PLUGGED IN! Online Counseling with Adolescents

PLUGGED IN! Online Counseling with AdolescentsPresented by Catherine M. UgaldePace UniversityPSY 690 Spring 2015

+

Hello Everyone,

My name is Catherine Ugalde and today I will be providing you with a brief presentation on the use of media and technology assisted therapy in my future practice as an aspiring mental health counseling within the adolescent population.1

Growing Up in Cyberspace

Internet surfaced in the 1900s and continues to advance at a rapid paceAdolescents aka Digital Natives

AdolescenceDevelopment between puberty and adulthood

+

As we all know adolescents is known as that tumultuous time between the onset of puberty and adulthood. Developmental theorist Eriikson identified this stage of development as one of the most crucial stages known as identity vs. role confusion. During this time teenagers test the waters and experiment with multiple different personality times in efforts to find the one that best fits all while seeking to obtain social relationships with peers experiencing the same emotions and feelings.

The birth of the internet has changed the way these social interactions take place.

Since its appearance in the 1900s and continued rapid advancement, adolescents are now considered the technological gurus of society. Often times when adults are provided with a new form of technology, they frequently consult with their younger counterparts to have it better explained.

As seen in the graph to the bottom right of your screen 93% of youth between the ages of 12-17 at least have access , if they do not own a computer.Almost of the 78% who own cellphones have smart phones and 23% of the surveyed youth own tablets.

Meaning that most youth are capable in some way to access the internet, especially with the availability of free wifi in many stores and locations.2

Getting Wired Up!9 out of 10 teens use SNSAs per Pew Research (2013)61% Tumblr55% Facebook22% Twitter21% Instagram13% SnapchatBradford and Rickwood (2014) identified reluctance of teens to seek professional services

With so many adolescents having easy accessibility to technology, Pew Research found an estimated 9/10 teens to utilize Social Networking Sites.

Thats A LOT of use!

As you can see from the statistics listed from Pew Research Center, Social networking sites are used by most of todays youth. Between 2013-2014 Instagram alone jumped 5%

In a Poll by Pew Research 75% of all teens text and an estimated 63% use text to communicate every dayJust for some fun facts of 201339% of youth make and receive voice calls35% socialize outside of school22% use instant messaging systems (not including SNS)19% talk on landlines6% exchange emailsThats a huge difference from how I remember growing up!

Interestingly, as per the office of adolescent mental health of 2013 one in five teens have a struggle with a diagnosable mental health disorder and less than half of that percentage actually sought out mental health services.

Bradford and Rickwood (2014) identified over half of all mental health disorders to emerge before the age of 14 and there is a steep increase in the prevalence of mood disrders in mid adolescence. Paradoxically, that increase is also associated with an increase in reluctance of adolescents to seek professional mental health care.

As pictured in the graph to the right of your screen, adolescents have the highest percentage of internet.Stallard and colleagues identified that more than half of the youth who report using the computer to search for information pertaining to their worries, unhappiness, and problems. A similar percentage of 47% reported utilizing the computer to find ways to cope or deal with their stressors and worries, and one third of the youth population use chat rooms and social networking sites to talk about their problems and concerns with others.

With such high percentages of research being done by youth, one would think to reproach this population with another modality of treatment and adapt to the unique needs of this population.

3

Elena Morales, LMHCIm all about establishing a good relationship with my clients and assisting them achieve goals we set together I utilize the here and now in all client sessions helping them take ownership of their feelings and behaviors and empower them

Employers:MHA UlsterPrivate PracticeAligned with LaneCounseling works no matter the framework with a good alliance

+

I initially sought out an interview with Dr. Amanda Maynard a developmental psychologist who teaches courses at Mount Saint Mary College, however she is not currently practicing, and therefore she directed me to a previous counselor from the college Elena Morales, LMHC.

Ms. Morales currently works with dually diagnosed and high risk clients within Ulster Countys MHA clientele. She also works part time within a private practice and is presently developing her own hollistic treatment approach to positive wellness and mental health through Aligned with Lane.

I asked Ms. Morales about her knowledge of online therapy and she said she personally doesnt utilize many technologically assisted formats for therapy. She said :

Im more of a hands on person who likes to literally be there in the moment with my clients

***READ QUOTE***

In the past with extremely anxious or agoraphobic clients I have used e-mail exchange in conjunction with home visits to support the clients. Im not saying that Im against it but I have an incredibly large case load and having to take time out of my day to exchange information via email is just a nuisance, and in the past Ive had clients get pissed at me for not responding to their messages in what they consider a timely fashion but in reality was a matter of 10 minutes because I was with someone else. I often use audio conferencing, sometimes that helps if they cant make it to my office. Being with the high risk population they dont really always have the means to technology to use video conferencing but I would be open to explore that modality as well. I personally find that when working with teenagers I use a lot of humor and if theyre not seeing my silly facial expressions or movements it kind of takes away from the joke or they may take it the wrong way so I am partial to face to face settings.

No Matter what Counseling works, no matter the framework with a good alliance counseling works4

Location Location Location!!Services offered:OnlineAsynchronous/Email/ forumSynchronous/Video ConferencingFace to FaceOutpatient ClinicCommunity Health CenterPsycho-educational OutreachIntegrated TherapyThis is the Goal! Utilize both methods

+

In light of my conversation with Ms. Morales and the research of the adolescent population and online therapy, I decided that I would utilize an integrated/ combined approach to therapy for my future setting.

I would term it Web-Assisted therapy.

Essentially I would provide asynchronous services via e-mail and forums on my website and synchronous services via video conferencing with the ultimate goal of getting them to face to face services with myself or another practicing professional.

I would provide face to face services via an outpatient clinic for scheduled appointments as well as group sessions at a local community health center to reach out to those who may not be able to afford services. I would also frequent school settings to psycho-educate and stress the importance of positive mental health to all staff and faculty in school settings as well as assemblies within the student body population.

The goal here is to get the youth comfortable enough to come to F2F settings.

To assist in this process I would utilize the software TherapyNotes which is HIPPA compliant and assists with client progress and case notes as well as scheduling, payments, and contact information.

I would also utilize the software VSEE. Its essentially similar to Skype however it is even more secure in confidentiality. VSEE security settings use RSA encrypted software and is not accessible by other servers, meaning that literally only you and the person you are seeing has access to the information being shared, it cannot be hacked. VSEE also utilizes less bandwith for better quality picture. VSEE allows for the users to stream up to 4 video streams to one device, and is essentially the most user friendly software out there.

Vsee also has an eplatform which allows for easy integration into a health portal such as a virtual waiting room and doctor dashboard.5

Apps and Forum Support

Reachout.com (forum)Mindshift (app)Teensphere (app)

*Hyperlinks are included*Links for these websites and apps would be provided on professional page

Clients would be encouraged to use these apps for time between sessions.

While researching into the realm of online therapy, I came across an article by King and colleagues from 2006 which reported on the motives and experiences of youth who opt for internet based therapies opposed to telephone and face to face conferencing. The study found that teens often reported out that the text environment was less confronting and didnt have fears of parents eaves dropping and were able to take their time while typing and provided a sense of control in the counseling process and felt less intimidated.

On the contrary, Bradford and Rickwood (2014) reported out that face to face services were still found to be the preference among youth although there was a relatively large portion who reported utilizing online services first.

The most interesting article I found was by Webb, Burns, and Collin (2008) who reported out on a web site that is now within the US which originated in Australia called reachout.com. Through the implementation of this website, Australia reported an astonishing 56% decrease in suicide attempts in youth through the implementation of this program in school settings. There was an increase in positively associated visits with school health centers, guidance counselors, and referrals to health professionals.

As someone who always gives credit when credit is due, I must give major kudos to the founder of this program Jack Heath. The site is just wonderfully set up and definitely set up to appeal to the edgy teenage eye.

Essentially reachout.com is a website that touches on almost any internal and external conflict that youth may be facing. Evidence suggests that young people feel empowered online and are provided a degree of anonymity which means they are more confident talking about sensitive and embarrassing issues through the disinhibiting effect. Through the fact sheets provided on each topic and real stories told by youth, the site is completely controlled by supervisors and moderators. Nothing gets posted until reviewed by moderators. The forum is always viewable, however members can only post comments between 6p-10p. In order to become a member, they must read and agree to abide by the terms of use which clearly state that the forum is a peer support group and not a counseling service. There is a 24/7 crisis hotline number provided as well as a a texting service available from 6p-midnight.

All in all I absolutely loved the site and highly encourage any youth and professional working with youth skim through the literature and stories youth posted. There has been a lot of criticism within much of the literature I read reporting how often times there isn't enough moderation and puts these vulnerable youth at risk to cyberbullying and predators or negative comments from peers however the system in place on this site eliminates all of those flaws. The only flaw reported in the article was that of the teens stating they wished there wasnt a lag in wait time for responses and that the window of time was extended.

I would most definitely offer services to a site such as this and link this site on my professional page for youth to visit. I would offer to counsel youth on this page seeking services, or mimic this site identically for my own use (which is illegal but its that good!)

I would also encourage youth to use self help apps such as mindshift and teen sphere to assist in moderating their emotions outside of our counseling settings.

Mind shift offers facts and coping skills as well as a journal to assist youth through their crises while teen sphere also can be used as a quick reference for youth who may be increasing their mental health awareness and literacy.6

ConsiderationsTheoretical ConsiderationsEclectic ApproachCognitive BehavioralPerson CenteredExperientialPractical ConsiderationsAbsence of Non-Verbal cuesLimited access to technical programsDial upChanging of numbersTransportation barrier

Ethical ConsiderationsLegal ConsentTo post a comment you must be logged in. Must fill out registration form.DOBEmailUsernameTerms of AgreementPrivacy Policy

+

Theoretical ConsiderationsI personally feel that one shoe doesn'tt fit all which is why in terms of theoretical considerations I refer to my style as an eclectic approach. Numerous studies such as Spece and Colleagues (2011) and Hoek and colleagues (2012) identified Cognitive Behavioral therapy as the most successful form of therapy to use with teens online. Dowling and Rickwood (2014) however surveyed professionals in the field who are currently utilizing online services reported spending a large bulk of their sessions building rapport and gathering information than on goal setting and task accomplishment. This leads me to believe that one would definitely need to utilize a person centered approach when working with this online population as well as experiential because I personally enjoy implementing many of the techniques within that approach.

As for practical Considerations theres always the fear of the absence of non-verbal cues because they often times tip off the counselor more so than words of the client. As pointed out by Ms. Morales during our interview there is always the possibility of the client not having adequate technology to support the bandwidth or dial up of the software as well as at risk clients consistently changing their numbers which is presently an issue with the youth that I presently work with. Another barrier which prevents clients from seeking services is the availability of the counselor and the transportation to get to and from them or a location where they can safely use technology to get in touch with their counselor.

Ethical considerations are always one of the biggest concerns. Confidentiality being the leading question among all clientele. Adolescents receiving services must provide legal consent for services during their consultation. We would review the confidentiality policy in depth, and I would remind them of the limitations to confidentiality in terms of harming oneself and others. For online services just as listed within the reachout.com website, the clients must become members and provide the listed information and read through the terms of agreement and privacy policy which highlights the forum not to be professional counseling but merely a means to support them and assist them in obtaining services. The information listed above can be provided to law enforcement who can directly contact the individual in the event that they disclose information that puts themselves or others at risk of harm.7

Web Assisted TherapyGoal is to get the client into Face to Face services as it is presently most effectiveHoweverSupportive Assistance Via Technology may be a good way to better reach the adolescent population

+

In a nutshell.

My tech plan utilizes a web-assisted approach to therapy. I believe that while the internet is a wonderful methodology to further extend services, it wouldnt be a service that I would feel comfortable providing solely for a client.

My personal goal would be to utilize the internet to educate and reach this population and prep them to take part in face to face sessions with a professional.

I would be open to collaboratively using video conferencing and occasional email exchange to keep in touch with clients progress. Although I genuinely like the idea of group counseling, from most of the literature I read I am not sure it is really beneficial to the clients to use that method through chat groups. I may be open to using a group session in the format of avatars and voice counseling or video conferencing but even that I have my reservations due to the impulsivity of youth and disinhibiting affect. Maybe down the line if I were to get a good group of kids who I felt would be mature enough to not sabotage the group focus I would explore it.

Ultimately it would be my goal to get them into a face to face session.8

Outreach & Advocacy

As professional mental health counselors it is our ETHICAL RESPONSIBIITY to service our clients to the BEST of our ABILITY

Technology and the internet are easy platforms to better reach our clienteleDont you think?

+

As aspiring counselors it is our ethical responsibility to service our clients to the best of our ability

This slide includes some professional logos as well as common youth programs utilized by adolescents today.

Technology and the internet are easy platforms to make our adolescent clientele even more easily accessible, and its time that we take advantage of this platform to better serve our youth dont you think?9

ReferencesShapiro, L.S., & Margolin, G. (2014). Growing up wired: Social networking sites and adolescent psychosocial development. Clinical Child And Family Psychology Review, 17(1), 1-18.Spence, S.H., Donovan, C.L., March, S., Gamble, A., Anderson, R. E., Prosser, S., & Kenardy, J. (2011). A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. Journal Of Consulting And Clinical Psychology, 79(5), 629-642.Stallard, P., Velleman, S., & Richardson, T. (2010). Computer use and attitudes towards computerised therapy amongst young people and parents attending child and adolescent mental health services.Child And Adolescent Mental Health,15(2), 80-84. doi:10.1111/j.1475-3588.2009.00540.xKing, R., Bambling, M., Lloyd, C., Gomurra, R., Smith, S., Reid, W., & Wegner, K. (2006). Online counselling: The motives and experiences of young people who choose the Internet instead of face to face or telephone counselling.Counselling & Psychotherapy Research,6(3), 169-174. doi:10.1080/14733140600848179Webb, M., Burns, J., & Collin, P. (2008). Providing online support for young people with mental health difficulties: Challenges and opportunities explored.Early Intervention In Psychiatry,2(2), 108-113. doi:10.1111/j.1751-7893.2008.00066.x Arnberg, F. K., Linton, S. J., Hultcrantz, M., Heintz, E., & Jonsson, U. (2014). Internet-delivered psychological treatments for mood and anxiety disorders: A systematic review of their efficacy, safety, and cost-effectiveness.Plos ONE,9(5),Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M., & OKearney, R. (2009). The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents.Journal Of Consulting And Clinical Psychology,77(6), 1021-1032. doi:10.1037/a0017391Evans, S. (2014). The challenge and potential of the digital age: Young people and the internet.Transactional Analysis Journal,44(2), 153-166. doi:10.1177/0362153714545312Bradford, S., & Rickwood, D. (2014). Adolescent's preferred modes of delivery for mental health services.Child And Adolescent Mental Health,19(1), 39-45. doi:10.1111/camh.12002 ReachOut.com. (2015). Retrieved May 2, 2015, from http://us.reachout.comPewResearchCenter.org (2015). Retrieved May 2, 2015, from http://www.pewresearch.org

10