volume 4, Issue four SUMMER 2014
Crowdfunding How Communities Pull Together PAGE 40
PAGE 14
From Starting a Blog to Landing a Movie Deal... All on the WWW PAGE 22
“Tech Support” Using Technology to Support Ongoing Recovery
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 4, sUMMER 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.
TILT MAGAZINE sUMMER 2014
Features 14 From Starting a Blog to
Landing a Movie Deal... All on the WWW
22 “Tech Support” - Using
Technology to Support Ongoing Recovery
40 Kickstarter:
A Warm Thank You to Our Supporters
Issue in every
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News from the CyberStreet
10 Research Review 13 Research Call 20 Wired to Worry 30 Views From the Front Line 36 Student Spotlight 46 CyberSupervision 50 New Innovations 56 Marketing Toolbox
60 For the Love of Books
A Note from the Managing Editors… It’s been a nail-bitingly exciting time here at TILT Towers between issues! Your Managing Editors decided to reach out to you, our readers, to help us keep the magazine going for the foreseeable future, and we held a Kickstarter campaign to achieve that. Our goal of $5000 within two months was well met, including a generous contribution by Hushmail. We tell you the story of kate anthony & deeanna merz nagel with the TILT’s creation, process and future in this issue, online therapy institute in second life and we are also pleased to welcome Lyn Kelley to our Innovations column to talk you through the options available to start a crowd funding campaign of your own. The gratitude we feel to have received such support from colleagues, friends and strangers in supporting us really cannot be put into words. It was a great creative boost, and we hope that is evident in this latest issue. Also in this issue, Darlene Ouimet tells us the exciting story of how her recovery from dissociative issues and chronic depressions led to her sharing her journey via a website and subsequently a blog – and how this led to being contacted by award winning producer Robin Jay, with an invitation to be in her next self-help movie “The Secrets of the Keys” which is a prequel to her first movie “The Keeper of the Keys”. Darlene writes of how she never imagined that her passion for reaching the world with her message of hope and healing would land her a movie deal! Her four and a half year journey, via “Emerging from Broken”, is an inspiration to us all. Susie Mullens and Teresa Warner tell us of their work in the ongoing support of people in recovery via their innovative app A-CHESS. A-CHESS is comprised of many features to help those in recovery and is currently being vetted as an evidence-based practice, theoretically based in Self Determination Theory (SDT) which focuses on how social and cultural factors facilitate or undermine people’s sense of volition and initiative, in addition to their well-being and the quality of their performance. A-CHESS has been well received by its users as part of their recovery programmes, enhancing the client’s treatment experience and improving client engagement. Elsewhere we have all our usual regular columnists to keep you abreast of developments and work in the field, including CyberSupervision, Research, Views from the Frontline and of course our resident cartoonist! Our Student Spotlight column features Thomas Tsakounis, who recently completed the Online Therapy Institute’s Reiki training, and who exemplifies the Institute’s mission to bring innovative ideas and practice to traditional ways of working to those with an open mind and a passion for delivering their services in a dynamic and sophisticated way. Best wishes to all our readers for the autumn!
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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Stay in the Know with our Blogs! Online Therapy Institute’s Blog recent post:
CyberWork: The Irony of Attending Conferences to Discuss Virtual Work! Kate’s Blog recent post:
The Language of Trolls DeeAnna’s Blog recent post:
On Learning To Be An Intuitive Guide
For all the places you can find us See our Community page: http://onlinetherapyinstitute.com/community/
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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/
Learn How Technology Can Enhance Your Reiki Practice! http://onlinetherapyinstitute.com/reiki-training/
Certified KYBERNETES MasteR Reiki Master
Offering Quality Continuing Education and Professional DevelopmenT
TILT – Therapeutic Innovations in Light of Technology
Research rev
Can Just O Of Online I
f brevity is the soul of wit, its equivalent in terms of efficiency and speed of progress is sometimes cited as one of the potential advantages of working online. Some proponents of online work take this to the extent of examining single-session interventions, including those where services are provided without the requirement that a formal appointment be made. I will leave aside here questions of the degree to which this should fall under the title of ‘therapy’, sometimes defined as a formally contracted process; some would prefer to think of single-session work as a kind of guidance, support or emergency intervention but distance provision, whether online or by telephone, has long offered a means of contact, regardless of the title, to people seeking a short, readily accessed means of obtaining help. The authors of a recent study (to be published by the British Journal of Guidance and Counselling in early 2015), suggest that services that provide one-off contacts have
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seen rapid growth in the online environment. They found, however, that although there are studies that suggest that the quality of therapeutic alliance that can be achieved even in these extremely short encounters - can be equivalent to other settings (e.g. Sucala, 2012) and that they can lead to demonstrable, positive improvements in well-being and distress (e.g. Dowling & Rickwood, 2013), only a small amount of research has been carried out on what actually happens in these singlesession contacts (Rodda et al, in press). The authors set out to explore the processes involved in single-session online support work by analysing a sample of 85 one-off textchat based sessions provided by a total of 25 counsellors at a national service that specialises in addressing gambling problems in Australia (Rodda & Lubman, 2012). Gratifyingly, they did so with a deliberate emphasis on the clients’ points of view which was prioritised over those of the practitioners. Only around half of the sessions were, in fact, relating to an immediate crisis of some
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view
by Stephen G oss
One Session e Therapy Help? sort, countering the received opinion that emergency help is where single-session work is most commonly focused. Sessions tended to be structured around the client ‘telling their story’ while rather less emphasis appeared to be spent looking at ways of creating change. The authors suggest that traditional models of counselling process like Egan’s ‘Skilled Helper’ model (Egan, 2009) may, therefore, benefit from being adapted to better represent what takes place in online provision of this specific type. In a separate study to be published in the same journal, Nieuwboer, Fukkink and Hermanns (in press) looked at the effects of single-session support, in this case directed towards the empowerment of parents, by comparing the outcomes achieved by trained and untrained providers. They report that while training in parental empowerment techniques did not make a significant difference to the outcomes achieved, parents who contacted the service and could be included in the study showed a significant increase in self-confidence.
A third paper in this series, which form part of a special Symposium edition on online practice edited by myself and Dr Tristram Hooley, looked at the impact of emotional first aid delivered over the Internet (Gilat, in press). In this study, a follow-up questionnaire was sent out as a means of following up spontaneous email contacts with trained voluntary practitioners who were responding to people in distress under the aegis of the Israeli Association for Emotional First Aid. The study reported that email contact was chosen as a means of helpseeking primarily because of its accessibility and, furthermore, because those clients who had chosen to use the service had a distinct preference for written communication. This could be seen as supporting the position of many online practitioners that work via text based communications has specific advantages not available in face to face encounters. Most clients, especially women, reported that they found the responses helpful. Help was most often perceived as lying in the ability of the service to assist clients to restructure their
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Research review cognitive appraisal of the situation that had brought them to the service in the first place and, perhaps surprisingly for counsellors and therapists trained not to offer direct guidance to their clients, through practical ways of coping. Email was seen by the authors of the study as offering unique opportunities and mechanisms for providing emotional support that apply just as much in ad hoc, un-contracted support service provision as they do in longer term psychotherapeutic or counselling work that might stretch over many sessions. n
The Special Symposium on Online Practice, edited by Stephen Goss and Tristram Hooley, will be available from January 2015. Some papers already available online, including Anthony, K. (2014) "Training therapists to work effectively online and offline within digital culture" – click here!
Stephen Goss, PhD, is Principal Lecturer at the Metanoia Institute, and also an Independent Consultant in counselling, psychotherapy, research and therapeutic technology based in Scotland, UK. He is also Co-Editor (Counselling) of the British Journal of Guidance and Counselling (BJGC) (http://about.me/stephengoss).
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co n t inu e d
Please send reports of research studies, planned, in progress or completed, to the TILT Editor at info@onlinetherapyinstitute.com
references Dowling, M, & Rickwood, D. (2013). Online Counseling and Therapy for Mental Health Problems: A Systematic Review of Individual Synchronous Interventions Using Chat. Journal of Technology in Human Services, 31(1), 1-21. Egan, G. (2009). The skilled helper: A problemmanagement and opportunity-development approach to helping: Brooks/Cole Pub Co. Gilat, I. (in press) The perceived helpfulness of rendering emotional first aid via email. British Journal of Guidance and Counselling, 43(1). Nieuwboer, C., Fukkink, R.G. and Hermanns, J.M. (in press) Single session email consultation for parents. An evaluation of its effect on empowerment. British Journal of Guidance and Counselling, 43(1). Rodda, S N, & Lubman, D I. (2012). Characteristics of gamblers using a national online counselling service for problem gambling. Journal of Gambling Studies, Online First 8 January 2013. doi: DOI 10.1007/s10899-012-9352-7 Rodda, S.N, Lubman, D., Cheetham, A., Dowling, N. A. & Jackson, A. C. (in press) Single session web-based counselling: A thematic analysis of content from the perspective of the client. British Journal of Guidance and Counselling, 43(1). Sucala, M, Schnur, J B, Constantino, M J, Miller, S J, Brackman, E H, & Montgomery, G H. (2012). The therapeutic relationship in e-therapy for mental health: a systematic review. Journal of Medical Internet Research, 14(4).
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Research Call
New Technologies for the Management and Rehabilitation of Chronic Diseases and Conditions Clinically and cost effective management of chronic diseases and conditions (such as cardiovascular pathologies, diabetes, obesity, chronic obstructive pulmonary disease (COPD), chronic pain, traumatic brain injuries, etc.), more common in elderly persons, typically requires long-term monitoring and treatment protocols in out-patient settings. New technologies can help clinicians and motivate patients in maintaining significant lifestyle behavior changes; improving health outcomes, quality of life and well-being; and ensuring functional patient empowerment and engagement. We invite investigators to contribute original research articles, clinical studies, and review papers that will stimulate the continuing efforts to understand and discover the potential role of new technologies in chronic care management. Potential topics include, but are not limited to: • Telemedicine and eHealth applications • Biomedical sensors and devices, integrated platforms, and disappearing technologies for remote monitoring and management • Web and Internet based clinical protocols in psychology and medicine • mHealth (mobile Health) solutions and applications For more DETAILS, PLEASE VISIT: http://www.hindawi.com/journals/bmri/si/519493/cfp/
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From starting a blog to landing a movie deal....
all on the
Darle
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WWW!
ene Ouimet
When I overcame dissociative issues and chronic depressions by seeing where they originated in the first place and how the false understandings of how relationships worked were stuck in my belief system, I found myself with a massive passion and desire to share my new found freedom and wholeness with the world. T I L T M A G A Z I N E s ummer 2 0 1 4
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In the beginning I started speaking in mental health seminars and I noticed that almost everyone in the room could relate to what I was speaking about when I talked about this ‘root belief system stuff’ that had resulted from the messages that I got from the actions of adults in my childhood. I was seeing people’s eyes pop open and they were mobbing me on the breaks. It was really validating to have so many people interested in talking to me in order to learn more about how I found this new freedom from depression and how I recovered my self-esteem.
courses. I determined from my studies that having a professional blog was the most effective way to present content and I took an online course with step by step instruction on starting a Wordpress blog and I set up my website “Emerging from Broken.com”.
I was in my mid-forties at this time and although I considered going back to school to become a Although I had never therapist, I still had 3 kids at home and I lived considered myself way out in the country and couldn’t figure out “a writer” I started how I would attend school if I did go back, so I writing about my decided to become a professional coach. Since I journey to wholeness: was already working in the mental health arena, I wrote small I chose a well-known American psychiatrist who consumable bite was the dean of a reputable coaching institute, sized stories about as my coaching instructor, so I could learn how how I discovered the to coach without crossing over into therapy. false messages that were stuck in my Through coach training I learned about internet brain because of the marketing and began to read about how to damage and trauma get known through the internet. The prospect I had endured in my of reaching a worldwide audience was really childhood. I wrote exciting to me and armed with the confidence about sexual abuse, in my message that I was receiving as a mental dissociative identity health advocate and inspirational speaker, I disorder, trauma started to take a few courses on how to get set and depression. I wrote about my life and the up on the world wide web. I am not very techie. I solutions that I had found that helped me barely knew how to cut and paste! overcome the trauma in my own life. I learned I was overwhelmed with all the possibilities but about key words, and facebook and a few other I worked hard every day and downloaded every social media mediums and learned how to get free training that I came across until I found my content found and how to share it and how the people that I really wanted to learn from to get it shared and I started to get comments on and then I took a few actual internet marketing my blog! 16
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That was four and a half years ago now. My blog grew and grew and within two years I was averaging 1000 legit comments a month and many of the comments were and still are over 2000 words. I invited some experts to guest post and I have invited people to share their own personal stories of healing. I have guest posted on other sites, and commented on other blogs
related to my blog topics, all of which helped me to increase my reach, which was my primary goal in the beginning! I also built a very successful private coaching practice through my blog. I have never advertised, or posted that I had an opening (not even in facebook) because I usually have a waiting list. I
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coach on the phone in Canada and the USA and via videoconference in all other countries. 50% of my clients are American and the other 50% are from all over the world. Today the blog itself has over 400 posts and over 33,000 comments! When Emerging from Broken was about 4 months old I started a facebook fan page and I have organically grown the following there to over 50,000 people, and the Emerging from Broken facebook page attracts an average of 100 new followers a day. I have become known as an expert on emotional healing and my website is read in 156 countries. Recently I was contacted by award winning producer Robin Jay, with an invitation to be in her next self-help movie “The Secrets of the Keys” which is a prequel to her first movie “The Keeper of the Keys” staring Jack Canfield (co-creator of “Chicken Soup for the Soul” and author of “The Success Principles”), Marci Shimoff (author of “Happy for No Reason”), and Dr. John Gray (author of “Men are from Mars, Women are from Venus”). “The Keeper of the Keys” was the first funny selfhelp film. It won the Las Vegas International Film Festival Award for Best Independent Film and The INDIE Fest Award for Best Documentary. Robin Jay signed me to co-star in the next “Key”
About the author Darlene Ouimet is a certified international coach, inspirational speaker and author of high traffic emotional healing blog ‘Emerging from Broken’. Darlene empowers readers to break through their false belief systems in order to gain higher self-esteem, increased ambition and confidence.
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movie “The Secrets of the Keys” as a featured “Key Expert”. I will be presenting on the key of Harmony. I will be co-starring in this film with icons of the personal development industry including Brian Tracy, Michael Beckwith, Dannion Brinkley (Author of “Saved by the Light”) John Assaraf, Gloria Loring, and will feature special guest don Miguel Ruiz, author of “The Four Agreements”. I am so excited and extremely honored to costar with these amazing messengers in the field of self-help and personal development. I never imagined that my passion for reaching the world with my message of hope and healing would land me a movie deal! Most Coaches and Therapists have a passion to help people. That’s why we do what we do and who doesn’t want to reach a wider audience? I saw a problem in the world and I believed I could contribute to the solution. I believed that I had unique information and I found a way to share it. I researched the best way to deliver this information and I learned how to do it. I celebrated the milestones along the way and I persevered through the tough times. There was a time when I thought that building this whole thing took too long but when stop and think about it honestly, it’s only been 4 and a half years and in that time have built a really high traffic website with hundreds of thousands of readers, I built a successful business, I have just published my first e-book “Emerging from Broken ~ The Beginning of Hope for Emotional Healing” and I have a movie deal. I think that is pretty awesome! Hope and persistence mixed with passion plus courage and the willingness to share information has been the recipe that got me on the road to the where I am today. There is beauty (and success) on the other side of broken. n
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WIRED TO WORRY
Not So Secret Secrets
Christine Korol
If you’re not in on the secret already, Whisper is an app that lets you post your secrets anonymously overlayed on top of a stock photo or an image that you provide. You are also able to communicate with others anonymously on Whisper by either publicly or privately sending a reply to one of their posts. With over 2.5 billion page views per month, it seems that there is a huge audience yearning to reveal and share their deepest darkest secrets with the world in an internet meme format that can be archived and shared over and over again.
While it would be nice to think that anonymous sharing of what people are really feeling or struggling with would help those with similar struggles feel less alone, the reality is 20
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that over-sharing online is risky. Although much of the content appears to centre around sexual indiscretions, secret crushes and general teen angst, some of the “whispers” could potentially alter lives if anyone was able to figure out who wrote the secret. Most concerning are the whispers of those who are suicidal or struggling with obvious mental health concerns who leave themselves open to messages from anonymous trolls. A quick search for the term “suicide” revealed several whispers about suicidal ideation. One person posted, “I think about suicide a lot” overlaid on an image of a silhouette of a man graphically blowing his brains out with a gun. The one public response he received urged him
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and reduce stigma, over-sharing on sites (anonymous or not) could result in guilt, shame, embarrassment, rejection or a worsening of depressive or suicidal symptoms. I regularly ask about social media usage when I take a patient history and look for instances where they have been bullied, shamed or embarrassed online. We can then work on strategies for coping with having shared too much online and how to protect themselves in the future. . to try it. Another person posted, “I constantly have thoughts about suicide. I can’t do this anymore,” on top of a picture of a woman with her head in her hands looking at a noose. She received four responses that included someone else saying they were feeling the same way, another who told her to stay strong and think of the people who
would be devastated by her death, one who was curious about how it felt, and finally someone who posted the number to a national suicide prevention line. A little better... but still concerning. More research is needed to guide therapists in understanding the impact of social media on mental health. While it can be used as a tool to connect people
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. T I L T M A G A Z I N E s ummer 2 0 1 4
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Mullens and Teresa Warner
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M
ost clinicians have experienced the vibration or ring of a cell phone during session. Depending upon whether we are “digital immigrants”, “digital natives” or those who would like to seek “digital asylum” our responses might be very different (Prensky, 2001). Many clients are technologically connected in ways that counselors may not have traditionally experienced in the clinical setting. Most addiction counselors pride themselves on “meeting clients where they are,” yet many find it difficult to embrace our client’s connectedness or attachment to their devices. Untangling the mystery and fear of technology for “digital immigrants” doesn’t have to be scary; the clinician need only be willing and open to working within the digital culture using websites and smartphone applications to enhance recovery. First Choice Services Inc. and its sister corporation First Choice Health Systems Inc. have embraced technology for many years using the original modality of providing telehealth – the telephone. Its two phone-based programs, the West Virginia Prescription Drug Abuse Solutions program
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and Problem Gamblers Help Network of West Virginia (PGHNWV) program, provide information and referral services across West Virginia, with PGHNWV having provided therapeutic interventions for more than 11,000 problem gamblers and their loved ones since 2000. Additionally, both programs provide a “Chat” option on their websites to engage those who are seeking help and who are more comfortable utilizing computers or mobile devices. In 2012, First Choice Services, Inc. was awarded a Technology Assisted Care (TAC) grant from SAMHSA to further incorporate technology into treatment services in West Virginia, and as a result developed the Appalachian Technology Assisted Recovery Innovations (ATARI) program. The ATARI program’s objectives include: introducing technology into treatment and recovery support programs in West Virginia; maintaining and increasing client engagement; preventing relapse and developing community partnerships. To help achieve its objectives, ATARI contracted with the University of Wisconsin to utilize the A-CHESS (AddictionCenter for Health Enhancement
System Studies) smartphone application, which has been nationally recognized and showcased in the Journal of American Medical Association Psychiatry, TIME magazine, WebMD and Yahoo News. A-CHESS is comprised of many features to help those
Many clients are technologically connected in ways that counselors may not have traditionally experienced in the clinical setting.
in recovery and is currently being vetted as an evidencebased practice. A-CHESS is theoretically based in Self Determination Theory (SDT), which focuses on how social and cultural factors facilitate or undermine people’s sense of volition and initiative, in addition to their well-being and the quality of their performance (Deci & Ryan, 1985). Conditions supporting the individual’s experience of autonomy, competence and relatedness are argued to be the most volitional and therefore, high quality forms of
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motivation and engagement (Deci & Ryan, 1985). When clients receive the A-CHESS app, they are encouraged to create a “profile” similar to the profile feature of Facebook. The profile allows clients to share common interests that they might not know about one another. The additional features of the app allow the client to connect to recovering peers and their clinicians through the team feed, support team, messaging, and discussion boards. The messaging function is used as a private email which allows clients to contact each other, their recovery coach, and/or their counselor. The discussion board is used to engage clients in ongoing discussions about recovery topics which can be started by clients or the coach/ therapist. Clients have access to recovery podcasts, recovery news, events, and recovery information which help keep them in touch with more selfdirected resources.
to call or text their support team, email their therapist, or engage in various recovery based interventions through the app. They can choose to listen to podcasts that focus on assertiveness cues, relaxation techniques, dealing with urges, and refusal skills. This provides a 2-3 minute “time out” to the distressed client who may
need to ride out the temporary emotional state. The A-CHESS has an administrative function where the clinician can mass message clients, add sober events to the clients’ calendar, monitor participation, and evaluate client progress and concerns on the app. Data available to the clinician include individual and
One of the most innovative features of the app is the “panic button” which allows the client to make contact with one person or many people if they are in a risky situation or at risk of relapsing. At the touch of a button the client can choose T I L T M A G A Z I N E s ummer 2 0 1 4
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group Brief Alcohol Monitoring (BAM) survey responses. The client is prompted weekly to complete the BAM survey which assesses not only relapse triggers, but evaluates protective factors as well. If the client’s BAM responses are indicative of clinical decline the treating therapist is alerted by the ACHESS system which allows for prompt intervention to occur. The treating clinician is also provided with information regarding client’s use of specific features on the app, as well as, the amount of time the client is engaged with the technology. This data can be utilized in treatment planning and developing client specific interventions. This easy to read clinical data compliments quality practice and assists in providing measurable outcomes required by the Affordable Care Act. Clinicians are given the tools needed to provide a continuum of care for each client participating in the A-CHESS program. As a next step, First Choice Services Inc. through the ATARI program partnered with 26
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The International Society http://ismho.org/ Online Therapy Institute http://onlinetherapyinstitute.com/ National Frontier & Rural ATTC www.attcnetwork.org/regcenters/index_nfa_frontierrural.asp Telemental Health Institute http://telehealth.org/ Telehealth Resource Center www.telehealthresourcecenter.org American Counseling Association Code of Ethics 2014 http://www.counseling.org/resources/aca-code-of-ethics.pdf
sixteen organizations around West Virginia to provide access to smartphones with unlimited talk, text and data for six months, including comprehensive behavioral health centers, smaller behavioral health centers, and private practices. The phones are pre-programed with the A-CHESS app along with several recovery-based apps that were vetted and chosen by staff, including Sober Day, 12 Steps, NA Speakers, and Room to Breathe. The additional apps were chosen to help compliment and add to the tools available with A-CHESS. While A-CHESS is more focused on recovery from alcoholism, clients may use these other apps to access to resources related to recovery from narcotic use etc.
Client engagement is a very strong indicator of success in treatment and relapse prevention. A-CHESS allows for engagement with staff, both clinical and non-clinical, as well as peers who are in the same treatment groups. The Affordable Care Act is going to change how many treatment providers deliver service to clients and A-CHESS is a great example of a safe, secure, closed recovery environment which is very affordable at less than $2.00 per week per client. If clients are engaged with their clinician and peers, it seems a very good investment and would likely lead to better outcomes. The ATARI program administers a “first day survey” through a custom A-CHESS survey
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option to collect information about access and impact of technology prior to joining the program. In looking at data from ATARI’s first six months and comparing to data obtained in these “first day surveys,” clients are reporting a 21.6% increase in abstinence, a 9% decrease in depression, a 24% decrease in anxiety, and a decline of intravenous drug use from 7% to zero. “A little over half of ATARI participants had no online recovery help before this program,” says Carmen Combs, evaluator at First Choice Services Inc. and First Choice Health System Inc., “Now 87% of the clients who responded to the survey stated they feel connected with their recovery support using A-CHESS.” This means recovery help is making an impact. In the spirit of Motivational Interviewing, adopting new technology during these times of extreme changes in the field has presented challenges. Clinicians and staff enter partnership with ATARI at varying stages of fears, concerns, and excitement. The setting and role of the clinician made a difference in the willingness to embark on integration of the smart phone and apps. Many of the
more traditional clinicians were extremely concerned about HIPAA and boundaries. However, recovery coaches, peer specialists, and staff at day report centers were eager to embrace technology and were excited to have the additional resources made available by A-CHESS, and saw the ability to provide a reliable form of communication with clients via the smart phone as a tremendous resource. In order to allay fears of HIPAA breaches, clients were provided an extensive informed consent, required to set a unique password on the phone, and given the option to select a user
Client engagement is a very strong indicator of success in treatment and relapse prevention.
name which could be fictional. For additional accountability, the ATARI staff participated in bi-weekly calls with 50 other TAC grantees across the nation to share program successes and problem solve obstacles as they arose. Additionally, we worked closely with JBS
International and participated in onsite reviews of the ATARI program. In March 2014, the ATARI staff participated in a technology showcase at the SAMHSA headquarters where we were able to meet with Dr. H. Wesley Clark and the TAC grantees for a two day healthcare and technology conference. This provided a platform to not only evaluate the current Healthcare Technology Programs, but to begin to develop sustainability objectives and look toward future projects. As a result of these successes. ATARI has begun to develop a secure online platform for the delivery of one-onone counseling services in order to further facilitate the integration of technology in West Virginia. There are many platforms available and a very comprehensive list can be found at www. behavioralhealthinnovation. com. In addition ATARI selected approximately 25 Master’s level licensed social workers, licensed professional counselors, psychologists, and Advanced Alcohol and Drug Counselors from West Virginia and provided the face-to-face two-day training for the National Board of T I L T M A G A Z I N E s ummer 2 0 1 4
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Certified Counselors’ Distance Credentialed Counselor (DCC), a national credential recognizing a professional with training in the best practices in distance counseling. Some states are beginning to require additional coursework, continuing education or credentialing before clinicians provide “distance counseling.” West Virginia licensing boards do not require additional formal education, however, the newly released American Counseling Association Code of Ethics indicate under section “H.1.a Knowledge and CompetencyCounselors who engage in the use of distance counseling, technology, and/or social media develop knowledge and skills regarding related technical, ethical and legal considerations (e.g. special certifications, additional course work)” (American Counseling Association, 2014). Additionally, counselors and agencies need to seek clarification from malpractice insurance carriers about whether distance counseling is covered under their policy, and usually provide information about the platform security and assurance that the service delivery method falls within the counselors’ competencies and scope of 28
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practice. Additional resource organizations which provide training and certifications include the Online Therapy Institute and the Telemental Health Institute and the National Frontier and Rural Addiction Technology Transfer Center (NFARATTC), which solely focuses on addiction treatment and technology, instead of “telemedicine” and “telepsychiatry”. These allied professions have certainly forged the path for all behavioral health professionals; however, many of the resources fall short in addressing the needs of licensed counselors. NFARATTC, International Institute for Mental Health Online, Online Therapy Institute and the TeleMental Health Institute provide more specific resources for what is considered substance abuse and mental health. The Regional Technology Resource Centers are also a tremendous
resource and similar to the ATTC Network, most states have a regional center and they are happy to assist. As “digital immigrants” being able to conceptualize technology based counseling was initially difficult. However, this project has allowed us to see how this additional layer of support has enhanced the client’s treatment experience and improved client engagement. Health care reform, governmental policy, and reimbursement sources are all trending toward technology enhanced treatment. However, we have been most powerfully impacted by receiving thankful messages like “I’m not sure where I would be without this program” and “this program has helped save my life quite a few times just by having instant access to my fellow addicts and counselor.” This is an exciting new time.
More about ATARI project: http://1stchs.com/atariappalachian-technology-assisted-recovery-innovations.html
““Tech Support” Using Technology to Support Ongoing Recovery first appeared in the July 2014 issue of Advances in Addiction & Recovery. © 2014 NAADAC, the Association for Addiction Professionals. All rights reserved. Reprinted with permission. For more information, visit www.naadac.org/advancesinaddictionandrecovery.
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References
ABOUT THE AUTHORS
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author Chih, M., Patton, T., McTavish, F., Isham, A., Judkins-Fisher, C. L., Atwood, A. K., & Gustafson, D. H. (2014). Predictive modeling of addiction lapses in a mobile health application. Journal of Substance Abuse Treatment, 46(1), 29-35. PMCID: PMC3963148 Deci, E. L., & Ryan, R. M. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum. Gustafson, D. H., McTavish, F. M., Chih, M. Y., Atwood, A. K., Johnson, R. A., Boyle, M. G., Levy, M. S., Driscoll, H., Chisholm, S. M., Dillenburg, L., Isham, A., & Shah, D. (2014). A smartphone application to support recovery from alcoholism: A randomized controlled trial. JAMA Psychiatry. 2014 Mar 26. [Epub ahead of print] doi:10.1001/jamapsychiatry.2013.4642. NIHMSID: NIHMS550949 Gustafson, D. H., Boyle, M. G., Shaw, B. R., Isham, A., McTavish, F., Richards, S., Schubert, C., Levy, M., & Johnson, K. (2011). An e-Health solution for people with alcohol problems. Alcohol Research & Health, 33(4), 327-337. PMCID: PMC3536059 McTavish, F. M., Chih, M. Y., Shah, D., & Gustafson, D. H. (2012). How patients recovering from alcoholism use a smartphone intervention. Journal of Dual Diagnosis, 8(4), 294-304. PMCID: PMC3541672 Prensky, M. (2001). Digital Natives, Digital Immigrants. On the Horizon, 9(5):1-6. Substance Abuse and Mental Health Services Administration. (2011). Leading Change: A Plan for SAMHSA’s Roles and Actions 20112014. HHS Publication No. (SMA) 11-4629. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved at: http://store.samhsa.gov/shin/content/SMA114629/08-HealthInformationTechnology.pdf
Susie Mullens MS, LPC, ALPS, AADC-S, Licensed Psychologist, SAP, DCC (Distance Credentialed Counselor) is the program director for the ATARI project at First Choice Services in Charleston, W.V. She is the immediate past president of WVAADC and serves on the NAADAC Veterans Subcommittee. Prior to ATARI, she was the Director of Counseling & Wellness at Davis & Elkins College in Elkins, WV. Ms. Mullens has been working in the mental health & substance use disorders field for over 23 years.
Teresa Warner is the ATARI Program Coordinator for First Choice Services, Inc. She has over 20 years working with substance dependent and the dual diagnosed clients, providing direct service in the community behavioral health centers, serving as a case manager in outpatient and residential settings, and as a probation officer for the West Virginia Supreme Court. In 2011, Ms. Warner began working for the West Virginia Physicians Health Program which provides intervention and supervision of medical professionals struggling with addiction. Under the supervision of Dr. P. Bradley Hall she obtained her Medical Review Officer Assistant Certification.
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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 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 passion for quality health outcomes, Mark has successfully operated or engaged in multiple entrepreneurial start-up and turnaround opportunities in healthcare technology. Choosing a behavioural health and mental wellness solution Online behavioural health and wellness solutions ideally offer programmes with evidencebased therapeutic content delivered to users via computer-based and/or online technology. Users self-administer the programmes with different degrees of personal support and monitoring provided by a therapist or behavioural health practitioner/supporter. The time requirements for support by a trained practitioner are greatly reduced, allowing clinicians to monitor and provide feedback to multiple users in the same time frame as compared to a traditional therapy session. These programmes can bring many of the benefits of delivering therapeutic interventions in an online environment, while significantly reducing the cost and time in providing the service. These benefits allow the clinician to provide services to more people, and more appropriately targeted therapy according to individual intervention intensity requirements. Evidence-based content It is most important that content delivered in online programmes is evidence-based. The content should also draw from a wide breadth of information and perspective. Cognitive
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behavioural therapy (CBT) is a therapeutic approach that lends itself well to being easy to deliver and self-administer. Yet, other theoretical approaches including the use of mindfulness and positive psychology as aspects of interventions are growing in use and prevalence in psychology and therefore should be welcomed. Between sessions support Online solutions vary in availability of personal support offered. One of the main reasons identified as a factor for the traditionally high dropout rates for online programmes has been lack of personal support. Richards and Richardson’s (2012) research review flagged retention rates as an issue, having found that an average of 57% of users dropped out of online programmes. However, they also found that personal support, in the form of any kind of personal contact by a supporter, significantly improved retention rates. They found that retention significantly improved some support was present, with dropout rates dropping to: 28% for studies where therapist support was provided, 38.4% for studies where administrative support was present and 74% for unsupported studies. It therefore appears that having any kind of personal feedback and contact is essential in promoting programme adherence and completion by preventing dropout. Reference T Richardson, D Richards, Computer-based psychological interventions for depression treatment: a systematic review and meta-analysis Clinical Psychology Review 32 (4), 329-342.
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.
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What the UK online therapy user wants In recent years with the development of Human-Computer Interaction (HCI) approaches to engagement, and the recognition that supported delivery of CBT online yields greatest clinical success, e-therapy interventions have greatly improved, thereby improving outcomes (Doherty, et al., 2010; Sharry et al., 2013). Berkshire Healthcare NHS Foundation Trust and SilverCloud Health formed an innovation partnership to help extend the reach of Improving Access to Psychological Therapies (IAPT) services. The IAPT programme is rooted in the effectiveness of guided computerized CBT for interventions relating to depression and anxiety disorders. Talking Therapies users want 24/7 online therapy solutions Talking Therapies, the IAPT service within Berkshire Healthcare NHS Foundation Trust identified that many clients wanted online therapy solutions 24/7 rather than fitting around the service opening hours. Previously, the service used traditional methods of telephone work and printed out client workbooks. This proved costly on time and stretched resources. This was at a time that referral rates were soaring with pressure to meet a four-week treatment waiting time. The concept that therapy within IAPT could be delivered more efficiently but with the same effectiveness, led to online health and wellness programming. Using SilverCloud Health’s IAPT compliant materials it was possible to create an easily accessed, stepped care, NICE evidenced-based internet-delivered therapy for multiple user groups in Berkshire and for all IAPT services. The resulting programme improves access to diagnosis, treatment and care services in ways that promote equality of access and experience and deliver patient choice. Reference Doherty, G., Colye, D., Sharry, J. Engagement with online mental health interventions: An exploratory study of a treatment for depression. In Proc. CHI 2012, ACM Press, 1421-1430. Sharry et al, A Service-Based Evaluation of a Therapist-Supported Online Cognitive Behavioral Therapy Program for Depression, J Med Internet Res. Jun 2013; 15(6): e121.
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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. What should an online behavioural health and mental wellness programme offer? There are a number of important factors concerning the content and platform functionalities to consider when selecting a solution to meet the needs and standards of service delivery. As well as ensuring some user support, it is also crucial to ensure client engagement, to maximise retention and programme completion Several important ingredients can promote individual engagement with online programmes: • non-linear delivery • interactive multi-media content • social and community features Non-linear delivery As online programmes have evolved, it has emerged that users do not like being forced to work through a programme. They find having to complete each section, before being allowed to move on to a new one, both frustrating and limiting. This can be particularly so when the content is also perceived as irrelevant, or if they wish to jump back and forward to review different content. Usage statistics from more recent technological solutions, that offer greater flexible in both their delivery of content and user navigation, indicate that a substantial proportion of users take an exploratory approach to content. This may increase their engagement (Sharry et al., 2013). This may be facilitative in keeping their interest, therefore improving retention and programme completion. Interactive multi-media content The format in which the material is presented also needs to be a consideration. Individuals have personal preferences and different learning styles and, depending on their clinical presentation, concentration may be an issue. It is therefore particularly important that online therapeutic programmes include a variety of formats. These can include videos, quizzes, traditional text-based
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content, interactive activities, “personal stories”, a personal space for users, a journal, charts, slideshows, and invitations to reflect and comment on content and activities. A variety of formats will cater for a wide range of individual preferences, broadening programme reach and increasing personal relevance. Social and community features Community features have also been shown to promote engagement, adherence, completion and a reduction in dropout. These features enable users to share comments and content preferences with each other, while remaining anonymous. They can include user ratings for particular programme content, tips and insights. These community activities have become familiar to many, thanks to the widespread use of social networking sites, and can therefore add an element of familiarity. Individuals sharing their experience within a community enjoy the fact, and feel empowered knowing, that their input could be helpful to someone else. Of course, the choice not to engage with such features, in spite of complete anonymity, is still a valid user choice. Reference Sharry, J., Davidson, R., McLoughlin, O., & Doherty, G. (2013). A service-based evaluation of a therapist-supported online cognitive behavioural therapy programme for depression. Journal of Medical Internet Research, 15(6), e121.
AMOSSHE Conference Manchester July 16th -18th July 14th, 2014 – The team at SilverCloud Health were delighted to attend and exhibit at the AMOSSHE ‘Brave New World’ conference this July 16th -18th in Manchester. AMOSSHE is the largest and most important gathering of student services professionals in the UK. Aislinn Enright and Dr Derek Richards enjoyed meeting student services representatives on the day.
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STUDENT Spotlight Thomas Tsakounis
Experiencing the Online Therapy Institute Reiki course It’s Never Too Late…To Go Back to School…
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I
never thought I would be writing an article like this but here I am. I was initiated into Reiki for the first time over 10 years ago. I have been using Reiki in various forms ever since. On a personal level I have used Reiki with family, my friends, pets, food and myself. On a professional capacity I have used it with many clients. In both cases, the same remarkable results, a restoration of balance and a return to better health. When you do something for a long time, you develop a style and the truth is your style may differ a bit from how you learned to do it originally. I was invited to enroll in the Reiki Training Program through the Online Therapy Institute by DeeAnna Nagel. DeeAnna is a pioneer in technology-assisted venues for professional development so it was a no-brainer for me. I have to admit, I was very excited. I had not been in school for many years. It seems the more technologically developed we become; the more hurried our lives become. In my opinion, success in this fast paced world will be awarded to those that welcome this technology with open arms. I am one of those people. My experience with the online Reiki course has been quite rewarding. I live a busy life with a variety of professional and personal obligations. Finding the time to attend a brick-and-mortar training demands a time commitment that is not always available so engaging in an online training has been very convenient. I follow the study outline, read the articles, watch some amazing videos, engage with my coach and submit my assignments all from the comfort of my homeoffice. I set the pace and I am responsible for my progress. I have the flexibility to dig deeper and conduct my own research if there is a topic I wish to explore a little further. I am given experiential exercises, which supplement the lessons and
bring me back to the bones of what I learned years ago I am notified through e-mail when my assignments have been reviewed and I am given feedback from my coach. Innovation is what makes the Reiki program at Online Therapy Institute unique. The enlightened understanding that Reiki transcends time and space so that a student can receive their initiation into Reiki despite their geographic location is brilliant. Taking that principle one step further and using technology to bridge the gap between people and the barriers that prevent people from receiving the help they desire is a tremendous accomplishment. Once upon a time busy lives, illnesses, age, physical limitations and rural locales often times limited people’s access to the helping professions. Online Therapy Institute is helping me eliminate those obstacles and showing me how to deliver Reiki, also known as energy work, to my clients and potential clients. To me as a business owner, this makes good business sense. In summary, I must say, my experience with the Reiki program at Online Therapy Institute is empowering. I feel motivated, inspired and grateful that I have learned new tools to add to my resources. This program has also taught me to be careful when you think to yourself, “I know that!� Keeping an open mind has allowed me to understand that you can always learn something because the stream of human consciousness is always evolving. In light and love. n Contact Thomas through A Quiet Journey Counseling, LLC, Silver Spring, MD. Find out more about our Reiki program at Online Therapy Institute by clicking here!
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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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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!
Kickstarter – A Warm Thank You to our Supporters! Kate Anthony and DeeAnna Nagel
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When we first discussed the possibility of creating a publication of benefit to those not only in our field of working online professionally, but also to those approaching the idea of fitting technology into practice, we talked at length about a journal. We even had a name for it, JOT, the Journal of Online Therapy. We approached publishers, wrote proposals, started seeking an Editorial Board and started making lists of potential peer reviewers. In short, we started initially by going down the academic road to getting information about technology in our work to the field of counselling and therapy.
Why didn’t we continue down that road? Well, firstly we knew that the work we do, and the work our colleagues worldwide do, need not be straight jacketed into the phrase “therapy” in its traditional sense. We wanted a publication that spoke to other members of the helping profession – the coaches, the alternative practitioners, the befrienders and peersupporters (to name but a few). Essentially, we wanted to reach an audience that encompassed every type of change-agent using technology – and we include the client in that group as self-facilitator of their improved mental health. Secondly, it became clear that journals need to make money to attract publishers. Making money from professional journals involves a large financial commitment by readers, and how could we square that with reaching as many people as possible to educate and entertain them about online work? We would have been preaching to the choir at best! We needed a platform where we could offer the magazine free to our students, free for archived issues, and at minimal cost to everybody else for the current issue. T I L T M A G A Z I N E s ummer 2 0 1 4
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Finally, we wanted a publication that could keep readers as upto-date on developments in the field as possible, and this meant that we had to trust our own skills and judgement in what we let get through the editorial process to the page. We contribute articles to journals, peer-review papers (sometimes three times over), and work with editors all over the world. We know what a
long process that can be first hand (and applaud those who stick with it!). Those of you familiar with Therapeutic Innovations in Light of Technology will be familiar with our in-house style. We put as much care into how TILT looks as we do soliciting interesting and dynamic content for you. Our dedicated team of columnists know what we want, and apart from a few images here and there which just can’t live up to the high technical specifications of producing the magazine, we do our contributors justice, we feel. But you may be interested in just how DeeAnna and I actually fit into its production, from coming up with the title itself to every issue you have read. We share a philosophy and work ethic that has led to the steady growth of the Online Therapy Institute to be our life work achievement since
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2008, providing education and training not just in our core field of psychotherapy, but also our sister fields of coaching and complimentary health provision. We live 3,300 miles apart (and that’s as the crow flies, never mind the miles we tread searching for coffee and an occasional airport cocktail en route). We work five hours apart, meaning that we have to synch our day to take that into account when it comes to deadlines and check-ins with each other. And most importantly, we have to recognise each other’s strengths, and work to them accordingly. Give Kate 100,000 words to edit or write, and she’s a happy bunny ying-wise, whereas DeeAnna’s strength often lies in the visual. She can conceptualise what it is the words are trying to say, and then choose visuals to compliment and demonstrate the power of those words. So with TILT, Kate takes first lead on submitted columns and features, and merrily edits away before uploading to Dropbox for DeeAnna’s turn. A folder of words sits waiting for the magic to happen. And then poof – when DeeAnna’s visual yang kicks
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We recently brainstormed over how to keep TILT going - TILT costs money to produce to meet those three targets above: wide audience; open access; quick production. We also wanted to include our community of like-minded friends and colleagues, to foster that Web 2.0 concept of crowd-funding to meet our mission. in, Kate’s desktop sees images aplenty uploading. We consult on the cover image only (which tends to consist of us ummming and ahhhhing a lot). We turn it over to our wonderful designer Delaine, and a new edition of TILT is born. We recently brainstormed over how to keep TILT going - TILT costs money to produce to meet those three targets above: wide audience; open access; quick production. We also wanted to include our community of likeminded friends and colleagues, to foster that Web 2.0 concept of crowd-funding to meet our mission. We chose KickStarter to do this since their mission matches ours:
• Being a new way to fund creative projects • Each project is independently created • Together, creators and backers make projects happen • Creators keep 100% of their work • Creative works were funded this way for centuries • Backers support something they want to see exist in the world
individuals or organisations pledged $100, and 51 of you pledged $20 or more. We are ever so grateful to the good folks at Hushmail for offering very generous sponsorship pledge to our Kickstarter campaign. We have been fans of Hushmail for at least a decade and include a reference to Hushmail in nearly all our online and in-person training about online therapy and coaching.
• Kickstarter helps bring creative projects to life
What is Hushmail?
We gave ourselves a target of $5000 to reach in 60 days. And thanks to you, our readers, we exceeded that! Over 15
Hushmail has been providing secure webmail solutions since 1999, and is a private email service with built-in encryption.
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Hushmail’s web interface looks and feels just like any other web-based email, but adds encryption to your emails, providing protection for data both in transit and when stored in a user’s mailbox. This built-in encryption not only protects sensitive information from prying eyes, but it also complies with HIPAA regulations making it a preferred choice amongst therapists in the e-counselling fields, but also suitable for any healthcare practitioner requiring to email Protected Health Information securely. On top of the encryption features, privacy is Hushmail’s top priority, so all accounts are ad-free (they do not scan users content for marketing purposes) and receive less spam (they use sophisticated
engines to prevent spam from cluttering your inbox and block viruses and malware). Hushmail is a fully hosted service where users can quickly create accounts and their email/ data stays securely stored in their servers located only in Canada. Hushmail is a proven, reliable service, and they pride themselves in their first-class customer support.
we feel to have received such support from colleagues, friends and strangers cannot really be put into words. It was a great creative boost, and we hope that is evident in this latest issue of TILT Magazine. n
Again, we cannot thank everyone enough. The gratitude
ABOUT THE AUTHORS Kate Anthony and DeeAnna Nagel are co-founders of Online Therapy Institute and Managing Co-editors of TILT Magazine -Therapeutic Innovations in Light of Technology.
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Marketing for Counsellors Build your own WordPress website course Make a Facebook business page workshop Small online groups - CPD hours - www.marketingcounsellors.nl
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Cyber Supervision Anne Stokes
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‘ve been reflecting a lot on endings recently. This is partly because I’m entering a new phase of my life and have cut down my work load (I can hear friends and family snorting with laughter and disbelief at this point!). However it is also to do with other things that I have been doing. At the recent UK Council for Psychotherapists’ (UKCP) conference ‘Psychotherapy 2.0’, I was fortunate to co-host the online delegates’ stream with Aaron Balick. One of the interviews I conducted was with Aaron about his new book ‘The Psychodynamics of Social Networking’. Anyone who knows me will know that I am truly not into social networking sites (SNS), so I
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had to read the book most intently before the day, and to my surprise, really enjoyed it! One of the many things that took my attention was the chapter in which Aaron explored ‘Being in the Mind of the Other’. Here an area he considers is the fact that SNS allow or enable people to continue to know about ‘the other’ even when the relationship has, on the surface, come to an end. So when a relationship breaks up, one or both partners can still find out a lot about their expartner. That led me to think about online supervision, both from the perspective of supervisor and supervisee. As a supervisor, it would be quite
possible for a supervisee to ‘keep tabs’ on me, or follow what I was up to by tracking me through SNS after our contract came to an end. The same would apply to me as a supervisee – what would I do if I had a sense, or knew, that an ex-client was following me as best s/he could after we finished our work together? What might alert me to this, and what would I need to do about it within supervision? In either case, it might be totally benign, or it could be rather like stalking. Also what does it mean for me, for my supervisees and for clients if in fact there hasn’t been a total ending? Are we shying away from experiencing the feelings that may arise from the loss of another? If so, how might
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When Is An Online Ending Really An Ending? that affect our ability to deal with the losses experienced through the death of someone we love (or hate)? I don’t have an answer to this, but it is good to have been made to consider it, and think about what is available freely about me online. A different online ending I have been wrestling with actually happened to a therapist friend. As she put it, ‘My supervisor dumped me by email!’ She did know that the supervisor was retiring before too long and that they were working towards an end. They normally met online synchronously, using video, and there had been a difficulty in making the next session due to both of them having holidays booked. However,
my friend was ‘gobsmacked’ when she received an email from her supervisor stating that as they had not made another appointment, she (the supervisor) was ending the contract and hoped it wasn’t too much of a shock. Could this possibly have happened in a f2f relationship? I rather think not, as there would have had to be a telephone call, or a letter, and letters tend to be more thought through than emails in such circumstances, I would venture. Apart from it being unprofessional and unethical simply to end supervision without an ending, it seems to me that there is something about the ease of pressing ‘send’ that may have allowed the supervisor to do this without
due consideration. Perhaps she would have done well to remember the ’24 hour rule’. In supervision online, particularly if it has been asynchronous, every exchange, every word, may have been stored. As Dunn (2014) states ‘ They describe returning to the transcripts, sometimes months or years later, and gaining new insights from re-reading the exchanges’. She is talking about clients. But in fact the same applies in the supervisory relationship. We perhaps have more to return to after the ending than in f2f supervision. So when is an ending not an ending? Perhaps we need to reconsider what we mean almost in the same way that
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bereavement therapy has moved from encouraging ‘letting go’ to ‘continuing emotional bonds’. Considering that together could be a part of working towards a good enough online supervision ending. Who will we be for and to each other in the future? n
REFERENCES Balick, A. (2014) The Psychodynamics of Social Networking: connected-up; instantaneous culture and the self. London, Karnac Dunn, K. (2104) The Therapeutic Alliance Online. In Psychotherapy 2.0 – where psychotherapy and technology meet. Ed Weitz, P. London, Karnac
ABOUT THE AUTHOR 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.
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TILT – Therapeutic Innovations in Light of Technology
NewInno vations
What is Crowd Why Should Yo LYN KELLEY
The new hot topic for for your business (or any especially since in most cases, entrepreneurs these days venture for that matter). This after you receive your funding is crowd funding, which model allows “regular” people goal, you do not have to pay is anticipated to at least to get start-up funding from it back. supplement, if not replace, the $5,000 on up by getting other I will attempt to outline this slow and mysterious process “regular” people to invest small model in simple terms for of current Angel and venture amounts of money online. It is you and offer some practical capital investors. “Crowd not a “get-rich-quick” scheme, advice on how YOU can get Funding,” or “Crowd Sourcing” nor is it a “network marketing” some start-up money for your is a way to get start-up equity scheme. It’s a great idea, venture. Congratulations to
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Funding and ou Get In On It? DeeAnna Merz Nagel and Kate Anthony with Online Therapy Institute for recently completing their goal for $5,000 on Kickstarter to fund this fabulous online magazine TILT: Therapeutic Innovations In Light of Technology! Sign up for your subscription here: http://onlinetherapyinstitute. com/about-tilt-magazine/ if you don’t already have one! In fact, I’m so excited about this new possibility, I will be starting MY OWN funding program to promote my book Bad Dick, Good Jane next month – watch out for it! I will be doing much more research on crowd funding before I actually engage in it, and I recommend you do the same. There are many different types of crowd funding, and things
are changing very rapidly. You can learn more about it on the most popular websites such as www.Kickstarter.com, www. IndieGoGo.com and www. CrowdTilt.com. There are also many different types and models of crowd funding. Some of the main ones are listed below. As far as I can tell, here is how the basic crowd funding works. You sign up with one of the sites. With Kickstarter, you create your project and determine how much money you will need to start it up or get it going, and within what time frame you want to receive it (OTI started with $5,000 within 3 months). You then send emails, calls, or social media posts to everyone you think would be interested in getting
your project going, asking for pledges for donations. They can pledge as little as $1, and do not have to pay out money when they make a pledge. They only pay out IF the project receives enough pledges to meet their goal, such as $5,000. If the project meets their goal, they will receive the $5,000 (less the crowd funder’s percentage which is usually 3% - 10%). You do not have to pay the money back, but you do have to use the money for the project you stated you would. You do not have to share what you are doing specifically with the donations – it is largely based on trust. Therefore, you need to have a trusting audience. The larger and more passionate your audience is, obviously the better. Along the way, during the 3 month campaign, you will want to provide your audience with updates on your funding, such as, “We’ve raised 72% of our funding goal with 16 days left!” Once your project time period has ended, you need to send an update to
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your audience with how you did, and thank them for their pledges. After that you can send updates to them on how your new project is taking off if you like. It’s a good idea to stay in touch with your audience, as you never know when you may want to ask them for a pledge for a future project. IndieGoGo has a slightly different platform. It is much like Kickstarter, except that if you don’t reach your funding goal you still get whatever money you were able to get pledged, less a higher fee %. For example, if your goal is $5,000 and you reach your $5,000, the fee might be
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something like 5%. If your goal is $5,000 and you only receive pledges of $3,000, the fee might be something like 9%. Here are some different types of crowd funding:
Good-cause crowd funding This model is a good thing, and has been around for years. Example sites include StartSomeGood and the Facebook Cause page. People can invest (donate) money to a project which has good moral/ ethical value. Contributors can enjoy the feeling of doing good.
Pre-order crowd funding Here people make online pledges with their credit cards during a campaign, to pre-buy the product for later delivery, if it is ever built. Kickstarter is the big player in this space. It has had some notable successes for entrepreneurs (over $1M in funding), as well as non-starters. Kickstarter also allows you to receive funding for a product or service that is not associated with ordering a product or service for later delivery, rather helping the entrepreneur get their product or service going.
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Rewards-based crowd funding
finished. This has been popular in many countries for years via sites like LendingClub and Kiva. The allure is fat returns, but they come with a huge risk.
This is a variation on the two previous ones, where investors get the satisfaction of helping, and immediately Ideas crowd get a pre-determined reward sourcing or perk of value, such as a t-shirt, or other recognition, Technically, this model is not but no equity or finished involved with funding at all, product. For example, OTI but “crowd sourcing” and (as mentioned above) offered “crowd funding” are often a free subscription to TILT used interchangeably. Sites Magazine with a $20 pledge. like GeniusCrowd get your You could pledge less or more ideas off the shelf, and give than $20 but if you pledged at you the wisdom of the crowds. least $20 you would get a free Of course, this might also lead one year subscription, which to investors, partners, and was a great incentive. A good licensing opportunities. example site, and one of the earliest in this category, is Don’t confuse any of these models with other popular IndieGoGo. funding sites for start-ups, like FundingUniverse and GoBigNetwork. These are Debt-based primarily matchmaking sites crowd funding between entrepreneurs and In this model, sometimes professional investors or called micro-financing or peer- banks. Often they do sponsor to-peer (P2P) lending, you pitch contests with small cash borrow money from a number prizes for funding, as well as of people online and pay other valuable services to them back after the project is support entrepreneurs.
So it’s easy to see that whether you are a new entrepreneur or a new potential investor, the Internet has opened several new options for the crowd to help you. These also open new concerns about lost intellectual property, Internet scams, and long-term return on investment. Most of the information I am sharing here was found at: http://blog. startupprofessionals.com/ What makes for a good Crowd Funding project? Just like the TV shows Shark Tank and Dragon’s Den, you need to make a great “pitch.” The most important thing is to make sure you’re actually giving something to people. Either you are giving them a physical object or you are giving them the satisfaction of “helping” you create a good thing. The next most important thing is to make sure you are targeting a passionate crowd at the right time. Your “crowd” is people you know, or people in your social media and business media networks. They should be people who LOVE the idea of your project and WANT to
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About the Author see it get off the ground. It also helps to give people incentives to pledge. You can give everyone who pledges some sort of gift, or those who pledge $25 or more a nicer gift, and those who pledge $50 or more a nicer gift, and so on. I will give you some examples of successful Kickstarter projects here.
What was the key? It appears the key here was that it was a project with millions of fans already built in. They also gave donation incentives. The minimal donation landed you some goodies like posters, and script pages. The director of the movie is calling people to personally thank them for donating.
“Save Blue Like Jazz”raised more Dan Provost and Tom Gerhardt money than any other project are two friends that decided on Kickstarter -- $345,992 to make a little contraption to save a movie project that that could put your iPhone in was going to be cancelled. a tripod. They wanted $10,000. The book “Blue Like Jazz,” was They got $137,417. This is turned into a film, but ran out probably because they gave of funding before it could hit away a free tripod gadget to the big screen. Supporters people who pledged a certain started a Kickstarter project to amount, and it looks like a LOT get it going and created what of people wanted one of those they call, “the largest crowd- gadgets! sourced creative project ever.”
LYN KELLEY is a Practice Building Coach at www. growpublications.com who helps colleagues increase their practice growth and success. She is also faculty at Online Therapy Institute/Online Coach Institute.
Punk Mathematics is a project from improv comedian and math professor Tom Henderson to make an accessible, punk math book. He raised $28,701 which is 10X is original goal of $2,400. If you would like more information, do a “Google” search for “crowd funding” and/or check out the websites and resources I’ve listed here. Sign up for my newsletter and I will share my own experience with you as it unfolds! n
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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.
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TILT – Therapeutic Innovations in Light of Technology
Marketing Toolbox
Sarah Lawton
What is good SEO anyway? Search engine optimisation (SEO) is the process of ensuring a website is not only visible to search engines, but appears as high in the resulting ranked list of results as possible when users input a search term. Good SEO results in more potential customers finding your website.
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search engine ranking will quickly backfire, resulting in a site ban.
Rule one If your users love your site, so will the search engines.
Over the past few years, Google has been advancing its search algorithms in favour of good, ‘white hat’ SEO. It has also applied rules that specifically penalise ‘black hat’ SEO; deceptive techniques to improve rankings, such as hidden text and link spamming across the web.
Creating a website optimised for search engines
White hat developers and content producers should aim for a well-built website with high quality, original content, social integration and good links to other relevant sites. Recent search engine developments have demonstrated that any black hat methods for artificially raising
Search engines send out small programmes, called spiders or crawlers, which constantly search the web and index its content. New websites can be registered with the main search engines; Google, Bing, and Yahoo! to ensure they are found and indexed quickly.
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When building a website and creating content for it, developers should focus on several factors to ensure good SEO is supported from the outset. A search engine assesses each website for usability and usefulness using sophisticated algorithms that function by checking for specifics, which include: 99 Structure; search engines do not crawl pages more than three ‘deep’ from the site’s root directory. Good use of navigation will ensure all pages are indexed and can be found by both real users and crawlers. Page size and structure is also relevant. Content higher up each page has more weight than content further down. 99 Technical accuracy; good quality coding is essential, and 301 redirect pages and a site map are required to ensure visitors always reach their intended destination on content pages. Broken links and overuse of frames are penalised. Server downtime and the page response time also have high SEO impact, so a reliable web host is important. 99 Meta Tags; these hidden text elements provide important information to search engines. Both the site itself and each web page should include a title, a description and keywords. 99 Keywords; a set of words or phrases that are most likely to be input by users into a search engine to find the specific content on each page. The more specific these are, the better SEO they will deliver. It is important to ensure that keywords in meta data do indeed match the content on the page or the site will be considered spam. Using keywords in the headings and page URL also adds to positive SEO.
99 Headings and highlighted text; search engines seek out terms of emphasis that give weight to the words within them. Including an H1 header, sub headers and bolded text helps readers make sense of a piece of copy more rapidly. Headings should use keywords were possible and faithfully describe the content. 99 Content; the content must be original and discuss the subject which the page and the web site claims to be about. Search engine crawlers assess keyword density, proximity and placement and have the ability to recognise and penalise unnatural or irrelevant copy. 99 Inbound links; links on a page pointing to other pages or external content should use descriptive anchor text. So, rather than using a word such as ‘Link’, describe what that link leads to, preferably using keywords, then stretch the link across the phrase. 99 Back links; the number and quality of links on other websites pointing to your site add positive SEO. However, spam linking is a well-known ‘black hat’ method that is heavily penalised by Google. Make sure any links back to your site are from legitimate, relevant or popular websites and, if at all possible, create reciprocal links. 99 Accessibility; to ensure a site is accessible to blind readers it is important to include descriptive ‘Alt’ text to all images. This also allows Googles Image Search to find and catalogue each image. 99 Freshness; recently updated pages and links add positive SEO to a site. So, the more often you add new content, the better. Social
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content such as blogs and twitter feeds are a popular method for ensuring a regular flow of both new content and fresh links. 99 Popularity; increasing the number of visitors to your site, how long they stay, and how many links they click, will also improve your search engine ranking. 99 Location and contact information; Google maps looks for place names in headers, keywords and site descriptions so including geographical details can increase your search engine visibility. Email details included on a web page should be domain specific or they may be considered by search engine crawlers to be spam. For example, my website is www. for-content.com so it is important that my email address uses the same domain; sarah@ for-content.com
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Measuring the success of SEO Attempting to track page ranks to assess SEO success is rather futile. Ultimately, you are not interested in how well your page ranks. You are looking for increased traffic to your site. You are hoping that visitors are interested in your products or services. You want their buy in. Site traffic and sales leads are therefore key performance indicators for good SEO. Use Google Analytics and Webmaster Tools to measure, record and analyse site traffic. Segment incoming traffic using the built-in advanced segmenting reports, then compare non-paid search traffic with another time period (year on year, or month on month). Filter out branded phrases, such as company and product names, using Webmaster Tools as these are unique, so searches based around brand names have no
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Google Hummingbird improved Google’s natural language processing and semantic understanding. This also gave social signals greater impact on search results.
Quality content and social integration for customer contentment
reflection on SEO. You are looking to measure organic visits.
Understanding Google zoology As Google evolved, new updates were released which have changed the landscape of search engine performance. In February 2011, Google introduced the Panda update penalising sites with content copied from other sites. April 2012 saw the launch of Penguin, which penalised sites using black hat ranking techniques. More recently, in September 2013,
These updates mean that Google is now sophisticated enough to be difficult to fool. As a search engine’s ultimate aim is to find the best quality content that most accurately matches the search terms input by users, it is now simple common sense to aim to produce just that. Priority number one should be to write content that people, and in particular your customers, want to read. By making content easy to find, quick to assess, enjoyable to read, visually pleasing and within an environment that offers both additional information (in the form of quality links) and social context and commentary, you will automatically be increasing your search engine ranking. More to the point, your reputation for providing useful or interesting information will increase return visits and enhance site popularity, which will not just increase your SEO, but will ultimately bring you more customers.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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Love For the of
Books
v y l e u q i n u a e r a s ” . “Book c i g a m e l b a t r o p EN ~sTEPH
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Distant Healing: A Complete Guide Paperback Jack Angelo Most of us have prayed for someone facing a health challenge, only to wonder if it actually helped. What if there were a set of skills you could use to dramatically increase your ability to aid in the healing process? With Distant Healing, you will join esteemed teacher Jack Angelo to learn dozens of simple ways to draw on the power of spiritual intention and send healing energy wherever it is needed. Explore the Rainbow Breath to balance your energy field; Distant Healing techniques for plants and animals; “etheric gateways” and the body’s subtle energy centers; and Astral-Level healing and other advanced techniques designed for solo or group practice.
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Look out for Kate’s book review of Psychoanalysis Online in a forthcoming edition of the British Journal of Guidance and Counselling!
Psychoanalysis Online: Mental Health, Teletherapy, and Training Jill Savege Scharff (Ed.) Psychoanalysis Online: Mental Health, Teletherapy and Training, edited by Jill Savege Scharff, MD, is an international collaboration by psychotherapists and psychoanalysts who consider the impact of virtual reality on our society and the uses of communications technology for analytic treatment and professional training. Having examined the impact of communications technology on mental health and relationships, the authors explore its use in analytical treatment conducted on the telephone and over the internet, and review its problems and possibilities. They provide a multi-faceted view of it, an ethical stance in relation to it, and evidence from which to judge its effectiveness.
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Looking into the future they imagine a time when technology-supported analytic treatment may be not only convenient as a supplement to in-person treatment but also preferable for some patients and therapists in various circumstances. Psychoanalysis Online: Mental Health, Teletherapy and Training invigorates the debate about technology and its responsible use in psychotherapy and psychoanalysis and in distance learning programs for mental health professionals.
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/