looking to improve their customer experience (thanks to ForeSee for the image I borrowed btw).

So I’m going to move further away from the distinction of the offline and the online, take away the need to define therapy by how we deliver it rather than what it is we are actually doing, and if we really need to call it something to remind us we’re not necessarily physically in a room anymore (but it’s OK if we are!), just call it omnichannelled therapy.

I like to think Douglas Adams would be proud of me.

🙂

Gaming online – when does it turn into a diagnosable psychiatric disorder?

October 1, 2014 by Kate Anthony

I have a special interest in this field, not only as part of my work in general but as an avid gamer myself. With the exception of World of Warcraft (more on that later), I’ve pretty much run the gamut of gaming, from the Atari’s Pacman and Space Invader games back in the 70s right through the Legend of Zelda suite to the current rash of mobile and Facebook time-sucks (I use that term fondly) such as Bubble Witch Saga 2 and Candy Crush.

And I can truthfully say that Level 500 of CCS sucks:

Recently a group of researchers tackled the controversial fact that the DSM-V includes non-substance addiction as a psychiatric diagnosis, in the journal Addiction. This is a very welcome paper, not least because the DSM-V has pretty much sidelined the concept of general Internet addiction in favour of the specific behaviours conducted over the Internet. This has wide implications for various online addictions, including gambling, sex and virtual reality environments.

I found the recent showing in the UK of Web Junkie riveting – of course I was aware of the gaming boot camps in China, but watching the participants discuss their use of nappies to ensure they didn’t miss a minute of the game for their hygienic needs really brought home the huge problems gaming can cause. These boot camps cost twice the parent’s average monthly income to attend – it is apparently never voluntary and often involves subterfuge to get the young people there in the first place. Indeed, when a group of the boot camp members “escaped”, they headed straight for the nearest Internet Cafe to play for four hours before being “caught”. Many cite combating loneliness as one of the main attractions.

I took one look at the game World of Warcraft when at a friend’s house, and vowed never to touch it. The appeal of those beautiful graphics, the team-playing, the role-playing, the social side of like-minded people banding together to defeat obstacles and missions… what’s not to like if you are an avid gamer? My gaming colleagues and friends (you know who you are) have tempted me over the years – but WoW is a time-suck too far for someone who already has mild(ish) issues with online gaming. I have almost (almost) sacrosanct boundaries in place for my gaming habit, playing only three in any one period (currently Bubble Witch Saga 2, Diamond Diggers Saga and the epic Tribez and Castlez, since you didn’t ask). These boundaries are necessary for reasons of both time (addiction/avoidance) and finance (in-gaming purchases to facilitate the addiction) – my time on Candy Crush Saga and Kitchen Scramble meant I eventually had to block them from all my devices (though if you’re ever stuck on a level, give me a shout 😉 )

There are complicated reasons for all addictions, and those within online gaming should not be ignored. My current work is focusing on the innocent use of gaming to combat other addictions, not least gambling -after all, it’s only virtual money, right? Wrong – my anecdotal research with gamblers show that online freemium play models are triggers, and a short step to being back in the offline casino or similar. The DSM-V inclusion is welcome if only to bring the topic to the fore and allow academics to reach conclusions around potential treatment.

But let’s not forget the inclusion of the excellent concept of gamification in therapy! For further reading, I’ll refer you to my colleague Mike at GamerTherapist.com – the guru of gamer affirmative psychotherapy. Check out his blog to understand the positives gaming can bring to life experience – and happy (boundaried) gaming!

🙂

Being Virtually Homeless

September 24, 2014 by Kate Anthony

Avatars and virtual environments have been on my mind a lot lately: we recently relaunched our Avatar Identity Specialist Certificate; I finally got around to finishing the book Infinite Reality; and a recent question to the British Association for Counselling and Psychotherapy on the topic from a colleague led to the organisation making it their research enquiry of the month. This allowed me to revisit my own writings on the subject, and reflect on past experiences that feed into my thirst for understanding how different technologies fit into the lives of others.

On Sunday of this week, it was my absolute pleasure to join DeeAnna in a shop in Second Life (SL) to choose our new virtual office furniture. Since our previous SL landlady moved on to other projects and closed her beautiful island, we have been virtually homeless for around six months, both of us feeling out-of-sorts and ungrounded within an important part of our work – the virtual world. If you have ever been homeless, as I have, you will know exactly what I mean. And if you haven’t, I promise you it’s not exactly a bundle of fun emotionally (quite apart from practically, of course).

To borrow the name of one of my favourite bands, it makes one feel “uncluded”. I’m not going to exaggerate my experience – it was temporary, during the summer, and mercifully only for a matter of a few weeks – but it certainly gave me an outlook on life that enabled me to understand why people seek communities and environments created by those on the outside of mainstream society. And what technology has enabled us to do, at least in the developed world, is to seek those out and be part of them virtually.

In our search for a new island in Second Life, I looked at spaces next to graffiti-covered biker bars, got thrown out and banned from a house of a, ummm, shall we say a “private” nature, and gatecrashed a virtual wedding. I fell into virtual fountain and virtually almost drowned. I met an aardvark who then googled my avatar name and emailed me for therapy. I went to virtual Paris and bought a virtual croissant from a virtual vendor who bizarrely only spoke Spanish. These were interesting experiences, but none of them made me feel included.

So we turned to our dear colleague Gentle Heron, who runs Virtual Ability Island and who had available land for rent – you may remember her from the documentary film Login 2 Life and the feature she wrote for us for TILT Magazine. We now have space in SL which could have been made for us – a therapeutic community, with a conference centre and cafe for our students to hang out in (office-warming party coming soon!), and a beautiful building with roof garden, library, therapy room, Reiki centre, and TILT’s headquarters . It’s a work in progress as DeeAnna and I find time to shop together inworld from our offline offices either side of the Atlantic – but it gets more like our virtual home every day.

I am very used to the odd looks I get when trying to describe the virtual living so many people partake in – it’s why we ask the majority of our students to experience it for themselves as part of their Foundational Course in Cyberculture. We don’t need to have the same experiences as clients to empathise with them, but we do need to understand how they live. If the community of the virtual world is where they feel included – rather than uncluded – then who are we to dismiss that as being unreal?

🙂