Away for Christmas

Hey all, 

I'm heading to northern Australia for Christmas so I'll be gone for the next two or so weeks. I will be back about the 8th of January and will be resuming blogs then. Unless I get so motivated I can't help but post a blog... it's possible :)

Wish you all a Merry Christmas and happy 2011!

Interview About my Work in SL.

Hey all,

Here's a link to a blog in which I was recently interviewed for.

Social Work Career Transition Blogger

I will be sharing stories about my career transition from marketing to the social work field.

By Dorleem.

Cheers, 

Kylie

Working Online? Take a Break!

Dear Readers,

I wanted to write something unrelated to therapy today. I suppose this is a more general issue and one that I'm still trying to get right myself, because it requires strict and consistent self-discipline. Online therapy, or any online business requires that operators sit at their desks for hours on end in front of softly humming LCD screens. When you own your own online service, it can be tempting to work endlessly and tirelessly in front of your computer. If you're a bit of a perfectionist like I am, you may find yourself feeling guilty or even insecure about taking a break from your work. At times I've found myself unable to leave my desk, but also not working... it's amazing what you can justify to yourself when you're procrastinating.

To start with, many people who run online businesses run them from home. At home your work is always available to you so this is where boundaries become so important. Anyone who has an occupation that requires sitting down for hours on end needs an exercise regime. Not only does exercise stimulate blood flow and reduce the risk of cardiovascular disease, it increases higher cognitive functioning and releases endorphins. I'm sure you're all aware of the prevalence of obesity that has arisen from sedentary lifestyles in our society. Higher cognitive functions are related to memory, thinking and processing which is central to your job performance. Also, most creative and inspired ideas don't come to mind whilst sitting at your desk, so get outside and go for a walk.

On a side note, you're a therapist, while it's sometimes difficult to lead by example I do think it's important to believe in what you teach your clients and the best way to believe in your techniques and advice is to experience the evidence yourself.

I'm sure I don't need to delve into the physical benefits of regular breaks. When my study and counselling life began to demand that I sit at my desk for eight hours a day my eyesight deteriorated rapidly. I now require glasses when engaging people in conversation, driving and basically anytime I don't want fuzzy images more than an arms length in front of me. Furthermore, your back, neck and physical health in general will all suffer if you do not take breaks.

All these things seem to revolve around functional time management. Those who do not have good time management are usually unorganised, stressed-out, unfit and leading unhealthy lifestyles. It is important to prioritise and love yourself as much as you love your work. By love I mean taking care of yourself, eating right, taking time out to have fun, exercising, meditation, it all contributes to the productivity of your profession. Approach life holistically and you'll find you don't have to work those fourteen hour days when the quality of your work increases. Burnout is just as likely for online therapists as face-to-face therapists. The amount of empathy and energy needed to join with a client online can leave you feeling exhausted. Take breaks, journal, eat right (balanced diet) and exercise (at least 30 mins a day) and I guarantee you'll keep burnout at bay.

Now time for my morning meditation and exercise.

Getting Your Message Across in Second Life

Good morning, it's your usual chai-sipping bloggeress here :)

Firstly, I apologise for the size of the font, I wrote my blog up in Word and now it only allows me the choice now of 'Quick get your reading glasses!' and 'C'mon I'm not that blind!' 

This morning I wanted to talk about getting your intended message across to clients in Second Life (SL). Before we begin I want to share a quote with you.

             “I know that you believe you understand what you think I said, 
              but I'm not sure you realize that what you heard is not what I meant.”
                                    ~ Robert McCloskey~

Communication is tricky enough without the added pressure of not being able to see or hear another person, despite this online counselling works and perhaps in this blog we may discover some of the reasons for this. 

While there is some overlap between SL counselling and other text counselling I think SL has some advantages. The first one is that you can use 'visual aids'. Of course, sending a newly made file to a client over Windows Live Messenger (or any other chat application that you may be using) works nearly as well. 

The reason I'm such a fan of SL for visual aids, is because the amount of time it takes to drag a 'texture' from your inventory to a blank object is far quicker than sending a file over the internet. This works even better if you have a client that has already spent countless hours on SL and has fully immersed themselves in the experience. What do I mean? Well, when a client has started to identify through their avatar, they have also started to identify their avatar in the environmental context, this means that the environment has an impact on them indirectly, and a counsellor can use this to their advantage -- more on that another time.  

Some people argue that without the cues of body language and tone of voice, it’s simply not possible to provide effective therapy with only text; however, I tend to agree with John Suler on this.

“Despite the lack of face-face cues, conversing via text has evolved into

 a sophisticated, expressive art form. The effective clinician understands

 and attempts to master this art.” ~Online Counselling Handbook~

So let's list the tools we have at our disposal for getting our message across to clients. 

Text Chat, while appearing to be a very bland way to communicate, can be very useful in getting your intended message across. Examples of specific ways to ‘express’ oneself online include.

•  Flow of Ideas
• Spelling Errors
• Grammar Sophistication
• Spacing of Paragraphs
• Use of Quoted Text
• Caps Lock
• Emoticons 

Then there are the Visual Aids I mentioned before. Below is an example of one of my cards that I use often with clients.

As you can see, it works very well. If a client requires a special document, I can quickly make one up in paintbrush and upload it to SL. There are whiteboards in SL also, but I find that without a digital pen and pad, this gets tricky. Also, a paintbrush made .jpg allows you to send the file through email to the client for later reference. Cognitive Behavioural Therapy (CBT) requires a lot of visual aids when going through thoughts, behaviours, feelings etc, and how they all relate to each other. 

Of course, let’s not forget good old counselling skills. They are just as effective in SL/Online as they are in RL. This includes: Paraphrasing, Reflection of Feeling, Reflection of Meaning, Disclosure, Consequences, Active Listening through the use of Encouragers (Examples --*nods*, yes, right, okay), Summarising etc --I’m sure you don’t need me to list them all as there are so many.

I use a lot of clarification phrases  online as to make sure that any messages are not lost in translation, if I didn’t hear the client properly,  I may use metaphors and analogies to try and clarify exactly what they mean. It is possible to get accurate representations of your meaning and the clients meaning across to each other, and it's because of this that online therapy has a bright future. 

Well, my cup is empty and none of us like blogs that drag on. For now, I’m just touching on general ideas, later I will review specifics.

Have a wonderful day!

Difficult Personalities in Online Text-Counselling

Greetings,

This morning as I peer sleepily at my screen over a steaming cup of sweet chai tea, the first of eight for the day *grins*, I consider what challenges I've faced in online therapy over the past five years. I thought to myself, 'what type of client has proved to be the most difficult?'

It seems obvious that someone with a difficult personality would be challenging to work with through any medium whether that be face-to-face, online, telephone etc, but I think that the online medium intensifies the difficulties faced by therapists with this style of client. I'm reminded of a few cases, which I can not talk about in specifics, but they certainly had a few things in common. (And boy did I learn some lessons :))

1. The clients were demanding.
2. The clients were highly reactive to all their emotions (often threatening to self-harm).
3. The clients were unpredictable and attention seeking.

Your first thought might be 'well, set some boundaries then?' And this would be an excellent point, but when those boundaries conflict with deeply established maladaptive patterns of behaviour (patterns now firmly a part of the personality) this requires time and awareness on the clients part in order for those patterns to be altered.

The obvious question to ask now, is 'how does online counselling (in text) creates further difficulty for this style of client?' The first thing that pops into my, now awake, mind is emailing. The client has a constant link to you, your email.

In a physical setting, you most likely have a receptionist or an answering machine, something you probably won't check several times a day (Well maybe you do?). My point is, email makes getting in contact with you ethically questionable. The difficult client can send you emails about ending their life, self-harm, or anything else that goes on in their day that they deem necessary for you to know about. With messages like this in your inbox, you may be left feeling a little concerned or worried -- well, I would certainly hope so! Of course, your training may have taught you that you should call the police or contact the client directly. What happens if they're overseas? Do you call their phone (if you have that number)? If they're anonymous, how much are you responsible for if something happens to them and you were the last to be informed?

These are all challenging questions to answer.

As I said in my previous blog, you do what you can. The only way clients learn boundaries, is through consistency. Supportive consistency. Address the issue with the client, establish consequences for the continued behaviour in the next session.  I don't mean you should threaten to withdraw your support, even if the client is making it difficult for you to help them, the threat of withdrawing support is not helpful whatsoever. I have dealt with this style of client by bringing up a modified version of "The Boy who Cried Wolf." Clients are usually aware that they go through emotional crises which are not always life threatening, make a plan for them that doesn't involve sending you emails (coping skills!). If the client doesn't use these coping skills then that needs to be addressed also. Finally, the best way to ensure you do not put yourself in this situation in the first place is to Screen your clients. And I say it again, Screen your clients! In the few instances where I have agreed to work with these types of clients, I made sure that they would work on their issues and that they would do their homework -- and they did. They demonstrated great enthusiasm to change, and this is the first thing I look for in my clients before I take them on. Deeply ingrained maladaptive coping skills, with hard work, can be changed. The client is more likely to change if they are willing to change. Sometimes these types of clients have terrible living conditions with little social support, and in this case you can make a huge impact on this persons life, whether they are difficult or not.

Know your limitations in this online context. Set your boundaries. Take your time testing whether you can help your clients. Lastly, risk/reward. Will you be putting yourself at risk for a client that you will probably not be able to help? Then don't do it. Helping others requires that we as therapist give so much of our own energy, if you exhaust that energy supply, you and your clients will be affected.

Now, time for a refill.

The New Clinic and Ethical Qualms.

Well hello fellow therapists, Second Life-ians and anyone else bothering to read this blog.

I have been particularly busy this week working on my new clinic in Second Life (SL). Yes, out with school work, in with work-work. You might protest at the idea that a job entailing moving around in a virtual world is called "work", but I beg to differ. Anyone who's ever used SL will be aware of the frustrations of searching through endless inventory items, setting objects up in a 3D environment with limited viewing and of course trying to get your scripts functioning without digital hiccups. Despite all the frustrations I've experienced bringing this project to fruition, I'm quite excited about the prospect of holding group therapy and individual therapy in SL.

My previous clinic, which existed digitally last summer (yes Australia has hot Christmases-- haven't you heard 'Hey luv! Put another shrimp on the barbie will ya?' Here's a translation link if you're feeling a little confused about that Aussie Slang ), was mainly an information clinic where clients could make appointments in SL and then flesh out the details through email. From there we would set up appointments using Windows Live Messenger and Skype.

I do have qualms about counselling in virtual environments, at least if I use Windows Live Messenger I can encrypt chat with Bitdefender. Emails can be encrypted, there are ways to make sure you're practising ethically online. SL is not a great environment ethically. You're probably asking 'so why counsel there then?'. The simple truth is that the private IMing system in Second Life is fairly secure. Not completely, but I don't think Linden Labs really cares about what goes on in Private IMs unless you're discussing ways to penetrate the SL mainframe or organising a terrorist attack. Clients can be made aware of the possible consequences of continuing in a virtual environment but still, people I don't know can access the private messages between myself and a client -- I feel uneasy about this.

When I think of ethical issues, I'm reminded of Psychology301 - a psychological testing subject I studied recently at university. When conducting research it is ethical to use people in experimentation provided the possible findings are worth a bit of discomfort. Participants are given every bit of information they need to make an informed decision, I believe this exact protocol should be followed by SL therapists. Anyone entering a therapeutic contract in a virtual world should be made fully aware of the ethical and confidentiality issues.

So what do I do to reduce the risks? Well, I do as much as I can.


I make sure client information is not stored online. In fact, all client information is stored on my password protected external hardrives (that are only connected to my main computer for the retrieving and storing of information) up until 6 months after the conclusion of any therapy, then that information is transferred into a locked filing cabinet in my house.

I make sure clients receive an informed consent document before they begin sessions.

I try to encourage clients to chat over Windows Life Messenger or Skype (or any other chat program).

I do not enter a therapeutic relationships with people under the age of 18.

All counselling is conducted in private IM so that other SL residents cannot 'overhear' our discussions.

The clinic is a Skybox that is very high up in the sky. I allow only one person there at a time so that client Avatars cannot be identified (except for group counselling). I also have moderation rights to the Sim, so that anyone who intrudes will be quickly ejected.

Lastly, I only see people with normal everyday issues. People that, while they're stressed or concerned over an issue, are not usually prone to psychosis or volatility. This can be fairly easy to gauge with a first session where therapists can get a feel for the perceptional and emotional state of a client. And yes, this can be achieved online, and no I will not be discussing this at this point in time (later okay? *grins excitedly* ).

I think the most important thing as a counsellor is to help and support others without putting them in unnecessary risk. Online services are very affordable and have been proven to be just as effective as face-to-face therapy. In my opinion those with more serious issues would be less likely to benefit from online therapy, but many issues people seek help with are problems that can be overcome with a little caring support, problem solving, and coping skills training. It is because of these reasons that I continue to counsel as a SL therapist and advocate online therapy practices.

A little about me

When I was 16 I decided I wanted to be a therapist. Of course I wandered off that track from time to time, but I always returned. After attaining a counselling diploma in 2007 I discovered the internet as a vehicle for therapeutic interventions and began providing free counselling to anyone who wanted it—sourcing client’s mainly through Myspace. I was amazed at how busy I became, I made it quite clear I was a student in training, no-one seemed to mind, they just wanted someone to talk to. After promoting my free services in the virtual world of Second Life, I began forming waiting lists just to cope. After completing a literature review called ‘The Efficacy of Online Text-Based Therapeutic Interventions’ my confidence in the industry increased. Next year I will be undertaking an empirical honours thesis, investigating online counselling. The following year I hope to take my investigations further with a research degree. After this I'd like to help others learn online counselling skills, help develop online specific therapeutic application frameworks, supervise other online therapists and perhaps develop a handbook for future practitioners. I hope this blog will attract like minded people and we can share and discuss our experiences of cyberpsychology.