in favour of online counselling?

Keywordscounselling, online, Relationships Australia

(Queensland)

IntroductionTraditionally, organisations like RelationshipsAustralia Queensland (RAQ)2 have provideda range of ‘face-to-face’ counsellingservices for individuals, couples andfamilies. However, recent advances intechnology (National Board of Employmentet al. 1995; Barak 1999, p 3) and consumerdemand for counselling to be providedonline (Relationships Australia Queensland(RAQ) 2001) are compelling human serviceorganisations to make a decision about

the future direction of their counsellingservices. Relationships Australia(Queensland) began debating this issue, in part, because of a recognition thatcounselling and computer technology are intricately linked in the 21st Century but also after receiving an increasingnumber of requests from potential clients seeking counselling services online – RAQ received one hundred and nineteen requests across an eightmonth period (Relationships AustraliaQueensland 2001) from people seekingassistance via our web site (seewww.relationships.com.au) – and we do not yet offer an online counsellingservice. Consequently, RAQ has recentlyconsidered a range of issues regardingonline counselling including:• Financial issues (purchase of newtechnology and staff training in computertechnology and text based counselling);

In favour of online counselling?Susan Hunt

A ‘surf on the net’ reveals that internationally, many organisations are providing arange of counselling services online including counselling via email, interactive‘chat rooms’ and teleconferencing. Online counselling appears to be offeredprimarily as a ‘fee for service’ and many online practitioners work in the area ofmental health. In Australia, KIDS Help Line offers ‘free’ counselling for young peopleusing both email and chat rooms. Meanwhile, other organisations/professionalgroups are struggling to come to terms with this new form of service delivery. Thispaper begins with a brief explanation of where Relationships Australia (Queensland)is placed in terms of online counselling followed by some of the advantages anddisadvantages of online counselling based on a literature search. Concludingstatements lean towards favouring online counselling as it offers a new form ofintervention that may suit many clients and organisations. The term ‘online’counselling refers herein to e-counselling or email counselling.11

Susan Hunt is employed by Relationships Australia (Qld)as the Professional Development Manager. Email: [email protected]

260 Australian Social Work/December 2002, Vol. 55, No. 4

• Insurance issues (the cost ofprofessional liability insurance for a new type of service delivery);• Legal issues (such as the possibility oftext based counselling sessions beingsubpoenaed as well as legalities regardingadequate and appropriate informationprovided online for potential clients) and;• Development of Policy and Proceduresand a cultural shift required within theorganisation (to assist those counsellorswho are either resistant to onlinecounselling or who are not computerliterate).

Before RAQ ventured too far down thepath of tackling these issues they firstweighed up the following advantages anddisadvantages to online services.

Advantages to onlinecounselling1 Computer technology is a modern formof communication that is increasing inpopularity in terms of service delivery and consumer demand and access tocomputers is widening as libraries makecomputers freely available to the public(National Board of Employment et al. 1995;British Association for Counselling 1999;Australian Bureau of Statistics 2001;Australian Drug Foundation 2002, p 5).2 Organisations wishing to keep abreastof changes in service delivery, that wish toremain part of the computer age and aim tomeet consumer demand will need to offerservices online (Barak 1999, p 3).3 A range of unprofessional services,unlicensed and untrained providers couldprovide online counselling (Childress 2001,p 4; Barak 1999, p 14). ‘Professionals’therefore need to engage in modern forms

of interaction with clients to ensure thatclients receive the best counselling servicesavailable.4 There are minimal differences betweenprofessional practice ‘face to face’ and‘online’ as the frameworks and models usedby practitioners remains constant.5 Clients can communicate at their ownconvenience online – if they lead busy lives(Childress 2001), have transport problems,work shift work, and/or have child-careproblems (Barak 1999; p 9) – when theymay not have otherwise accessed face-to-face counselling services. This could applyequally to families living in rural, remote and metropolitan areas.6 Email or interactive communication isusually the preferred option for clients whofeel more comfortable self-disclosing online.Kids help line statistics reveal that there is ahigh demand for online services and thatcounselling emails included issues such assuicide, sexual assault, pregnancy, familyrelationships and mental health (Kids helpline 2000, see also Childress 2000, p 3;Murphy & Mitchell 1998 on self disclosureonline).7 Online services are attractive to clients who wish to remain anonymous(Grohol 1999).8 Online counselling may change theclient’s perception about counsellors (Barak 1999; p 9) who may seem to be more easily accessible. Greateraccessibility and the speed at whichcommunication can be conveyed via email and the Internet may result in fasterrapport building between client/counsellorresulting in an increase in positiveoutcomes for people accessing counsellingservices.9 Online counselling is almostinstantaneous, however, clients and

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counsellors have time to consider theirresponse(s) and are able to ‘edit theircommunication’ (Childress 2001, p 3), keeprecords of all sessions and refer back toearlier sessions (Barak 1999; pp 8,10).10 Online counselling allowsorganisations to fully meet their duty of care to clients by providing online (a)educational material, (b) details of the terms and conditions of online counsellingservices, (c) details of qualifications of staff and their skills and areas of expertise,(d) details relating to client confidentialityand (e) the advantages/disadvantages ofonline counselling. The availability of thisinformation online provides clients with an opportunity to read and refer to thisinformation across time and allowsorganisations to inform clients of their rights and responsibilities (Grohol 1999).11 Cognitive-behavioural therapy may beeasily adapted to email counselling withdaily homework able to be set for clientswho would otherwise have delays in seeinga counsellor (Childress 2001, p 4). In thesecases counsellors may have greaterinfluence to change clients behaviour(s)and, although there is little publishedresearch available to identify positive clientoutcomes for people accessing onlinecounselling, there are indications that this is the case (see Celio et al. 2000 &Winzelberg et al. 2000).12 Online counselling may be costeffective for clients and organisations.13 Online counselling may demystify the counselling process.14 There is flexibility of service deliverywith chat rooms and video counselling thatoffer ‘real time’ interaction.15 Counsellors already familiar withcomputer technology and online systems

(such as internet and email) are likely to bewilling to participate in online counsellingand could provide a range of services such as, e-counselling, e-groups (Barak1999; p 11–12) or self help guides.16 E-counselling communication recordscan be made available to supervisors andmanagers within an organisation thusincreasing accountability and enablingquality control of practice within anorganisation.17 Online communication can be usedfor research purposes.

Disadvantages to onlinecounselling1 There are social justice issues, firstly,inequality of access to computers andassociated technology (Oravec 2000, p 129). Secondly, some clients may not beskilled in the use of computer technologyand/or may be found by counsellors to be‘not suitable’ for online counselling. Forexample, people who are illiterate, olderpeople, people with certain medicalconditions, for example, dyslexia, mentalillness, and/or certain cultural groups, forexample, Indigenous people, people from non-English speaking backgrounds. Finally, there may be issues with age of‘consent’ (Childress 2001, p 10) andparental consent.2 Text-based counselling could result in miscommunication due to the loss of non-verbal cues (Barak 1999, p 8; Rich1999), except in the case of videocounselling, that provide contextualinformation in conversation and caninfluence interpretation of meaning incommunication (Childress 2001, p 6).


Miscommunication may result in clientsterminating counselling with little or noopportunity for counsellors to understandwhy this has occurred, which in turn mayresult in clients experiencing traumathrough online counselling.3 Furthermore,text-based communication can be (butneed not be) harsher than verbalcommunication, in part because the non-verbal cues, such as tone of voice and body language, are missing from the communication.3 Online counselling can be problematicif clients from interstate or overseas seek to use these services. The difficulty herelies in counsellors providing online servicesacross national and international borderswhere intra and inter national laws vary.Take, for example, the law in regards tomandatory reporting of child abuse thatvaries across Australian States andTerritories. If online counselling services are offered to all people, counsellors/organisations will need to know whichauthority, in which State, they should report suspected child abuse. Similarly, a counselling organisation based inQueensland, that provides onlinecounselling to a client(s) overseas, may be legally and ethically irresponsible inoffering this service if another country has strict laws about who can providecounselling services to its citizens (seeState Government Victoria 2001). In this case, not only could counsellors/organisations find themselves in a court of law, but, there may also be mattersregarding professional indemnity insurance.4 Clients could abuse theclient/counsellor relationship with numerousand constant emails sent. Counsellors mayalso be harassed.

5 Client privacy and confidentiality couldbe breached with hackers, viruses andother persons (e.g. spouses, parents)accessing online counselling sessions(Barak 1999, p 9).6 Organisations may not have adequatehuman and financial resources to deliveronline counselling (Childress 2001, pp 6,9).7 Technological delays and malfunctionscould inhibit client/counsellor onlinecommunication.8 Inadequate or inappropriate responsescould occur due to lack of training ororganisational targets needing to be met.9 Exact transcripts of e-counsellingcommunication can be subpoenaed andthe level of detail provided in contrast tocase notes in face to face counsellingsessions could leave organisations/practitioners vulnerable to prosecution(Mackay 2001, p 48).

Overcoming thedisadvantagesGenerally speaking, RAQ determined thatthe advantages to offering onlinecounselling outweighed the disadvantages.The rationale for this decision was based on the following:• In terms of social justice (referdisadvantage 1), clients/potential clientsliving in remote areas or people who havetransport and child care issues cannotaccess face-to-face counselling so theprovision of online services would enhanceaccess to counselling services. In relationto literacy levels, the increased use ofcomputers (ABS 2001) indicate that morepeople are accessing and using computersfor communication purposes and may


therefore take up the option of onlinecounselling if it is offered. Furthermore, theyoung people of today may be the onlinecounselling clients of tomorrow and ifmobile phones and abbreviated textmessaging is any indication then literacylevels regarding online counselling may notbe an issue. However, research on theusers of online service is required.• In terms of client suitability to receiveonline counselling (refer disadvantage 1) astandard online registration form (TherapyOnline 2000; Webb et al. 2000) could bedeveloped to seek details of a client’s age,although, this system does not allow foranonymity. Online registration forms canalso assist in the intake process to clarify aclient’s history.• In terms of confidentiality (referdisadvantage 5) clients can be informedabout secured and non-secured sites and,as with face-to-face counselling, clients can be informed about the limits ofconfidentiality. Encrypted messages can prevent hackers accessing onlinecounselling session(s) and passwordsbetween client and counsellor can beestablished prior to online counsellingcommencing to protect client confidentiality.This procedure would also ensure that eachparty is confident that they are the personthey say they are online. Furthermore,clients can be informed about anorganisation’s procedures regarding thekeeping of hardcopy and electronic recordsand can be informed that they could deletetheir own emails for security at their end.Finally, organisations can develop policyand procedures regarding e-counsellingservices and professional bodies caninclude online counselling services in theirCode of Ethics (Bloom 1998, pp 54–55)

(some professional bodies have alreadydone so, see American CounselingAssociation 1999, British Association forCounselling 1999, National Board forCertified Counsellors 2000, p 28).Furthermore, clients can be provided withinformation about the limitations of onlinecounselling and the rights andresponsibilities of clients, organisations and counsellors (Kane & Sands 1998).• In terms of professional boundaries,duty of care and organisational safety (refer disadvantage 4, 6–9) organisationscan develop guidelines and provideinformation for clients seeking onlinecounselling and place these on their websites. Internal guidelines, policies andprocedures and a Code of Ethics andStandards of Practice can be developed to set clear boundaries regarding onlinecounselling services and to protectcounsellors and the organisation from legal ramifications. Furthermore, onlinecounselling as a form of service deliverycan be added to insurance policies anddisclaimers can be incorporated into websites to reduce liability.• In terms of the skills and abilities ofcounsellors to provide on line counselling(refer disadvantage 2), RAQ has found thatmany practitioners are already skilled ininternet and email communication andmany are willing to pilot e-counsellingservices for existing clients with a gamblingaddiction. However, staff training in text-based communication for counsellingpurposes is a critical part of anorganisation’s online service delivery as areissues relating to supervision forcounsellors providing online services.• In terms of e-counselling transcriptsbeing subpoenaed (refer disadvantage 9)


and the consequences of this occurring,this problem is no different to case notesbeing subpoenaed when face-to-facecounselling occurs. The main issue is aboutwhether or not case notes/email transcriptsare written in a factual, professional, ethicalway so that if email transcripts aresubpoenaed individuals and organisationsare not sued or subject to criticism.Adequate training in case note writing andrecord keeping as well as supervision ofpractice regarding e-counselling canprevent criticism from courts or legalliability.

ConclusionIf organisations decide to proceed withonline counselling they may choose to gothrough a similar process as RAQ andanswer the following questions:• Which type of online counsellingservices will they deliver and in what order will it be delivered? For example, will they provide e-counselling (emailcounselling), interactive ‘real time’ (‘chat room’) counselling, video-counsellingor, a combination of all three onlineservices?• Do they have the technological capacityto support these changes?• Do they have sufficient humanresources to train, develop, implement,manage and supervise online services?• Will they charge for online services?• Will they offer an anonymous onlineservice?• Will their insurance company coverthem for this service?• Will an evaluation of online services becompleted?

• What ethical and professional positionwill be taken?

Considering these points and weighingup the advantages and disadvantages toonline counselling may be the best thatorganisations have at present to determinewhether to proceed with this new mediumof counselling as there is little publishedresearch on users of online counsellingservices and whether there are any positiveclient outcomes using this medium. Nonethe less, client demand for online servicesis growing and the technology is availableto support this trend. In light of thesecircumstances RAQ has decided toadvance their participation in onlinecounselling with a focus on e-counsellingand videoconferencing.

Given that online services are beingdelivered at a faster rate than thedevelopment of professional standards andcodes of ethics it seems timely that theAustralian Association of Social Workersinclude in their Code of Ethics a sectionunder Ethical Practice regarding onlinecounselling. In particular, reference couldbe made to ethical practice in regards toonline service delivery at Section 4.4Responsibilities in the Workplace andSection 4.5.3 Private Practice. This additionto the AASW Code of Ethics would assistand support RAQ (and other) socialworkers in practice to continue to workethically with the relatively new onlinecounselling intervention.

Footnotes1See Yellowlees (2000) for definitions of e-therapy.2RAQ is funded by the Federal Government under theFamily and Relationship Support Program and Statefunded for Gambling Help and Family ViolencePrevention Programs.


3Without adequate supervision counsellors may alsoexperience stress from clients terminating cybercounselling without an explanation.

Acknowledgements

Thanks go to Relationships AustraliaQueensland for permitting the publication ofdetails pertaining to their organisation, andRachel Robinson for editing and support.

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Article accepted for publication July 2002.


in favour of online counselling?

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