Online Counseling: A Handbook For Mental Health Professionals

Seemingly aimed both at students and at internet-illiterates, this book provides fairly comprehensive coverage of the history and development of online counseling. As a practical guide or handbook, however, it lacks depth.

This handbook gathers together 27 authors with experience in online psychological services and/or internet research, and covers, or at least competently introduces, an impressive range of topics of possible interest to psychologists/therapists who are considering providing online services.

The book seems to be aimed both at students, with a series of “study questions” for reflection at the end of each chapter, and at internet-illiterates (which contemporary students are hardly likely to be). This suggests a dual focus, on students and on older mental health professionals seeking to extend their practice. While the references and “suggested reading” sections at the end of some chapters are extensive and useful, the lists of key terms which close each chapter include just about everything, with simple explanations of terms like “diagnosis” and “email”, making me wonder whether the book was actually aimed at people who have recently arrived on the planet.

It is probably inevitable that a book covering a topic like the internet should sound dated in places (even when it was first published, let alone now). A piece on marketing your practice, complete with recommendations to pay for placement on search engines such as AltaVista, as well as the conspicuous absence of any mention of modern services like Skype (released the year before the book appeared), stick out like sore thumbs.

There is significant historical coverage of the birth and development of mental health services online, and indeed of the internet itself, which provides a fuller context to chapters such as The Psychology of Text Relationships, Online Counseling Research (the conclusions are cautiously hopeful, the field still in its infancy), Technology of Online Counseling, Ethical and Legal Considerations, Business Aspects, Clinical Issues in Online Counseling, Online Counseling Groups, Internet-Based Psychological Testing and Assessment and International and Multicultural Issues in Online Counseling.

The nature of the internet is plurality, diversity, cross-cultural dialogue, breaking across national and cultural boundaries and identities and, in theory at least, creating a global network and level playing field for all. In this context I found the book disappointing on “multiculturalism”. My reactions ranged from horror at mentions of how the counselor might approach the “multicultural client” — I find the unqualified assumption that a professional service provider is white and the receiver some kind of “other” who needs adjusting to intensely irritating — to some interest in the chapter by British authors Skinner and Latchford, which at least urged the counselor to investigate their own culture, and considered practical issues of security, identity, confidentiality and redress when counselor and client operate under different legal systems. The chapter did not go much further, though, in investigating the intriguing psychological potential of a situation in which an online counselor from anywhere in the world may engage in a therapeutic relationship with a client in any part of the world.

The book’s view of Future Perspectives seemed unnecessarily constrained — an author is quoted as saying that the most successful online therapists he knows have only a handful of clients, and the prospects of making a living in online counseling are exceedingly slim. This is no longer the case, which is either a question of the development of the field, or the fact that the online counselors I know, including myself, actually do work with clients from all over the world.

This curious overlooking of the potential inherent in the medium and the concentration on online counseling as a kind of “different” way of doing “more of the same” may partly stem from the nature of US legislation: several chapters go into lengthy consideration of legal issues which are relevant only to US practitioners, and, at the time the book was printed, painted a rather restrictive view of online practice — basically it was legally impossible for a counselor to engage in work with a client outside the state in which they are licensed to practice.

As a practising online counselor, I found the practical sections on counseling skills the most useful, such as the chapter by Stofle and Chechele on in-session skills, which includes transcripts from both online chat sessions and asynchronous email. Maybe the most interesting of all was Suler’s chapter on The Psychology of Text Relationships. The more general counseling skills chapter by Zelvin and Speyer deals with suitability for online counseling (both client and therapist) and the skills of contracting, engaging, terminating, etc. — but it was representative of the book in general in mentioning possible relationship distortions and transference merely in passing (the main focus seemed to be on the ‘disinhibition effect’, and the positive side of this). I lost confidence somewhat in the whole section upon reading, “it can come as a shock to online counselors when they realize that some clients not only save and reread their emails, but also may copy and paste in order to quote them verbatim in their replies”. (p. 174) And there I was thinking that this was a no-brainer, an obvious advantage of online work over a face to face session in which things can notoriously be misheard, misremembered or not heard at all — a brilliant opportunity for reflection between sessions, deeper engagement within them, and transparency.

While the handbook is fairly comprehensive in its coverage of history, development of the field and technological issues, and covers all the practical legal and ethical issues, it did seem to me to be constantly lagging behind the internet itself in the breadth and immediacy of resources available. While you can get an idea of the issues involved, you could not actually install software or start to effectively market your practice from reading the handbook, whereas you probably could after a few internet searches. Maybe this is inevitable, and a book is a place more suited to in-depth engagement — however, this book touches on so many very different ways of working with the internet, chat, email, moderated and unmoderated support groups, psychological assessment, and so on, that it also leaves one with the impression that nothing has been gone into in depth.

While I would recommend the book to a mental health practitioner who is just starting to use the internet, for others it offers no more than an overview, maybe a ‘feel’ for online work, and a valuable collection of more specific references for further investigation.

Please see our Review Disclosure Policy.

• online mental health
• overviews & guides
• training and development