Minor complaints aside, ‘Technology in Counselling and Psychotherapy’ offers a solid contribution to the literature on how technology in three specific areas has been used in counselling and psychotherapy.
Technology in Counselling and Psychotherapy: A Practitioner’s Guide
Edited by Stephen Goss and Kate Anthony, 2003. ISBN 1403900604. Palgrave Macmillan. xx + 217 pages.
The 11 contributions of this edited volume aim to cover three main areas of technology as used in counselling and psychotherapy: email and IRC, telephone and video links, and stand-alone and practitioner-supported software. The contributions address these three areas in widely varying degrees of depth and with approaches ranging from heavily case-based expositions to literature reviews.
The book is both enjoyable and extremely quick to read, but any readers hoping that the subtitle A Practitioner’s Guide might help them actually to use technology better in their counselling or psychotherapy practices are apt to be disappointed. While the editors emphasize the book’s practical slant, with one main exception (noted below), the bulk of what contributors provide is information about what has been done, as distinct from practical information about how to do it.
Therapy and Counselling via Technological Intermediaries
That main exception is Chechele’s and Stofle’s chapter ‘Individual therapy online via email and Internet Relay Chat’, which may help new online practitioners or those contemplating this type of working by drawing attention to relevant practical considerations as well as by providing worthwhile verbatim examples from both email and IRC therapeutic exchanges. The authors choose where to focus their attention based upon their own experience of online therapy as almost always being brief and generally being most suitable for clients with comparatively simple difficulties, who benefit from insight, education, and behavioural interventions. This narrow characterization of online work does not at all match my personal experience of offering online therapy and counselling services (see “Online Therapy and Online Counselling”) — either in terms of the breadth of client matter or in terms of the variability in duration. (For specificity, my own experience includes providing something over 300,000 words of individual email-based counselling during the first 8 months of 2004.) Of course, this notable difference suggests not that Chechele’s and Stofle’s chapter is somehow wrong, but merely that it does not address the full spectrum of what can be done via the medium.
The book also includes a useful chapter on online groups mediated or facilitated by mental health professionals and two on supervision — one of these covering email-based supervision and the other supervision via video link or telephone. Maxine Rosenfield, well known for her 1997 book Counselling by Telephone, provides a chapter on the topic, including two case studies, while Susan Simpson writes on ‘Video counselling and psychotherapy in practice’. While slightly marred by occasional technical inaccuracies, Simpson’s chapter provides a useful literature review covering both the author’s research and that of others in the field. This chapter is notable for including specific technical and clinical recommendations concerning the provision of counselling and psychotherapy via video link.
The final section, on software, consists of two companion chapters written by the same group of people (with the exception of one co-author); the two, taken together, review the history and some of the literature associated with the use of computer systems for supporting the delivery of counselling or psychotherapy or for actually delivering it (effectively replacing the therapist), as well as some of the relevant practical, ethical, and business considerations. I was disappointed that neither chapter mentioned one of the leading, and particularly well researched, online CBT projects, MoodGYM (see “Web Resources in Counselling, Psychotherapy and Mental Health”).
The Call to Research
The chapters I’ve described above were preceded by a brief introduction from the two editors and a chapter by one editor which I would characterize primarily as an historical review of leading up to email and IRC. The collection finishes with a conclusion from the two editors — a conclusion which seemed to me one part actual conclusion, reflecting material included in the remainder of the book, and two parts new material reflecting and developing the views of the editors. Goss and Anthony devote particular attention to what they see as a pressing need for research, especially into the effectiveness, efficacy and safety of online service provision.
Long-time readers of CounsellingResource.com will know that I am a strong proponent of research into efficacy and effectiveness (see “Effectiveness of Counselling & Psychotherapy”), and as a former research scientist myself, I have every sympathy with the urge to identify relevant causal factors and study their contributions to effects. But even so, I found myself disagreeing pretty strongly with the simplicity inherent in what I understand to be the Goss and Anthony research priorities. The reason is that the ease of identifying and isolating a particular factor (e.g., is this a process taking place online via email, or is this a process occurring face-to-face?) implies nothing about the ease of identifying that factor’s contribution to outcome — and, indeed, nothing about the practical relevance of simple questions about that factor in the form of ‘is this effective?’ or ‘is this safe?’ or ‘is this efficacious?’. Obviously, it is possible to offer online therapy ineffectively. It is equally obvious, to those of us who do it, that it is possible to offer it effectively. No general conclusion to the question ‘is online service provision effective?’ will change that. To my mind, in order to be of any use from a practical standpoint, research should focus on far more specific variables than the simple binary alternative ‘is it online or face-to-face?’.
(By analogy, I hope no one will spend research hours on the question ‘is counselling in Greek effective?’ or ‘is counselling in Mandarin effective?’. General answers to these questions would be of extremely limited practical value; by contrast, much more specific investigations, for example into the ways a language which is tonal and lacks verb tense, such as Chinese, might help or hinder clients’ communication with their therapists, could be very useful indeed.)
This minor complaint aside, the book remains, overall, a solid contribution to the literature on how technology has been used in counselling and psychotherapy. Contrary to the sentiments expressed in the Preface by the then-Chair of the BACP (who, perhaps unsurprisingly, uses the Preface largely as a platform for plugging the BACP), I would not go so far as to call the work ground-breaking. There is little here that is especially new, although the book certainly is unique in that it collects together in one place many ideas and references to other literature which were previously available only by scrounging together disparate resources. But it does not need to be ground-breaking to be useful! Readers who approach the book expecting to find a solid resource, good historical summaries and literature reviews, and worthwhile case studies, will not be disappointed.
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