A growing number of people have lived with the Internet all their lives, with concomitant increase in the use of new communications technologies in therapy and in training mental health practitioners. Editors Kate Anthony, DeeAnna Merz Nagel, and Stephen Goss draw on the expertise of 40 additional contributors on multiple continents in The Use of Technology in Mental Health: Applications, Ethics and Practice. This groundbreaking volume integrates a solid foundation in mental health practices and research with cutting-edge Internet technology applications.
Contributor specialties include but are not limited to neurology, engineering, ergonomics, community outreach and advocacy, and new media. The book’s authors also include medical and social science academicians and clinicians researching and practicing a wide range of treatment methodologies. Dr. John M. Grohol of PsychCentral is among them.
Most of the book’s 30 chapters address the uses of new technologies in therapy, both in practitioner-client and in peer-to-peer relationships. Technology applications include e-mail, texting, and chat; virtual reality environments and gaming; videoconferencing; forums and social networks; websites, blogs, and wikis; and podcasts; along with more established modalities like the telephone and the uses of film and media.
Roughly the last third of the book discusses the uses of technology in training and evaluating therapists and in performing research. Inherent in this section is the recognition that more research in online therapy and training is needed. Whereas earlier chapters included best practices in using communication-based technologies with clients, these latter chapters adapt best research and assessment practices, such as sampling and validity concerns, within new technological frameworks.
As in the past, these new applications are seen as supplementing, not replacing, face-to-face therapy. The anonymity offered by some, like identity-stripped texting used by the Samaritans or avatars used in Second Life’s virtual communities, make the Internet a gateway for people who might not otherwise seek help. As a tool for self- or assisted therapy and for self-education, the Internet offers a greater sense of equality and “reduce[s] the stigma traditionally attached to mental health concerns.”
The advantages of these technologies include cost and travel savings, as well as basic accessibility to therapy in remote areas lacking clinical facilities. In one example, people living in Bangladesh use cell phones to access distant medical care; in another, a clinic on a remote island in Scotland uses videoconferencing to help treat a patient with an eating disorder. Teletherapy options are used to treat patients confined to their homes, whether as a result of physical limitations or of social anxiety disorders. Within correctional facilities, a telepsychiatry clinic provides continuity of care to inmates experiencing institutional transfers, makes their medical records more portable, and eliminates transportation difficulties associated with using an offsite clinic.
The nature of the technology itself aids interactions. One example given of the Internet’s disinhibition effect is that of an adolescent who texted her therapist in the middle of a face-to-face session in order to communicate more freely. The use of online chats in family therapy can help defuse power struggles by making sure each member has a turn in the discussion. Virtual reality programs like Second Life allow patients to explore different identities and test different behaviors in a safe environment, before integrating their new knowledge into actual life.
Similarly, online simulations may be used to train counselors, helping them grapple with common misconceptions in a “mistakes allowed atmosphere.” Forums connect students in the field with each other, their supervisors, and their professors, while wikis foster collaboration among researchers.
The book includes numerous case studies and composite transcripts of online sessions. These examples illustrate the importance of adjusting one’s approach to the different communications modalities. For example, text methods of therapy omit nonverbal cues such as body language or tone of voice. Users can overcome this limitation by stating their emotions inside parentheses — e.g., “(worry)” or “(feeling pushy)” — or by using abbreviations and symbols called emoticons for expressing emotions.
The decision about which modality to use is made on a case-by-case basis, taking into account such variables as the disorder being treated, the technology available to participants, their ease and facility with that technology, and security and privacy issues. Remote modes of therapy or training can be synchronous (as in chat, videoconferencing, or virtual reality sessions, where feedback is immediate) or asynchronous (as in e-mails and forums, where responses are delayed). The former creates a “being with” experience where participants address issues as they arise, while the latter offers therapists more time to reflect on their responses and allows for more quality control in training. Individual virtual reality programs and games provide a low-intensity service with minimal supervision, while allowing for monitoring by the therapist. Patients can work at their own pace in areas that include overcoming phobias and managing depression.
Websites, blogs, wikis, and podcasts can be used by professionals to educate lay audiences and colleagues. These forms of publishing and broadcasting can convey a broad range of subject matter, including fictional case studies, book reviews such as this one, self-help articles, resources for organization members, and psychological exercises. Material focused on a therapist’s specialty can increase a client caseload. Online publishing lets one combine formats, offering embedded audio, video, and hyperlinks to relevant sites. These technologies also foster interactivity and feedback from readers, listeners, and viewers.
The book gives step-by-step guidance and provides examples to help readers reach their intended audience. It also tells readers how to distinguish between reputable and disreputable websites, and how to make clients better informed as they conduct their own informal research. Along with its potential to educate, blogging is used by clients as self-therapy and as ways to find community. Ethical considerations include the setting of ground rules and boundaries if both client and therapist maintain an online presence, so as to avoid inappropriate dual relationships.
Privacy and security issues associated with online communication are still being integrated into ethical standards. Furthermore, those standards must now accommodate the Internet’s global reach instead of being just country- or state-specific. Legal issues include the ownership and control of data, the role of third parties like Internet service providers, and the management of location-based licensing and fee structures in an online environment that transcends location.
The Use of Technology in Mental Health: Applications, Ethics and Practice provides guidance on matters of informed consent, ensuring and protecting the identities of therapists and clients, and guarding against unauthorized access to sensitive data. Detailed discussions of encryption methods and legal interpretations are beyond its scope. Readers are pointed to the ethical codes of the American Counseling Association and the British Association for Counselling and Psychotherapy; and to electronic resources like the Online Therapy Institute, The Future of Innovation, and other websites in the areas of training, education, and research.
That said, each chapter in this volume is packed with easily digestible information, practical illustrations, and numerous references. Non-technical readers will appreciate concise introductions to the different applications and the explanations of their terms.
When the Samaritans, one of the oldest support networks for people in distress, began operations in 1953, its services by telephone generated the same resistance that current innovations now face. The Use of Technology in Mental Health: Applications, Ethics and Practice addresses that resistance with solid experimental and anecdotal evidence, while evaluating the strengths and limitations of therapy’s more modern tools. This volume forms an invaluable resource for professionals and students involved in all aspects of mental health care.
The Use of Technology in Mental Health: Applications, Ethics and Practice
Edited by Kate Anthony, Msc, FBACP; Deeanna Merz Nagel, LPC, DCC; and Stephen Goss, PhD, MBACP
Charles C. Thomas Pub Ltd: October 2010
Hardcover, 354 pages