The role of social media in counselling and psychotherapy
I trained as a therapist in the pre-intemet 1990s. Apparently, not having grownup with digital technology I am considered a ‘digital immigrant’ rather than a ‘digital native’ (Prensky, 2001: 1) in contrast to the majority of the students, supervisees and clients with whom I work. Adapting to the virtual world and reflecting on its implications for professional practice has certainly caused me to consider my own biases and assumptions about social media and social networking, in particular. Informed by my theoretical orientation, which is essentially integrative with a humanistic core, dialogical questions have arisen in my reflections on the role of social media in my work context. These questions predominantly relate to the intersection of one’s personal and professional life. The challenge is that of holding professional boundaries while seeking transparency and authenticity in the therapeutic relationship.
Although this consideration is not new in a traditional therapy setting and is continuous in reflective practice, social media use inherently challenges the personal and professional boundary in clinical practice and tests conventional perspectives on what constitutes the therapeutic space. However, at the heart of this dialogue is the commitment to maintaining ethical best practice, therapeutic integrity and ongoing reflection on Paul’s (1969: 44) seminal question, ‘what treatment by whom, is most effective for this individual with that specific problem and under which set of circumstances?’ Hence, as a practitioner, multiple layers of complexity arc presented when considering the role of social media in counselling and psychotherapy practice. This chapter sets out to discuss some of the opportunities and challenges that social media use presents in this context.
Internet technology in psychological therapy
Internet technology developments have become part of the fabric of our everyday lives. With the advent of the internet in the early 1990s, the last number of decades have seen rapid growth in the development of web-based therapy as evident in the growing body of literature in this area. What is also apparent is the increasing number of randomised controlled trials (e.g. Richards ct al.,
2018) and mcta-analyscs (e.g. Andrews et al., 2018) being conducted to evaluate the efficacy and effectiveness of computer and internet-based intervention and through which an evidence base is being established. For example, in their meta-analysis of the effectiveness of web-based psychotherapy, Barak et al. (2008: 141) concluded that ‘Internet-based therapy, on the average, is as effective, or nearly as efficacious, as face-to-face therapy’. They also reported that interactive web-based programmes had better outcomes in comparison to online programmes that did not require active user participation. However, only three treatment approaches (behavioural, cognitive behavioural therapy and psycho-education) were represented in the meta-analysis. Nonetheless, the findings may suggest that specific therapy approaches for particular symptoms may have better outcomes in online delivery. More recently, Andrews et al. (2018) concluded from their meta-analysis of 64 efficacy trials with adults, that computerized CBT (cCBT) and internet-delivered CBT (iCBT) were effective interventions for depression and anxiety and equivalent to facc-to face CBT in terms of helpfulness. The authors note, however, that as there was variation in the content and method of delivery of the iCBT programmes in the studies meta-analyscd, further investigation is warranted.
Among the reported advantages of web-based therapy are the convenience, case of access, outreach to marginalised populations, and the relatively low cost involved (Callahan & Inckle, 2012). It may also have a destigmatizing and disin-hibiting effect due to the relative anonymity associated with web based communication (Suler, 2004). Conversely, the disadvantages of online therapy, as summarised by Amichia-Hamburgcr et al. (2014) arc associated with the lack of physical presence, the absence of verbal signals, the challenges of risk management, therapist and client technological competence and technological malfunctions. Other population specific concerns relate to young people’s participation in websites that promote unhealthy behaviours (e.g. suicidal postings, Lehavot et al. 2012; extreme communities, Bell, 2007). Clients also present with issues that implicate the internet and social media use, for example; cyberbullying, online addiction (Giota & Klcftaras, 2014). Notwithstanding these disadvantages, online social networks offer a myriad of self-help and mutual support opportunities. The internet provides a wealth of readily accessible mental health information to the public and potential clients and the role of social media holds extraordinary potential for the wide dissemination of such information. For a comprehensive review of current applications of technology in mental health practice see Goss and colleagues (2016).
As potential and current clients increasingly seek mental health information online and frequently via social media sites, therapists need to be cognisant of the range and quality of such information as a resource for their clients (Bell, 2007). Alongside the internet’s ‘promise of the democratization of expertise’ questions regarding the trustworthiness and professional standards of that expertise are raised (Harshman et al., 2005: 227). To that end many helping professions arc concerned with the credibility of the information available to
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the public and how informed consent, professional boundaries, confidentiality and emergency protocols arc adequately provided for in these situations (Santhivecran, 2009).
