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Mental Health Counseling and the Internet: Peggy Kirk and Jeffrey T. Guterman
DRAFT
Updated 13 April 1998
Copyright © 1998 by Peggy Kirk and Jeffrey T. Guterman

Mental Health Counseling and the Internet

View/Respond to the Discussion Group devoted to this article

Peggy Kirk
Jeffrey T. Guterman

W hile in some respects the Internet has become ubiquitous in recent years, it also remains an esoteric form of mass media for many people, including a large number of mental health counselors (Cohn, 1997). This is unfortunate as the Internet provides mental health professionals a base from which to readily share and access information. One of the main purposes of this article is to describe the various current and potential uses of the Internet within our field in hopes of demystifying this important medium and thereby encouraging its use by the broad constituency of the American Mental Health Counselors Association (AMHCA). The authors have been active in developing various Internet activities for mental health professionals and students and thus some of these are described. In addition, various ethical issues are raised in relation to using the Internet in counseling and related fields, including the advantages and limitations of online counseling. In this article, a position also is taken that the Internet is a fitting exemplification of the postmodern orientation that has been set forth as a defining feature for our field (Guterman, 1994, 1996a, 1996b). We begin by describing the Internet and how this medium can be understood from a postmodern perspective.

The Internet

Although a comprehensive description of the Internet is beyond the scope of this article, a brief historical review is provided to orient readers who might be unfamiliar with the basic workings of this medium. Readers interested in gaining a more thorough understanding of the Internet are directed to the many resources that cover this topic (e.g., Gralla, 1996; Levine, Baroudi, & Young, 1997). The term Internet refers to a global interconnection of computer networks that are capable of exchanging data (Levine et al., 1997; Sampson, Kolodinsky, & Greeno, 1997; Tittel & James, 1997). The Internet only recently has become accessible to the general public, but its beginnings can be traced to shortly after World War II when United States government officials began developing a system from which to transmit electronic messages in the event of a nuclear attack. Users of the Internet at that time needed to have extensive computer expertise to work the complex, text-based systems that exclusively were used then and thus very few people had access to this medium. The development of the World Wide Web (WWW), however, has made the Internet a form of mass media.

The WWW was born at the European Laboratory for Particle Physics, also known by the acronym CERN for its French name Conseil Europeen pour la Recherche Nucleaire (CERN: European Laboratory for Particle Physics, 1998). Tim Berners-Lee, a computer specialist at CERN, recognized that hypertext principles could simplify how data is accessed and exchanged on the Internet. Hypertext refers to a form of nonsequential writing. Unlike traditional writing that follows a sequential order (such as the text in this article), hypertext consists of "chunks" of data and is based on the point and click method that allows users of the WWW to have some degree of choice regarding what material is viewed and in what order. When you click on a link (with a pointing device called a mouse) located on any given WWW page (usually denoted by a word or phrase that is underlined), you are taken to another page or an altogether different site that, in turn, includes links to other resources (and so on). When discussing the WWW, it is more fitting to refer to this principle as hypermedia since various forms of data are accessible through such links, including graphics, audio, and video.

Users of the WWW access resources through a software program called a browser. The most widely used browsers are Netscape Navigator and Microsoft Internet Explorer. Web site authors first make resources accessible by uploading files to their Internet Service Provider's (ISP) server. Once a file resides on a server, others can access it by using a Uniform Resource Locator (URL). A URL is an address that signifies the location of any given WWW or other Internet resource. The URL of one particular page from the American Counseling Association's WWW site, for example, is http://www.counseling.org/aboutaca.htm. There are three main parts to a URL: protocol identifier, domain name, and resource location. The protocol identifier specifies the type of resource the URL accesses. For WWW resources, the protocol identifier is http://, whereas ftp:// is used to denote FTP, gopher:// refers to a Gopher resource, and so on. The domain name part of a URL indicates the general Internet address where the web author's (e.g., individual's or organization's) files reside (e.g., www.counseling.org/). The resource location specifies one particular file, or page, name (e.g., aboutaca.htm). Each WWW site generally has a home page that serves as a Table of Contents and entry point to each of the other parts of the site. One usually can access a home page by specifying a site's domain name, with no resource location added on. Thus, the URL of ACA's home page is http://www.counseling.org (American Counseling Association, 1998).

The language used to create text and other resources on the WWW is HyperText Markup Language (HTML) (Castro, 1997; Pfaffenberger, 1996; Tittel & James, 1995). HTML is a universal, cross-platform language that is readable on different types of computers, including personal computers (PCs) and Macintosh computers (Macs). The HTML language allows one to format data in a text-only ASCII file that virtually any computer can read. Editors now are available that enable WWW site designers to create pages in HTML without having knowledge of how HTML works. Among the most important recent advances for the Internet and the WWW is Java, a language that allows software designers to create small programs called applets that can, in turn, be run on any computer via the Internet and without the need for an external download. Developed by Sun Microsystems, Inc. (1997), Java brings interactivity to the WWW that previously was not possible without additional software. Other recent developments for the Internet have included software that allows for audio and video, including live audio and video conferencing (RealNetworks, Inc., 1997). Experts in the field of Internet technology expect that the development of more powerful computers and a concomitant increase in bandwidth transmission capabilities will ultimately result in a medium that is more versatile than television (Gates, Myhrvold, & Rinearson, 1995).

Most recent user surveys (e.g., Georgia Tech Research Corporation, 1997; Yankee Group, 1997; Infotainment Telepictures, 1997, 1998) have found that electronic mail (e-mail) is the most widely used Internet application. E-mail does not require powerful computer technology and allows for the transmission of text and other media to an individual or an entire mailing list without the sender's use of paper or postage, or, in most cases, incurring long distance charges. Most e-mail software enables the use of attachments so that various forms of media (e.g., graphics, audio, video, and large data files) can be transmitted quickly and easily. Communication is virtually instantaneous to anyone around the globe who has Internet access. But, unlike when answering a telephone call, the recipient can retrieve and respond to the message at his or her convenience, and the sender need not be concerned with time zone differences or otherwise interrupting or disturbing the recipient.

The ease and convenience of e-mail also has contributed to the proliferation of mailing lists that allow for ongoing discussions on any topic. An electronic mailing list connects people who share a common interest, such as a profession, hobby, or medical condition. Any member of a particular group can send a message to a single group-identifying address, and the message, if the list is unmoderated, is automatically sent to all members' electronic mailboxes. In the case of a moderated list, the list administrator screens and "may kill duplicate messages or messages that are not related to the list's theme" (Gralla, 1996, p. 45). A listserver, or listserv, is simply a computer which automatically handles the task of subscribing or unsubscribing a person to a mailing list, per the person's e-mail request to the listserver. Electronic newsletters, in which only one person (e.g., the newsletter's creator) can send messages, but all subscribers to the list receive them, also are a quite popular type of mailing list.

While e-mail messages may be delivered almost instantaneously, retrieval and reply occur at the recipient's discretion and convenience. Chat, on the other hand, is a tool for immediate dialoguing as it allows two or more people, regardless of where in the world they are located, to converse in "real time." That is, they can all read each line of text as soon as a participant types it. The popularity of chat has been fueled in part by its availability on commercial networks such as America Online, Prodigy, CompuServe, and the Microsoft Network (ISPs which also are known as Online Services). There are various chat applications available on the Internet. Internet Relay Chat (IRC) requires an external download called a client. The development of Java-based chat applications, however, has made this medium more accessible since they do not require users to download any client software to their hard drives. Thus, people not using their own computers, such as students in a computer lab or patrons in a public library, may be able to participate in a chat since the "borrowed" computer need not be altered.

It is important to underscore that the WWW, e-mail, and chat are only three of the Internet's many parts. Other Internet tools include File Transfer Protocol (FTP), Gopher, Usenet, Telnet, and Wide Area Information Server (WAIS), just to name a few. The WWW and e-mail, however, have become the most popular Internet applications largely due to their ease of use and multimedia capabilities. Furthermore, one can access virtually all of the other Internet applications through the WWW by clicking on hypertext links. The software required to access the WWW, e-mail, and the other Internet applications mentioned above can be obtained free of charge from most ISPs. Almost all ISPs on the market charge about $20 or less per month for unlimited Internet access, and some also provide customers with space for a WWW site at no additional charge. Internet access is required in some work settings (e.g., education) and thus users who are employed or enrolled at these settings (e.g., professors and students) might get free access.

The Internet and Postmodernism

Previously writers have discussed how the Internet exemplifies postmodernism (Goldpaugh, 1997). Moreover, postmodernism recently has become a topic of considerable interest and debate in the Journal of Mental Health Counseling (JMHC) (Ellis, 1996, 1997a, 1997b; Ginter, 1997; Guterman, 1994, 1996a, 1996b, 1997; Rigazio-DiGilio, Ivey, & Locke, 1997). It has been suggested, for example, that postmodernism serves to crystallize our field's developmental focus and emphasis on the client-counselor relationship (Guterman, 1994). Postmodernism is an epistemological (i.e., pertaining to the study of knowledge) formulation that holds that our views of so-called "reality" are socially constructed, intersubjective, and language-based (Lyotard, 1978). Put simply, we create our notions of truth through the conversations we have with one another (Hoffman, 1987). It follows that clinical realities, including those that derive from our theories of counseling, are not necessarily objective phenomena but, rather, are metaphors formed through collaboration and social consensus (Guterman, 1994, 1996). It could be said that the JMHC exchange about postmodernism has contributed to understanding this perspective as a metatheory from which to inform theory building and practice in mental health counseling. Albert Ellis (1997a, 1997b), for example, has identified caveats and limitations to his rational emotive behavior therapy (REBT) model. Rigazio-DiGilio et al. (1997) have proposed a comprehensive approach to postmodern mental health counseling that involves intervention at multiple levels.

Atkinson, Heath, and Chenail (1991) have suggested that, from a postmodern perspective, "the legitimization of knowledge requires the judgment of an entire community of observers and is most appropriately a democratic process in which all stakeholders have equal input" (p. 162). In a similar vein, the Internet affords virtually everyone in our field the opportunity to be heard. One can set up a personal World Wide Web (WWW) site for a nominal cost (through an ISP) or for free (through an organization such as GeoCities (1997)). It also is possible to make a contribution by posting comments on bulletin boards and guestbooks found throughout the WWW, through electronic mailing lists, and by way of Usenet discussion groups. Indeed, the Internet makes it possible for mental health counselors and students to engage in much needed dialogues within our profession. The hypertext principles upon which the Internet is based allow for both the communication among professionals and the worldwide exposure we need to implement our field's various missions.

Also in keeping with postmodernism is the active role that users play in the production of others' works on the Internet. Unlike with traditional forms of mass media in which one is a passive recipient of what is experienced (i.e., read, heard, viewed, and so forth), users of the Internet are participant-observers who interact with and thereby change the content. Like counselors who embrace postmodernism, some computer industry experts recognize that users of the Internet both influence and are influenced by what is being observed. Furthermore, ideas on the Internet are fluid, rather than fixed and thus the only constant is change. Consider, for example, that an online version of this article has been posted on the WWW along with space for users to add comments, suggestions, disagreements, clarifications, and proposals for revisions (Guterman & Kirk, 1997). Thus, in contrast to other articles in the JMHC (and all traditional text for that matter), in which the text is fixed and static, the online version of this article mirrors postmodern conceptions of knowing insofar as the work is constantly changing and evolving.

Some articles in the JMHC are interactive in that they represent ongoing exchanges that have transpired on topics such as eclecticism (e.g., Ginter, 1988, 1989; Hershenson, Power, & Seligman, 1989; Kelly, 1991; McBride & Martin, 1990; Simon, 1989), men's issues (Kelly & Hall, 1992a, 1992b, 1994; Scher, 1993; Twohey & Ewing, 1995), and postmodernism (Ellis, 1996, 1997a; Ginter, 1997; Guterman, 1994, 1996, 1997; Rigazio, Ivey, & Locke, 1997). Posting scholarly articles on the Internet, however, reduces publication lag (i.e., the delay of publication due to the backlog of previously accepted manuscripts) and results in more timely dissemination of writers' thoughts on potential advances in our field. The Internet also changes how further research material is accessed. As mentioned previously, WWW resources (such as the online version of this article) provide users with potentially infinite choices via hypertext links. Hence, users can chart their own course when accessing WWW documents which, in turn, influences the reader's perception of and response to the information. The online version of this article, like much of the information found on the Internet, is therefore a collaborative effort between the original authors and those who interact with the text.

Implications for Mental Health Counseling

The use of computers is not a new phenomenon for mental health counseling and the various other counseling specialties (e.g., Barnett, 1982; Cohn, 1997; Davidson & Jackson, 1996; Jackson & Davidson, 1996; Sampson, 1986, 1990a, 1990b; Sampson & Krumboltz, 1991; Sampson & Pyle, 1983; Sharf & Lucas, 1993; Talbut, 1988). For years, counselors have used computer technology to expedite billing and insurance claim filing and to facilitate testing, assessment, and other supplemental tasks. What is new, however, are the possible uses of the Internet within our field. Some in the counseling profession currently are using the Internet for several purposes, including the marketing of traditional services; education, training, and supervision; and the direct delivery of services. The potential for counselor use of the Internet has grown so much that the ACA's monthly newspaper Counseling Today has a regular column devoted to the medium called "Counselors in Cyberspace." In preparing the ensuing description of current and potential applications of the Internet by and for mental health counselors, the authors of this article reviewed both print media and resources located on the WWW. Due to the growth of the Internet, we cannot be comprehensive in our listing of WWW resources, so we have identified what we consider to be the best as well as those that are most likely to exist beyond the time when this article is published. Every effort has been made to provide the most current information, but due to the fluid nature of the Internet, it is foreseeable that some of the resources cited will not be operative at publication time.

Electronic Mail

Electronic mail (e-mail) is an important tool for mental health professionals because it is easy to use and allows for almost immediate communication with others in any part of the world. Some of the uses of e-mail by mental health counselors include routine correspondence, professional collaboration and consultation, exchange of data with co-authors, transmission of articles, and planning of meetings and workshops. Except for the posting of the first draft on the WWW, the authors of this article used only e-mail to exchange suggestions for wording and content throughout the months of collaboration. In fact, the very decision to co-write was processed through a series of e-mail messages. We also used e-mail to request comments from professional contacts regarding any new ideas or behaviors they may have developed as a result of collaborating and interacting with others on the Internet, and we have incorporated their e-mail responses into this article. The authors also routinely use e-mail to solicit hosts and participants for upcoming on-line chat events. In counselor education, students can use e-mail to submit papers, assignments, and questions. Likewise, instructors may post information, answer questions, and return student work.

Electronic discussion groups and newsletters by and for mental health professionals abound on the Internet. A large selection of professional electronic mailing lists can be found at Psych Central (Grohol, 1995-1998). Not on the above list but of particular interest to counseling professionals, educators, and students are the International Counselor Network (ICN) and the Counselor Education and Supervision Network (CESNET-L). Some listservs are set up for a limited purpose and membership. For example, The National Board for Certified Counselors (NBCC) Standards for the Ethical Practice of WebCounseling (1997) evolved from the WebCounseling Task Force's 2-year use of their own listserv "primarily to disseminate information and to receive feedback on early drafts of the standards" (J.W. Bloom, personal communication, January 28, 1998). Discussions also occur in the form of bulletin boards on WWW pages, e.g., The Counseling Zone Virtual Bulletin Board, to which any web site visitor may post a message. Contributors are invited to display an e-mail address, so that subsequent bulletin board readers may contact them individually, instead of, or in addition to, posting a response on the bulletin board. Newsletters, which subscribers receive by e-mail, include ACA eNews (1998), which also can be sampled on the ACA web site. The Concerned Counseling Newsletter (1998) is aimed at the general public, but nonetheless is informative for professionals.

World Wide Web (WWW) Sites

Other than e-mail, the WWW is the most widely used Internet medium in counseling and related fields. It is easy to use, like e-mail, and often serves as an entry point to the other available Internet resources (e.g., e-mail, chat, FTP, Gopher, and so forth). The WWW has been used in our field for various purposes, including dissemination of research results and scholarly articles, education, and direct delivery of services, just to name a few. In addition, the WWW has become a popular forum for professional organizations to market their services. All of the national professional associations in the larger mental health field (American Association for Marriage and Family Therapy, 1997; American Counseling Association, 1997; American Psychiatric Association; American Psychological Association, 1997; and National Association for Social Work, 1997) have created WWW sites.

The ACA introduced its WWW site in April 1996 at the annual World Conference in Pittsburgh (Marino, 1996). The ACA site includes an online version of its monthly newspaper Counseling Today, a resource catalog, insurance information, and many interactive features. Online options include joining ACA or renewing memberships, registering for conferences, and posting messages on a virtual bulletin board. Many of ACA's divisions also have developed sites, including the American Mental Health Counselors Association (1997), American College Counseling Association (1997), Association for Gay, Lesbian, and Bisexual Issues in Counseling (1997), Association for Multicultural Counseling and Development (1997), American School Counselor Association (1997), Association for Specialists in Group Work (1997), International Association of Marriage and Family Counselors (1997), National Career Development Association (1997), and National Employment Counseling Association. (1997). As the WWW has grown, state and local chapters of ACA and its divisions also have created home pages. The proliferation of such organizational sites and of those set up by individuals and private companies makes the WWW an enormous resource for information pertaining to the field of mental health.

Search engines. There is so much mental health related information on the Internet and the WWW that locating any particular resource can be a difficult task. The use of search engines, however, can help narrow the field. A search engine, usually taking the form of a WWW site in itself, functions so that users can locate the URLs of specific sites by entering keywords. Some of the search engines available on the WWW are Alta Vista (1997), Excite (1997), Hotbot (1997), Infoseek (1997) WebCrawler (1997), and Yahoo (1997). Despite the use of such search engines, it still can be difficult to locate a specific resource. In April 1996, for instance, Sampson, Kolodinsky, and Greeno (1997) found 3,764 URLs upon conducting a search on the WebCrawler search engine with the keyword counseling. In August 1996, Sampson et al. (1997) did the same search and found 4,584 URLs (an increase of almost 22%). The authors of the current article replicated the above search in November 1997 and found 11,616 sites. It follows that with the increase in the number of resources on the WWW, it is becoming increasingly difficult to find specific information.

It is important to point out that more than half of the home pages found in the above searches using the single keyword counseling were not necessarily related to mental health counseling, but rather "typically dealt with financial or legal matters" (Sampson et al., 1997, p. 205). One way around this is to use more specific terms or multiple keywords. Also, some authors of mental health related web sites provide extensive lists of links to other mental health URLs. However, the user still may have the sense of grasping at straws if he or she is looking for explicit information. To ease this burden, some search engines specific to the field of mental health have been established. One of the largest collections of mental health resources and one that has its own search engine is Mental Health Net (1997). Developed by CMHC Systems, Mental Health Net included listings to over 6,300 resources as of November 30, 1997. As with commercial search engines, users can locate, by keyword, any site listed at Mental Health Net. The book, The Insider's Guide to Mental Health Resources Online (Grohol, 1997), also is an excellent resource for identifying some of the best sites on the WWW.

WebRings. An alternative to the search engine method of locating information on the WWW is the WebRing (1997) system. Developed by computer student Sage Weil and NewDream Network (1997), the Webring system puts WWW sites with similar content in groups by linking them together to form a circle or ring. Thanks to specialized HTML code placed at each site of any given ring, users can continuously travel from one site to another by clicking on links denoted as "next" or "previous." Each ring has a homepage that usually provides criteria for inclusion and instructions for joining. Laypersons have created numerous rings devoted to mental health issues, such as Anxiety Ring (1997), Children and Adults with Multiple Mental Health Disorders (1997), Human Mind WebRing (1997), and Survivor's Line Around the World (1997). There remains a paucity, however, of rings geared primarily for mental health professionals.

At least two rings for mental health professionals can be found through the WebRing (1997) system: Webring Mental Health (1997) and Mental Health Ring (1997). The former included 41 sites as of March 19, 1998. The latter, developed by the first author of the current article, is a newer ring and included 27 sites as of March 19, 1998. These rings, like much of the activity on the Internet, serve to foster a sense of interdisciplinary collaboration and result in the blurring of distinctions between professional camps. The Mental Health Ring (1997), for example, includes WWW sites created by psychologists, family therapists, and mental health counselors. In addition, members of the Mental Health Ring (1997) come from all over the world, including such distant places as Australia, the United Kingdom, and the United States.

Online communities. Another recent trend on the WWW has been the development of online communities that include various interactive features at one WWW site. Unlike static web sites, an online community is designed to encourage users to consider it a place to go, and return often, to interact with people who have similar interests. A number of online communities have been developed for mental health professionals, including ACA LIVE! (New Media Solutions, Inc., 1997), the World Counseling Network (WCN) (New Media Solutions, Inc., 1997), and Behavior OnLine: The Mental Health and Behavioral Science Meeting Place (Levin, 1997). ACA LIVE! debuted in 1996 along with ACA's WWW site. Like commercial networks such as America Online (AOL), ACA LIVE! is an independent computer network which operates through the Internet but requires the installation of proprietary software. However, unlike AOL, it works only on PCs and is not yet available to Mac users. ACA LIVE! includes chat, discussion groups, e-mail, and many other interactive features. As of February 5, 1997, a net total of 313 people had downloaded the ACA LIVE! software.

The WCN, introduced in May 1997, is an online community that has all of the features of ACA LIVE! but does not require an external download and allows users of both PCs and Macs to participate. As of November 30, 1997, 107 people had joined the WCN. It is assumed, however, that more than that number have used the WCN as signing up as a member is not requisite to using its features. Given the freedom afforded by WCN's lack of external downloads and its accessibility to Mac users, the total of 313 ACA LIVE! members probably is the limit. Although each of these sites has various interactive features, it could be said that the chat applications have allowed for the most interactivity. Later, in the Chat section, we describe the development of several chat sessions by and for mental health professionals on ACA LIVE!, the WCN, and other web locations.

Online publications. The WWW also has been a forum for the posting of scholarly publications related to the field of mental health. Sometimes falling under the rubric of e-zines or online journals, they may contain articles that previously were not published, were published elsewhere and are duplicated online, or were published elsewhere and are updated or revised online (e.g., Bromwell, 1997; Johns Hopkins University, 1997). There are some advantages to using the WWW as a publication medium. Unlike with traditional journals, online articles can be disseminated in a more timely manner as there virtually are no space limits. In a posting on an Internet bulletin board, however, Steenbarger (1996, November 28) expressed the following concerns:

The idea that one can...claim a "publication" is too, too appropriate for where the profession is...Postmodernism has become an umbrella that makes respectable the wholesale abandonment of peer review, educational and professional standards, and the epistemological underpinnings of the profession.

Although the Internet provides more freedom to publish articles than traditional journals -- virtually anyone can post an article and thereby take credit for a 'publication' on the Internet, and there are fewer limitations regarding space -- there is a need for more online peer review in order to legitimize the content. There are some journals online that have peer review (e.g., Bromwell, 1997; Grohol, 1997). The online journal Gestalt! (Bromwell, 1997), for example, has an editorial board with an editor, associate editors, and reviewers. It has been suggested that editorial review policies of traditional journals often are unfair (cite). The flexibility of the Internet provides an opportunity to reconsider standard review policies.

Chat

Many chat discussions on mental health topics take place on the Internet, but most are geared toward consumers (e.g., Austin, T; Grohol, J. 1997; Mental Health InfoSource; Support-Group.com; concernedcounseling.com). Some of these chat discussions for laypersons follow self-help, support group, and advocacy formats. Others include counseling services and advice by mental health professionals. The direct delivery of counseling services on the Internet is addressed later. In this section, we focus on chat discussions that are designed for mental health professionals for educative purposes.

There are many benefits to providing chat discussions on the Internet for professionals. First, such chat sessions allow mental health professionals to interact in real time with prominent counselors when they otherwise could not do so. Second, counselor educators can use the chat medium during classes to help students learn about theory, practice, and research. Examples during Albert Ellis's January 21, 1998 chat included Phillip A. Whitner, Ph.D., an instructor at the Heidelberg College Graduate Counseling Studies Program, Maumee, Ohio campus, and his 15 students in "Clinical Seminar In Methods Of Intervention and Prevention: Cognitive And Behavioral Counseling;" and Monique Manhal-Baugus, Ed.D., Assistant Professor in Counseling and Human Development at Troy State University, Montgomery, Alabama, who had 20 students online. Third, the transcripts of professional chat discussions can be copied and archived and used for research purposes. Fourth, this medium allows mental health counselors to clarify theories, learn new techniques, and develop research projects, while engaging in meaningful dialogues.

Shortly after ACA LIVE! was introduced in April 1996, the authors of the current article began developing a series of live "chat" forums on this network. On November 20, 1996, Peggy Kirk (1996) hosted the first student-led forum on ACA LIVE! entitled, "Counseling via the Internet." The first-ever ACA LIVE! chat forum was held on August 21, 1996 and featured Rational-Emotive Behavior Therapy's (REBT) founder Albert Ellis presenting, "Counseling in the Postmodern Era: The Dialogue Continues" (ACA, 1996 (FTP); Ellis, 1996). The JMHC debate about postmodernism (Ellis, 1996, 1997a, 1997b; Ginter, 1997; Guterman, 1994, 1996a, 1996b, 1997; Rigazio-DiGilio, Ivey, & Locke, 1997) served as an impetus for this chat forum. In addition, the chat forum was held within a few months of the 1996 ACA workshop entitled, "Ethical Issues in the Postmodern Era" (Ginter, ..., ..., & ..., 1996) that was informed by the JMHC postmodern exchange. In this workshop, Ellis and Guterman stated their respective positions regarding postmodernism, and a panel of respondents -- Allen E. Ivey, Don C. Locke, and Sandra A. Rigazio-DiGilio -- contributed their postmodern perspectives.

Approximately 30 people came online at some point during Ellis's forum (Jaco, 1996). The chat forum with Ellis served to clarify some of the theorist's positions on postmodernism and therapy in general. At the 1996 ACA workshop mentioned above, Allen E. Ivey explicated a proverb set forth within the Yakima Nation, a native American Indian community located in Washington state, in an effort to exemplify a postmodern, social constructionist perspective:

Progression from childhood to maturity is the work of the young. But it requires the guidance and support of the family and society. Education of each boy and girl is the gradual revelation of a culture. When thoughts and action become one with culture, maturity is the result and respect is the reward. (Ginter et al., 1996).

At the 1996 ACA workshop, Ellis responded to Ivey's citing with the following caveat: "One interpretation occurred to me immediately: Well, that's great. But then another interpretation was: Hitlerism! Hitler was a culture and consequently you have to watch it!" (Ginter et al., 1996). This interchange between Ellis and Ivey led to further dialogue in Counseling Today (Ellis, 1996; Ivey, Rigazio-DiGilio, & Locke, 1996) and the JMHC (Ginter, 1997). During the first ACA LIVE! forum, Ellis's position was clarified by way of a series of questions between him and attendee David Coe. Here is an excerpt from the chat session:

David Coe: Dr. Ellis, in the June 1996 issue of Counseling Today, Ivey, Locke and Rigazio-DiGilio made a response to the ACA workshop between them, you, and Guterman. They stated that to use the words Hitler or Nazi out of context trivializes the Holocaust.... However, I felt that when you warned that Hitler was a culture, given your frame of reference, it was meant as just that, a warning and had nothing to do with the proverb itself.

Albert Ellis: Yes, that is correct. When we use a word like culture, it may imply many things and although most cultures seem to be okay in themselves and even on a worldwide basis, we had better face the fact that there are some cultures, such as the Nazi culture, which are evil in themselves. But this may have very little to do with the quotation that Dr. Ivey made in our symposium but only with some implications that people might give this quotation. I agree that this is a generalization and a big one, and if we follow postmodern philosophy, we had better be skeptical of all kinds of generalizations, including one like this.

Being There on ACA LIVE. The idea for "Being There on ACA LIVE!," a full day of forums ("Internet forum 'Being There on ACA LIVE!' to feature," 1997) was born in an informal ACA LIVE! chat between the authors of the current article. The theme "Being There" was borrowed from the movie of the same name which is about the socially constructed nature of reality (Ashby, 1980). The plan was to organize numerous forums to be held throughout the day so that users could log on at any time and participate in those programs that were of interest to them. Many counselors and therapists expressed an interest in participating and by March 5, there were 11 consecutive hours of forums scheduled. The "Being There" forums included the following presentations (transcripts of forums are cited if available): Peggy Kirk & Jeffrey T. Guterman (1997) Sandra A. Rigazio-DiGilio (1997), Albert Ellis (1997), Kenneth J. Gergen (1997), Thomas L. Sexton (1997), Frank Fine, Scott Polson and Peggy Kirk (1997), Steven Durkee (1997), Monique Manhal-Baugus, and Lisa Efthymiou.

Although Kenneth J. Gergen was scheduled well in advance to present at "Being There," it was not until the day before this event that we learned that he could not download the ACA LIVE! software. ACA LIVE! is accessible only to PC users and Gergen had access only to a Mac. It was for this same reason that Allen E. Ivey, Bill O'Hanlon, Joan Atwood, and other notable Mac users could not be there for this event. Our solution to this problem was to have Kenneth Gergen and the current authors on a three-way telephone conference call at the time of his presentation so that the text could be transcribed online. The reason we had a three-way conversation was because participants at this event frequently were being "bumped off" (i.e., disconnected) from ACA LIVE! due to the heavy load placed on the server. Guterman typed for Gergen and Kirk stood by in the event that Guterman was disconnected so that she would be able to carry on the live transcription of Gergen's forum. The current authors found the discussion that transpired on the telephone to be as stimulating as what was happening online. Here is an excerpt of Gergen's (1997) forum on ACA LIVE entitled, "Social Constructionism in Counseling and Therapy":

Kenneth J. Gergen: Let's take the problem of constructionism and the "real world." For constructionists there are no foundational statements about what is "real" or "unreal." Let's just say that what exists, exists. However, the moment we begin to converse, we begin to give what exists meaning. And the meanings we give to what there is are intimately related to our actions. Here is an example. We may all say that bodies exist and we invest the concept of the body with many meanings. The woman's breast would be a particular example. And our lives are often built around these meanings.

Forums on the World Counseling Network. Unlike ACA LIVE, the Java-based chat application available on the World Counseling Network (WCN) has allowed users of both PCs and Macintosh computers to participate. The first author of this article developed an aegis of forums for the WCN called Chat98 (Guterman, 1997, 1997; Sams, 1997). Various forums have been held via the Chat98 aegis (Ellis, 1997; FitzMaurice, 1997; Guterman, 1997; Martin, 1997; Mitchell & Murphy, 1997).

Education and Training

Students and professionals have the opportunity to acquire education and training credits via the Internet. Many college instructors and their institutions of higher education now use it to provide (in text, hypertext, graphical, sound, or video form) updated syllabi, tutorials, office hours, practice tests, lecture notes, and even news groups for enrolled students. Also, homework assignments and term papers may be submitted, commented on, graded, and returned electronically (Herz, 1995; Institute for Research on Higher Education, 1996; Young, 1995). A growing number of schools also have developed distance education, or distance learning, by which one may work toward a graduate degree in counseling while remaining off-campus. For example, the New York Institute of Technology (NYIT) offers a series of online courses from its Masters of Professional Studies in Human Relations (MPS) program that meets the educational criteria for licensure as a mental health counselor in many states (New York Institute of Technology, 1998).

The Internet may be used for much more than simply exchanging course materials. The implications for students' use of the WWW to gather supplemental information are obvious. Also, chat can be used in traditional as well as distance education settings. Counselor educators may hold chat sessions at appointed times, attended by all class members, even though conceivably no two class members are in the same room. An example of such a collaborative opportunity would be an online role-playing session, during which one's fellow students and instructor provide immediate feedback. Graduate counseling classes also may invite experts from across the globe to contribute to their private discussions, or, as in the cases mentioned in the "Chat" section above, attend already-scheduled general-access chats.

Some online continuing education programs have received or are awaiting approval from certification and licensing bodies to offer continuing education units (CEUs) for mental health professionals (e.g., AudioPsych, 1998; Psy Broadcasting Corporation, 1998). The system for offering CEUs through Psy Broadcasting Corporation (1998), for instance, is as follows: A counselor subscribes to a panel on some topic in the field of mental health. Upon subscribing, the counselor receives a series of e-mail messages containing the texts of dialogues among a group of "experts" on the panel topic. Subscribers may participate in the dialogue via e-mail or, if they wish, only passively receive the content. Later, a multiple choice test is distributed via e-mail on the material that has been disseminated. If the subscriber passes the test, then he or she receives a CEU certificate.

Online Counseling

Coinciding with the growth of the Internet has been an increase in the number of counselors offering online services to clients (Sampson et al., 1997). Online counseling takes various forms. Some mental health professionals use e-mail simply to answer consumers' questions about issues and problems (Hannon, 1996). Responses may include a recommendation that the individual seek face-to-face (F2F) counseling, and sometimes provide an actual referral (Sampson et al., 1997). Where the online professional deems it appropriate, e-mail is used as a supplement to (Cohn, 1997) or in place of (Murphy & Mitchell, 1998) F2F counseling sessions. Some WWW sites, such as the Concerned Counseling Network (1998) offer online chat rooms for real-time individual and group therapy sessions with licensed therapists. While self-help psychoeducational materials (e.g., Albert Ellis Institute, 1997) are available on the WWW, there also is a proliferation of non-credentialed providers of "advice" as well as unmonitored support groups. In this article, we focus our attention on the direct delivery of counseling services on the Internet by licensed mental health professionals. We suggest that research be done on the efficacy of the advice and information provided at unmonitored sites and by the non-credentialed, as well as on such new Internet-created problems as "Internet Addiction" (Young, 1996, 1997) and virtual affairs (Cohn, 1997).

While many in the counseling community are concerned about the ethics of doing counseling on the Internet (Kirk, 1996, 1997), numerous advantages of online counseling have been identified (Kirk, 1996, 1997; Murphy & Mitchell, 1998; Sampson et al., 1997). Among the practical benefits, online counseling can be invaluable for clients who reside in remote areas, are home bound, or have disabilities that make it difficult to establish a relationship in or travel to an office (Sampson et al., 1997). Possible applications include text-based chat counseling sessions and e-mail exchanges with hearing-impaired clients, and audio tools for those blind clients who might not otherwise get services (Kirk, 1996, 1997). Online counseling also may serve as a first step for clients who are reluctant to initiate a face-to-face counseling relationship. S. A. King (personal communication, February 1, 1998), posits that "small, closed, moderated, professionally facilitated e-mail lists have an undeveloped potential for effective group therapy with populations such as people with Social Phobia." The Internet also can be used as a tool for giving homework assignments or administering assessment tools (Cohn, 1997; Kirk, 1996, 1997), and counselors can intervene "in the moment" (Sampson et al., 1997, pp. 207-208), as clients use a computer-assisted learning, assessment, or self-help tool.

Beyond the practical advantages of using e-mail, chat, and Internet audio and video, Murphy and Mitchell (1998) have identified several therapeutic benefits of using their "therap-e-mail" tool. First, both client and therapist have a permanent record of their interactions. The therapists can use it to aid in supervision and consultation, and the client can review his or her change process, as well as the therapist's validating and encouraging remarks. Second, writing about a problem can allow clients to externalize their "problems, and therefore promote therapeutic change" (p. xx). Third, writing allows for reflection, reconsideration, and editing, and reduces the chances of self-contradiction. The client may experience change before the therapist ever sees the e-mail. Fourth, Murphy and Mitchell believe that writing by both client and therapist levels the playing field, so that change seems to be as much a result of the client's hard work as the therapist's intervention. Finally, e-mail allows clients to reveal their feelings to the therapist as they are experiencing them, rather than waiting until a scheduled appointment time, when they may struggle to articulate for the therapist an accurate account of the experience. Murphy and Mitchell "believe that when clients [write about a problem as it occurs], they have acted in their own best interests ... and it will have a positive therapeutic impact" (pp. xx-xx).

According to King, Engi, and Poulos (1998), e-mail and other Internet tools can be used "to assist family therapy, especially in the treatment of families where members are geographically separated" (p. xx). Benefits that King et al. found included: (a) costs were reduced and there were fewer scheduling constraints compared with phone therapy; (b) the therapist's copy of all e-mail correspondence allowed for addition or revision of significant treatment goals; and (c) family members (as with Murphy and Mitchell's (1998) individual clients) had a chance to review and contemplate their own written words, sometimes resulting in positive change. According to King et al., "an evaluation of the use of the written word in recently developed family therapies lends support to this proposed use of the Internet as a means of facilitating therapeutic family communications between remote members" (p. xx).

The Internet can be used other than for traditional ongoing therapy. For instance, King (1996) suggests uses of the Internet by disaster mental health (DMH) teams: (a) to give victims and rescue workers a wider range of social contacts, (b) "to help the person in crisis to begin to normalize their experience" (p. 3), (c) to invite trauma victims "into a closed IRC channel for one to one counseling" (p. 3) (available 24 hours a day), and (d) to provide those involved the opportunity to contact and reassure family members over wireless devices when other power sources and telephones are out of service. Also, in using the Internet for career counseling, Sherman (1994) sees many advantages, such as "increased focus and clarity, ... [and] ... elimination of prejudicial reactions ... [about a] client's age, race, disability status, physical appearance, or even sex" (p. 31). Sherman claimed to have grown as a counselor since he had "worked with a greater variety of people, careers, and issues in a few short months on line than in my many years of working in college career centers" (p. 31).

One of the main concerns about online counseling regards the degree to which client confidentiality can be maintained on the Internet (Kirk, 1996, 1997; Marino, 1996). Along similar lines, the client or counselor might be unable to verify the identity of the other when using Internet applications. Recent advances in security on the Internet, however, might serve to address these issues. In particular, encryption software (e.g., Symantec Corporation, 1997; Pretty Good Privacy, 1998) scrambles information so that it will be unintelligible to other than the intended readers. Passwords already can restrict access to e-mail messages (receiving or sending) and to chat rooms. Other potential security devices include biometric technologies such as thumbprints, voiceprints, retinal scans, and face recognition programs (e.g., WhoVision, 1998; Visionics Corporation, 1998; Diebold, Incorporated, 1998; Keyware Technologies, 1998); anonymous remailers (Replay and Company Unlimited); digital signatures (Pretty Good Privacy, 1998); and limited-access intranets (Gralla, 1996). Misuse of any of the above tools by counselors, educators, students, supervisors, researchers, or even clients themselves would, of course, threaten the privacy of client data. According to Sampson et al. (1997), "counselors need to keep aware of potential threats to confidentiality and become familiar with and consistently use appropriate security methods" (p. 209).

Of course, security concerns are not new to counseling. The "Confidentiality" section of the ACA Code of Ethics (American Counseling Association, 1995) covers counselors' responsibilities for the ethical handling of records, obtaining client permission to record or observe sessions, giving clients access to their own records (including those obtained in multiple-client situations), and disclosing or transferring client records (pp. 2-3, 5-6). Professionals for many years now have been concerned with the potential mishandling by insurance companies and others of detailed client data on computer systems (Davidson & Davidson, 1995). Internet counseling presents a new set of possible hazards, including group members' ability to record others' statements during a chat session or a client's family member reading an e-mail to or from the counselor. Researchers should look into methods of handling or avoiding such contingencies, and professional codes of ethics should be revised often to reflect the availability of new technologies (Kirk, 1996, 1997; Sampson et al., 1997).

The "Computer Technology" section of the The ACA Code of Ethics (American Counseling Association, 1995, pp. 4-5), although probably written with assessment and instructional tools in mind, can be applied to Internet counseling. Specifically, both counselor and client should be adequately trained and able to use e-mail, chat, or whatever application is chosen; the counselor should deem that tool conducive to accomplishing the goals of the client's treatment; counselors should define for the client any known drawbacks of online versus face-to-face therapy; and counselors, in order not to discriminate, "need to ensure that less affluent potential clients have some readily accessible 'public' location for connecting to the Internet ..." (Sampson et al., 1997, p. 210). The NBCC Standards for the Ethical Practice of WebCounseling (NBCC, 1997) specifically address these and other related online counseling issues.

Many question the efficacy of online counseling because of the geographical separation and text-based mode of communication inherent in Internet relationships. The fact that a counselor's and client's locations can be a world apart may preclude the counselor's awareness of "location-specific conditions, events, and cultural issues that affect clients [and] may limit counselor credibility or lead to inappropriate interventions" (Sampson et al., p. 210). Also, because of the physical separation, an online counselor must have a contingency plan in place, such as the phone number of the client, client's relative, or a rescue crisis center in the client's community, in the event that a client, prior to termination, stops sending or retrieving e-mail, stops attending chat sessions, or threatens harm to self or to another (King, 1996); or the online connection is broken (for instance, during a chat session) for any reason. And what can be done if a client has a crisis and the counselor is not available to retrieve his or her e-mail? A back-up counselor, whether one associated with the primary counselor or one in the client's location, and the proper way to contact that person, should be identified at the beginning of the relationship. The distance issue also brings up complicated questions of licensure and liability insurance coverage across state and national borders (Morrissey, 1997; Sleek, 1995).

Finally, more research is needed to determine whether text-based communications' lack of visual and auditory cues and lack of physical presence prevent the conveyance of feelings and meanings and impede the development of such client-counselor relationship components as rapport and trust (Ginter, 1988, 1989; Guterman, 1994, 1996; Mitchell & Murphy, 1998; Kirk, 1996, 1997). The practice of counseling without face-to-face contact is hardly new to our field since counselors have used telephones for many years (Arbeiter, Aslanian, Schmerbeck, & Brickell, 1978; Coppersmith, 1980; Curry, McBride, Grothaus, Louie, & Wagner; 1995; Guterman, 1996; Hines, 1994; Iscoe, Hill, Harmon, & Coffman, 1979; Swinson, Fergus, Cox, & Wickwire, 1995; Wartik, 1994; Wright, 1986). Also, in the near future, improved functionality and accessibility of Internet-mediated audio and video applications on the Internet (Gates et al., 1995; Sampson et al., 1997) should help counselors to simulate all aspects of face-to-face sessions except human touch (Kirk, 1996). In the meantime, research and anecdotal evidence exist to support the belief "that it is possible to communicate caring and compassion via text" (Murphy & Mitchell, 1998, p. xx).

To say that online counseling should not be conducted based on the limitations cited above is too simplistic. Given the exponential growth of the Internet, the question is how, by whom and under what circumstances this medium shall be used (Kirk, 1996, 1997; Miller, 1996; Sampson et al., 1997). The Internet, used circumspectly, might be a safe tool for accomplishing such supplemental tasks as referral, consultation, education, supervision, intake, appointment scheduling or cancellation, follow-up on or continuation of an established face-to-face relationship, and career counseling (versus "psychotherapy") (Kirk, 1996, 1997). Much research, however, remains to be done on the advisability of assessing and diagnosing clients and conducting online therapy, whether brief or long-term, when no prior face-to-face relationship exists. We suggest that researchers solicit data on both positive and negative experiences from those licenced therapists who already have practiced online therapy. Therefore, a case for or against the ethics and efficacy of online counseling can be made based on evidence, rather than on speculation. In the meantime, counseling professionals and students, provided computer training in graduate school classes or continuing education programs, can only benefit from gaining a working knowledge of the Internet and all of its potential uses. Thus, they will be better equipped to make an informed decision about whether to use the Internet for any counseling-related activity, and will be able to join, as knowledgeable participants, the debate about online counseling, which is providing much needed dialogue in our field.

What Next?

We expect that there will be significant advances in Internet technology by the time this article is published, including improvements in online security; wider accessibility of real-time audio and video applications; and smaller, less expensive equipment. In addition, the number of users among counseling practitioners and students probably will grow as with the general population. It is fair to say, then, that the Internet will continue to be used within our field. Thus, it is imperative that mental health counselors take an active role in improving our use of this technology. The ACA and AMHCA codes of ethics need to address the reality of counseling and professional communication on the Internet. We need to appoint peer review boards and put in place mechanisms for identifying whether the content of Internet "counseling publications" is legitimate. Computer/Internet proficiency should be a requirement for graduate counseling students, if only to enhance their researching skills and career opportunities. And all counseling students, educators, and practitioners should be expected to have a fundamental, reality-based understanding of the potential benefits and drawbacks of conducting online counseling.

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