A Decade of Online Counselling: Reflections, Conceptions, and Projections

1. Online counsellingA Decade of Technology and Practice –Reflections, Conceptions and Projections‘10 Years on- and Still Changing’Presented by Jane Evans MA BACP (Senior Accred Member)

2. Worldwide PC sales are exactly where they were in 2008- Are PCs a thing of the past?“The advent of smartphones has spelled doom for computers”.In 2015, there were just over 275 million PCs—desktops and laptops—shipped worldwide. It was the first time computer sales fell below 2008 levels, the year after the first iPhone was launched. Last year, worldwide shipments of PCs slipped further to about 260 million units sold, according to the International Data Corporation (IDC).-https://qz.com/908201/worldwide-pc-sales-are-exactly-where-they-were-in-2008/

3. A selection of what was happening relating to Online Therapy in 2008

4. NHS were offering cCBT programmes for clients (computer-based Cognitive behavioural Therapy) • ACTO was already established, as a voluntary organisation to support online counsellors • 1st OCTIA conference- First live streamed conference specifically for counsellors in the UK? • Some online services developing in Higher Education and Young people services • Exenzone state they were pioneers of online counselling and support in the UK. In 2004, they established the first online counselling service in the UK for children and young people, Kooth. Following the success of Kooth, Qwell was launched as our service for adults. Source: https://xenzone.com/about-us/ • Samaritans email service? Launched email support in 1994 Source:https://en.wikipedia.org/wiki/Samaritans_(charity) Second Life- Virtual world- launched in 2003 Source: https://en.wikipedia.org/wiki/Second_Life

5. Mediums used to deliver online counselling in 2008Email TherapyLimited IM and Webcam, due to security, bandwidth issues, and encryption issuesOnline Supervision The beginning of a new way to access supervision- via email and IM?

6. Where are we now?How do we engage with online clients?

7. Are we adapting to clients preferred mediums for online Therapy ? • Young Person Case example of Preferring ‘Instant gratification’ Client is engaging with face to face counselling but explicitly refers to withdrawal feelings around not having phone with her in the session and being able to text. Client feels validated by texts received from others. “despite being in the same room as the client, and engaging in an activity within close proximity this still didn’t provide the same feeling as being heard through text”

8. Young Person Case example 2 of-Guiding the therapist to a medium which was most comfortable to them in expressing feelings • “We were put back in the same room with the computer. The client used it again and to express sadness at the sessions ending. To ask why they had to end, and why there couldn’t be another session. I wondered what may have been opened up earlier on in the sessions if we had had this facility available, and not just through the use of the log in bar, but perhaps an iPad or other device where we could type to each other whilst in the same room. A few times in between typing the client would look to me for my answer, which I gave verbally, but again wondered where we could have gone if I had the ability to reply back to him in the same medium.”

9. Is the evolution of online counselling receiving the credit it deserves? • Reports in the media stating that there is no registration for online counsellors, or mandatory registration for counsellors in general • Currently no mandatory requirement to be trained as an online therapist in order to set up an online practice • Limited number of professional bodies who help to set professional standards for online counselling – BACP & ACTO May Bulman Social Affairs Correspondent @maybulman Saturday 13 January 2018 12:45 GMThttp://www.independent.co.uk/news/uk/home-news/online-counselling-therapy-mental-health-mentally-ill-exploited-unaccredited-nhs-a8123131.html

10. Media report- Mentally ill 'exploited' by unaccredited online counselling- What is the media saying about online counselling? • Figures published by The Independent earlier this year show an almost ninefold rise in webcam and instant messenger appointments through the NHS’s flagship mental health scheme between 2012-13 and 2015-16, compared to a 144 per cent rise in overall appointments. The number of appointments carried out this way, under the Improving Access to Psychological Therapies (IAPT) scheme, in England, rose from 5,738 to 49,475. http://www.independent.co.uk/news/uk/home-news/online-counselling-therapy-mental-health-mentally-ill-exploited-unaccredited-nhs-a8123131.html

11. New figures show almost ninefold rise in online appointments over three years • “People with depression and anxiety are increasingly being offered online therapy through the NHS’s flagship mental health scheme, using methods that one expert said “fly in the face of what it means to be human”. • New figures obtained by The Independent show an almost ninefold rise in webcam and instant messenger appointments through the Improving Access to Psychological Therapies (IAPT) scheme between 2012-13 and 2015-16, compared to a 144 per cent rise in overall appointments. http://www.independent.co.uk/author/daniel-kraemer http://www.independent.co.uk/life-style/health-and-families/health-news/online-therapy-mental-health-help-services-webcam-appointments-increase-messenger-nhs-depression-a7626496html • The findings of these reports come after Theresa May announced extra funding for the development of digital mental health services in January 2018. “Digitally assisted therapy” – treatment provided over the internet or through a computer – will also be used in an attempt to make overstretched resources go further. • http://www.independent.co.uk/news/uk/politics/theresa-may-mental-health-stigma-funding-government-nhs-a7516461.html • .

12. Continued: • “When we use a keyboard or a webcam we are distancing ourselves from those immediate intimate connections of therapy and offering a barrier.” • Sarah Bateup, clinical director at Ieso Digital Health, said she is used to hearing the criticism that text therapy is counter-intuitive, but thinks patients and therapists can still develop a therapeutic relationship. “Having read thousands and thousands of transcripts, you can see the presence of the therapeutic relationship, and feel it in the same way as if you were reading a novel – you would feel emotions, fear, happiness. The written word will evoke emotion,” she said. • http://www.independent.co.uk/life-style/health-and-families/health-news/online-therapy-mental-health-help-services-webcam-appointments-increase-messenger-nhs-depression-a7626496.html

13. Key Considerations for online counsellors to promote a sense of safety and reassurance for clients- based upon small research group 4 years ago • Evidence the counsellor is linked to BACP or ACTO, and also information for clients on how to verify those details • Counsellor provides information about them self on the website, experience and qualifications etc • A photo of the counsellor • Clear and concise assessment and contracting process, and a clear indication of the online counselling process • An appealing website which is easy to navigate • The initial contact from the counsellor is ‘warm’ and conveys a sense of them so clients feel confident to engage in therapy with the counsellor

14. New Regulations that determine how we work online with clients and how we process and store client data GDPR General Data Privacy Regulations

15. What does GDPR (General Data Privacy Regulations)mean for me as a counsellor and counselling supervisor? • The Data Protection Act 1998 will be replaced on 25 May 2018 by the ‘General Data Privacy Regulations’ (GDPR) which will be incorporated into UK Law and repeal the DPA 1998 – currently the Data Protection Bill • There are quite a few resources online to help counsellors and Psychotherapists, and counselling services in how to comply with the new laws, which apply to all European states, including the UK. • “The GDPR will affect how counsellors, psychotherapists and counselling and psychotherapy services (the ‘data controllers’) store and use sensitive personal data on their clients (the ‘data subjects’), and the client’s rights to access and request erasure of their data, including when it is held by another person or organisation, such as an IT company (the ‘data processor’).” • New data protection regulations Therapy Today, March 2018, Volume 29 Issue 2 The General Data Protection Regulations will change how we can store and use client data. Susan Dale explains. https://www.bacp.co.uk/bacp-journals/therapy-today/march-2018/new-data-protection-regulations/

16. Additional Resources to help you prepare for GDPR An upgrade for data privacy? Counselling at Work, January 2018: Issue 95 https://www.bacp.co.uk/bacp-journals/counselling-at-work/january-2018/an-upgrade-for-data-privacy/ GDPR– Getting ready for the new regulations: https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/ Some counsellors and supervisors are unsure if they need to register. It’s best to follow the guide on the ICO website which helps you decide if you need to register. In respect of GDPR if you hold or use personal information about living individuals you are: • A data controller This includes processing personal data and sensitive personal data, for example creating, maintaining and storing client records. You are obliged to protect that information.

17. Storage of client Records Record Keeping How long should I keep records for? GDPR does not specify how long we should keep client records for. We are expected to decide what is appropriate for our practice. It is usual to keep clinical records for seven years. Records have to be stored securely- paper copies and electronic copies If working with young people under the age of 18 the new regulations suggest that records should be kept for a minimum of a client reaching the age of 18, or beyond if there is a legitimate reason for doing so It is considered relevant to have a data storage system where it is easy to recognise when data has achieved it’s due date for deletion, ie the system highlights what needs to be destroyed and when. Records have to be destroyed safely and confidentially. Shredded if paper copies and ‘wiped’ if electronic copies. Please do use the links provided, plus resources available via OCTIA and our professional bodies to guide you as a practitioner in complying with GDPR

18. Where are we going? The future of online therapy • Will we reach a plateau, or keep changing with technology and the client demand? • Where will the ‘Digital Natives’ take us? • Virtual Reality • Mobile Apps • 3D Therapists online

19. Are artificial intelligence and robots the future of mental health?Maybe THAT future is NOW: • Paro: a therapeutic robot in the form of a baby harp seal used to reduce stress. Paro has the ability to learn its name and change its behavior. • Keepon is mainly used with autistic children. • Popchilla can be used through an iPad application. • Phobot helps children who suffer from extreme anxiety and phobias. • Nao assists in autism therapy and caregiver assistance therapies. It can act like a personal assistant because it has human-like interaction based on voice and gesture. • ELIZA is a computer program that acts as a psychotherapist. ELIZA uses string substitution and responds based on keywords. Some people believed that ELIZA was an actual human being. Sourced at: https://www.bestcounselingdegrees.net/online/

20. What Is Virtual Reality Therapy? Virtual reality therapy, also called virtual reality exposure therapy, allows you to enter a virtual world that is carefully constructed to increase your exposure to negative stimuli, so you can build resilience and emotional strength. Becoming engrossed in a virtual world can also help you shift your attention away from pain. “Already, virtual reality therapy has been used in several specific conditions.” These include: Fear of flying Fear of public speaking Fear of spiders School phobia in children Pain, particularly pain from severe burns PTSD Depression Anxiety Eating disorders Sourced at: https://www.betterhelp.com/advice/therapy/virtual-reality-therapy-a-therapeutic-use-of-technology/

21. How It WorksVirtual reality therapy is typically a part of a larger therapeutic intervention. For the VR part, the client is exposed to a specially-designed virtual environment with stimuli they have previously associated with fear or unpleasant situations. The first scenes you see might contain just a few instances of these stimuli. Over the course of therapy, the negative stimuli increase in number and intensity. Being exposed to your greatest fears helps your body and mind become more used to them so that they no longer provoke anxious or fearful feelings.Source: mental.jmir.org

22. What will online therapy represent in 10 years from now?