TILT Magazine Issue 18

volume 4, Issue three SPRING 2014

The Generation Y Approach to Mental Health Solutions PAGE 22

PAGE 15

Mentorship and the Path of E-Mastery PAGE 41

Using the Internet to Build a Dream

PLUS...

Cybersupervision, Marketing Toolbox, Student Spotlight and much, much more!

TILT - Therapeutic Innovations in Light of Technology TILT is the magazine of the Online Therapy Institute, a publication published four times a year online at www.onlinetherapymagazine.com.

ISSN 2156-5619 Volume 4, Issue 3, spring 2014 TILT Magazine Staff Managing Editors Kate Anthony & DeeAnna Merz Nagel Magazine Distribution Coordinator Sophia Zollman Magazine Design and Layout Delaine Ulmer Associate Editor for Research Stephen Goss Associate Editor for Innovations Jay Ostrowski Associate Editor for Supervision Anne Stokes Associate Editor for Marketing and Practice Building Sarah Lawton Resident cartoonist Christine Korol

Advertising Policy The views expressed in TILT do not necessarily reflect those of the Online Therapy Institute, nor does TILT endorse any specific technology, company or device unless Verified by the Online Therapy Institute.

If you are interested in advertising in TILT please, review our advertising specs and fees at www.onlinetherapymagazine.com Writer’s Guidelines If you have information or an idea for one of our regular columns, please email editor@onlinetherapymagazine.com with the name of the column in the subject line (e.g. Reel Culture).

If you are interested in submitting an article for publication please visit our writer’s guidelines at www.onlinetherapymagazine.com.

TILT is about envisioning therapeutic interventions in a new way. While Kate was visiting DeeAnna on the Jersey Shore, they took a late afternoon boat ride and a display of sail boats tilting against the sunset came within view. It reminded them how, as helping professionals, we should always be willing to tilt our heads a bit to be able to envision which innovations – however seemingly unconventional – may fit our clients’ needs.

Our clients are experiencing issues in new ways in light of the presence of technology in their lives. As helping professionals, so are we. TILT and the Online Therapy Institute is about embracing the changes technology brings to the profession, keeping you informed and aware of those developments, and entertaining you along the way.

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Features 15 Mentorship and

the Path of E-Mastery

22 Leaving a Legacy

The Generation Y Approach to Mental Health Solutions

41 Using the Internet to Build a Dream

From Burnt Out Pysch Nurse to Thriving Wellness Coach

Issue in every

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News from the CyberStreet

10 Research Review 14 Research Call 20 Wired to Worry 32 Views From the Front Line 38 Student Spotlight 46 CyberSupervision 50 New Innovations 54 Marketing Toolbox

58 For the Love of Books

A Note from the Managing Editors…

For our third issue of Volume Four of TILT, we have three special features for you, centered around personal experiences of our colleagues across the globe. We are delighted to hear of Cedric Speyer’s mentorship during his career from Tom Francoeur, Professor Emeritus of McGill University in Montreal who specialized in Counseling and Religious Education.

Cedric likes to call Francoeur the ‘godfather’ of his kate anthony & deeanna merz nagel with the InnerView approach to short-term therapy, which online therapy institute in second life “actually plants the seeds for long-term soul work”.

Cedric also illustrates his work with quotes from his email clients, which are always so exciting to read for those of us who practice online. Our personal favourite is: “Once I had purged everything in writing and had responses back which I could access at any time, the healing began quickly. It was like a wonderful wave of self realization and peace washed over me.”

The power of the written word – the “writing cure” as Cedric calls it – is so present in our work!

We also have the career experience of Angela Brooks, who took the journey from burnt out psychiatric nurse to being a thriving wellness coach, using the Internet (and social media marketing and blogging in particular) to sell (which she acknowledges is never a popular word in our helping professions!) her essential oils to enhance the lives of other people.

Our final feature is on the development of PlusGuidance – a new platform for online work from Emily Swinburn and colleagues and which you will have heard of by now if you are based in the UK! Emily has made it her lifetime ambition to change the way mental health is dealt with and improve access to talking therapies, to leave a legacy for her Mother, who lived with depression for over a decade, to ensure that her decision to take her own life stood for something. That a new service for us to use to connect with our clients at the “soul-level” that Cedric talks about is surely a fitting tribute to a woman who died so sadly.

Our regular columnists are here as well, and we particularly welcome Derek Richards’ contribution to our Research pages hosted by Dr Stephen Goss; and our Student Spotlight writer Myke McKay, currently taking the second part of his Certified Cyber Facilitator course. Myke describes his experience on the Foundation in Cyberculture part of the CCF and the value he found in it.

We’ve taken a slightly different turn for our Love of Books page – featuring an important new peerreviewed journal in our field: Internet Interventions is the official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII). Don’t miss the chance to brush up on your academia!

Best wishes to all our readers for the Summer,

Managing Editors TILT MAGAZINE WINTER 2014

NEWS CyberStreet TILT – Therapeutic Innovations in Light of Technology

from the

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We also offer the required coursework toward: Approved Clinical Supervisor Board Certified Coach Florida Certified E-Therapist Be sure to check out the details here: http://onlinetherapyinstitute.com/certificationcredentialing/

INSTITUTE NEWS PGCert, PGDip and MSc Cyberculture In collaboration with Metanoia Institute, we now offer an academic route to training!

Earn 60 Level M (7) Credits towards your future study!

In other online training news Need Coach Courses? ICF and BCC Approved!

For all the details visit http://onlinetherapyinstitute. com/earn-masters-degree/

Certified Cyber Facilitator/Specialist Certificate in Cyberculture We now offer a Certified Cyber Facilitator (CCF) Credential (choosing 1 of the 5 concentration areas as your focus) at 60 hours of training OR the Specialist Certificate in Cyberculture at 30 hours of training.

• • • • •

Online Therapy Online Coaching Online Supervision Avatar Identities Complementary & Alternative Medicine

More Certification Courses Certified Professional Coach (CPC) Certified Intuitive Practitioner (CIP) Certified Essential Oils Consultant (CEOC) Certified Kybernetes Reiki Master (CKRM)

If you are seeking coach training that is ICF approved we always refer folks to our partners at The Institute for Life Coach Training (ILCT). ILCT is an ICF and BCC approved school and our selfdirected courses here at OTI (also BCC approved) are offered through ICLT. Our partnership with ILCT continues to grow and that means great opportunities and savings for you!

In their latest email newsletter these courses and discounts are mentioned. Take a look- good stuff for BCC credentialed coaches!

Where are we facilitating workshops live?

Be sure to check out our Facebook Pages for a full listing of events!

Online Therapy Institute~ Events Online Aromatherapy Institute~ Events

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TILT – Therapeutic Innovations in Light of Technology

Stay in the Know with our Blogs!

For all the places you can find us - see our Community page: http://onlinetherapyinstitute.com/community/

Online Therapy Institute’s Blog recent posts:

Cyberwork: The Reality of Virtual Trauma Therapist-Coach Questions about the Legalities of Technology Application Kate’s Blog recent posts:

TILT’s Yin and Yang CyberKarma and Working with Colleagues DeeAnna’s Blog recent posts:

Online Reiki. Yes. Online Reiki I Train Therapists, Coaches and Healers

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Like TILT Magazine?

Support our efforts and purchase a subscription!

Your purchase will go a long way in ensuring we can continue to give you this quality resource! http://onlinetherapyinstitute.com/tilt-subscription/

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Liability Insurance for Coaches and Energy Medicine Practitioners

The perfect fit for your Practice Do I need to have Liability Insurance for my Energy Medicine Practice? This is a question you need to be asking yourself if you are seeing clients as a student, practitioner, instructor or a volunteer. Even when you do your absolute best work, there’s always some risk that someone with whom you interact will be dissatisfied. Professional Liability Insurance protects you against covered claims arising from real or alleged claims in your work.

Professional and General Liability Insurance available through www.OnlineTherapyInstitute.com

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TILT – Therapeutic Innovations in Light of Technology

Research review

The 2014 D

T

he Delphi Poll for psychotherapy has been published each decade since the 1980’s. It has been largely predictive of the changes that were to evolve in the field of psychotherapy, and no less so now, with its most recent contribution.

The Delphi Poll is a methodology that aims to find a consensus among a group of experts regarding a subject or field. In this case; the future of psychotherapy. It has a historical reputation as being a robust methodology.

“The Delphi approach is particularly suited for emerging areas of inquiry and for building consensus among a group of experts” (Norcross, Pfund, & Prochaska, 2013) Expert panel group

The expert panel group that were involved in reaching consensus for this current Delphi poll included: 1. The 34 living participants of the original poll 2. 58 contributors of the History of Psychotherapy 3. 28 editors of leading mental health journals

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While the researchers started with an invited group of 120 persons, the final data were collected and analysed for 89% of the final sample. By all standards, this can be considered a high return on the data collection. The panel includes influential thinkers and leaders in the fields of mental health and psychotherapy.

Framing the results To frame the results the authors have identified four major themes that will be the principal drivers of change in psychotherapy for the future decade. These are: Technology, Economy, Evidence-Based Practice, and New Ideas.

Interestingly, in previous iterations of the Delphi poll, the theme ‘Economy’ has dominated as the principle variable that drives change. However, in the current poll ‘Technology’ has come to the fore.

“In all probability, psychotherapy faces a period of disruptive, technological innovation” (Kazdin & Blasé, 2011 cited in Norcross et al., 2013) The driving themes of Technology, Economy, Evidence-Based Practice, and New Ideas will be the variables that determine the future. Predicted changes include evolution in: 1. psychotherapy systems that will be used over time 2. the types of therapeutic interventions that should likely dominate the scene

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Edi ted by Stephen G oss

Delphi Poll Featuri n g D erek R i c h a rds 3. the types of psychotherapists who will be providing care and support to clients 4. the various formats of therapy that will prevail Items throughout the Delphi Poll are rated.

A rating of 4.5 or higher represents an item expected to increase over the coming decade.

Psychotherapy systems that will be used over time The poll has predicted that a number of theoretical orientations are likely to increase in prevalence over the coming decade. Some of the highest rated ones include: • Mindfulness therapies (5.55) • Cognitive-behavioural therapy (5.48) • Integrative therapy (5.23) • Multicultural therapies (5.20) • Motivational interviewing (5.15) It is not surprising to see cognitive-behavioural therapy being listed as it is the most researched therapy intervention worldwide. This approach has demonstrated efficacy for the treatment of a wide range of mental health difficulties (Butler, Chapman, Forman, & Beck, 2006).

In addition, the interest in eastern orientated philosophies is a trend that has been growing over the past number of years and this is seen in the evolution of mindfulness therapies (Allen, Chambers, & Knight, 2006).

Historically technology has principally facilitated cognitive-behavioural interventions, but

modern solutions, such as the SilverCloud online platform, have been able to incorporate elements from mindfulness therapies and motivational interviewing, alongside localization that helps in addressing multi-cultural issues.

Types of therapeutic interventions Predicted change in therapeutic interventions highlight how technology, as a theme, will continue to be a key driver in the field of psychotherapy practice.

At the top of the list of interventions predicted to increase in the next decade, are online-delivered interventions (5.91). These include the use of smartphones (5.84), virtual reality (5.38), and social media (5.21).

For a company like SilverCloud this comes as no surprise. The pervasiveness of technology in people’s lives is a testament to their ability and willingness to engage with technological solutions. Now that people conduct so much of their lives online, it makes sense that this should extend to their health and mental health care.

At the simplest level, a recent study of youth in Ireland showed that Google was their number one source of information on health and mental health (Dooley & Fitzgerald, 2012). It seems obvious then that, online delivery of therapeutic interventions using technologies such as SilverCloud, will quickly become an expectation rather than a novelty; ‘Why can I not access my mental health treatment online?’

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Research review Types of psychotherapists It would be impossible to train enough fully qualified doctorate clinical and counselling psychologists to meet the ever-growing demand presented by mental health difficulties. This solution is not an option.

New models are therefore required to meet the care needs of a large number of individuals with mental health difficulties. The Delphi is predicting that, with the growing use of online solutions (5.81), graduate level counsellors (5.46) will be employed to support clients in their use of the interventions.

This has already been happening for a number of years. Some of the earliest interventions delivered online had nurse practitioners supporting users. In its delivery of an anxiety programme for generalized anxiety disorder to students at a large university, SilverCloud successfully employed graduate psychologists to provide support. SilverCloud’s Irish national implementation of an online intervention for depression in the community also successfully used the trained volunteers from a national depression organization to deliver support to users.

Formats of therapy Over time, it has become more apparent that due to factors such as time, cost and stigma, traditional long-term therapy is not for everyone. Services also recognize that resources are squeezed. Alternatives are required to meet the demands of the lives and needs of clients.

It is expected that shorter therapy formats (5.12) will prevail into the future decade. It will be important that these interventions are based on a sound evidence base. It is also important that good quality controls are in place to maintain the highest quality of standards in the delivery of care for shortterm interventions. In addition, there will be more

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co n t inu e d

weight for group (4.96) practice and population based interventions (4.61).

Scalability is something that is becoming important.

A solution like SilverCloud represents a best option for the provision of a solid technological platform.

The online platform includes data gathering and inclusion of psychometric assessments, alongside a large library of evidence-based therapeutic content for a range of mental and behavioral health difficulties.

Future scenarios The expert group collectively made projections about future scenarios. Among the top scenarios outlined were the following: • A growing percentage of psychotherapy will be offered using technologies (5.49) • Evidence-based practices are required by healthcare systems for reimbursement (5.75) • Practice guidelines become a standard part of daily psychotherapy (5.26) • Psychotherapists routinely treat the behavioural components of health problems and chronic illnesses (5.20) These future predictions highlight what has already been established as the main driving theme for the next decade: Technology.

To date, there has been significant work in the area of online-delivered interventions and the use of technology for a broad range of behavioural and mental health difficulties. These have included work in depression treatment (Richards & Richardson, 2012; Wagner, Horn, & Maercker, 2014), anxiety disorders (Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Carlbring et al., 2006), and alcohol and drugs (Agyapong, Ahern, McLoughlin, & Farren, 2012), among others.

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New technologies, especially online-delivered interventions, bring a power of access and scalability while reducing costs. However, any technological solutions must deliver evidence-based content and have the ability to collect the necessary data for healthcare systems reimbursement. This is especially so in the move towards outcome-based payment models.

Supporting the future The increase in graduate providers of care and support will require training. They will also require the delivery of support to clients in accordance to practice guidelines. This support will need to cover: theoretical and therapeutic approach taken, service level requirements, necessary qualifications for practice, review and evaluation of service provision, professional accreditation, continued professional development, feedback from clients, and other necessary guidelines for the safe and ethical practice of therapy.

The psychological aspects of long-term conditions have often gone overlooked. Due to an aging population, dietary factors, lifestyles and stress, the burden of long-term conditions in the western world is expected to increase. The prevalence of comorbid psychological distress for those with long-term conditions is three times greater than the prevalence found in the general population (Frasure-Smith & Lesperance, 2006; Frasure-Smith & LespĂŠrance, 2010).

Conclusion The next decade is anticipated to be an exciting time for psychotherapy. Those of us championing the ethical use of technologies in the delivery of high quality interventions for people with behavioural and mental health, certainly welcome

the predictions of the Delphi expert group.

While robust, one must keep in mind that the results are potentially limited. For instance, the poll is US-based and the panel lacked a sufficient gender representation. It therefore potentially does not reflect the field as a whole. Additionally, representatives were from limited fields of work such as universities, medial schools and academic journals.

Yet, despite these limitations, the research does reflect well the relative changes that seem likely to occur in psychotherapy and its delivery over the coming decade. Its future outlook should therefore, in my opinion, be welcomed. n Please send reports of research studies, planned, in progress or completed, to the TILT Editor at info@onlinetherapyinstitute.com

references Agyapong, V. I., Ahern, S., McLoughlin, D. M., & Farren, C. K. (2012). Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord, 141(2-3), 168-176. doi: 10.1016/j.jad.2012.02.040 Allen, N. B., Chambers, R., & Knight, W. (2006).

Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations. Aust N Z J Psychiatry, 40(4), 285-294. doi: 10.1111/j.1440-1614.2006.01794.x Andrews, G., Cuijpers, P., Craske, M., McEvoy, P., & Titov, N. (2010). Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: A meta-analysis. PLoS ONE, 5.

Full list of references: http://onlinetherapyinstitute. com/2014/05/13/2014-delphi-poll/

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Research Call Ultreya Therapy is conducting a phenomenological inquiry into the influence of social media on the counselor-client relationship. For this study, social media will be defined as texting and Internetbased applications which allow the creation and exchange of information between users. Ultreya Therapy is looking to speak with counselors AND clients. As a counselor, the inclusion criteria are that you use social media with your clients, but it is not distance counseling. In other words, you do meet face-to-face with your clients fairly regularly and the social media interactions/assignments are a part of the therapeutic process.

The interview will be conducted via Skype or another webconferencing protocol. It will take approximately an hour. for more information, please contact: UltreyaTherapy2005@gmail.com

CALL FOR PAPERS Australian Psychologist Special Issue on “TelePsychology and Mental Health: Research and Practice” “Tele-Psychology” is the provision of psychological services using telecommunication technologies such as videoconferencing, video or voice call. This Special Issue will be devoted to examining the state of the art of tele-psychology, and will aim to include both Australian and international contributions. The issue will provide a range of articles that explore the integration and application of relevant theory and knowledge as applied in a range of contexts in which tele-psychology can be used to overcome isolation. The goal is to provide an informative resource for psychologists who want to learn ways in which they can harness currently available technologies to offer psychology services.

The Guest Editors for this Special Issue would be interested in receiving review and empirical manuscripts from researchers at the forefront of the development of tele-psychology. Authors will address key questions that highlight the utility of tele-psychology in the Australian context: •

What are the strengths and weaknesses of tele-psychology in comparison with in-person services?

•

What do we need to know about the provision of tele-psychology services?

•

How can tele-psychology address current gaps in the provision of psychology services?

•

What is required of researchers and practitioners in tele-psychology in order to increase the accessibility and acceptability of tele-psychology to practitioners in applied settings?

Guest Editors: Dr. Susan Simpson and Dr. Nadine Pelling (University of South Australia), with Dr. Lisa Richardson (Murdoch University).

For more information and to find out how to submit your manuscript: Please visit: http://www.unisa.edu.au/Calendar/Tele-mental-Health-Research-and-Practice-inVideoconferencing-for-Psychology-and-Psychiatry-Conference-20141/

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Mentorship

&

the Path of E-Mastery

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“There is nothing in a caterpillar that tells you it’s going to be a butterfly.” ~Buckminster Fuller

‘Bucky’ is right when we’re just looking at the outside of a caterpillar… or at a person whose potential is latent, which at some point in our lives could be said of all of us. Yet if we envision the oak contained in the acorn, the butterfly yet to emerge, or the seed of someone’s purpose before it fully blossoms, then we can be a mentor to them or what Shlomo Carlebach calls a real holy friend.

“There are three kinds of friends in this world.

An ordinary friend sees only what you are; for that you don’t need a friend. Then there’s a friend who sees in you what you can be.

But in the presence of a real holy friend, you already are!”

If we are so blessed, we have such a person when we first set out on our path, a mentor who treats us as if we already were what we potentially could be and thereby inspires us to become what we can be (Goethe). This is best expressed by Viktor Frankl in this passionate talk to students.

He cites Goethe’s maxim as the most important perspective a therapist can have.

I have such a mentor in Tom Francoeur who was my counseling professor and mentor when my vocation was anything but clear to me. Dr. Thomas Francoeur (92 yrs) is Professor Emeritus of McGill University in Montreal who specialized in Counseling and Religious Education. If there can be such a thing as genius when it comes to 16

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the gift of presence, Tom Francoeur is at that level.

With him, I experienced the kind of conversation that can be called communion and not merely communication. When I exhort E-counselors to hone in on ‘the person behind the problem’ I am carrying on the legacy of Francoeur, as practiced online through the mystery of non-local presence (explored further below).

I like to call Francoeur the ‘godfather’ of the InnerView approach to short-term therapy, which actually plants the seeds for long-term soul work.

InnerView evokes the interior landscape of what the soul knows. InnerView guidance is a matter of realignment with the feelings, needs, values and purposes which allow our inner and outer worlds to be congruent. That integral coherency in turn opens our limited personal selves to transpersonal and archetypal realms and we come to see our life situation with the kind of wide-angle lens Tom naturally uses. It’s about what kind of person is having the problem, rather than what kind of problem is discouraging or even disabling the person.

Francoeur’s InnerView guidance has brought thousands of students, clients, and seekers of all kinds into alignment with the best of their human nature. That mission continues online. A person is a presence and a feeling, not just a personality, so if features of the client’s personality are not ‘in the room’ so to speak, it can actually be an advantage. In addition, “writing is a strong

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easement for perplexity.” (Emily Carr) Tom Francoeur continues to have a profound life-changing effect on those who experience his healing presence. He has consistently lived his message that “Happiness comes from giving of oneself.” Originally envisioned as a tribute to his mentorship and influence, a documentary profile of Tom became the first episode in a series called GuideLives for the Journey: Ordinary Persons, Extraordinary Pathfinders: http://www. guidelives.ca/bio.html As one of the pioneers of online counseling in Canada circa 2000, I now see it was difficult to find my way before then because my career wasn’t invented yet! In the 80’s, when Francoeur was prophetically saying, even in front of others, that I was going to be a leader in the field, it was flattering, but I really thought he was taking the encouragement too far. I told him honestly how I felt at the time – that what he was seeing in hisprotégé was more of a good client than a counsellor. Yet he never wavered in his vision or questioned my own when I launched into a Creative Writing Masters and preferred literary criticism, radio drama and film courses to graduate reviews of psychology theories. The internet itself was still a decade away, and I envisioned being therapy-wise in service of my writing rather than the writing leading the way to what became, not just another modality, but a new field of therapy.

“I was initially a little skeptical that online counselling would be a good medium to deal with emotions and complex personal issues - despite the typed words and computer screen, I felt her warmth and geniune interest in my well-being shining through each message.”

“I feel as if someone has put an arm over my shoulder and is talking to me.”

“Your words are as comfortable and appropriate as my favourite pants and sweatshirt on a cold night!”

“I’m actually not too comfortable talking about myself – which is why I am absolutely amazed as to what I have been writing in these mails.”

“I was very impressed with the quality of

In my role as clinical supervisor for the largest EFAP company in Canada, I have now overseen 80K short-term asynchronous cases. Along the way, I discovered 18 therapeutic elements unique to the medium and proved that the ‘writing cure’ is equally and often more effective than the traditional ‘talking cure.’ Lest anyone still believes there is something inherently impersonal about online therapy, the clients have always said otherwise.

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The Way It Is There’s a thread you follow. It goes among things that change. But it doesn’t change.

People wonder about what you are pursuing.

You have to explain about the thread.

But it is hard for others to see.

While you hold it you can’t get lost.

Tragedies happen; people get hurt or die; and you suffer and get old.

Nothing you do can stop time’s unfolding.

You don’t ever let go of the thread. ~William Stafford support that I received and the objectivity.

I felt completely validated and encouraged to look after me. I feel that the email exchanges allowed for complete disclosure from me as I didn’t have to face someone directly – people react to things being said and body language can be encouraging or discouraging. The online process removes this barrier.”

“Once I had purged everything in writing and had responses back which I could access at any time, the healing began quickly. It was like a wonderful wave of self realization and peace washed over me.”

“She spoke to me as if I was right in the room with her and had a very good approach to speaking to me even when relating to a previous letter.”

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“I have printed all of our correspondences, and will use them over the next months and years. I feel the quality of the counselling I received was A++, much better then several sessions I had been to in person with a local counsellor charging $150 an hour.”

“I had no idea it was possible to form a bond and a trust with someone based solely on the written word. Thoughts and feelings just seemed to flow out of me in a way I never could have imagined. My e-counsellor helped me put things in perspective and look at things going on in my life in a whole different light. I was apprehensive about trying e-counselling but find it was the best move I ever made.”

Asynchronous E-counselling, by virtue of being an introspective process while remaining part of

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a therapeutic dialogue, can involve the best of both worlds, inside/outside, individual and relational. It allows for a measured ‘heart-to-heart talk’ that takes place in a shared space mediated by the internet. Both insight and emotional catharsis are possible in the safest of environments when a window is opened to the thought and feeling processes on both sides of the computer. Beyond text-based bonding is the notion of tele-presence, non-local presence, or the feeling of persons being present to each other, even at a physical distance. As cyber psychologist John Suler observed, "There is a special type of interpersonal empathy that is unique to text relationships. Some claim that text-only talk carries you past the distracting, superficial aspects of a person’s existence and connects you more directly to the other’s psyche."

Or as the poet John Donne might have tweeted, “More than kisses, letters mingle souls.”

The process of focusing, or paying close attention to one's own self-awareness, feelings, and thoughts, is facilitated by a text-based dialogue taking place behind the scenes of self-presentation, where counsellor and client do not face each other. Both have more of an opportunity to look within themselves as they communicate.

The essence of non-local presence is the paradox of being alone together. Similarly, witnessing or taking a step back from one's internal dynamics to gain perspective is enhanced by the act of composing oneself and getting it down in writing. When this text-based externalization occurs, the client is invited to live in a bigger, more meaningful story.

“I find the process of writing in these InnerView sessions a form of healing.

Emotions transform when I key events onto

this page and I begin to awaken from a selfabsorbed or selfish state.”

I still have notes from the group supervision course led by Tom Francoeur in 1987. He conducted case conferencing master classes like a skilled artist who paints with only a few deft strokes…

“Together with the client, you are two architects of their life.”

“Every human heart is built to heal.”

“We can’t learn skills apart from knowing persons.”

There is an intangible attunement one receives from an inspired mentor, a golden thread that keeps you on your path through the mazes of life. You hold onto your end, and it keeps you forever connected with your teacher. You then extend it to others as their mentor and guide. It’s a response-ability you pay forward. It’s just the way it is when you are committed to your path and practice. n

About the author Cedric Speyer helped design and develop one of Canada’s first online counselling services and has overseen the delivery of 80K cases. He currently supervises an ‘E-team’ of 30 E-counsellors. Cedric conceived and promotes a therapeutic approach called InnerView and directs a documentary series entitled GuideLives for the Journey: Ordinary Persons, Extraordinary Pathfinders. http://www.guidelives.ca/

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WIRED TO WORRY

Twitter Storms & Anti-Vax Flack Recently, Jenny McCarthy asked her twitter followers to tell her the most important personality trait they looked for in a mate and to reply with the hashtag #jennyasks.

She inadvertently caused a twitter storm. Here are a few examples of the flurry of angry tweets directed at the prominent anti-vaccinator:

Christine Korol

Kevin Folta @kevinfolta Mar 16 Ideal mate accepts scientific consensus & considers the elderly, infants & immune compromised b4 spreading baseless hysteria. #JennyAsks Thomas Levenson @ TomLevenson Mar 14 My ideal mate? Easy: someone who cares enough about our kids to protect them from wholly preventable diseases. #Jennyasks #vaccineswork SchneiderSales @ SchneiderReps Mar 14 #JennyAsks I’m gonna go with intelligence. As in, someone who understands

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some basic facts about medicine and immunology.

Evidence of increasing opposition to McCarthy and the anti-vaccine movement is easy to find online. There is an anti-anti-vax website that keeps a running tally of the number of deaths attributed to the anti-vaccine movement. As more measles outbreaks occur throughout North America journalists and medical researchers are quick to point the blame at McCarthy. The recent twitter backlash is just one more example that not everyone is buying her pseudoscience stance.

I am happy that there is debate on this issue and that social media gives non-celebrities a means to talk back and to counter misinformation. I am less happy about the tone of that debate. Although I do think that McCarthy is misguided, I would never agree that she doesn’t care about kids. I

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believe that she cares deeply and that is why she has been willing to face what has to be an overwhelming amount of hostility and criticism.

Stephen J. Hoffman from McMaster University has suggested that we follow celebrity medical advice for a variety of reasons, including cognitive dissonance and the halo effect (Hoffman, 2013). This is fine when the advice is good, such as Jamie Oliver’s campaign to improve nutrition in school lunch programs. However, it becomes problematic when the advice is based on misinformation or ideology rather than science or evidence. Hoffman suggests that professionals are able

to counter harmful celebrity advice by educating our patients - whether it is about vaccinations, a questionable fad diet or unsafe exercise regimen.

In addition, as therapists we need to speak out on social media whenever we hear similarly harmful information.

However, we need to remember that it is never necessary to make a point at the expense of someone else’s feelings or dignity.

We have the opportunity to raise the level of discourse, stick to the facts and reject personal attacks that only serve to increase animosity between each side of a debate.

REFERENCE Hoffman SJ, Tan C. Following Celebrities’ Medical Advice: Meta-Narrative Analysis.

British Medical Journal 2013; 347: f7151. doi:10.1136/bmj. f7151.

ABOUT THE AUTHOR/ ILLUSTRATOR: Christine Korol, Ph.D. is a cartoonist, psychologist in private practice in Calgary, Canada and the host/ producer of a podcast on WiredToWorry.com that provides free online anxiety and stress reduction education videos.

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Leaving a Legacy

by Emily Swinburn

The Generation Y Approach to Mental Health Solutions “No health without mental health” is the new ‘buzz-phrase’ used by

the government to highlight its commitment to psychological wellbeing, and I couldn’t agree more with it. In popular culture there is a huge emphasis on maintaining physical health; you can’t turn on the TV or surf the internet without seeing a programme promoting a new fitness regime or diet. But where are the programmes on coping with emotional distress? Maintaining a healthy mind? Ways to change distorted thinking? If our government and health system see our mental well-being as the crucial counterpart to our physical health, why is this not reflected in British society?

TILT – Therapeutic Innovations in Light of Technology

I

n February 2014 the Department of Health released the publication 'Closing the gap: priorities for essential change in mental health', which states that mental health must have equal priority with physical health and that everyone who needs mental health care should get the right support, at the right time. This is a topic I am particularly passionate about. I have experienced the devastating path that mental health can take without adequate support. My Mother lived with depression for over a decade which led her to take her own life at Hatfield train station in April 2009. I don't believe my Mother was given the support she required; waiting lists were and still are detrimentally long, and in my opinion counselling as a solution was and still is underplayed.

A recent report published

by Mind, ‘We Still Need to Talk’ (2013), revealed that 1 in 10 people waited over a year to receive treatment.

Mind stated that access to psychological therapies as

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soon as possible after referral and assessment "can be the difference between recovering well and a mental health problem spiralling into a crisis.

The wider human costs of long waiting times are devastating and can have detrimental effects on all aspects of a person’s life". I think that if my Mother had been given access to talking therapy early on, things may have been different. Since her suicide I have always known I was going to do something to help people get better access to talking therapies.

There are numerous statistics that reveal there are hundreds of thousands of people who feel ‘down’ as a result of very common life conditions.

Some examples are: postnatal depression; long term illness; issues with body image; work stress; and familyrelated problems, but there are many more. The statistics are accessible for everyone to see, and society is aware of the prevalence of mental health issues, however they still don't seem to be taken seriously. Instead, many

problems are covered up by antidepressants and other drugs. I know from personal experience that talking to a counsellor provides a safe place to discuss your problems and to overcome challenges; and it certainly changed my life from a dark existence to a place of hope and positivity.

Unlike many health conditions that exist, there is a solution!

Counselling improves many people’s lives, so why aren't we promoting it more?

Furthermore, reports and studies have repeatedly shown that psychological therapies (Cognitive Behavioural Therapy (CBT) is commonly the independent variable in such studies) are relatively low cost and show good recovery rates. I've talked to many people who have had to wait for up to a year to receive counselling or therapy, and I believe that the health system is failing millions of adults and children

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with common mental health problems such as anxiety and depression. Clearly the lack of access to talking therapies is preventing people from getting help, and this needs to change.

Unfortunately there are even more barriers to people getting the

professional help that might benefit them. The stigma associated with seeking professional psychological help is believed to be one of the most significant barriers to treatment (Sibicky & Dovidio, 1986; Stefl & Prosperi, 1985).

The explanation for this may be that the public tends to associate negative traits with individuals who have mental health problems (Crisp et

al, 2000). Many people also find it difficult to get time off work to see a counsellor, and/ or struggle to find the time due to family commitments.

Some people have difficulties travelling to their appointments, and some just can't face leaving the house.

The explosion of the internet in recent years has meant the way that we communicate

has changed phenomenally and the demand for talking therapy delivered online is higher than ever. The ability to access a counsellor via the comfort of your own home removes the shame, time commitment and effort of having to travel.

Furthermore there are

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generations of people who expect counselling to be easily available online.

In July 2013, Wagner et al investigated whether online therapy was as effective as face-to-face. Based on smaller previous projects they expected to find that online counselling would be equally as effective as face-to-face therapy, but their expectations were exceeded when they discovered that under certain conditions, online therapy was actually more beneficial.

In this experiment, six therapists treated 62 patients with moderate depression.

Patients were randomly assigned to one of two groups;

either face-to-face or online treatment, and each patient was offered eight sessions of therapy based on cognitive behavioural techniques. At the end of the treatment, 53% of patients in the online group were no

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longer considered depressed and 50% of those in the face-to-face group were no longer considered depressed.

After three months following treatment, those who had received online therapy continued to see marked improvements, although there was little further improvement in those who had received face-to-face therapy. There was no depression detected in 57% of the online group compared to 42% in the face-to-face group after a 3 month period.

The findings from Zurich offer support for earlier findings from the University of LinkĂśping, where an investigation of the effectiveness of online therapy was conducted involving 117 volunteers with mild to

moderate depression. In this instance the volunteers were offered web-based therapy both individually and in groups, and given online selfhelp materials. The researchers

noted that the outcomes of this experiment demonstrated that online therapy was just as effective as conventional therapy at treating depression; although they did state that the relationship between the therapist and client is a major factor in determining the success of online therapy.

This is not an uncommon finding and many other studies have confirmed this conclusion. A study in Ontario, Canada randomly assigned 495 participants to either face-to-face (254) or online therapy (241), and also found that online therapy was just as, if not more, effective than in-person treatment.

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The Lead Counselling Adviser at PlusGuidance.com, Sarah WorleyJames (Head of Online Counselling at Cardiff University) quotes "My experience of counselling online has made me realise how effective it is at helping people work through, process, come to terms with, and find more effective ways of coping with trauma and life's difficulties. I have found that the anonymity and safety that expressing ones innermost fears and thoughts online, enables people to share deeply uncomfortable and painful feelings and experiences. Often this process of opening up occurs more quickly, with the client sharing their feelings and experiences in a deeper way than they feel able to do in the first face-to-face session.

Face-to-face, the fear of being judged and showing your vulnerabilities to a stranger can be scary, and it can take many sessions for the trust to build. Clients regularly tell me that seeing their words and thoughts written down is a release in itself, as their feelings seem less intense when viewed externally.

Another key benefit that clients have expressed to me, is how helpful it is to have a written record, through the emails or saved transcript of the Instant Messaging session. This enables them to review their progress and refer back to strategies and issues discussed, rather than relying purely on fallible memory of a face-to-face session.

Working online also encourages creativity of expression, which can give new perspectives and insights. For example a client may share a link to a song, a poem, quotes from a novel, a photograph or picture they have drawn. These enable me to gain a very personal, deep understanding of who they are, their personality, and how their difficulties are affecting them.

I enjoy the flexibility online counselling offers clients, and I am happy to move between media to suit my client's needs, such as moving to Instant Messaging if they have not had time to write their email, or moving from webcam to email if they are struggling to meet the time agreed for a synchronous session. Working online is an inspiring and creative way of counselling, and as it evolves will continue to offer clients an effective and flexible way of addressing their difficulties".

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In response to these findings, and realising that better access to online counselling could greatly benefit a lot of people, Nathaniel Smithies and I joined forces to create PlusGuidance. com.

PlusGuidance.com is a brand new web platform that allows qualified counsellors to offer their services to clients via high definition video call, voice call, instant message or email.

Smithies (CEO and cofounder) comments "Creating better and more immediate access to talking therapy online is going to help many people take that first step of reaching out to a professional.

Furthermore, a key factor for people experiencing emotional distress is talking to the right counsellor or therapist (increasing the likelihood of a strong client-counsellor relationship from the start). PlusGuidance.com enables people to reach out and talk to a large number of counsellors, and choose

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someone based on the initial relationship and a host of other criteria. They can then choose from the counsellors available time slots, as well as choose which online medium they wish to have a session in".

These days people expect to be able to access anything over the internet, whether it is ordering a weekly food shop, buying clothes or sending a personalised birthday card.

All these tasks can be carried out by the touch of a button.

The same needs to apply to accessing a counsellor, people deserve to have this available to them. I feel that the open nature and ease of access of PlusGuidance.com, where the user is completely in control, is revolutionary to counselling services.

In this day and age it is almost impossible to find someone who doesn't own a smartphone or a tablet device.

If we want to approach a sensitive topic with a friend or ask our crush on a date we can avoid potentially humiliating or embarrassing situations by interacting with someone online. PlusGuidance.com

allows counsellors to meet clients where they are most comfortable – it is within this online shared space that people are most likely to express their true feelings more quickly. This willingness to open up and become less guarded about emotions is known as the disinhibition effect which is a huge benefit of counselling online.

The potential that online counselling has for the mental well-being of society is tremendous. Studies have indicated that women tend to have more positive attitudes than men do regarding seeking professional help (Fischer & Farina, 1995) and women tend to seek help more often than men do (see MollerLeimkuhler, 2002). Some researchers have suggested this may be due to traditional gender roles, with the male role having an emphasis on being independent and ‘in control’; they may be less likely to seek help in order to protect self-esteem. I believe that the emergence of online counselling will greatly increase the probability that men will seek help when they

need it. Being able to access a counsellor from home will mean cutting out having to explain where people are going, having to travel to a clinic and the awkwardness of sitting in a waiting room. I believe that having the option to be anonymous will help many more people generally to seek help too.

Nathaniel and I are graduates in Psychology from Cardiff University and are delighted to have a number of academic staff from the institution on our advisory board. Professor Ed Wilding who is the Head of the School of Psychology stated “The model and the team behind Plus Guidance has quite rightly received enthusiastic support. There is a real opportunity here to provide a platform that makes a difference”.

In the past I have participated in several voluntary positions within the mental health sector and taken part in various campaigns – as great as these are, I believe there is only so much waving a ‘stop mental health discrimination’ sign can do in terms of

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shifting attitudes. I truly believe however, that making counselling easily accessible online and encouraging those to seek help early on before their challenges escalate and get out of control will contribute to a change in attitudes towards mental health over time.

Since my Mother passed away, I have made it my lifetime ambition to change the way

mental health is dealt with and improve access to talking therapies. My aim is to leave a legacy for my Mother and ensure that her decision to take her own life stood for something – to spark my passion to change attitudes and treatment of mental health issues to help future generations, which I believe PlusGuidance.com has the capability to do.

References Closing the Gap: Priorities for essential change in mental health, Department of Health (2014) https://www.gov.uk/government/ uploads/system/uploads/attachment_data/file/281250/Closing_the_ gap_V2_-_17_Feb_2014.pdf Crisp, A et al (2000). Stigmatisation of people with mental illnesses.

Psychiatry, 177:4-7.

Fischer, E. H., & Farina, A. (1995). Attitudes toward seeking professional psychological help: A shortened form and considerations for research.

Journal of College Student Development, 36(4), 368-373.

Moller-Leimkuhler. (2002). Barriers to help-seeking by men: a review of sociocultural and clinical literature with particular reference to depression. J Affect Disord.

O’Reilly et al (2007) Is Telepsychiatry Equivalent to Face-to-Face Psychiatry? Results From a Randomized Controlled Equivalence Trial.

Psychiatric Services Sibicky, M. & Dovidio, J.F. (1986). Stigma of psychological therapy: Stereotypes, interpersonal reactions, and the self-fulfilling prophecy.

Journal of Counseling Psychology, 33, 148-154 Stefl M. E., & Prosperi, D. C. (1985). Barriers to mental health service utilization. Community Mental Health Journal, 21, 167e178.

Wagner, B et al. (2013). Internet-based versus face-to-face cognitivebehavioral intervention for depression: A randomized controlled non-inferiority trial. Journal of Affective Disorders. Doi:10.1016/j. jad.2013.06.032 We Still Need to Talk, Mind 2012-2013: http://www.mind.org.uk/ media/494424/we-still-need-to-talk_report.pdf

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ABOUT THE AUTHOR Emily Swinburn is the CMO and Co-founder of PlusGuidance.com and currently lives in Cardiff. She has a BSc degree in Psychology and has carried out experimental research at Cardiff University.

She is an active campaigner with a passion in improving the way mental health is dealt with in society.

Your Options Explained!

Deciding which Online Therapy, Coaching, Supervision, Avatar or Intuitive training is right for you!

You may have seen that Online Therapy Institute now offers an academic route to training through our collaboration with the Metanoia Institute. You may also be wondering what the differences are between that and our Certified Cyber Facilitator credential.

The simple answer – the difference is what you require at the end of your training!

If you are looking for Continual Professional Development or Continuing Education Credits, then our Certified Cyber Facilitator (CCF) course may be enough for you. You can read all about this course at http://onlinetherapyinstitute.com/ certified-cyber-facilitator/ and get in touch with us at info@onlinetherapyinstitute.com to discuss it if you need more information.

However, if you would like to train as a potential starting point to a Post Graduate Diploma (PGDip) or Masters (MSc), then you will want to consider taking our option with the Metanoia Institute, which includes the CCF plus a final case study module to help you formulate your thinking in implementing a work-based solution to your future clients’ needs.

The PGCert in Cyberculture for Therapeutic Purposes is the initial step towards your academic training, and awards 60 Credits at Level 7 (M).

You can read all about this course at www.metanoia.ac.uk/cyberculture

Download the information booklet, or get in touch with Kate direct at kate.anthony@metanoia.ac.uk if you need more information or to discuss what your work-based project might look like!

TILT – Therapeutic Innovations in Light of Technology

Views From The

FRONT LINE An industry perspective

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Aislinn Enright and Mark Wallin represent SilverCloud Health in the UK and US respectively. As leaders in their field, producing and promoting engaging online health and wellness solutions, their roles require them to stay abreast of industry relevant matters. However, their geographic localities each present different issues and priorities, and occasionally divergent perspectives.

A view from the UK Aislinn Enright, UK Director, SilverCloud Health Aislinn worked within the NHS for 13 years as both a clinician and project manager, and more recently she has worked in private and non-profit organisations, within the mental health and primary care field. She has vast experience developing and implementing talking therapy services, primary care and long-term condition motivational services.

Managing long- term conditions There are currently more than 15 million people in England with a long- term condition (LTC).

We know that for some people discomfort and stress is an everyday reality, especially older people and those with more than one condition. Despite this, care for many people with LTCs has traditionally been reactive, unplanned and episodic. This leads to heavier reliance on health and social care services, including community services, urgent and emergency care, and acute services.

The Department of Health’s (DH) strategy for LTCs aims to put people at the center of decision making regarding their own care. This should result in the delivery of care in the most appropriate setting for each individual’s needs.

In a survey by the DH (2010), over 90% of people with an LTC said they were interested in being more active self-carers. Over 75% felt they would be more confident about self-caring if they were given information and support from a healthcare professional or peer. Despite this, many people with LTCs have limited knowledge of, or influence over, their care.

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• People want services that support them to remain as independent and healthy as possible.

• They want increased choice, with information to help them make choices and to understand and manage their conditions better.

• They want far more services delivered safely and effectively in the community or at home, with more seamless, proactive and integrated services that are personalised to them and their needs.

At SilverCloud Health we believe that, with modest investment it is possible to reduce the burden of illness and improve productivity in the treatment of people with LTC. We have begun to look at how online solutions can help reshape services.

In February 2014, we were awarded a grant to extend capabilities of our online platform to support the self-management of symptoms and wellbeing of people with cardiovascular disease (CVD). This project will combine SilverCloud’s media-rich web platform with evidencebased, CVD-specific content developed in conjunction with academics based in the Florence Nightingale School of Nursing, King’s College London. The resulting psycho-educational and therapeutic intervention package will improve access to holistic care while reducing healthcare costs associated with CVD. By reshaping services in a collaborative way and ensuring users are at the heart of service delivery, we hope to help reduce the number of GP consultations and hospital (re)admissions for individuals with LTCs. There can be huge benefits for the NHS, local authorities, the third sector and ultimately for those receiving services.

Reference DH (2010) - World class services for people with long term conditions –information tool for commissioners

A View from the US Mark Wallin, SVP, SilverCloud Health Inc. Mark has U.S. and international experience with corporate healthcare and eHealth organizations, such as Aetna, WebMD and ICW AG. Driven by a

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passion for quality health outcomes, Mark has successfully operated or engaged in multiple entrepreneurial start-up and turnaround opportunities in healthcare technology.

A breakthrough for Population Health?

Traditionally, the delivery of care for patients with a chronic condition is approached from a physiological perspective, with a focus - quite reasonably - on ‘the body’. However, across various perspectives and stakeholders in the US healthcare market there is a growing recognition of the impact behavioural health has on population health management.

For patients, there are often co-morbidities of depression, anxiety or stress that co-occur along with their physical chronic conditions. Application of cross-disciplinary, physiobehavioural care delivery can bring greater benefits to the patient and improve quality health outcomes.

Introduction of behavioural health support to the patient with a chronic physical condition can be delivered via traditional methods, which carry traditional costs. Evolving technologies can be more cost-effective than traditional face-to-face therapies. They are easy to use and can be implemented with quality clinical effect.

Online solutions can bridge behavioural and physical health Online platforms, like SilverCloud, provide a pathway to a blended approach of dynamic online patient engagement. Such a platform can create a bridge between behavioural and physical health.

Infusing behavioural healthcare into the treatment of chronic care patients represents a real opportunity to address the underlying challenges of non-adherence and non-compliance in an innovative and dynamic way. It supports not only patient engagement, but also patient empowerment for better self-management. This leads to healthier lifestyles and quality outcomes – and a lower cost impact on the healthcare system.

This breakthrough could not have come at a better time for the US healthcare market as it continues to wrestle with the issues of cost and quality across the entire healthcare ecosystem.

Guided online behavioural health and mental wellness solutions for chronic care patients can provide low barrier access and quality outcomes. They also represent opportunities to help stabilize the growing healthcare costs in the United States and support healthier lifestyles.

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A Clinical view Derek Richards, Clinical Research Director Derek Richards was responsible for pioneering the first online mental health community for students in conjunction with the Centre for Research in IT in Education (CRITE). Now, as Director of Clinical Research & Innovation at SilverCloud Health, Derek is very interested in the development, implementation and clinical research of technology delivered interventions for mental health problems, in particular interventions for high prevalence disorders such as depression and anxiety.

Expanding choice in interventions Long-term chronic conditions are a global problem. The behavioural and mental health needs of patients with long-term conditions have often gone overlooked.

Many of those with long-term chronic conditions also have significant comorbid psychological distress. While anxiety or mood difficulties can sometimes remain at a subclinical level, it should be understood that subclinical symptoms can be significant for the functioning and emotional state of the individual. This in turn can impact on their ability to self-manage.

This impact on the individual is of crucial importance as, with long-term chronic conditions, the central aspect of treatment is appropriate self-management. Therefore, any comorbid psychological distress that may interfere with appropriate self-management can only have detrimental effects.

Expanding choice and accessibility to behavioural and mental health care interventions can therefore only benefit people with long-term chronic conditions. This can be achieved through the use of an online solution.

Personalised content Making evidence-based interventions available online brings with it the advantages associated with this delivery format. These include access at any place and time, and the removal of potential barriers to access such as location, disability, or indeed difficulty with stigma and asking for help.

However, in the context of a person with a long-term chronic condition, or indeed with multi-morbidity needs, the presentation of content must be considered carefully. The intervention will need to meet the person where they are. Content will have to be personalised to the user so that the benefits of engaging with the content can make a difference to the individual and the self-management of their condition.

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Addressing the need Little is known regarding the feasibility and utility of an online solution that would help people with behavioural and mental health aspects of their chronic condition. A solution aimed at supporting individuals in their ability to successfully self-manage chronic conditions. However, the work that SilverCloud Health is involved with seeks to address this need and learn how such a programme can be developed and implemented online.

Online Counselling Software

Secure and encrypted email, chat, and video!

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STUDENT Spotlight 38

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Myke McKay

MY EXPERIENCE

The Foundation Certificate In Cyberculture As a student, how can I define my experience of the Foundation Certificate in Cyberculture with the Online Therapy Institute?

The reality for me has been a psychologically and emotional passage of time over recent months.

Incorporating study with my volunteering role as a Counsellor had been a little discerning initially as I had to incorporate a new routine in to my life where I could apply undivided attention.

Returning to study when you’re my age requires an element of careful thought before committing yourself to the required study time.

However returning to ‘online study’ is a different and unique experience in comparison to f2f classroom study and required a different level of commitment and understanding of what e-learning is. Defining my experience of the Foundation Course required reflection as to how I felt I had benefitted from the course. In reality I am (was) a former technophobe dedicated to f2f counselling and avoiding technology as much as possible. Studying the course transformed my awareness and understanding

of how technology can benefit and enhance the therapeutic experience as a whole. Learning to understand technology and the benefits it conveys altered my perception of its value within the counseling relationship. Opening my mind allowed me to grasp new technology and incorporate it in to my future counselling practice.

A simple tantalizing glimpse in to Cyberculture is offered at the outset of the Foundation Course and doesn’t infer a horrendous sense of study as other courses do. A gentle slide in to a comfy mode of learning is available to a prospective student; yet don’t be fooled into thinking it may be a simple case of whack a few words down in an essay and e-mail it over, this is definitely further from the truth. Be prepared for extensive reading and reflection of the online study materials, learning to understand extensive Cyberculture Terminology and Language can be a difficult task for a slightly more mature student <cough> but it is a respected and valuable part of your learning.

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The course itself imparts identifying and utilizing basic internet functions which I assure you, you will not be aware of at the initial stages of the course. A simple glimpse in to web 2.0, 3.0 and 4.0 is offered at the end of module one, for myself at the outset I thought we had web 1.0 and that was it!! My learning soon identified for me a new world of exciting knowledge and available skills to be incorporated in to my former technophobic f2f counselling practice. Moving through the modules and identifying methods and locations for communicating in cyberspace was an intense experience. Identifying types of new therapeutic relationships was certainly more than I bargained for, but eagerly lapped up by my innate sense of curiosity and learning.

For me, one of the most important aspects of the whole course was study centered around the Online Change Agent Relationship, Presence and the Online Disinhibition Effect.

In f2f counseling, disinhibition and presence are conveyed in a physical sense, in cyberspace it is more an ethereal sense. Identifying and learning to work with online anonymity and fantasy within the therapeutic relationship is a valuable area of study, as when we create fantasy or visualization in f2f counseling, we create a fixed or guided set of boundaries. To utilize this approach online identifies a much wider scale of required boundaries and tighter control of the fantasy world we potentially enshrine ourselves in. Information and learning is provided in

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a professionally structured and supportive manner which I can only compliment and recommend highly. Experiencing the impact of legislation and liability that is commensurate with cyberculture is certainly a valued area of study which I cannot convey enough.

Technology allows us to communicate and support a wider audience who are unable to physically or emotionally attend f2f counselling.

Technology is imprinted in our lives, we now need to learn to grasp and utilize its benefits.

Concluding my experience of the course, I cannot impress enough the quality of the material and the tutor support available. My time studying has been an experience which I would recommend to anyone contemplating studying and introducing cyberculture in to their professional practice.

Take the plunge, youâ&#x20AC;&#x2122;ll not regret it. n ABOUT THE AUTHOR Myke McKay began his training in counselling and sign language in 2008 with COSCA at Perth UHI with a view to working with the Deaf Community.

However his passion for counselling took over and he entered University in Dundee under the tutelage of John McLeod. Graduating as a counsellor his role for the last three years has been as a volunteer counsellor based in Dundee working with people who self-harm, suicide, anger and trauma issues.

More recently his aim has been to expand these areas utilizing his training from the Online Therapy Institute.

Using the Internet to Build a Dream From Burnt Out Pysch Nurse to Thriving Wellness Coach

by Angela Brooks

TILT â&#x20AC;&#x201C; Therapeutic Innovations in Light of Technology

A true online business is not an overnight success story. It comes with true blood, sweat and tears...

For the last four years, I have had my head down learning everything I could about online business, from blogging, auto responders, guest writing, and building traffic. When I decided I wanted to build my own website the adventure began.

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I have been a full time nurse for the last 25 years in a state funded mental hospital, running my business from home in the afternoon from the baseball field, laundry mat in hotels, sitting in my truck on my lunch break and many more spots.

When I decided I needed a website/blog I had no clue how to add links, images or even what a banner was for.

I started learning anyway without extra funds in the family budget I couldn't pay someone to help me and I had to do learn. I worked for 6 months and had a page that sold products...and it was ugly!

Over time that has changed. I put myself around people who could help me and finally took the plunge to get a business coach to help me take the next small steps. A true online business is not an overnight success story. It comes with true blood, sweat and tears...

well maybe not the blood but defiantly some tears and frustration.

I worked three nights a week 13 hour shifts on the night shift. I had a small son at home and a son who played travel baseball. Between lack of sleep and lack of time I could not sit in my office to run a business.

The business had to go with me - it had to be mobile or it was not going to happen.

I had lots of time sitting at the ball park between games and sometimes four games a day. At the time, all I had was a Blackberry phone and I took notes and wrote blog post on my phone and emailed them to myself so I could finish when I got home.

I never dreamed that what I had started would grow like it has the last two years.

I applied everything I learned even when it didn't make sense and I was seeing no

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results. I had every reason in the world to quit. There was something inside my gut that would not let me. I wrote two blog posts a week for months about my experience as a nurse and the people I had met and things I had seen in mental health.

The readers began signing into my newsletter that went out on Monday to get each post that I wrote. Then I began noticing people were retweeting and reposting them. The products mentioned in my blog began to sell, as I taught how the essential oils worked for me and how I was using them at my work more and more. More people wanted the products

for the same problem they had.

used and how they could get it.

You see we are problem solvers not salesman - people have problems and they are looking for the answer.

They don't want to hear how amazing your product is compared to another company, they want to know how what you have can help them, then for you to tell them how they can get it.

People were buying products that I have never talked too they were signing up to get business kits for the essential oils without me calling and begging them to purchase.

As a matter of fact - I have done 100% of business online without picking up the phone.

I used the same method that I teach my team now to use.

So I did.

The ones who sees results are the ones who are consistent and stay at it.

I use social media platforms like Facebook and Twitter (my favorites) and Google+, LinkedIn, and bookmarking sites to send my content out into the marketing world. I told my story - I told the products I

I don't think I am an expert - I just don't give up, I work when nothing is happening and when most people would throw in the towel. If

I had every reason in the world to quit.

There was something inside my gut that would not let me.

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I wish for your biggest dreams to come true: donâ&#x20AC;&#x2122;t want for them, go find them. They already belong to you. something is not working I look for another way to present it. This week I had a giveaway if people signed for the essential oils kit - I gave instructions of what they had to do to get the free book and as soon as they followed through with all the steps - I shipped the book. Eight people in 4 days bought a kit I did not talk to the first person on the phone - just Facebook, other social media and my blog.

I had lots of steps to learn - I had to learn about marketing, PPC, auto responders, why I needed a weekly newsletter how you talk to people online is a little different than in

person. The #1 tip I give is stop talking to people to make a sell. Solve their problem - make the conversation all about them - open your ears and listen. People tell you their problem without asking for it. Then tell them about your deal whatever it is that would make their life better. Stop pushing people or they will run; become the go to person and share with them what you have that will help them.

In the last year and a half I have spoken on stages to share my story, my blog literally is being read around the world, not only is my essential oil business growing - I am now mentoring a group of people who want to learn

more about what I do in a private group. I have won awards, and receive a nice compensation each month that has tripled my 25 year nursing income from the comfort of the ball field or riding down the road as my husband drives. I don't let time or place stop me - I take it on the road with me.

I wish for your biggest dreams to come true: don't want for them, go find them. They already belong to you. n

ABOUT THE AUTHOR Angela Brooks is a former burntout mental health nurse who is now a nurse educator, thriving business owner, and online marketing trainer. She quickly learned how to take her business "on the move" so she could have more time enjoying her family using mobile marketing. www.angelabrook.com

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TILT – Therapeutic Innovations in Light of Technology

Cyber Supervision Anne Stokes

T

he starting point of this issue’s column was an exchange I had with an online supervisee.

She isn’t a counsellor, but uses counselling skills in her role as team leader of family supporters within a charity.

Let’s call her Liz. She was planning a short training on interpersonal skills for her team, and we were discussing possible inputs and models.

Looking at what she had planned, I said that it reminded me of Egan’s ‘The Skilled Helper’. Liz did not know the model, so I briefly and perhaps simplistically mentioned ‘explore/understand/ act’.

The response from Liz was: ‘Yes- that is exactly what’s needed. The team manage most of the time to help

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the clients explore and understand their issues, but then they don’t know how to act in the clients’ best interests’.

Dilemma – do I explore with Liz how to help the assistants to ‘know how to act’ or do I explain that actually it’s about what actions the client is going to take? In this supervision, I stayed with Liz’s agenda, which was enabling her team, who are not counsellors, and part of whose job is to take action – enable links between various agencies in particular. I did later email a paper about Egan’s model.

However, it started a train of thought about the use of Egan’s model as an online supervision tool.

This was pushed forward by a presentation which one of the participants on the Diploma in Online Therapeutic Supervision gave recently.

This was around the C.L.E.A.R. model developed by Peter Hawkins in the 80s (Contract, Listen, Explore, Action, Review). Those middle three stages are so reminiscent of Egan.

Hawkins produced this as a coaching model, which led me to consider online coaching and supervision. What do they have in common? I looked up various definitions of coaching, finding a number where if the words coach was replaced with supervisor, they would still make sense to me.

Coaching is unlocking a person’s potential

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Meandering Through Models of Supervision and Coaching! to maximise their own performance. It is helping them learn rather than teaching them’ (Whitmore,2004).

they are all borrowing from Egan; simply musing about the fundamentals of coaching and supervision. Three of the models were:

Coaching is a process that enables learning and development to take place and thus performance to improve. To be successful, a coach requires a knowledge and understanding of the process as well as a variety of style, skills and techniques that are appropriate to the context in which coaching is taking place’ (Parsloe, 1999).

GROW

I then explored various models of coaching as they might well be able to inform and expand my online supervision practice. Many of them have that same similarity to Egan.

I am in no way implying that

Goal, Reality, Options, Way forward /Wrap up TGROW Topic, Goal, Reality, Options, Way forward OSKAR Outcome, Scaling, Know how, Affirm and Action (so should it really be OSKAAR?) and Review If I wanted to integrate any of these coaching models, what might be the constraints in online supervision? One is the apparent emphasis on outcomes. Sometimes

supervisees (and supervisors) need time to go away from an online session and muse before taking any action. That’s where email supervision can really come into its own, as it builds in this time naturally.

Perhaps I also shy away from the term ‘performance’ in the definitions. That may be disingenuous of me as there is a sense in which any role, even as an online counsellor, has a degree of performance in it.

A possible downside might be another emphasis, this time on identifying the goal of supervision. I do believe this is necessary if the supervision is not to be wishy-washy and aimless, though I might prefer to use the term ‘focus’. My niggling concern is that online, we sometimes are so quick

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CyberSUPERVISION to get down to work in both synchronous text and email supervision that we miss some of what I would call ‘walking around’ the focus. However, conversely, the inclusion in all the models of Know How, Options, Ways Forward avoids another pitfall in online supervision, of ‘talking’ around the issue, but never looking at its implication for practice.

I think that is why I feel drawn toward TGROW, as the initial T stage is about clarification of the reasons the Topic is important to the coachee/ supervisee at this moment in time, and what impact it may have on the longer term vision (coaching expression) or process (supervision expression). It may uncover issues and a focus which is different from whatever the supervisee/ coachee thought they wish to bring to that online exchange.

Rereading the above paragraph, I realise I had in mind synchronous supervision, so another constraint may be the

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ABOUT THE AUTHOR

application to asynchronous exchanges. In email supervision the clarification may only be possible in a more general sense, as there is no immediate interaction.

The positive that I take from looking at OSKAR in particular is the inclusion of Review, which sits well with the Cyclical Model (Page and Wosket, 2002). This seems such a necessary part of supervision and again can be missing from email supervision simply because it is not synchronous.

Yes, we carry out reviews of how the online supervision is going from time to time, but often miss the review of individual exchanges.

So where have my meanderings taken me? They have reminded me of the value in staying open to considering ideas and models from other similar fields, of weighing them up and taking from them aspects that may inform or improve my own online supervision practice. Not a bad dayâ&#x20AC;&#x2122;s work. n

Anne Stokes is based in Hampshire, UK, and is a well-known online therapist, supervisor and trainer and Director of Online Training ltd.

She can be contacted at anne.stokes4@btinternet.com.

REFERENCES Downey, M. (2003). Effective Coaching: Lessons from the Coach's Coach Knutsford Texere Publishing (TGROW) Hawkins, P. & Smith, N. (2006) Coaching, Mentoring and Organizational Consultancy: Supervision and Development. Maidenhead OU Press ( C.L.E.A.R.) Jackson, P. & McKergow, M. (2006) The Solutions Focus: Making Coaching and Change SIMPLE 2nd edition London Nicholas Brealey Publishing (OSKAR) Page, S. & Wosket, V. (2002) Supervising the counsellor: a cyclical model 2nd edition London Sage Whitmore, J. (2002) Coaching for performance 4th edition London Nicholas Brealey Publishing (GROW)

Earn your credential and work in the health and wellness industry!

EARN CE

Certified Professional Coach Certified Intuitive Practitioner Certfiied Essential Oils Consultant

info@onlinetherapyinstitute.com www.onlinetherapyinstitute.com

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NewInnovations

How Do I Start in Counseling Jay Ostrowski

Research has proven that technology can be helpful in counseling and coaching. Clients can gain personal insights and change that they could not have easily taken place without technology. But few have talked about how to actually get started. Most clients are already searching for the magic App that will solve all of their problems.

They just don’t talk to you about it. Apps can help enhance the growth of your clients if you use them for specific aims in time limited intervals. But whether you’ve been watching from the sidelines or have just thought about using technology in your work, you may wonder how to get started. There are some boundaries to keep us in line, but a lot of opportunities to make a big impact on our clients.

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Using Apps in Counseling or Coaching It can be overwhelming when you hear about the many Apps or online therapy platforms and the many applications for their use. There are so many ways in which technology can help people in counseling or coaching. The best way to start is to think about how

technology could assist one client with one problem.

Most Apps fall into a few operational categories.

1. Tracking behavior numerically by counting something I did, such as the number of times I did the new technique I just learned.

2. Reminding me to do something or not do something, like compli-

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t Using Technology g or Coaching? ment my spouse, even though I don’t feel like it.

3. Capturing my thoughts about the fight I just had with my brother-in-law who really gets on my nerves.

4. Connecting with others, like texting my progress to my best friend.

5. Leading me to change my thinking and behavior by asking me questions about my current state and reminding me of what and how I need to change.

Consider whether your client would benefit from tracking, reminders, capturing, connecting or leading. I bet they

could use all of them, but re- the client undue distress and strain your inner hero and harm your credibility. To get just pick one. Then get specif- comfortable with making ic about how often you’d like a recommendation, try the that information to be gath- technology for yourself first. ered or used and what you You may find a personal and the client would do with benefit which would make that output. With these clear for a compelling story that objectives in mind, you can would appeal to those you search for apps used for these are helping. The trial will also purposes on the comparison help you discover operational site www.telementalhealth- challenges your client might comparisons.com/apps to find encounter which could help prevent early abandonment the app that fits your needs. of the idea. Keep in mind It can be both exciting and some basic limitations like awkward to introduce a new privacy, security, ensuring the idea to a client, especially client is really on board and if if it is new to you too. It’s a it is really useful for the client’s bit of a risk to recommend goals. Using apps for one of an app or an online service these purposes may be just because a bad experience what they needed to make on these venues could cause that breakthrough.

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TILT – Therapeutic Innovations in Light of Technology

About the Author

Jay Ostrowski is a Telemental health and marketing innovator with www.

BehavioralHealthInnovation. com. BHI created www. telementalhealthcomparisons. com to help professionals choose technology. He lives in Charlotte, NC, USA.

or not. This video could be hosted on your website and link provided to every current and prospective client to consider. You could also have two computers set up in your office to demonstrate what it would look like at the end of a session, if the client is interested.

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Distance Counseling and Coaching

cols that you need to know to create both great outcomes and to protect yourself from known legal and ethical risks.

When you are ready to provide distance counseling or coaching and have already received training and credentials, the best way to start is by asking your current clients if they’d like to meet online. If you haven’t had training, it’s a very good idea as there are a number of risks and proto-

If you need a jumpstart to get clients using your online services consider creating a 2-3 min video of yourself walking the client through the set-up, scheduling and session experience. Make sure the video looks really good as it will be used by the client to decide whether they want to see you

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Talk to colleagues and ask if they are using technology and how.

Using technology in counseling and coaching will take a little effort, but it’s worth the effort. While most clients usually embrace technology in practice, it may take a few trials for you to become more comfortable with a new way of working. It may take a few trials before you get it right, but the benefits can truly be life-transforming. n

The Use of Technology in Mental Health Applications, Ethics and Practice Edited by

Kate Anthony, MSc, FBACP

Online Therapy Institute

DeeAnna Merz Nagel, LPC, DCC

Online Therapy Institute

Stephen Goss, PH.D., MBACP

Independent Consultant in Counselling, Research, Supervision and Technology in Mental Health 2010, 354 pp., 7 x 10, 6 il., 5 tables • (hard) ISBN 978-0-398-07953-6 • (paper) ISBN 978-0-398-07954-3 • (eBook) ISBN 978-0-398-08447-9

Technology is revolutionizing the delivery of mental health services. In this book, the reader is introduced to the broadest possible sampling of technologies used by mental health professionals today. It contains 30 chapters on different aspects of technological innovation in mental health care from 43 expert contributors from all over the globe, appropriate for a subject that holds such promise for a worldwide clientele and that applies to professionals in every country.

A wide range of styles is offered, from the individual practitioner exploring a new technology and writing anecdotally about their personal experience, to some of the world’s most experienced practitioners writing a thorough overview of a technology and its uses in the profession.

In each chapter, you will find introductions to the technology and discussion of its application to the therapeutic intervention being discussed, in each case brought to life through vivid case material that shows its use in practice. Each chapter also contains an examination of the ethical implications – and cautions – of the possibilities these technologies offer, now and in the future. Technological terms are explained in each chapter for those not already familiar with the field, while the content should stimulate even the most seasoned and technologically minded practitioner.

Psychotherapists, counsellors, psychiatrists, life coaches, social workers, nurses – in fact, every professional in the field of mental health care – can make use of the exciting opportunities technology presents. Whether you have been a therapist for a long time, are a student or are simply new to the field, The Use of Technology in Mental Health will be an important tool for better understanding the psychological struggles of your clients and the impact that technology will have on your practice.

Further information on ethics, training and practical exploration of online therapy can be found at: www.onlinetherapyinstitute.com, whose work extends and deepens the resources made available in this volume.

Order Online at:

www.ccthomas.com

TILT – Therapeutic Innovations in Light of Technology

Marketing Toolbox

Sarah Lawton

MICROVIDEO MARKETING In 2013, the number of mobile devices exceeded the wordl’s total population.

An average home will now contain up to six internet-enabled devices. People, and their content, are constantly on the move.

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Micro video

Rich media, such as video, must therefore be accessible across a variety of platforms. It must load rapidly and run efficiently. For this reason, short video formats are rising to the forefront of marketing strategy.

YouTube is the mecca for video sharing, and will continue to be so. Vimeo is an admirable alternative. However, applications such as Vine (6-second videos) and Instagram (15-second videos) now deliver easily administered micro video that is set to become a key element in future digital brand strategy.

“If 2013 was the year for Instagram, 2014 will be the year for short video.” Dom O’Neill, Managing Director, Digit

2/3 of the world’s data will be video by 2017

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Vine is an app from Twitter that helps you produce and share six-second videos very easily.

While many companies attempt to create the next great viral video buzz, a successful SME strategy maintains an emphasis on quality over quantity. Generating a higher engagement rate than any other video medium throughout 2013, the 6 second Vine video, is well worth the attention of therapists and consultants seeking ways to attract new customers and promote loyalty among current customers.

Professional, yet authentic videos can efficiently and cost-effectively cater to consumers’ appetites for entertaining and useful content.

Creating successful marketing micro videos

You must deliver a clear message within the tight timeframe. By applying Time Lapse, you have the opportunity to capture a greater number of story elements in a rapidly executed flow. Think about highlighting the benefits your services bring.

Try to put yourself in the position of a potential customer. What will peak their interest? What is important to them? Make every second count.

Try to be original and show personality. Tailor your message to your target audience in as fun a way as possible.

Craft content to match a call-to-action. Ask yourself: What do you want your audience to do after they watch the Vine and why would they do it? Will they feel incentivised to click on a link and find out more? Will they understand that

It is important to keep audience interaction focussed, valuable and engaging. Content should be as visually appealing and authentic as possible. As the Vine site itself suggests; ‘Create short, beautiful, looping videos in a simple and fun way.’

Think about creating a video teaser to promote longer downloads, blogs or articles. Alternatively, use them to promote your brand and draw potential new customers back to your website. Create ‘how-to’ video content to demonstrate thought leadership, build reputation and raise awareness of relevant issues and how they might be solved.

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something new is already available, or perhaps it is merely imminent and they should keep an eye out for further information?

your subject repeatedly, moving it subtly between shots, until you fill 6 seconds.

As with Twitter, Vine can be searched using hashtags. So use them!

Vine videos replay in an endless loop.

You can consider taking advantage of this by connecting the last and first shot, creating a seamless loop in the process. To do this, all you need to do is make the first and last shots the exact same scene.

Five tweets per second contain a Vine link

SMART PRODUCTION Plan your micro video story. You have six seconds. Use six storyboard boxes. Create sketches for each scene. Is each one different?

Does each one last one second, or will one or more need longer?

Think about what you want to achieve, and how you can achieve it to best effect, before hitting the record button.

Natural lighting is most often used in Vine videos but you might wish to consider using light sources and light modifiers to create effects. Plan your lighting and framing. Apply the Rule of Third when framing your subject.

Play with perspective and aim to maximise your video’s entertainment factor and appeal.

If you are applying time lapse (also referred to as stop-motion video), you will need to shoot

Lastly, add a catchy title, relevant tags and a captivating description.

Share & promote Distribution strategy is key to success!

Micro videos are easy to watch and share. The concept was created to enable easy delivery across platforms. So, once produced and published, don’t forget to share and promote your final results to widen your reach. Share a link from Vine on Facebook, Twitter, Pinterest and other social platforms. Don’t forget to include a link back to your company website.

Embed your Vine video into the content of a blog. Don’t be afraid to share it several times to catch your fans and followers when they are online. n

ABOUT THE AUTHOR Sarah Lawton is a UK based content marketer and social media expert. With a passion for communication, new technologies and top quality content, Sarah encourages SMEs to make the best use of both traditional and online solutions. For further information or advice, please contact: sarah@for-content.com and see www.for-content.com

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Learn How Technology Can Enhance Your Reiki Practice! http://onlinetherapyinstitute.com/reiki-training/

Certified KYBERNETES MasteR Reiki Master

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TILT – Therapeutic Innovations in Light of Technology

Love For the

Journals of...

v ed z i l a m r o is f h c r a d e n s a g n “Re i k is po t I . y t i s .” e s o p curiou r u ap h t i w g n pryi rston ~zora

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INTERNET INTERVENTIONS Editor-IN-CHIEF: GERHARD ANDERSSON Internet Interventions is the official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII).

The internet is increasingly used for delivering interventions aimed at improving mental and physical health. Internet interventions — often self-guided or partly self-guided — have in the past proven effective in treating a number of psychiatric conditions, including among others: depression, panic disorder, social anxiety disorder, insomnia, as well as more general medical conditions, such as headache, back pain, tinnitus and smoking cessation.

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Today’s increased focus on internet interventions can be explained by its global applicability, and cost efficiency. Technological advances allow for novel intervention components, such as user-friendly visual screening instruments, video-based exposure therapy, interactive role-playing, automated reasoning models, all lowering the helpseeking threshold.

The aim of Internet Interventions is to publish scientific, peer-reviewed, high-impact research on Internet interventions and related areas, such as: • Intervention studies targeting the promotion of mental health and featuring the Internet and/or technologies using the Internet as an underlying technology, e.g. computers, smartphone devices, tablets, sensors.

• Implementation and dissemination of Internet interventions.

• Integration of Internet interventions into existing systems of care.

• Descriptions of development and deployment infrastructures.

• Internet intervention methodology and theory papers • Internet-based epidemiology • Descriptions of new Internet-based technologies and experiments with clinical applications • Economics of internet interventions (cost-effectiveness) • Health care policy and Internet interventions • The role of culture in Internet intervention • Internet psychometrics • Ethical issues pertaining to Internet interventions and measurements • Human-computer interaction and usability research with clinical implications • Systematic reviews and meta-analysis on Internet interventions.

Visit the Online Therapy Institute’s Book Store to purchase featured books and more! http://www.onlinetherapyinstitute.com/bookstore/

Online Therapy Institute, Inc. P.O. Box 392 Highlands, NJ 07732 877.773 5591 www.OnlineTherapyMagazine.com Magazine Designed by www.StudioUltimateDesign.com

Stay tuned next issue for...

99 More great articles about online coaching, online therapy and related topics!

99 As always, we will feature our regular columns about ethics, research, law, film, marketing and technology!

99 If you are interested in submitting an article, review our author guidelines at www.onlinetherapymagazine.com 99 If you are interested in advertising in TILT magazine, please visit http://onlinetherapyinstitute.com/advertising-options/