Videoconferencing As A therapeutic Tool for Victims

Denise De Jesus Spring 2014

Pace University Counseling 2.0

Online Counseling

Online counseling is a new medium making headway into our society.

As we try to keep up with a society that is consistently dependent on technology new forms of services need to be adequately implemented.

Asynchronous and synchronous communication are mediums for which we use to communicate.

Asynchronous communication does not take place in real time and is considered email, and text. Synchronous communication is done in real time and can be done by the phone, videoconferencing, and Skype.

Online Counseling

Pros

Targets a greater population

Eliminates geographical barriers

Increases disinhibition

Allows for Zone of Reflection

Is cost-effective

Cons

Lack of visual cues

Disruptions with communication

Security network issues

Difficult to process crisis situations

Most insurances don’t cover it

Not very clear ethical guidelines

Populations that would Benefit

A group that will benefit highly from this form of transaction (online counseling) are victims of rural domestic violence and sexual assault.

Domestic violence is defined as physical abuse and includes assaultive and coercive behaviors, physical attacks, sexual assault, psychological and emotional attacks and economic coercion.

About 2 million women in the United States are assaulted each year by their partners, and takes them about five attempts of leaving an abusive situation before they are successful.

Barriers not allowing this population access to services are because of geographical reasons, transportation difficulties, individual or social factors, reason regarding anonymity and confidentiality.

Disparity in provider’s access to evidenced-based treatments, insufficient time to learn evidenced-based treatments, lack of access to informational resources and the prohibition of expense of training.

Unfortunately, those that due receive services are usually done by their primary care physician and are not allocated the proper services by a mental health provider.

New Wave of Telemedicine

Telecommunications and information technologies have had an increased impact and improvement towards the health care system as a whole. Leading us to the idea of telemedicine—a combination of innovative and mainstream technologies defined as “the use of electronic information and communications technologies to provide and support health care when distance separates the participants (Field, 1996).”

As a whole we are constantly using social networks like Facebook, instagram, LinkedIn, twitter, and etc..

We build parasocial relationships where we think we know the person on the other end but in reality they have no idea that we exist.

We are all highly dependent on technology for example; how much time do we spend on out phones?

Increasing research on providing mental health services via technological mediums.

Practical, Ethical & Legal Implications

Licensed clinicians have to know the regulations of their state and their professional associations in order to not have to deal with legal risk or penalties.

No specific guidelines have been put into place.

General guidelines have been provided by the American Counseling Association.

In order to follow ethical standards clinicians should abide by the following;

Need to be competent

Keep records secured and private

Can’t break confidentiality

Have the responsibility of “duty to warn”

Should not false advertise credentials

Provide consent

Tech Plan

To provide synchronous online counseling to rural populations having been victims of domestic violence and sexual assault via videoconferencing.

Group workshops would be held and called “ healthy relationships” and would help individuals see what are the differences between healthy behaviors in any relationship and unhealthy ones.

Therapy would also be targeted at increasing self-esteem, and decreasing symptoms of post-traumatic stress disorder, and depression, as well as any other related disorder.

Individuals would be coached in how to leave their current partner if that was a goal and making sure that their safety was not compromised.

Resources would be available for continuous support.

Hardware / Software

Encrypted videoconferencing-based technology (Polycom), an integrated videoconferencing unit that not only allows many individuals to meet at the same time via audio conductors, but also provides visual information.

Simple to set up.

Increases rate of absorption of information, improves retention, is accessible and can be used in conjunction with other tools, exhibits higher quality and uses lower bandwidth.

Can be used with a Windows or a Mac computer/ desktop, and its stable

Reliable internet connection as well as wireless access, microphones and web cameras.

Telephone and facsimile contact (a system that transmits and produces graphic material through signals sent over telephone lines as back-up.

Programs like iChat and Skype will also be considered when appropriate.

A firewall system like Norton Internet Security or ZoneAlarm will be established through the implementation of a router to monitor client safety.

Research

One particular study set out to demonstrate the effectiveness and feasibility of providing evidence-based, trauma focused treatment via videoconferencing to rural survivors of domestic violence and sexual assault. The results when regarding the Post-Traumatic Stress Disorder index, The Center for Epidemiological Studies Depression Scale and the Wyoming Telehealth Trauma Clinic Client Satisfaction Scale, exhibited large reductions in PTSD and depressive symptoms and very high levels of satisfaction for psychological services administered via videoconferencing (Hassija & Gray, 2011).

Another interesting study that focused on enforcing a telepsychiatry program for rural victims of domestic violence displayed a substantial amount of evidence on how telepsychiatry provided the opportunity to address specific problems in care delivery as an integral part of the mental health system, as the use of teleconference facilitated the patients comfort and alliance as it allowed for control and distance, while also decreasing the use of emergency and inpatient psychiatric care.

Research Cont.

Further, another study examined the effectiveness of cognitive behavioral therapy (psychotherapy) administered via videoconference for post-traumatic stress disorder and the results showed a significant decline in frequency and severity of symptoms with an increased improvement in overall functioning (Germain et al., 2009).

Interview with Dr. Joseph Franco

1. What are your current feelings about online counseling?

I think that it is critical for our profession to use all appropriate technological resources for clients so that they can reach us with ease and so that we can be available to a wider audience.

2. Do you have any knowledge about online counseling?

Yes, I have used Skype and other forms of technology to counsel clients on a professional level. I do so only with clients that I have personally conducted an intake and bio psychosocial, to be sure that I have clear insight as to their clinical issues.

4. Plans to use online counseling.

I will continue to use on-line counseling for sure and want to explore improved delivery systems for clients so that video and audio are clearer than they are now. Any glitches tend to impact clinical sessions in major ways.

Interview Cont.

5. Feelings towards privacy and confidentiality when using online counseling?

I do believe that clinicians need to be familiar with these issues as well as their ability to provide clinical services across state lines. In fact, I plan to complete the Distance Learning Credential (DCC) offered by the National Board of Certified Counselors (NBCC) so that I can be well-versed on these issues.

6. Where do you see online counseling in 20 years.

While I do believe that on-line counseling modalities will definitely increase, it seems to me that we will always have the option of face-to-face counseling depending the client's ability to physically see that the therapist based on transportation and geographic challenges. I also believe that online counseling in 20 years will allow us to reach clients on a national and international level who may not otherwise have the opportunity to do so.

7. How will you compare it to the face to face module.

I still enjoy face-to face sessions much more, but once more technological options become available that are more desirable, I will further enjoy the flexibility that online counseling allows. It also low cost to counseling clients online rather than face-to-face.

Conclusion

In the next few years online counseling will become something that will have more substance as more research will be conducted and clinicians as well as clients will be less hesitant to participate in it.

More individuals will receive mental health services

Decrease in mental health problems not be addressed as services will be much more widely used.

References

Field, M. J. (Ed.). (1996). Telemedicine: A guide to assessing telecommunications for health care. National Academies Press.

Germain, V., Marchand, A., Bouchard, S., Drouin, M. S., & Guay, S. (2009). Effectiveness of cognitive behavioural therapy administered by videoconference for posttraumatic stress disorder. Cognitive Behaviour Therapy, 38(1), 42-53.

Kenoyer, M., Malloy, C., Vanderwilt, P., & Wakefield, S. (1999). U.S. Patent No. 5,900,907. Washington, DC: U.S. Patent and Trademark Office.

Kraus, R., Stricker, G., & Speyer, C. (Eds.). (2010). Online counseling: A handbook for mental health professionals. Academic Press.

Hassija, C., & Gray, M.J. (2011). The effectiveness and feasibility of videoconferencing technology to prove evidence-based treatment to rural violence and sexual assault populations, Telemedicine ans e-Health, 17(4), 309-315.

References Cont.

Thomas, C. R., Miller, G., Hartshorn, J. C., Speck, N. C., & Walker, G. (2005). Telepsychiatry program for rural victims of domestic violence. Telemedicine Journal & E-Health, 11(5), 567-573.

Mattson, S., Shearer, N., & Long, C. (2002). Exploring telehealth opportunities in domestic violence shelters. Journal of the American Academy of Nurse Practitioners, 14(10), 465-470.

Richardson, L. K., Christopher Frueh, B., Grubaugh, A. L., Egede, L., & Elhai, J. D. (2009). Current directions in videoconferencing tele‐mental health research. Clinical Psychology: Science and Practice, 16(3), 323-338.

Schwenn, U. (2005). Status of Videoconferencing standard. presented on 5th IAEA-TM on Control, Data Acquisition, and Remote Participation for Fusion Research.

Future Recommendations

Target a greater populations and not only victims of domestic violence

Implementation in schools so children learn at an early age the ramifications of domestic violence and how to avoid it. (As a learning tool)

Finding different modes to provide therapeutic services to these victims for example asynchronous counseling.

Coach these same victims to be group facilitators by building self-esteem and self-worth.