British Journal of Guidance & Counselling

ISSN: 0306-9885 (Print) 1469-3534 (Online) Journal homepage: http://www.tandfonline.com/loi/cbjg20

Developments in the use of technology in

counselling and psychotherapy
S. Goss & K. Anthony
To cite this article: S. Goss & K. Anthony (2009) Developments in the use of technology in
counselling and psychotherapy, British Journal of Guidance & Counselling, 37:3, 223-230, DOI:
10.1080/03069880902956967
To link to this article: http://dx.doi.org/10.1080/03069880902956967

Published online: 22 Jul 2009.

Submit your article to this journal

Article views: 609

View related articles

Citing articles: 16 View citing articles

Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=cbjg20
Download by: [Tangaza College The Catholic University of Eastern Africa]

Date: 12 November 2016, At: 11:15

British Journal of Guidance & Counselling,

Vol. 37, No. 3, August 2009, 223
230

Developments in the use of technology in counselling and psychotherapy

S. Gossa* and K. Anthonyb
a

Tayside Institute for Health Studies, University of Abertay Dundee, Scotland; bConsultant and
trainer-practitioner, OnlineCounsellors.co.uk, UK
(Received 12 September 2008; final version received 24 February 2009)
Counselling and psychotherapy has been influenced by technology for over 50
years. During this time, the rate at which ways that technology of one kind or
another can assist therapists and counsellors has seemed to increase exponentially.
This paper introduces and summarises contributions to the subject of technological enhancements or extensions of routine practice. While the variety of
technologies referred to is far from exhaustive, the paper offers a representative
sampling of the range available to practitioners from the now relatively familiar
email, internet chat and video conferencing through to the cutting edge of
developments in virtual reality, mood influencing packages and services that, like
Web 2.0, can be based upon the needs and designs of the users themselves.
Keywords: technology; Web 2.0; video; email; internet relay chat; virtual reality;
mobile telephone

In May of 2007, Derek Richards and his colleagues at Trinity College Dublin won
funding from the European Science Foundation (ESF) to run an exploratory meeting
of leading experts in the use of a variety of technologies used, or proposed, to
enhance or extend normal practice in counselling and psychotherapy. This
symposium comprises papers that have been developed and brought up to date
since the presentations given at that meeting and represents a sample of the cutting
edge of technological applications available
in some cases only just becoming
available
to practitioners today. It examines recent developments, current research
and emerging possibilities and issues, even dangers, associated with them.
The ESF event sought to bring together practitioners, trainers and, above all,
researchers from all over Europe, insofar as possible deliberately representing the
breadth of cultural contexts, therapeutic practices and technological interventions
present across the whole continent. This diversity is represented here in the range of
the innovative, developing practices and applications of technology reported.
Since its beginnings technology has often been, and sometimes still is, an area of
therapeutic work that seems to provoke somewhat polarised reactions. While some
are overtly enthusiastic and unhesitating, it is more often met either with a mixture of
careful optimism and appropriate caution at one end of the scale (Goss & Anthony,
2003; Goss, Robson, Pelling, & Renard, 1999; Lago, Baughan, & Copinger-Binns,
1999; Pelling & Renard, 2000) or, at the other, downright dismissive scepticism in the
face of what is merely unfamiliar (Goss & Anthony, 2002; Reynolds & Morris, 2002).
*Corresponding author. Email: s.goss@abertay.ac.uk
ISSN 0306-9885 print/ISSN 1469-3534 online
# 2009 Taylor & Francis
DOI: 10.1080/03069880902956967
http://www.informaworld.com

224

S. Goss & K. Anthony

That reaction against technological change exists among practitioners of counselling

and psychotherapy should not be surprising. If the introduction of the printing press
was met with both enthusiasm and resistance (Eisenstein, 1983), it is perhaps simply
that we have to wait until each new revolution in technology, whether large or small,
is sufficiently familiar to have become embedded into our lives and ceased to be
noticeable for it to be properly accepted (Adams, 1999). That caution remains in this
field, and is represented in the papers here, is testament to both the degree and the
rapidity of innovation and new thinking available to us. We can certainly be assured
that more new ideas are yet to come and the symposium presented here can only
highlight a sampling of the possibilities, many more of which, we must assume, are
yet to be conceived.
In addition to the exciting possibilities these innovations bring, there is real
reason to be cautious and as new possibilities for offering psychological help emerge,
so new dangers and pitfalls for the unwary, ill-informed or uninitiated present
themselves too. That care is important is reflected in the fact that counselling via
technological modalities is still the only area for which the British Association for
Counselling and Psychotherapy (BACP), for example, publish specialist ethical
guidance (Anthony & Jamieson, 2005; Goss, Anthony, Jamieson, & Palmer, 2001;
Payne, Casemore, Neat, & Chambers, 2006) in addition to the general ethical
principles and requirements that apply throughout the profession (Bond, 2002) and a
number of organisations have seen fit to issue their own guidance for working at a
distance (e.g. ACA, 2005; Goss & Anthony, 2004; International Society for Mental
Health Online, 2000; NBCC, 2007). The sheer rate of change and emergence of new
potential difficulties to match the opportunities is reflected in the rapidity with which
such guidelines may be considered out of date with BACPs first guidance being
replaced after just four years. Every practitioner is required to ensure that they are
properly prepared for work in any area that is new to them and it is important to note
that specialist training for provision of therapy via either email or chat systems has
been available since 2000 (see http://www.OnlineCounsellors.co.uk; http://www.OnlineTherapyInstitute.com; and http://www.onlinetrainingforcounsellors.co.uk for example), and should be considered essential if practitioners are to avoid falling foul of
the kinds of errors and lapses in good, safe provision of care that standard training
for face-to-face work has long sought to teach those entering the profession to avoid.
The conversion of verbal communication skills to its text-based, more nearly literary,
equivalents, for example, requires the development of a whole new level of skills in
written expression. The ability to ensure that ones meaning, once recorded in
permanent form that may be read, re-read and analysed for all its possible nuances
and interpretations by ones clients, is different than the ability to connect face to
face. It is necessary that practitioners can write in a way that is authentic and
congruent and sufficiently vivid to convey the full depth of the therapeutic
relationship and the emotional connection required to establish an effective bond
on the one hand, and this must be matched by the ability to sustain sufficient clarity
such that a vulnerable client cannot read unintended messages into the words on their
screen on the other hand. New specific requirements for providing adequate care, and
new possibilities for difficult situations for practitioners and clients also emerge in the
handling and protection of the full record of therapeutic interactions that counselling
by most forms of text (email or chat, for instance) presents.
This symposium covers a broad range of innovative technological possibilities but
also seeks to further discussion of what the possibilities might herald, while the

British Journal of Guidance & Counselling

225

emphasis is deliberately on the possibilities for providing enhanced care and

extending the reach and variety of practice. It should be borne in mind that the
intention is always that this be done with expert guidance and a full recognition
of the need for a degree of tentative care in our provision. Practitioners of
technologically mediated therapies should be wary, aware of the ethical principles
that inform the terms of good practice and should be adequately trained and
prepared for the role. The task of researchers and the developers of new areas of
practice, then, is to explore carefully to establish what may be done along with noting
the limitations of even the most exciting new and evolving possibilities for practice.
And excitement there certainly should be. To express caution is merely a corollary
of extending practice into areas that have been identified as holding new potential.
Many of the uses of technology in counselling practice have been first requested, or
enacted, by clients rather than practitioners and the fact that relationships can
develop online and can be emotionally meaningful has now been recognised for some
time (e.g. Anthony, 2001). Each of the papers in this symposium seeks to examine
one of the many areas of new practice and research that is available for therapeutic
use and each has its roots in aspects of technology that would be familiar to many in
other walks of life. The caution, then, may be more a concern for practitioners than
for their clients and if therapists of all kinds do not engage positively with
the developing possibilities of communication technologies, we will undoubtedly
risk doing our clients a disservice, at best missing valuable opportunities to reach
those who would prefer not to make the journey to a consulting office to sit in the
presence of a stranger while discussing their private issues, and at worst losing touch
with the way people communicate as a matter of course in the modern world.
The papers collected here examine only a proportion of the possibilities presented
by new technologies. It would have been possible to extend it to include other topics
as well, such as the use of haptic devices (Bonnani & Vaucelle, 2006), avatars (Goss &
Anthony, 2002), social networking websites (Thompson, 2008), wikis (Rollins, 2008),
the combination of technologies with face-to-face provision or the establishing of
effectiveness through randomised controlled trials (Cavanagh, Zack, Shapiro, &
Wright 2003a, 2003b). Space and resources have prevented this, however, and we have
preferred in any case to provide a snapshot of exemplars of the work currently being
carried out in this field.
Briefly, the topics covered here comprise, firstly, two papers that consider one of
the areas first thought to have a natural applicability for therapeutic use of
technologies: the use of email, chat or message boards with students and young
people. Richards reports possible benefits from increased service usage and
accessibility and related the potential gateway function of brief email contact
leading to face-to-face therapy to stepped care models, thus extending the reach of
services restricted to office hours and a location arranged for the practitioners
benefit. Efstathiou then considers a service, broadly similar in some respects and
referred to in this instance as web-consulting, in which university students queries
to a bespoke mental health website were answered by professional counsellors and
posted to a publicly accessible forum. Considerable levels of activity and high levels
of satisfaction were reported by service users along with notable gains in efficiency
for the service providers. This was achieved not least by reference, prompted by the
clinicians or otherwise, to answers to previous postings to the site by new visitors who
could find issues similar to their own and could make use of the answers provided to
meet their need.

226

S. Goss & K. Anthony

Hanley then considers the potential for, and qualities of, the working alliance that
can be built with young people via synchronous and asynchronous test-based
communication based on the experience of one particular website. Whether the
moderately encouraging findings that could be reported at this stage will be replicable elsewhere will need to be tested with suitable strategies to ensure that adequate
service standards are maintained.
Simpson then turns to the rather different technological interface of videoconferencing, sometimes seen as an enhancement of the more familiar audiotelephony which has long been seen as an accepted form of counselling (Rosenfield,
1997, 2003; Payne et al., 2006). She notes the limited but now expanding research
base for such work and offers a thorough, detailed and exhaustive systematic review
of the evidence to date. Studies were identified from 1961 to the present day and,
while only three randomised controlled trials were found and despite the often small
sample sizes used and the inevitably tentative and exploratory nature of studies
appropriate for innovations in therapeutic care, clear evidence of benefits is reported
and the findings overall are encouraging. Positive outcomes were found in most
studies and satisfaction with video-linked services was higher than for face-to-face
work for at least some clients. Indeed, the evidence base presented is sufficiently
strong to raise the question of whether, perhaps in common with other forms of
technologically mediated therapy, it may even be considered unethical to withhold
them from those who are willing to use them and are otherwise unable to access
suitable services.
Alcan iz, Botella, Ban os, Zaragoza and Guixeres then consider the use of
intelligent computer systems in the treatment of obesity, focusing especially on a
specific program developed by the authors in Spain. The costs associated with a
number of specific behaviour-related or mental health-related conditions, including
the example of obesity discussed in this paper, are such that investment in developing
effective treatments can be expected to offer good value for money, especially if
indirect costs (such as days off work) are included. The system proposed here
combines network and sensor technologies with the increasing ubiquity of technological means and could include use of virtual reality, augmented reality, natural
interfaces and virtual agents.
Botella, Gallego, Garcia-Palacios, Banos, Quero and Alcan iz then offer a detailed
account of a randomised controlled trial, again carried out in Spain, of an internetbased self-help package designed to treat fear of public speaking compared with the
same treatment delivered in person by a therapist. Consistent with previous findings,
which are also briefly reviewed, the interventions were found to be equally effective
with participants in both arms of the study also reporting equivalent satisfaction
rates. Outcomes were sustained 12 months later. High levels of acceptance of the
internet in general, and this program in particular, as a means of treating
psychological problems were found. Furthermore, less aversion to the internetdelivered treatment compared with face-to-face work with a therapist in vivo was
reported at 12-month follow up. An obvious implication of this paper, echoed by the
findings of some others here, is that direct contact with a therapist is not, or at least is
not always, necessary. This is consistent not only with findings of other technologically mediated therapies such as fully computerised versions of Cognitive
Behavioural Therapy (CBT) (Cavanagh et al., 2003a, 2003b; Marks, Cavanagh, &
Gega, 2007) but also with the concept, most recently developed by Bohart and
Tallman (1999) that it is clients that make therapy work for themselves despite not

British Journal of Guidance & Counselling

227

always being well fitted to the intervention chosen out of the whole panoply of
possible therapeutic options. Positive psychotherapeutic change, clearly, is achievable
even in the absence of that most cherished element of what counsellors and therapists
can offer: a personal therapeutic relationship.
Preziosa, Grassi, Giaggioli and Riva turn to applications of mobile phones in
support of mental health care. Given the near ubiquity of such devices, effective
programs delivered through them clearly hold much potential for extending the reach
of, and ease of access to, therapeutic services. After reviewing some of the previous
literature on the use of mobile telephony, noting that much is focused on pretreatment assessment and post-treatment support rather than on the direct delivery
of interventions designed to be beneficial in themselves, they then offer an account of
two contrasting studies that have dealt with the question prompted by that gap: can
people benefit directly from working with programs delivered via the restricted
(e.g. from screen size and keyboard controls) but relatively familiar technology of a
mobile phone? In both studies, one addressing exam stress and the other a more
general intervention for stress management, the findings are, once again, encouraging
despite the need for further research and development.
Specialist computer programs then come under the spotlight. Early findings of a
study of a clinician-supported computerised treatment for eating disorders offered
over the internet for a university counselling service are discussed by Bauer,
Moessner, Wolf, Haug and Kordy. Despite high attrition rates, this pilot study
already suggests that such systems can prove an effective means of both extending the
reach of face-to-face services and of screening potential clients for the severity of
their condition. Linked to a stepped-care approach, it is then possible to provide wellinformed, targeted allocation to a variety of treatments, ranging from low intensity
access to information, through medium intensity options such as the use of a
clinically moderated discussion board, or to much higher intensity out- or in-patient
treatment. Moreover, the authors suggest that this can be done in a far more timely,
more easily accessed and less costly manner, although they too note the need for
further research and, possibly, development of such systems.
Two further papers then consider examples of the use of virtual reality (VR). Riva
offers a thorough summation of the potential uses of VR in the treatment of
disorders such as phobias, body-image distortion or for neuropsychological testing
and rehabilitation. Perhaps the most obvious potential for VR is in its ability to
provide clients with a means by which they can achieve a self-evidently safe exposure
to feared, avoided or otherwise problematic stimuli, combined with the possibility of
manipulating specific images to control the virtual environments to suit their need at
that time. An intermediate step between actual exposure and merely imaginal
techniques, the potential of VR can now be further enhanced through the use of
devices such as full-immersion head sets, control gloves and other haptic devices that
enable kinaesthetic manipulation of virtual objects and even of the virtual
environment as a whole. Riva then provides an account of a specific cost-free and
open-access VR tool, known as NeuroVR, designed to allow non-experts to develop
their own VR environments and treatments in their own clinical context, for specific
client groups and, possibly, even for individual clients.
Ban os, Botella, Guillen, Garcia-Palacios, Quero, Breto n-Lopez and Alcaniz go
on to explore the theme of VR environments further by looking in some detail at one
specific package, developed by the authors, known as EMMAs World. The paper
examines the effects of EMMAs World, which was deliberately intended to be a

228

S. Goss & K. Anthony

flexible platform that can be used with a wide range of clinical populations. The
program is designed to respond actively to the users affective state. With the
therapist and client working together to manipulate the virtual environment as
appropriate, a variety of emotional stimuli can be provided. The preliminary findings
presented are, once again, encouraging and, while further research is required, they
suggest that affectively oriented VR tools can support clinically significant change.
Interestingly, in the case of EMMAs World, this is achieved not by creating realistic
representations of specific real-world objects or events, but by providing a virtual
environment that evokes a specific emotional response in the client whether that be of
fear, in the case of de-sensitisation, or calmness, where a reduction in excitation is
required. The focus on fostering general emotional states rather than recreating the
external, real world, suggests that the benefits of such programs are rather less reliant
than would otherwise be the case on developments in the quality and sophistication
of the hardware, software and graphical capabilities required to make VR everincreasingly realistic. Perhaps unsurprisingly, the EMMAs World approach was
rated by clients as a less threatening, less aversive form of treatment than those that
are based on re-experiencing even simulations of traumatic events, suggesting that
facing engaging with such a treatment may be easier and carry less risk of iatrogenic
(intervention-induced) harm. The absence of reliance on representing particular
objects or situations also means that the program can be used by a wide range of
clients, regardless of the specific stressors that brought them to treatment, while still
allowing it to be responsive to their individual needs.
The future of the profession, particularly with reference to ethical frameworks,
will also be affected by the use of technology in guidance and counselling. The phrase
Web 2.0 denotes the use of World Wide Web technology to foster the collaboration of
end-users to create a vibrant and resourceful society that exists online. More
discussion of Web 2.0 and its origins can be found at Wikipedia (http://
en.wikipedia.org/wiki/Web_2.0), but the implication of it for our profession is an
important one, not least because the concept of it shows us that the clients, not the
practitioners, will be the people who decide how guidance and therapy exist in the
future. Therefore, the clients will dictate development of the approach to online
therapy, the development of global guidelines and standards, and social networking
sites such as FaceBook or MySpace, and online communities such as Second Life will
create the first point of contact for therapeutic intervention. Many virtual therapy
clinics already exist in cyberspace commercially in response to the way societys
attitude to therapy is changing in the face of the new technologies (Wilson, in press).
The impact of Web 3.0 (http://en.wikipedia.org/wiki/Web_3.0), of which Wikipedia
itself is an example of end-user created information and is predicted to mature in the
second decade of the century, will hold even more issues for the profession, not least
around confidentiality because of the nature of open identity (OpenID) and the loss
of usernames and passwords. This means there will be no organisation or authority
to confirm a clients, or indeed a practitioners, identity.
This sampling of the possibilities offered by making use of technology to extend
or improve existing therapeutic practices and ideas represents an exciting foray to the
cutting edge of what technology can offer counsellors, therapists and their clients at
present. That further work remains to be done is an inherent feature of a field that,
despite having emerged over 50 years ago with the advent of electronic recording
devices (Rogers, 1942), still regularly sees immense leaps into realms previously

British Journal of Guidance & Counselling

229

undreamed of. The question that remains to be addressed, of course, is of where these
possibilities will take us next and what we all
practitioners and clients alike
should
do about them once they are there.
Notes on contributors
Stephen Goss, PhD, is Service Manager for the Campaign Against Living Miserably. He has
been involved in providing, researching and publishing on technologically mediated counselling and mental health care for over a quarter of a century. With Kate Anthony, he co-authored
the BACP Guidelines for Online Counselling and Psychotherapy, the leading ethical guidance on
the subject, and co-edited Technology in Counselling and Psychotherapy: A Practitioners Guide.
His other research interests include the development of pluralism in counselling and research
methods and the application of evidence based practice in mental health care.
Kate Anthony, MSc, is a Fellow of the British Association of Counselling and Psychotherapy,
and past-President and Fellow of the International Society for Mental Health Online. She is a
consultant, widely published author and trainer for practitioners using technology in mental
health services as CEO of OnlineCounsellors.co.uk and joint-CEO of the Online Therapy
Institute. Forthcoming books include Therapy Online [a practical guide] and Mental Health
and the Impact of Technological Development.

References
Adams, D. (1999). How to stop worrying and learn to love the Internet. Retrieved December 2,
2008, from http://www.douglasadams.com/dna/19990901-00-a.html
American Counseling Association. (2005). Ethical use of technology in counselling. In Ethics
and professional standards (Part 9). Retrieved December 2, 2008, from http://www.
counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx
Anthony, K. (2001). Online relationships and cyberinfidelity. Counselling, 11(10), 625
627.
Anthony, K. & Jamieson, A. (2005). Guidelines for online counselling and psychotherapy: 2nd
edition, including guidelines for online supervision. Rugby: BACP Publishing.
Bohart, A., & Tallman, K. (1999). How clients make therapy work. Washington, DC: American
Psychological Association.
Bond, T. (2002). Ethical framework for good practice in counselling and psychotherapy. Rugby:
BACP Publishing.
Bonnani, L. & Vaucelle, C. (2006). A framework for haptic psycho-therapy. Retrieved December
2, 2008, from http://leo.media.mit.edu/wp-content/uploads/2006/07/HapticPsychoTherapy.
pdf
Cavanagh, K., Zack, J., Shapiro, D., & Wright, J. (2003a). Computer programs for
psychotherapy. In S. Goss & K. Anthony (Eds.), Technology in counselling and psychotherapy: A practitioners guide (pp. 141
164). London: Palgrave.
Cavanagh, K., Zack, J., Shapiro, D., & Wright, J. (2003b). Computer plays therapist: The
challenges and opportunities of psychotherapeutic software. In S. Goss & K. Anthony
(Eds.), Technology in counselling and psychotherapy: A practitioners guide (pp. 165
194).
London: Palgrave.
Eisenstein, E. (1983). The printing revolution in early modern Europe. Cambridge: Cambridge
University Press.
Goss, S.P., & Anthony, K. (2002). Virtual counsellors whatever next? Counselling and
Psychotherapy Journal, 13(2), 14
15.
Goss, S.P., & Anthony, K. (2003). Technology in counselling and psychotherapy: A practitioners
guide. London: Palgrave.
Goss, S., & Anthony, K. (2004). Ethical and practical dimensions of online therapy. In
G. Bolton, S. Howlett, C. Lago, & J.K. Wright (Eds.), Writing cures (pp. 170
178). Hove:
Brunner-Routledge.
Goss, S.P., Anthony, K., Jamieson, A., & Palmer, S. (2001). Guidelines for online counselling and
psychotherapy. Rugby: BACP.

230

S. Goss & K. Anthony

Goss, S.P., Robson, D., Pelling, N.J., & Renard, D. (1999). The challenge of the internet.
Counselling, 10(1), 37
43.
International Society for Mental Health Online. (2000). Suggested principles for the online
provision of mental health services. Retrieved December 2, 2008, from http://www.ismho.org/
builder/?ppage&id214
Lago, C., Baughan, R., & Copinger-Binns, P. (1999). Counselling online . . . Opportunities and
risks. BAC special report. Rugby: BAC.
Marks, I., Cavanagh, K., & Gega, L. (2007). Hands-on help. Hove: Psychology Press.
NBCC. (2007). The practice of internet counselling. Retrieved December 2, 2008, from http://
www.nbcc.org/webethics2
Payne, L., Casemore, R., Neat, P., & Chambers, M. (2006). Guidelines for telephone counselling
and psychotherapy. Rugby: BACP Publishing.
Pelling, N., & Renard, D. (2000). Counselling via the Internet
Can it be done well?
Psychotherapy Review, 2(2), 68
72.
Reynolds, P., & Morris, T. (2002). Intimacy as we know it? Counselling and Psychotherapy
Journal, 13(3), 11.
Rogers, C.R. (1942). The use of electronically recorded interviews in improving psychotherapeutic techniques. American Journal of Orthopsychiatry, 12(3), 429
434.
Rollins, J. (2008). Rolling out the Wiki Welcome Mat. Counseling Today, 51(2), 40
42.
Rosenfield, M. (1997). Counselling by telephone. London: Sage.
Rosenfield, M. (2003). Telephone counselling and psychotherapy in practice. In S. Goss &
K. Anthony (Eds.), Technology in counselling and psychotherapy: A practitioners guide
(pp. 91
108). London: Palgrave.
Thompson, A. (2008). Counselors right to privacy: Potential boundary crossings through
membership in online communities. Counseling Today, 51(2), 44
45.
Wilson, J. (in press). Second Life and virtual practice. In K. Anthony & D. Merz Nagel (Eds.),
Mental health and the impact of technological development. Illinois: CCThomas Publisher
Ltd.