The Current State of Online Mental Health Training

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Online training for counsellors and therapists remains in a state of infancy, leaving counsellors in practice (or in training) to take on the job themselves of locating materials that will advance their understanding of the practice and process of online therapeutic work.

Online Training for Counsellors: In Its Infancy

For better or worse, training in online clinical practice is currently in a state of infancy. Mainstream university training programmes in psychology, psychotherapy, or counselling rarely claim to address online working in any great depth. And all too often, dedicated training programmes aimed specifically at online work focus primarily on the very basic mechanics of online practice, offering precious little engagement with the actual therapeutic process which may unfold between client and online therapist over a period of weeks, months, or even years. Unlike virtually all face-to-face training programmes, online training for counsellors very rarely offers students the opportunity to work with multiple real live clients for a sustained period of months.

One upshot of the current state of the field is that online counsellors in practice (or in training) have largely been left to fend for themselves in terms of locating materials that will advance their understanding of the practice and process of online work, not to mention helping to develop their actual online clinical skills.

The Acid Test of Experience

When I first trained as a counsellor and wondered about how the whole process might work when mediated by various types of technology, I eagerly began reading the available material on the topic. Having already spent several years of my professional life becoming proficient with the technology itself, and using it to communicate with geographically dispersed team members in a business setting, I was interested primarily in the the counselling process itself. In other words, I wasn’t looking for someone to help me understand the basics of online communication or explain to me how encryption worked; I was after materials that could enhance my understanding of online therapeutic process.

I was hugely disappointed.

So much of what I read was either chock full of technical errors or was written from a perspective suggesting very narrow assumptions about what online therapy could be (e.g., assumptions that online clients only undertake brief counselling, or assumptions that online clients only write short messages). Almost everything I read was the type of stuff that I felt was fairly obvious even without actually doing any online counselling. In fact, I did not read a single book or article that made me say to myself, “ah, now this person has clearly done a lot of this online counselling stuff, because they wouldn’t have uncovered this little insight they’re describing unless they had”. In almost all cases, when I asked myself the question “Is it necessary to have any actual online therapy experience to write this?”, my answer was a resounding ‘no’. For example, lots of people write about how important it is to offer clients encryption, and how important it is to store files securely, and how equipment failures could interrupt the therapeutic process, and how issues of identity are hard to address in online working, and how online therapy removes non-verbal cues, and how misunderstandings can easily happen via text, etc., etc., etc.

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Well, for goodness sake: how obvious is all that??

Of course, it’s important to be aware of these basics, but I am tempted to call this sort of thing armchair online therapy training, because it’s what any intelligent person is capable of discovering completely on their own, without ever encountering a real live client. (Unfortunately, it may well be that some people actually do online therapy from armchairs, so the phrase ‘armchair online therapy training’ doesn’t quite capture the sense I’m after!) Similarly, anyone can write a book saying how important it is for space travellers to maintain regular radio contact with mission control, take along pressure suits, and pack adequate food for their journey — but that doesn’t make them astronauts.

So, my own personal acid test for evaluating books and articles as well as online therapy training is very simple. I just ask myself the question: “Is this the sort of material that could be made up without ever working with a real client online, or is this something that would only have been discovered through actual online clinical work?”. If it’s the sort of material that reflects actual practical experience doing online work, then I’m immediately drawn to it. Of course, sometimes, armchair online counselling training might still be very useful — maybe someone sat down and thought hard for awhile and wrote a paper (or a course) full of things I could have come up with myself but in fact didn’t. All too often, though, when the material doesn’t pass the acid test of experience, it winds up being a re-hash of topics others have already commented on — sometimes over and over again — from the comfort of their armchairs.

Why Does So Much Online Training for Counsellors Fail the Acid Test?

In my view, the primary reason so much training for online therapy — and so much published material on the topic of online therapy — fails the acid test of experience is that not nearly as much actual online clinical work goes on as those selling training programmes would have us believe. Have you ever encountered an online counselling training website which offered a transparent explanation of the trainers’ own online clinical experience (assuming that being a trainer isn’t their only claim to fame)?

As of this writing in late 2005, I haven’t.

Instead, what I have read is quite a bit about how many years someone has been in practice, or how many talks someone has given at important gatherings, or how many papers they have published on the topic. Unfortunately, not a single one of these has any obvious connection to actual clinical competence online. (It might surprise you to know that some of the most widely-cited ‘authorities’ in the whole field of online mental health have never spent even a single hour providing counselling or therapy to a real live client online!) Significant ethical issues are raised by the many misleading ways online practitioners are sometimes tempted to market their experience.

In my view, a secondary reason why so much material fails the acid test of experience is that organizations such as the International Society for Mental Health Online are so widely viewed as thriving hotbeds of activity by those outside the field — i.e., by those who are not able to draw on their own direct experience of online therapy or online counselling in order to evaluate such organizations. The widespread view that organizations such as the ISMHO represent the ‘leading edge’ winds up acting as a strongly conservative, contra-developmental influence on the field: would-be online practitioners seek out such organizations, enthusiastically join up, and then conclude that this is all there is. The reality of my own personal experience of just under 3 years with the ISMHO is that I can count on one hand the number of occasions that discussions took place which offered me any illumination whatsoever of the actual online therapeutic process. And believe me: that’s not because I wasn’t paying attention, or because I didn’t want to learn! (I am now conscientiously not a member of ISMHO, following the publication of evidence concerning significant ethics problems within the organization.)

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