Overview of basic principles of etherapy. Part of a powerpoint series on online counseling for the Florida Certification Board's certificate in Etherapy

1. Clinical Principles & Treatment Modalities 4 Hours

2. Review the different modalities and most common usages in counseling Identify potential clinical and ethical issues Learn about at least 3 unique ideas for doing online counseling Define Treatment Structure Objectives

3. Review Online Counseling: A Handbook for Mental Health Professionals http://www.netlingo.com/ Text Reading

4. Tweets Emails Blogs Secure Forms Forums IM Video Chat Second Life Good ole telephone Modalities

5. This is a great way to push out positive thoughts for the day. I have used this for morning focus meditations and evening roundup meditations. It is NOT secure, so no PHI here. This includes graduation announcements or congrats. Good way to get the word out about you and your approach. This is not a therapy approach. Tweets

6. Technical Use a secure service. If you are not using a secure service, then make sure your email address does not give away who you are. Services offering Secure Email: Hushmail, ZixMail, Websites4Counselors Are considered part of the clinical record and can be subponeaed just like progress notes. Provide clients with a response time frame Benefits Can provide a running “diary” of progress Are excellent for people who like to write and ponder. (Introverts and Reflective learners) Emails

7. Drawbacks Can miss a lot when you do not see the rate of responding (increase in rate or errors in typing etc) Gives patients time to go back and edit which may remove some of the underlying meanings Not appropriate for patients in crisis Formats Diary—freeform Diary—Structured Worksheet completion (i.e. CBT, relapse prevention) Questions to ponder—(i.e. Miracle Question) Email Cont…

8. Provide information to people Not secure or HIPAA compliant unless you make them that way Excellent activity to inform patients about conditions, new treatments and new programs Excellent for patients who have something to say to the world—Awareness/Advocacy Campaigns Blogs

9. Secure Blog Formats Video Blog: Can be used for daily check-ins for clients—excellent for addictions, eating disorders and major depression Blog with pictures Can be used to as a means of creative and therapeutic expression for some clients Can also be created like an online scrap-book with pages for: What means the most to me, My Goals, My accomplishments, About Me (Best with teens) Text Blog Can be used as a running diary Blogs cont…

10. Forums are a good place to ask a question to a group and let them provide answers Group members can see each others responses and comment and/or learn More than some other modalities, it is imperative to be clear about appropriate behavior in the forums. If you do not have something nice or constructive to say, don’t say anything at all This is not a place for Borderline behavior Forums

11. Useful to get information quickly such as intakes, client’s week in review and CBT or DBT worksheets Can be created as fillable PDFs and securely emailed to you. Used as an adjunct to therapy for people who like using workbooks etc. Secure Forms & Worksheets

12. Mainstream communication for the younger generation Can be done via mobile devices Not secure/HIPAA unless you make it that way Provides real-time text-based interaction Nonverbals include Color, font, size of text Speed of response and error rate You must set boundaries You must know the lingo (see below) Instant Messaging (IM)

13. Next best thing to face-to-face Can connect patients and clinicians worldwide Must be done on a secure connection (Skype) Provided internet connection is adequate, provides nonverbals Drawbacks—You must have a backup plan for: Internet issues Software issues Firewall issues Power issues Video Chat

14. Appealing due to avatars Does not meet HIPAA security standards Has had incidents of being hacked and losing user data Does not provide subtle nonverbals May reinforce a fantasy persona in those with an unfavorable or unstable sense of self Second Life

15. Most people are comfortable talking on the phone It requires a high amount of concentration on your part Traditional nonverbals are not available Format VoIP VoIP sometimes goes out. Skype seems pretty reliable Must make sure it is a secure connection Cell Phone Data is minimally available when it hits cell towers Low risk of being “hacked” or “breeched” Land Line Excellent as a backup in the event of a power or internet outage Phone

16. Above All Do No Harm Evaluating appropriateness (diagnosis, crisis, age, comfort with computer technologies) Developing a safety plan Making appropriate referrals Netiquette Mastering the lingo Clinical Principles

17. Evaluating appropriateness Can you and the patient type? If no, look into video or phone counseling Is the condition appropriate for that level of treatment? Developing a safety plan Making appropriate referrals Above All Do No Harm

18. General All CAPS= YELLING Don’t overuse exclamation points!!!!!!!!!!!!! Use italics, different colors, fonts and font weight to emphasize ideas This is awful! I am totally over it. This is awful! I am TOTALLY over it. Paraphrase and check your understanding B4 U get offended Email Return emails in a timely fashion Add responses within the persons email to you Netiquette

19. Chat Rooms No Lurking Say hello and Goodbye If you step away, say BRB as appropriate Use private messaging for “side” conversations if allowed IM Never have multiple private chats going at the same time Respond quickly If you have to step away from a crisis, tell the client BRB Netiquette cont…

20. Options Email/IM/Phone/Video Only Email/IM/Phone/Video + weekly or monthly F2F Email/IM/Phone + weekly/monthly Video Considerations Cost Time effectiveness Patient preference Acute issues: Crisis, medication changes, impending triggers Treatment Structure

21. Have people review their emails or chat logs for patterns or improvements Use information documented in email and chat logs as “evidence” when confronting a client Have a client do a video tribute to someone who has passed away Have someone do a blog in the words of someone they have lost…What Mom would have said Have clients tweet commitments and/or statuses Neat Techniques and Tricks

22. Have clients research 3 famous people who have encountered similar situations About depression, temperament, CBT etc. Resources for coping with _____ How nutrition and/or exercise can help them Different hobbies Local clubs and social groups And the list goes on…. Tips and Tricks cont…

23. Online Counseling and etherapy make it possible for patients to access services Easier With Greater Confidentiality With Experts Worldwide It appeals to the younger generation and those who are very visual. Just like any other new modality, etherapy has its own techniques, language and netiquette. It will be important for etherapists to stay in tune to the evolving regulations regarding online services Summary