1. The New Millennium and On-line Counseling: Ecological Practice, Concerns and Discussion Presenter: Oscar McKnight Ph.D. LPCC-S LSW NCC DCC

2. ABSTRACT For counselors, the ecosystem is vast and encompassing; and professionals must understand the client in both context and time. This in and of itself is a daunting task; now, enter the New Millennium and on-line counseling. The Web is the poster child of interconnectivedness and interdependence of systems; however, is the Web bringing us closer or further apart? The Web is transforming society and potentially the ecological context of counseling. A review is necessary.

3. PRESENTATION OBJECTIVES Technology is transforming the world and how we live, communicate and interact. However, should counselors avoid, minimize, maximize or embrace the online environment? The objective of this presentation is to review the history of online counseling with respect to ecological practice. Discuss who and why people use online counseling from both the therapist and client perspective; and, evaluate how individuals are assimilating and accommodating the online counseling environment into their ecosystem. Exploration of the “goodness of fit” between the individual and their online environment is central. Special attention addresses individuals engaged primarily, though not exclusively with online automated counseling (a computer generated therapist). Future implications will be discussed openly with the audience and an online demonstration of CHRIS (online computer generate therapist) will ensue. In the end, the objective of this presentation is to discuss and review with professional counselors the current trends of online counseling and what they mean to the helping profession. Assessment data from students engaged in the on-line counseling process from a University Counseling Center will investigated. The presentation conclusion will address the effectiveness of online counseling, the measurement system and implications for ecological assessment.

4. ASSUMPTIONS The ecosystem is vast and encompassing Counselors must understand the client in both context (person, place and being) and time (relative)

5. PRESENTATION Background Technology is transforming the world and how we live, communicate and interact. TWO BIG QUESTIONS 1. Should counselors avoid, minimize, maximize or embrace the online environment? 2. How does On-Line Counseling fit with Ecological Counseling

6. SELECTED OBJECTIVES Review the history of F2F counseling and online counseling Discuss who and why people use online counseling Evaluate how individuals are assimilating and accommodating the online counseling environment into their ecosystem Explore the “goodness of fit” between the individual and their online environment

7. SELECTED OBJECTIVES (Continued) Special attention to online automated counseling Discuss and review current trends of online counseling Address the effectiveness of online counseling, the measurement system and implications for ecological assessment

8. THERAPEUTIC COUNSELING A HISTORICAL REVIEW

9. Psychoanalytic nature of the unconscious conflicts

10. Psychodynamic alleviate psychic tension

11. Brief Psychotherapy It is solution-based rather than problem-oriented

12. Existential feelings of meaninglessness

13. Humanistic emphasis on subjective meaning

14. Cognitive beliefs and reactions

15. Gestalt facilitates awareness in the various contexts of life

16. Transpersonal spiritual dimension of the human psyche

17. Systemic dealing with the interactions of groups

18. Eclectic Therapy adapt to each client’s individual needs

19. On-Line Therapy utilizes the power and convenience of the Internet

20. TYPES OF ON-LINE THERAPY Synchronous Interaction (e.g. web-video; web- telephone, electronic web-chat) Asynchronous Interaction (e.g. email, online testing and packaged outcomes, form completion)

21. ON-LINE COUNSELING: A REVIEW

22. Ask Uncle Ezra (1986)Ezra

23. The Pink Practice was established in 1990 in response to requests from lesbians, gay men and bisexual people for counselors who were lesbian or gay themselves

24. Ivan Goldberg, M.D. began fielding questions online about medical treatment of depression at least as early as 1993.

25. These trained volunteer crisis counselors have answered e-mail from despairing and suicidal persons daily since 1994, anonymously and without charge

26. John Grohol, Psy.D. has offered free mental health advice in a popular weekly public chat since 1995

27. Holmes, Ph.D. who offered "Shareware Psychological Consultation" answering questions on a "pay if it helps" basis. 1995

28. E – Therapy International 1997

29. E-Clinic 1999

30. E – Therapy 2000

31. GROUP PRACTICE ON-LINE: 2000

32. Human On-line Counseling An Overview 100% Never meet the Client F2F (excluding “Skype”) Most frequent site visitor was a female between the ages of 25 – 34; browsing from home; and, had no children. Purchased session times: 30 – 60 minutes.

33. 2008 SURVEY: ON-LINE CLIENTS Demographics

34. SURVEY: ON-LINE CLIENTS LOCATION OF SERVICE

35. ON-LINE COUNSELING: TIME/LOCATION

36. Female/Male LOCATION PREFERENCE

37. Female/Male COUNSELING PREFERENCE

38. DISCUSSION On-line Counseling

39. COUNSELING CENTER On-Line Clients 3 YEAR REVIEW N = 63 (Active Web-Clients) Active Client = > 6 sessions; Dx; scheduled 58/63 = 88% Had an open case – therapy extended online EMAIL = 43 CHAT =6 SKYPE= 14

40. COUNSELING CENTER 3 YEAR REVIEW (continued) No significant Difference found between gender and scheduling appointments for online counseling No significant pattern of diagnoses or presenting concern between those scheduling online counseling and those in traditional counseling No significant difference between the overall satisfaction ratings of those receiving counseling online and those in traditional counseling

41. WHY ON-LINE COUNSELING 3 TOP REASONS 1.Convenience 2.Did not want to be seen coming into the center 3.Live off-campus or attend a regional site

42. ANECDOTAL DIFFERENCES TIME Does not follow the 50 minute hour DISCLOSURE Disinhibition effect INFORMATION Abundance – will send links to blogs, journals, YouTube videos

43. DISCUSSION On-line Counseling

44. Non-Human Online Counseling ALICE Robo-Counselor CHRIS CHRIS 2

45. A.L.I.C.E. The Artificial Linguistic Internet Computer Entity

46. A.L.I.C.E 2002 The Artificial Linguistic Internet Computer Entity

47. Robo-Counselor

48. RoboCounselor 2008

49. ALICE/Robo-Counselor: Combined Demographics Daily time on site: – 7 day average 1.9 minutes – 1 month average 2.7 minutes – 3 month average 3.3 minutes Demographics – Males 18 – 24 with Some College

51. CHRIS Background 1 Began as a customer service program (manufacturing company) Beta tested with two small groups (business majors of AU/KSU) (business professionals) Project stopped (lack of funding)

52. CHRIS Background 2 No marketing of CHRIS (Imbedded program - hidden) CHRIS version(s ) remained online (data kept coming in) CHRIS not monitored (emails collected and stored)

53. CHRIS Background 3 CHRIS about to be shut-down (data retrieved) CHRIS data assessed (active users) CHRIS data categorized (psychological/counseling issues)

54. C.H.R.I.S.

55. CHRIS:FOUR CASES Mary (session 1 and 2) Robert Frank Bob

56. CHRIS: Case 1

57. CHRIS: Case 1 (continued)

58. CHRIS: Case 1 session 2

59. CHRIS: Case 2

60. CHRIS: Case 2 (continued)

61. CHRIS: Case 3

62. CHRIS: Case 3 (continued)

64. CHRIS: Case 4

65. CHRIS: Case 4 (continued)

67. Brief Demographics  250 active users  23 States  Male users on Saturdays  Female users on Fridays  Multiple Diagnostic Categories  Multiple Populations  Average Time on site 5.2 minutes; College Education  36% complete the entire counseling process  Counseling Helpfulness/Effectiveness 7.3 (10 point scale)

68. DISCUSSION On-line Counseling

69. The New Millennium and On-line Counseling: Ecological Practice, Concerns and Discussion NOW WHAT?