PMHP Basic Counselling Skills

THE COUNSELING
10.1177/0011000005278625
Mallen et al. / THE ONLINE
PSYCHOLOGIST
COUNSELING
/ November
PRACTICE
2005
The Practical Aspects of Online Counseling:
Ethics, Training, Technology, and Competency
Michael J. Mallen
David L. Vogel
Iowa State University
Aaron B. Rochlen
University of Texas–Austin
This article addresses the practical aspects of online counseling, including ethics, train-
ing, supervision, technology, and competency issues. The authors discuss online coun-
seling’s strengths and limitations and present guidelines for what types of clients and
counseling psychologists may be appropriate for online counseling. To illustrate the
components and skills associated with online counseling, the authors present and discuss
an example of a synchronous-chat online session.
With more than 100 million people searching the Internet for health infor-
mation (Harris Interactive, 2002) and with the demand for actual health care
services increasing (Grover, Wu, Blanford, Holcomb, & Tidler, 2002), the
need is clear for increased regulation and monitoring of Internet health prac-
tices. In terms of the practice of online counseling in particular, a small but
significant number of practicing psychologists offer professional services on
the Internet (Stamm, 1998), with the provision of such services expected to
“become as routine, readily accessible, and expected as the telephone”
(VandenBos & Williams, 2000, p. 492). The current use of online counseling
by practitioners associated with the American Psychological Association
(APA) ranges from 2% for individual psychotherapy via the Internet to 13%
to 15% for the use of faxes and e-mail to conduct psychological assessments,
evaluations, and family therapy (see VandenBos & Williams, 2000). Yet,
despite a person’s ability to access the Internet and receive mental and behav-
ioral health services, there remain few guidelines, restrictions, or practical
suggestions for the practice of online counseling, with the service modality
in general remaining complex and controversial (see Akister, 2003; Barak,
1999; Barnett & Scheetz, 2003; Bloom, 1998; Finfgeld, 1999; Fisher &
Fried, 2003; Griffiths, 2001; Grohol, 1998; Holmes & Ainsworth, 2004;
Correspondence concerning this article should be addressed to Michael J. Mallen, Department of

Behavioral Science, Unit 1330, University of Texas M. D. Anderson Cancer Center, P.O. Box
301439, Houston, TX 77230-1439; e-mail: mjmallen@mdanderson.org
THE COUNSELING PSYCHOLOGIST, Vol. 33 No. 6, November 2005 776-818
DOI: 10.1177/0011000005278625
© 2005 by the Society of Counseling Psychology
776
Mallen et al. / THE ONLINE COUNSELING PRACTICE 777
Hsiung, 2002; King & Poulos, 1999; Koocher & Morray, 2000; Manhal-
Baugus, 2001; Pomerantz, 2002; Ragusea & VandeCreek, 2003; Rochlen,
Zack, & Speyer, 2004; Rosik & Brown, 2001; Shapiro & Schulman, 1996;
Stricker, 1996). Clearly, delivering mental and behavioral health services
online raises new questions about the therapeutic process, and it is important
for counseling psychologists in practice settings to be familiar with basic eth-
ical, legal, training, and technological issues before they meet with clients
through distance-communication technologies.
We have made an effort to integrate key concepts and principles of the
scientist-practitioner model, which defines counseling psychology, into the
discussion of online counseling’s practical aspect. This model emphasizes
research, training, and practice in addition to the importance of research con-
siderations that support practice. The focus of this article is on issues germane
to the field of counseling psychology, including multicultural competencies,
educating and training future counseling psychologists, and recognizing the
importance of research considerations to support the practice of different
online treatment interventions. We discuss issues related to training online
skills and competencies for counseling psychologists, and we provide sug-
gestions for preparing to deliver mental and behavioral health services
online. To illustrate the practice of online counseling and to provide a unique
training example, we present a full-length transcript of a synchronous-chat
session with additional commentary about the session’s process. The tran-
script is intended to illustrate the most common mode of online counseling,
conducted through a text-based technology without the aid of nonverbal
cues. This type of technology illustrates many of the potential practical and
ethical issues that counseling psychologists may encounter when working
with a client through e-mail or synchronous chat.
ETHICAL AND LEGAL ISSUES FOR

COUNSELING PSYCHOLOGISTS
The most common concern addressed in the online-counseling literature

surrounds the ethical and legal implications of conducting counseling and
behavioral services to someone over a distance. Regardless of the distance
technology used in treatment, standard adherence to current ethical and legal
codes must be maintained (APA, 2002). For this reason, the ethical implica-
tions of online counseling have been rigorously debated for many years (see
Akister, 2003; Barak, 1999; Barnett & Scheetz, 2003; Bloom, 1998;
Finfgeld, 1999; Fisher & Fried, 2003; Griffiths, 2001; Grohol, 1998; Holmes
& Ainsworth, 2004; Hsiung, 2002; King & Poulos, 1999; Koocher &
Morray, 2000; Manhal-Baugus, 2001; Pomerantz, 2002; Ragusea &
778 THE COUNSELING PSYCHOLOGIST / November 2005
VandeCreek, 2003; Shapiro & Schulman, 1996; Stricker, 1996). The APA
(1997) released a statement concerning the use of the telephone and other
distance-communication technologies for delivering mental and behavioral
health services, stating that
the Ethics Code is not specific with regard to telephone therapy or

teleconferencing or any electronically provided services as such and has no
rules prohibiting such services [and that] complaints regarding such matters
would be addressed on a case by case basis.
Since this time, the APA has adopted a new Ethics Code, which took effect on
June 1, 2003. In the introduction to the new code, it states, “This Ethics Code
applies to these [scientific, educational, or professional] activities across a
variety of contexts, such as in person, postal, telephone, internet, and other
electronic transmissions” (p. 2). The new code added language throughout
the standards that addresses the Internet and electronic transmission of infor-
mation. The new language can be found only in the following four standards:
3.10, Informed Consent; 4.02c, Discussing the Limits of Confidentiality;
5.01, Avoidance of False or Deceptive Statements; and 5.04, Media Presenta-
tions. For example, Standard 4.02c stipulates that psychologists offering ser-
vices, products, or information through electronic transmission should
inform their clients of the privacy risks and the limits of confidentiality
(Smith, 2003).
Although the new APA Ethics Code acknowledges the Internet and elec-
tronic transmission of information, it does little to provide clear standards or
practical guidelines on how to overcome the unique obstacles of delivering
mental and behavioral health services to clients from a distance. As a result,
counseling psychologists interested in providing mental and behavioral
health services do not have firm guidelines and standards to ensure that they
are conducting themselves in a professional and ethical manner. The follow-
ing is a summary of the most commonly noted ethical and legal issues that
have emerged from the practice of online counseling (see also Kraus, 2004).
Danger and Duty to Warn
One of counseling psychologists’ primary ethical responsibilities in prac-

ticing therapy is to avoid harming the client (APA Ethics Code 3.04), and
they have an ethical duty to warn or duty to protect (Melton, 1988) if clients
present a danger to themselves or others (APA Ethics Code 4.05b3; Tarasoff
v. Regents of the University of California, 1976). Delivering counseling ser-
vices to someone from a distance creates new challenges for counseling psy-
chologists, as it may be difficult to assess and intervene in an emergency. As a
result, clients who pose a danger to themselves or others may not be good
candidates for online counseling. This caution applies to a range of possible
clients, including serious substance abusers and clients presenting psychotic
or actively suicidal concerns. Furthermore, to help ensure that therapists can
take steps in an emergency, it has been suggested that they must know the
identity of any client that they work with in an online setting and be aware of
emergency services in the client’s area (Kraus, 2004; Suler, 2001). Counsel-
ing psychologists are able to intervene in the case of an emergency only if
they have information.
Therefore, one of the first steps in online counseling should be to gather
basic contact information from clients and to discuss with them the steps that
would be taken if they report being a danger to themselves or others. In case
there is a duty-to-warn issue during the course of therapy, therapists will have
more options available if they collect this information before treatment
begins. Ideally, therapists should accomplish this by using a consent form,
completed at the beginning of treatment. In the appendix, we present an exam-
ple of the additional information that therapists should add to an informed-
consent document for online counseling. The consent form would detail an
agreement between the client and the counseling psychologist in terms of
what will be done in the case of an emergency or crisis. The form would also
state the relevant client contact information including home address, tele-
phone, physician, and emergency contacts. However, even if this procedure
were followed, a potential problem may arise if the therapist were provided
with inaccurate information. Therefore, in addition to gaining identifying
information from each potential client, counseling psychologists may need
to try to verify this information; however, this may prove difficult or even
impossible. As a result, although crises may be handled in a similar manner
as face-to-face (FtF) sessions, the distance involved between the therapist
and the client can complicate the therapist’s ability to intervene. One way to
reduce these potential problems would be for counseling psychologists to
conduct distance counseling only after an initial FtF meeting, assessing the
clients’levels of danger to themselves and others and gathering the necessary
contact information.
Scope of Practice
Counseling psychologists must be licensed in each state or province
where they provide services or perform activities that fall within the “scope
of practice” of that jurisdiction’s psychology licensure or practice act. As
with the practice of different types of counseling, specializations, and work-
ing with various types of clients, it is counseling psychologists’ ethical obli-
gation, both in training and in practice, to ensure that they have received ade-
quate preparation and training to demonstrate competence in their selected

areas of work. Online counseling should be no exception. Although it is true
that determining “competence” in the area of online counseling is currently
more ambiguous than in other areas of counseling psychology or specializa-
tions (e.g., eye movement desensitization and reprocessing, hypnosis), this
lack of clarity does not mean that counseling psychologists should abandon
standard scope-of-practice guidelines.
Distance-communication technologies make it possible to meet with indi-
viduals around the world 24 hours a day. This is one of online counseling’s
more promising aspects, allowing counseling psychologists to reach out to
populations that may otherwise avoid or not have access to mental health ser-
vices. This aspect of online counseling also raises another substantial ques-
tion: whether counseling is ethical or legal when crossing state or interna-
tional territories. This issue relates primarily to the notion of boundaries of
competence (APA Ethics Code 2.01), but it is more directly a matter of legal-
ity (APA Ethics Code 1.02). Most commonly, counseling psychologists are
licensed and practice exclusively within their states of residence; however, it
is possible for therapists to connect with clients from anywhere in the world.
This presents a significant question regarding what state’s or country’s regu-
lations (i.e., the client’s or the therapist’s) should take precedence if there is
any type of dispute related to the delivery of service. Similarly, malpractice
insurance is typically valid only if the counseling psychologist provides ser-
vices within the scope of his or her license, which is commonly bound by
state regulations. For example, the American Psychological Association
Insurance Trust will include online services falling within the psychologist’s
license and state guidelines; however, the insurance would likely be voided if
a counseling psychologist were providing services outside the scope of his or
her license. Therefore, if a counseling psychologist provided services to a cli-
ent from another state or territory, malpractice insurance companies may not
be obligated to cover any legal expenses or damages were the client to pursue
a malpractice claim. The ability to meet with clients around the world may be
enticing, but the legal risks could be extremely costly. Up to now, clients
receiving online counseling have not pursued malpractice claims (Kraus,
2004), but this will likely change.
If they are interested in providing online-counseling services, there are
several ways that counseling psychologists can deal with these jurisdictional
issues. Unless licensure procedures are simplified to make licensure transfers
across states easier, it is best for a counseling psychologist to deliver mental
and behavioral health services only in states in which he or she holds a pro-
fessional license. If counseling psychologists wish to broaden the scope of
their online practices, it is advisable to obtain a license in neighboring states
or from states that have simple procedures to transfer licensure. Although
this may be cumbersome, it is a legal way to broaden the scope of a counsel-

ing psychologist’s practice to encompass more area and potentially more cli-
ents. Counseling psychologists can also get involved in a growing movement
to make clinical licensure transferable and valid in all 50 states. For example,
the National Register of Health Care Providers in Psychology (http://
www.nationalregister.org/mobility.htm) is working toward reciprocity,
meaning that one state would immediately recognize another state’s license
as valid. In essence, this movement would turn a counseling psychologist’s
practicing license into something similar to a driver’s license, which is valid
across state lines. Another organization working toward licensure mobility is
the Association of State and Provincial Psychology Boards (ASPPB; http://
www.asppb.org), which offers services to assist and facilitate licensure
mobility for doctoral-level psychologists. For example, a counseling psy-
chologist could earn a Certificate of Professional Qualification in Psychol-
ogy, which is based on the psychologist’s meeting core licensure criteria, and
thereby not be required to document it over again each time he or she moves
or practices in a new state or province. There is also the ASPPB Agreement of
Reciprocity, which is based on participating states or provinces conforming
their licensure requirements to the agreement’s standards and accepting each
other’s licenses. Thus far, the following states and provinces have agreed to
reciprocity: Arkansas, Kentucky, Manitoba, Mississippi, Missouri, Nevada,
New Hampshire, Oklahoma, Ontario, Texas, and Wisconsin. Two other
states (Nebraska and Oregon) are in the process of making similar legislative
changes to join the ASPPB. Until these jurisdictional and scope-of-practice
issues are cleared, however, we recommend that counseling psychologists
limit the scope of their practice to the state or states in which they hold a
license.
Confidentiality
Another problematic ethical issue related to online counseling is main-
taining confidentiality (APA Ethics Code 4.01). For instance, to conduct
online sessions through synchronous chat or asynchronous e-mail, a coun-
seling psychologist must take steps to limit the risk of a third party’s receiv-
ing or stealing the information shared during an online session. The most
common security step is to use encryption to safeguard the data transfer when
communicating to a client. The process of encryption can be accomplished in
multiple ways, with different products and programs available, and with
varying levels of protection (Zack, 2004). We refer the reader to Stein (1997)
and Garfinkel (2002) for more extensive guides on using encryption devices.
A counseling psychologist should also inform clients that he or she can only
protect their confidentiality to a certain degree and discuss the limits of confi-
dentiality (APA Ethics Code 4.02). For example, a counseling psychologist

should educate the client about possible ways another person could view
messages sent from a computer, especially if the client decides to save an
electronic or paper copy of the sessions’ transcripts. Another factor that must
be taken into consideration is the Health Insurance Portability and Account-
ability Act (HIPAA), which was signed in August 1996. The act was
designed to protect citizens and to streamline the transmission of health care
information with regard to privacy and security. Counseling psychologists
who meet with clients online may need to ensure that their practices and
record keeping are compliant with HIPAA regulations (for more information
about HIPAA regulations and standards, see http://www.hipaa.org and http://
www.hhs.gov/ocr/hipaa/).
Record Keeping
Another issue surrounding confidentiality, specific to online counseling,

is the ease with which one can save what transpires during a therapy session.
Either the counseling psychologist or the client could save transcripts from
synchronous-chat sessions or from asynchronous e-mails to have an accurate
log of what transpired. This has both potential benefits and negative out-
comes. It could be beneficial for a counseling psychologist to have an accu-
rate account of what occurred with a client to refer back to when developing
future treatment plans. For instance, counseling psychologists could choose
to include full-length session transcripts from synchronous-chat sessions or
copies of e-mail communications (APA Ethics Code 6.01, 6.02). This may
allow counseling psychologists to make sure that they are focusing on client
strengths and assessing how much growth has occurred during the course of
treatment. In addition, it may also have potential benefits for the client to
reflect on important statements generated in counseling and to facilitate
further work on the material independently.
There are also several risks associated with saving transcripts. Most
important, if the client or the counseling psychologist decides to save the
messages, then another person might be able to retrieve them. As such, the
counseling psychologist should inform the client about the potential benefits
and confidentiality risks associated with either party’s having a transcript of
the sessions or discussions. In addition, if a counseling psychologist were
planning to save transcripts from synchronous-chat sessions or from asyn-
chronous e-mails, he or she should inform the client of this practice and gain
consent in a fashion similar to that required for videotaping and saving FtF
sessions (APA Ethics Code 4.03).
Use of Information
The ability to store what transpires between the counseling psychologist

and the client also raises the issue of how this information is used. While it is
possible for the counseling psychologist to review entire session logs to mon-
itor a client’s development, the client or someone related to the client could
also use the transcripts in a legal proceeding. To better illustrate this idea,
imagine that a husband is experiencing marital strife and seeks online coun-
seling. In the example, the counseling psychologist cautions the husband
about the possibility that his wife and family may be able to access the tran-
scripts of the counseling sessions if he saved them to the computer. There-
fore, instead of saving the transcripts on the computer, he decides to save
them on a removable disk and stores them in a safe. The man meets with a
counseling psychologist for 6 months and decides to become more assertive
with his wife as a result of his interactions and explorations during his online-
counseling sessions. Saved within the transcript during one of the final ses-
sions is the following comment from the counseling psychologist: “I have
really felt how hard you have worked over the past few months. It seems like
you are making the right decision in becoming more assertive and standing
up for yourself. I can tell that you have excellent qualities and it seems like
you would make a great partner in a relationship.” At first glance, the com-
ment appears to be typical intervention that combines empathy, reassurance,
and self-disclosure. The therapeutic relationship is successfully terminated 2
weeks later. Then, after 2 months, the therapist receives an irate message
from the man’s wife who has discovered the transcripts, complaining that the
therapist has ruined their marriage. The counseling psychologist’s comment,
in the context of a therapy session, might be considered a demonstration of
empathy and support, but months or even years later, it could be interpreted
differently in court during a sexual harassment suit (APA Ethics Code 3.02,
10.05) or during a divorce or child custody suit. With a saved transcript, it
may be possible for lawyers to use quotes out of context in a trial without
needing to question or to have the counseling psychologist present. Thus,
someone could even use the statements from the transcripts without the coun-
seling psychologist’s knowledge. As can be seen in this example, the
potential for misunderstandings and legal complications is increased when
full-length transcripts of sessions are available for later review.
The above example shows how new technologies can lead to the need for
counseling psychologists to take new precautions to safeguard a client’s con-
fidentiality and safety, both during counseling and in the future. It also dem-
onstrates that counseling psychologists need to protect themselves from pos-
sible legal actions or misinterpretations of their comments at a later date.
Counseling psychologists can minimize these potential ethical and legal

dilemmas by forming a common agreement with precise language in an
informed-consent document (see the appendix). The process of informed
consent can be replicated in online counseling and can be updated to include
policies in regard to what might happen in situations like the above example.
Counseling psychologists should continue to adhere to standard ethical
codes regarding careful documentation (Mitchell, 2001), supervision (Good-
year & Guzzardo, 2000; Larsen, 1998), and consultation (Arredondo,
Shealy, Neale, & Winfrey, 2004) when ethical or legal dilemmas do arise.
Marketing
Approaches to marketing online services have been discussed (Kraus &
Zack, 2004), but there are not yet strong guidelines for counseling psycholo-
gists looking to extend their practices online. Current APA ethical standards
(APA Ethics Codes 5.01-5.06) provide guidelines for the advertisement of
psychological services, in general, but few professional organizations have
released statements or guidelines on attracting clients to online or FtF coun-
seling (Loane & Wootton, 2002; Rochlen & Hoyer, 2005). Yet several ethical
issues should be considered when marketing counseling services online.
First, if a counseling psychologist designs a Web site and advertises his or her
services, then anyone around the world can access that page, which again
brings up possible jurisdictional conflicts. As such, it may be important to
clearly identify in what areas the therapist is licensed to provide services.
Counseling psychologists should clearly define the scope of their practice
and their competencies so that clients can make informed decisions about
whether to pursue online-counseling services. Second, counseling psycholo-
gists who choose to advertise their online services should inform potential
clients about the possible limitations of online treatment, such as the lack of
nonverbal cues, slower transmission of discourse, and technical difficulties
or glitches. It is important to provide this information for a potential client to
make an informed decision to enter counseling.
At this point, counseling psychologists cannot provide clear evidence to
potential clients about what types of online services may be effective or for
whom. Any type of marketing campaign promoting the online delivery of
mental and behavioral health services should address this shortcoming. As
discussed in the previous article (Mallen, Vogel, Rochlen, & Day, 2005 [this
issue]), research has demonstrated that clients are satisfied with online ser-
vices and have demonstrated a reduction in symptoms in some studies. Popu-
lations that seem well suited for online counseling would appear to be those
in rural areas or those that otherwise do not have access to continual FtF
encounters with a counseling psychologist. Although clear answers about

online counseling’s effectiveness are not available, counseling psychologists
can still inform potential clients about the scope of their practice and clinical
services.
For direction regarding the type of information that should be provided to
clients through marketing, counseling psychologists can work from a foun-
dation of research that has investigated the information that consumers and
clinicians value in advertising. In a study of clinical Web pages, Palmiter and
Renjilian (2003) noted that mental health professionals and potential con-
sumers considered several content areas essential for Web page advertise-
ments. Specifically, consumers wanted to see a professional’s degree or
licensure information, hours of availability, list of problems treated, list of
therapies offered, years of experience, insurances accepted, educational
background, fee scale, emergency procedures, description of policies, and
general information on therapy. In addition, it was found that a resumé, a pic-
ture of the clinician, and a link to other sources of self-help information were
desirable. Counseling psychologists should consider these consumer
demands if they are interested in branching out their services to include
online modes of treatment and in creating a Web site to market their services.
Not surprisingly, the authors found important differences between clinician
and consumer attitudes regarding clinical Web pages. For example, 80% of
consumers, but only 47% of clinicians, reported that clinical Web pages were
“very helpful” to consumers. In addition, consumers endorsed 22 key content
areas (i.e., years of experience, hours of availability, resumé, etc.) more
strongly than did clinicians, indicating that consumers find these pieces of
information more ideal and essential than do clinicians.
The results indicate that consumers value mental and behavioral health
Web pages more than do clinicians. This result closely parallels findings
from the previous article (Mallen et al., 2005), that patients were consistently
more satisfied with online-counseling services than therapists were. This
early trend in the research findings indicates that consumers may be more
willing to accept the new modes of service delivery than professionals are.
Research has also demonstrated that consumers with more experience visit-
ing clinical Web pages have higher expectations for content than those with-
out previous experience. This indicates that experienced consumers are more
demanding and savvier. As more individuals access mental and behavioral
health Web pages (Harris Interactive, 2002), counseling psychologists
should be prepared to meet the expectations. We discuss a more detailed
description of starting an online-counseling service in a later section on
technological issues.
TRAINING ISSUES FOR COUNSELING PSYCHOLOGISTS
Clearly, not all counseling psychologists have an interest in providing

online services, with trainees and practicing counseling psychologists being
likely to express differences in attitudes toward using this service. Hence, one
important factor in the selection of trainees—to initiate such practices or even
to participate in research on the topic—would be their overall desire to partic-
ipate in online-counseling work. If trainees are resistant to the notion of
online counseling, then it is likely that they will not be able to work effec-
tively in this environment. For those interested in providing online services,
an important challenge involves how to train and supervise this type of work.
The following section discusses the education and training issues involved in
providing online-counseling services.
Computer-Mediated Communication Competency

Although a counseling psychologist may be extremely skilled in FtF ther-
apy, he or she may not be able to successfully transfer these skills to an online
environment. To effectively deliver online mental and behavioral health ser-
vices, it is vital to gain experience in the necessary communication technolo-
gies. It would not be wise for a practitioner to conduct online sessions
through synchronous chat if he or she were unfamiliar with the technology.
As will be illustrated later during a discussion of a synchronous-chat session,
there are many nuances to fully understanding text-based communication.
Individuals more experienced with synchronous chat can assess and relate
more depth in the messages transmitted back and forth during the conversa-
tion. As with other new technologies or advancements, the most effective
way to gain experience is to practice using the hardware and the software. For
instance, if a counseling psychologist has never entered a chat room, he or
she could use an Internet service provider (e.g., America Online) to log into a
chat room and see how communication is accomplished. If a counseling psy-
chologist is thinking about delivering online services but is uncomfortable
with the technologies involved, structured courses in using computer hard-
ware and software are typically available at local community centers or col-
leges and through Internet services and readily accessible self-help guides
such as The Internet for Dummies (Levine, Levine-Young, & Baroudi, 2003)
and The Complete Idiot’s Guide to the Internet (Kent, 2001). These courses
often provide instruction about the basics of personal computing, including
the skills required to successfully navigate the Internet, download and upload
files, and use e-mail.
There are also several measures available for assessing one’s computer-
mediated communication (CMC) competency or experience (e.g., Potosky &
Bobko, 1998; Torkzadeh, Koufteros, & Pflughoeft, 2003; Torkzadeh,
Pflughoeft, & Hall, 1999). An example of a computer-efficacy measure is the
Computer Understanding and Experience Scale (CUE; Potosky & Bobko,
1998). The CUE consists of twelve 5-point Likert-type items, which ask par-
ticipants to rate their knowledge of various uses of computers, the extent to
which they use computers for various functions, and how good they perceive
themselves to be at using computers. Smith, Caputi, Crittenden, Jayasuriya,
and Rawstone (1999) indicated in a review that computer experience is posi-
tively correlated with attitudes toward computers as well as computer use.
Research has also found computer experience to be negatively correlated
with anxiety toward computers. Measures of CMC competency can be bene-
ficial in training counseling psychologists as they begin to use CMC technol-
ogies for delivering counseling services. If counseling psychologists were
found to be deficient in an area of CMC, they could become knowledgeable
and accustomed to the technology before using it with a client.
Counseling psychologists interested in providing online-counseling ser-
vices may also need to practice how to communicate effectively through text-
based asynchronous e-mail and synchronous chat. For example, a therapist
may be very skilled in verbalizing empathy during FtF sessions; however,
text-based online counseling renders those verbalizations irrelevant unless
they can be communicated through the text-based program. The therapist
must learn to adapt, or the working alliance and outcome of the session could
be negatively impacted. In FtF sessions, a counseling psychologist can use
body language to communicate emotion and understanding, but he or she
must translate this communication into text. Therefore, counseling psycholo-
gists would benefit not only from gaining experience with CMC technologies
and with general typing skills but also from becoming more educated about
writing. It is very likely that counseling psychologists who are capable of
crafting words and sentences coherently will be more effective than thera-
pists who struggle with writing when meeting with clients online through
text-based programs. As a result, much like how therapists learn to effec-
tively respond to clients in FtF settings through repeated practice and super-
vision, counseling psychologists interested in providing online services may
need to practice responding to clients in online environments and to receive
feedback and supervision about not only the clarity of the these interventions
but also the depth of empathy communicated in the statements. Because
research exploring how empathy is experienced in an online environment is
minimal, counseling psychologists would do well to check with their clients
to determine if the empathy is coming through the text-based messages.
Education and Supervision
Counseling psychologists are trained through graduate course work,

supervised practica, and internship to work with clients in an FtF setting.
Other texts have described the essential skills and techniques for counseling
psychologists in FtF counseling, and we refer the reader to those texts for a
more in-depth review of counseling skills and theories (e.g., Day, 2004;
Gelso & Fretz, 2000; Hill & O’Brien, 2004; Ivey & Ivey, 2003). The same
type of training is needed if counseling psychologists are going to work with
clients in an online environment. Although many of the skills required to con-
duct online counseling may be similar to FtF skills, counseling trainees will
need to be informed of the special issues involved in online counseling and be
supervised while they are learning the necessary skills. For example, coun-
seling psychologists may need training on how to accurately assess clients
and how to provide a nurturing environment and establish a working alliance
without the aid of nonverbal cues. Typically, counseling psychologists use
verbal minimal encouragers (e.g., “mmm hmm,” “yes,” “okay”) and nonver-
bal gestures to show support and understanding and to encourage clients to
continue exploring their concerns. These interventions are potentially lost in
text-based chat, and counseling psychologists must be trained on how to
replicate these intentions in a text-based environment.
An example of this type of training would be for therapists to become
more overt in communicating empathy. This may be accomplished in several
ways through text-based communication. First, counseling psychologists
could simply type their emotional reactions as clients present their issues and
concerns with messages such as “That must be such a loss. I feel sad for you”
or “Wow, I can’t believe the week you had!” Although this approach may
seem cumbersome and awkward, clients would have no way of ascertaining
the reactions of their therapist without these types of comments. A second
option available in text-based communication is to use emoticons in the mes-
sages. Emoticons, which is short for emotion icons (Walther & D’Addario,
2001; Wolf, 2000), are often used in the text-based online communication to
convey feelings or to demonstrate facial expressions, such as smiles or
frowns. Other examples of emoticons would be “:-(” to indicate a frown or
sadness or “;-)” to indicate a wink or sarcasm. Instead of typing, “I feel very
sad for you,” a counseling psychologist could type :-( to indicate sadness.
Although it is possible to convey certain emotions through these symbols,
they can be limiting and should not be solely relied on to communicate feel-
ings. Emoticons may be too simplistic, and the development of a therapeutic
relationship cannot be established with just a few smile icons. The relation-
ship between a counseling psychologist and a client is complex, and
emoticon use may not be able to communicate the complexities of empathy
and understanding during the course of a session. For example, the :-)
emoticon could indicate happiness, but it may not truly mean that the client is
smiling while he or she is typing the message. The :-) emoticon may be simi-
lar to certain rote phrases or gestures in FtF communication. Many times
throughout the day, individuals ask “How are you doing?” to each other. It is
not a true question but really another way to say “Hello.” Emoticons may
become overused in a similar way, and counseling psychologists are encour-
aged to discuss these nuances of online communication with their clients
because each client will or will not use them in their own unique way.
A third option would be for counseling psychologists to describe their
nonverbal reactions to the client. Examples of this technique would include
“As I was reading your last message, my whole body tensed up” and “I have
been smiling for the last few minutes because it seems like you feel you are
overcoming your fears.” Any of these methods can be used in conjunction,
and although they may seem clumsy at first, with practice they may be able to
convey the necessary support and empathy to form a therapeutic environment.
One problem with educating and supervising counseling psychologists to
work in an online environment is that there are few counseling psychologists
trained to provide quality supervision in this area. Put another way, there are
still few counseling psychologists who themselves have much experience
conducting online sessions; so providing supervision to other counseling
psychologists is inherently difficult. In addition, graduate course work and
advanced practica, at this point, do not account for online counseling in
their training. However, professional training in conducting online coun-
seling is becoming available through online workshops (e.g., http://www
.etherapytraining.com), and several recent books propose standards for
online service delivery (Hsiung, 2002; Kraus, Zack, & Stricker, 2004). In
addition, there are professional communities active in the development of a
standard of care for delivering online-counseling services. For one, the Inter-
national Society for Mental Health Online (ISMHO) was formed in 1997 to
promote the understanding, use, and development of online communication,
information, and technology for the international mental health community
(http://www.ismho.org). Through a clinical case-study group, therapists
around the world have consulted with one another to share their experiences
of working with clients online (Suler, 2001). Increasingly, resources are
becoming available to educate professionals interested in providing online
services, such as handbooks (Kraus et al., 2004) and special issues in profes-
sional publications (e.g., Journal of Clinical Psychology and Professional
Psychology, Psychotherapy: Theory, Research, Training, Practice), which
offer information about the practical aspects of conducting clinical work
online, commentary about ethical considerations, and research articles
related to service delivery through new technologies.
In addition, to facilitate the development of a trainee’s online-counseling

skills, Oravec (2000) stated that supervisors should encourage supervisees to
gain experience in various online interactions on an informal basis. Direct
supervision could facilitate the exploration into online interactions if the
supervisor and the supervisee are comfortable meeting online and in FtF ses-
sions. Oravec also stated that supervisors can model the new technologies by
using them in supervision. Klitzke and Lombardo (1991) offered an example
of a form of online supervision and described a technique of using a
teleprompter to cue trainees about interventions and skills while in session
with a client.
While questions remain, there are several options available for supervis-
ing online-counseling work. First, supervisors in counseling psychology
should hold to FtF standards regarding supervision. Trainees should be ready
to discuss the client’s issues as well as their own reactions to working with the
client. Trainees should keep professional records about each online session
they conduct, which can be reviewed by the supervisor. In addition to typical
case notes, supervisors should also have access to the full-length transcripts
of text-based counseling sessions. Similar to watching videotapes of FtF
counseling sessions, supervisors can identify certain areas of a session and
discuss the interventions that the trainee used. From that point, suggestions can
be made regarding any feedback that may typically be provided in a supervi-
sion context (i.e., addressing skills, theory integration, countertransference,
etc.). Supervisors should be extremely vigilant regarding assessment and
should direct trainees to continue monitoring their clients’functioning. With-
out the assistance of nonverbal cues, it may be difficult to assess that a client
is spiraling downward during a synchronous-chat session; so trainees should
be instructed to ask direct and specific questions of the client. Trainees are
instructed to continuously assess their clients in FtF sessions, but assessment
may take on even more importance in online-counseling sessions. These sug-
gestions are offered with the assumption that the supervisor and the trainee
are in the same location; online-counseling supervision becomes even more
complicated if the supervisor and the trainee are also meeting online.
Providing online supervision is rare, and few counseling psychologists
have experience conducting supervision sessions through CMC. A limited
number of faculty in APA-accredited counseling psychology programs iden-
tify online counseling as a research interest, and few APA-accredited intern-
ship sites offer an online-counseling specialization. Certain limitations of
text-based online-counseling sessions have previously been mentioned, and
these limitations also affect online supervision (Kanz, 2001). Supervisors
will be unable to read the trainee and may miss nonverbal signs of nervous-
ness, anxiety, or frustration, which could lead to valuable learning opportuni-
ties for the trainee. A second complication is that an online supervisor may
not be available if a crisis takes place or if immediate consultation is desired.

Because a supervisor is ultimately responsible and liable for the care of the
client, it seems dangerous to supervise trainees from a distance. A third issue
is that the relationship formation between the supervisor and the trainee may
require more time to develop than in traditional FtF supervision. Similar to
how therapists will need to be more overt about checking with their clients on
the session’s emotional content, supervisors will also need to be more overt
about the process of their relationship with the trainee. Issues such as trainee
resistance may be difficult to detect, and a working alliance could be ham-
pered by these and other complications. Online supervision requires docu-
ments to be sent back and forth through e-mail, fax, or postal mail; supervi-
sors must sign trainees’ case notes, and this constant flow of documents can
become confusing and cumbersome. Clients will also need to be made aware
of the nature of the online supervision and to sign a consent form agreeing to
the practice. Because the provision of online counseling remains in its
infancy, the leap to online supervision is even more daunting and should be
approached deliberately. Supervisors, trainees, and clients should be made
aware of policies and procedures, for example, in the case of an emergency or
a crisis.
To review, proper online-counseling supervision would include the
following:
• Supervisors should encourage supervisees to gain experience in various online

interactions, including asynchronous e-mail, synchronous chat, and video-
conferencing;
• Supervisors should continue to emphasize FtF standards on clinical work;
• Supervisors should educate trainees regarding the unique ethical and legal
issues detailed in this article, which are associated with delivering online
counseling;
• Trainees should be ready to discuss the client’s issues as well as their own reac-
tions to working with the client online;
• Trainees should keep professional records about each online session they con-
duct, which can be reviewed by the supervisor;
• Supervisors should also have access to the full-length transcripts of text-based
counseling sessions, which can be used to specifically identify certain portions
of a session and to discuss the interventions that the trainee used;
• Supervisors should be extremely vigilant regarding assessment and should
ensure that trainees are thorough in this domain; and
• Trainees should be instructed to continuously assess their clients in online ses-
sions and be aware that assessment may take on even more importance because
of the lack of contextual and nonverbal cues.
Cultural Conditions
The field of counseling psychology has emphasized multicultural compe-

tency throughout course work, practica, internship, and continuing education
and remains a leader in addressing cultural considerations in psychotherapy.
During the 2004 convention of the APA, Dr. Derald Wing Sue, president of
Division 17, focused exclusively on cultural issues and racism during his
presidential address, indicating that multicultural competence (APA, 2003;
Arredondo et al., 1996; Sue, Arredondo, & McDavis, 1992; Sue et al., 1982,
1998) and social justice (Arredondo & Perez, 2003; Helms, 2003; Sue, 2001;
Vera & Speight, 2003) should be at the forefront of counseling psychology.
He began his speech by stating, “First, counseling psychology has been in the
forefront in the development of multicultural competence and has a long his-
tory with respect to defining characteristics of the culturally competent help-
ing professional” (Sue, 2005, p. 101). His speech on how racism is still preva-
lent and pervasive in our society and the call to action that he voiced were
passionate and were met with a standing ovation from members of the Soci-
ety of Counseling Psychology. There are various models of multicultural
counseling available, including the cross-cultural counseling competency
model (Sue et al., 1982; Sue & Sue, 2003) and the racial identity development
model (Helms, 1984, 1990), which have been present in the literature since
the early 1980s (Ponterotto, Fuertes, & Chen, 2000). Multiculturalism has
become a defining core component for counseling psychologists who pro-
vide mental and behavioral health services. It is, therefore, important for
counseling psychologists working in an online environment to continue to
apply our knowledge of multicultural issues and to explore how online coun-
seling can accommodate counseling psychologists’ desire to realize the
importance of how clients live in their cultural reality and how their cultural
backgrounds may be interacting with their presenting concerns.
At this point in time, little is known about multicultural issues as they
relate to online counseling. However, online counseling would seem to pres-
ent unique challenges regarding the implementation of multicultural compe-
tencies. In text-based e-mail or chat, visual cues of obvious cultural differ-
ences such as skin color, language, age, and all other surface-level
appearance indicators are not available, which means that initial impressions
during online counseling are not influenced by these visual cues. While this
may have the positive benefit of helping a counseling psychologist not make
assumptions about the client based only on demographic data, it could also
have the reverse effect and actually increase the reliance on stereotypical
information. As a result, it is currently unknown whether an online environ-
ment could help clients to feel more comfortable because they would not feel
immediately judged by their appearance or whether they would feel less
understood because the cultural context is more difficult to comprehend

online.
Some examples illustrate these possibilities. A client who uses English as
a second language may have a difficult time writing sentences in an online
environment. A counseling psychologist may be tempted, if he or she did not
know the client was typing in a second language, to make negative judgments
about the client or his or her abilities. For example, the therapist may errone-
ously interpret the client’s mistyped comments as a demonstration of poor
intellect or lack of commitment to the session. This difficulty in writing could
also be interpreted as higher levels of anxiety, which may be interfering with
the client’s ability to communicate. In either case, the client’s true message
may be lost because the uncommon text messages might distract the counsel-
ing psychologist. As a result, the relationship between a counseling psychol-
ogist and a client may become strained and lead to the client’s feeling even
more embarrassed or isolated. Counseling psychologists can minimize the
possibility of misunderstandings by checking with their clients to determine
if they are anxious or communicating in a language in which they are not pro-
ficient or by recognizing that many clients will be unaccustomed to online
communication. In addition, counseling psychologists should rely on meth-
ods that have been effective in FtF sessions, such as informing the client that
culture is an appropriate topic for discussion and initiating conversations of
cultural difference with clients who may be hesitant to bring up such
differences.
These new modes of service delivery may allow for some novel research
methods and strategies for studying multicultural issues. At this point in time,
the potential advantages and disadvantages of online counseling as it relates
to working with multicultural clients are unknown. However, we do know
through research that certain cultural populations underutilize mental and
behavioral health services. As a result, online counseling may be an avenue
for reaching out to populations that typically avoid FtF treatments.
An online environment may also bring up unique multicultural issues for a
counseling psychologist conducting online counseling. An example of this
comes from a Mallen and Vogel (2002) study in which therapists-in-training
were connected with clients who were portrayed by confederates, but this
deception was not revealed until after the study. As far as the therapists-in-
training knew, they were working with a genuine client; so their behaviors
during the session and attitudes immediately after the session are informa-
tive. Several of the therapists-in-training were international students. After
the synchronous-chat session, participants were asked about their experience
through the chat program. The following quote obtained through synchronous
chat is from one of the participants:
Here’s one advantage of online counseling that’s probably unique to me—I’m

not an American, I’m an international student from Singapore. Although Eng-
lish is my native language, I don’t usually speak with an American accent, so it
requires additional effort when I talk to Americans because I have to mentally
translate what I say from my Singaporean/British accent to an American
accent. Of course I don’t have this problem in an online counseling session and
I can focus on the counseling.
The above quote is from only one counseling psychologist who was still
involved in training, and it may be that more experienced counseling psy-
chologists would not be as anxious or self-conscious about their verbal pre-
sentation to a client. However, it demonstrates that online counseling may
facilitate less anxiety regarding surface-level differences and more
concentration on clinical work.
An area that is also wide open for future research is the degree to which
people from various cultures and different parts of the world would be inter-
ested in seeking out online-counseling services. Help-seeking behaviors, pri-
vacy needs, and communication patterns are factors that could determine a
person’s interest in pursuing online-counseling services (e.g., Sue & Sue,
2003), but individuals from traditionally poorer cultures may not have access
to the necessary technology to use online mental and behavioral health ser-
vices. The following section discusses the potential struggles of individuals
who may not have the ability or knowledge to use CMC technologies.
Access
Online counseling also brings up other questions related to cultural condi-

tions beyond the potential to discern cultural factors during a counseling ses-
sion. In an increasingly mobile world, online counseling may provide coun-
seling psychologists with the ability to keep in touch with clients who
normally would be lost because they move or relocate. For example, students
moving away to college and individuals working in businesses who travel
frequently would be able to stay in contact with their therapists from home
instead of finding new ones. International students could continue to see a
counseling psychologist from their native countries, or a woman from the
East Coast who frequently travels for business could continue to meet with
her therapist from home. These possibilities again bring up jurisdictional
complications yet to be clarified, but the options for treating culturally
diverse clients may expand. Another possibility is that clients in rural areas
would have an increasing number of treatment options, including meeting
with a counseling psychologist online who might have greater knowledge
about the client’s specific needs compared with FtF options in the commu-
nity. In certain rural areas, the lack of professionals that can provide mental
health and behavioral services is a real crisis, and new technologies may
allow counseling psychologists to extend their services to these underserved
locations.
These examples illustrate how online counseling could service counsel-
ing psychology’s charge to improve services to underserved populations.
Yet, although computer technology is decreasing in price each year, it is still
primarily the more educated, young, and affluent who take advantage of the
Internet, which excludes impoverished, potentially older, or less affluent
populations from these services. Clients who pursue FtF counseling must
have the means to pay for the professional services, through personal
finances, insurance, or Medicare. Online counseling also requires that the cli-
ent have a home computer and an Internet connection that will allow him or
her to communicate with the therapist. The term digital divide (Hoffman,
Novak, & Schlosser, 2000) has been used to describe the cultural bias inher-
ent in access to the Internet and all the information and services that exist
online. For example, recent statistics indicate that only 2% of Internet users
are African Americans, who make up close to 13% of the general population
(Hoffman et al., 2000). Projections estimate that African Americans will rep-
resent 15.4% of the population in the United States by 2050. If their rate of
Internet participation does not change, 58 million of 60 million African
Americans will not be online by 2050 (Harvey, 2004). To combat this, efforts
may need to be made to increase underserved populations’ access to new
technologies such as establishing technology centers in low-income neigh-
borhoods. However, it is not only a matter of access to the technology, but the
digital divide also speaks to the lack of awareness of how the Internet can be
used successfully. For example, research has suggested that individuals from
low-income backgrounds may not even be aware of the amount of services
and information that can be accessed on the Internet (O’Bryant, 2004). As
access to online counseling grows, counseling psychologists must remember
to remain committed to providing services to the disenfranchised (e.g.,
Brammer et al., 1988; Pearson, 2003).
Older generations are another population that may not have immediate
access to computer technology. Computer technology, especially CMC such
as asynchronous e-mail, synchronous chat, and videoconferencing, is a rela-
tively new development, and most generations have spent the majority of
their lives without these services. Although research has demonstrated that
older adults can learn computer skills through effective training programs
(Blit-Cohen & Litwin, 2004), some older clients and counseling psycholo-
gists may not display as much comfort with CMC as do younger adults, ado-
lescents, and children who have grown up with this technology (Selwyn,
2004). Research has demonstrated that older individuals (aged 61-80 years)
report less confidence in their computing skills (Marquié, Jourdan-Boddaert,
& Huet, 2002) and demonstrate lower performance than do young individu-
als (aged 18-39 years) in using an online library database (Mead, Sit, Rogers,
Jamieson, & Rousseau, 2000). Results from another line of research (Echt,
Morrell, & Park, 1998) indicate that young-old adults (aged 60-74 years)
demonstrated fewer performance and motor control errors than do old-old
adults (aged 75-89 years). CMC technologies typically require fine motor
movements, including typing on a keyboard and successfully using a mouse.
There are technologies that allow for voice-activated, keyboard-control
functions, and videoconferencing eliminates some of the fine motor require-
ments of CMC, but older adults may be unable to use such new modes of
treatment. It is also possible that older adults will not trust new modes of ser-
vice delivery because they are not as comfortable or familiar with the tech-
nologies involved. Therefore, a potential generational gap exists that coun-
seling psychologists should be aware of as mental and behavioral health
services delivered through new modes become more commonplace. Further-
more, counseling psychologists interested in providing online-counseling
services should not overlook older adults as they work for social justice and
increased technological access.
TECHNOLOGICAL ISSUES FOR COUNSELING

PSYCHOLOGISTS
It is equally important to consider technological issues related to the

practie of online counseling. Various distance-communication technologies
have been used to provide mental health services, and each presents unique
dynamics, strengths, and weaknesses (Zack, 2004). The two most promising
avenues for online counseling involve videoconferencing and synchronous
chat. As such, we will describe these technologies in more detail. Video-
conferencing allows the transmission of audio and visual information, which
bolsters the amount of information a counseling psychologist can receive
from a client during a session. Instead of merely relying on textual informa-
tion, a counseling psychologist can also attend to nonverbal cues, such as
facial expressions and speech tone.
Videoconferencing technology has been used to serve the families of
emotionally disturbed children (Zipper, Broughton, & Behar, 2000) and
teenagers with seizure disorders (Glueckauf et al., 2002; Glueckauf, Pickett,
Ketterson, Loomis, & Rozensky, 2003; Hufford, Glueckauf, & Webb, 1999;
Liss, Glueckauf, & Ecklund-Johnson, 2002), to serve psychiatric patients
(Dongier, Tempier, Lalinec-Michaud, & Meuneir, 1986; Stevens, Doidge,
Goldbloom, Voore, & Farewell, 1999), as well as to conduct neuropsychological
assessment interviews (Clement, Brooks, Dean, & Galaz, 2001; Schopp,
Johnstone, & Merrell, 2000). Research on videoconferencing as a mode of

service delivery has demonstrated that clients respond favorably to treatment
and report fewer symptoms (Mallen et al., 2005). Although videoconferencing
technology is becoming more affordable and has been shown to have poten-
tial for service delivery, it has yet to pervade the marketplace to the same
extent as e-mail and synchronous chat.
Synchronous chat is available through numerous programs, including
America Online Instant Messenger (AOL AIM), Microsoft Network (MSN),
Yahoo! Messenger, and “I Seek You” (ICQ). Synchronous chat is similar to
e-mail except that both individuals communicate at the same time rather than
wait for messages to transmit back and forth. For instance, if a message is
typed into a chat window and sent, it instantaneously appears on the screen of
the other user, who can respond to the message immediately. Research on
using synchronous chat and related technologies have focused primarily on
Internet support groups (see Braithwaite, Waldron, & Finn, 1999; Bresnahan
& Murray-Johnson, 2002; Chang, Yeh, & Krumboltz, 2001; Finn, 1999;
Meier, 2000; Sharf, 1997; Shaw, McTavish, Hawkins, Gustafson, & Pingree,
2000). Research has demonstrated that synchronous-chat group therapy for
chronically ill individuals suffering from loneliness is effective compared
with a wait-list control group (Hopps, Pepin, & Boisvert, 2003). Research
has also shown that this mode of treatment reduces clients’ symptoms related
to anxiety after one semistructured session (Cohen & Kerr, 1998).
Costs and Promotion

The following discussion of the costs associated with starting and promot-
ing online-counseling services has been assisted by the work of Zack (2004)
and Kraus and Zack (2004). Of the various technologies mentioned that can
be used to support online counseling, videoconferencing may be the most
similar to FtF treatment. Therapists who wish to communicate with clients
through videoconferencing will first need a videoconferencing program,
such as NetMeeting, VideoChat, CU-SeeMe, and iVisit. Although the most
expensive option, videoconferencing can still be implemented for less than
$200 with the purchase of a webcam (available in most electronics stores).
For instance, a webcam on the market now is less than $150 and provides
Video Graphics Array–quality resolution (640 × 480 pixels) at up to 10
frames per second, which is ideal for videoconferencing. This webcam can
be connected to a desktop computer that is connected to the Internet, which
will allow the therapist to transmit his or her image and voice to the client.
Videoconferencing systems can be much more expensive (i.e., more than
$1,000) if therapists want higher-quality hardware or software. For clinical
purposes, however, regardless of the system, the client would also have to
possess the same videoconferencing program. Because the general public

has not widely adopted videoconferencing programs, online-counseling ses-
sions mediated through videoconferencing are still quite rare. The cost of
developing a videoconferencing component to a practice may not be that pro-
hibitive for counseling psychologists. The fact that very few clients have
access to the software and hardware required to use videoconferencing is
more of a detriment to starting an online-counseling practice based on this
technology.
An easier and more cost-effective technology that can facilitate online-
counseling sessions is synchronous chat. Therapists who wish to communi-
cate with clients through real-time text chat need to acquire a chat program,
such as the ones already mentioned—AOL AIM, Yahoo!, MSN, and ICQ—
which are typically free to download. The therapist will again need a desktop
computer connected to the Internet, but the chat programs are free of charge
and quick to download and install. These programs also allow the therapist
and client to save session transcripts, which can then be reviewed after the
session has concluded or in future sessions to access a client’s progress dur-
ing treatment. Besides the free chat programs available, therapists can also
choose from more expensive, Web-based systems such as LivePerson, which
would enable them to interact with clients online in a secure, real-time envi-
ronment. LivePerson offers more security than programs available for free
and can be accessed only by individuals given permission by the counseling
psychologist. For example, if a counseling psychologist were to use AOL
AIM with the screen name DrJones, anyone using AOL would be able to
send a message to DrJones. With a service such as LivePerson, the counsel-
ing psychologist has the ability to control who has access to the chat room.
Another interesting feature is the ability to include exit surveys after the cli-
ent exits the session. Surveys could be used to assess the session’s outcomes
and provide information for practitioners interested in research. These ser-
vices can be incorporated smoothly into an existing Web site; however, they
do come with a price, as it currently costs $99 per month for each individual
to use LivePerson’s services.
Potentially the easiest and least expensive option for using online counsel-
ing would be to exchange e-mails with clients, and this can be done from any
existing e-mail account. This option has the benefit of being accessible to
most counseling psychologists and many potential clients because it is the
most widely used form of CMC. E-mail also allows counseling psychologists
and clients to communicate outside normal business hours. For example, a
client can type a message at 12:30 a.m., when meeting with a counseling psy-
chologist in an office would be impossible. The counseling psychologist can
respond to the message the following day, and this process may provide a
great amount of flexibility in treatment. The downside is that the communica-
tion is not in real time, and issues that a client communicated 2 days earlier
may not be relevant by the time the counseling psychologist responds to the
message. The use of e-mail is also troublesome because clients in crisis will
not receive instantaneous treatment or referrals. If a client is suicidal and
writes this in an e-mail on a Wednesday night, the earliest the counseling psy-
chologist can respond to that message is Thursday morning, which may be
too late. Although e-mail is the least expensive and easiest way to communi-
cate with clients, the limitations can potentially create numerous ethical and
relational problems for counseling psychologists working with clients
through this form of CMC.
Joining an existing network of professionals is another option for thera-
pists interested in providing therapeutic services to clients online. Examples
of online professional networks are HelpHorizons.com, Find-a-Therapist.com,
and OnlineClinics.com. Instead of working to design their own Web sites,
therapists can join one of these companies for a fee and then charge clients for
each e-mail transaction or chat session. For example, HelpHorizons.com
gives therapists access to scheduling, record keeping, automated billing
functions, independent credential verification, and a basic entry in its direc-
tory for $9.95 per month. In addition, each e-mail transaction with a client
costs the therapist $4.00, while each online chat session with a client costs
$8.00. Counseling psychologists can determine if they wish to see clients
only in the state where they are licensed or to open up their services to clients
outside state lines. Although counseling psychologists can decide to conduct
online-counseling sessions with clients outside their jurisdictions, we recom-
mend that therapists meet with clients only in states or provinces where they
hold a license.
Although signing up with an online network is potentially easier than cre-
ating a Web site and online-counseling service from scratch, there are poten-
tial dangers as well. First, it is possible that the network could go out of busi-
ness, which would force therapists and clients to scramble to find alternative
services. Second, each therapist still shoulders liability issues, and joining an
online network may offer a false sense of security for the therapist when it
comes to ethical issues related to providing online counseling services.
Online networks provide an easy option for therapists to begin conducting
online sessions, but therapists should educate themselves about the net-
works’ policies and procedures. Counseling psychologists with a business
background may consider organizing their own such agency to gain more
control over the process of working with clients in an online environment.
Regardless of the mode of service delivery (i.e., asynchronous e-mail,
synchronous chat), counseling psychologists will likely need to advertise
their services online to reach their target audience. In addition, even if a coun-
seling psychologist was not interested in providing online-counseling ser-

vices, he or she may still want to create a Web site to advertise FtF services to
reach more individuals than a typical phone book could. The easiest way to
do this is to create a Web site, which advertises and possibly hosts the clinical
services. To continue with the example of Dr. Jones, let us assume that he
would like to start his own Web site. The first step is to register a domain
name, which is similar to an online phone number. Instead of dialing Dr.
Jones’s office, Internet users can go to DrJones.com, which will transport
them to Dr. Jones’s Web site. For the record, http://www.drjones.com is not
currently a registered Web site, meaning that anyone could buy the rights to
run his or her site through this domain name. Domain names are relatively
cheap to acquire and maintain; usually, prices are around $35 per year. Once
Dr. Jones has the domain name, a Web site must be created and a monthly
fee paid to a Web-hosting service. Additional fees would be required for
the maintenance of the site if greater levels of security were desired.
Because therapists working with clients online would need to gather billing
and confidential information, increased security would be essential to any
online practice. Web sites have a limitless range of creativity and complexity,
and the design, features, and setup will depend on the individual therapist and
the need to meet the ethical issues described previously.
As can be seen by the description of the costs of starting and promoting
online-counseling services, providing online counseling should not be
entered into lightly. While counseling psychologists who would like to offer
services can choose a number of online services for a small investment or
even for free, it can become more expensive if additional features are desired.
In particular, given the ethical issues previously discussed, counseling psy-
chologists would likely need to add security and to limit access to the infor-
mation that is communicated. Videoconferencing is currently the most
expensive form of online counseling, with prices for software and hardware
beginning at more than $100. In all cases, clients must also have access to the
same technology and a desire to pursue online counseling for the treatment
their psychological and behavioral issues.
ONLINE-COUNSELING SKILLS IN SYNCHRONOUS CHAT
It would seem that text-based synchronous chat and asynchronous e-mail

would be the most disorienting for counseling psychologists to adapt to
because nonverbal cues are not present. In a study of more than 500 doctoral-
level psychologists, 98% reported that they used a telephone in their practice.
However, only 2% reported that they used Internet, satellite, or video-
conferencing technologies in their practice (VandenBos & Williams, 2000).

Telephone and videoconferencing technology allow the participants in the
session to attend to vocal and visual cues, which is not possible in the text-
based formats. Because text-based technologies may be the most challenging
to adapt to, our discussion of online-counseling skills focuses on a
synchronous-chat session.
The following transcript is an example of a 50-minute session taken from
a Mallen and Vogel (2002) study in which therapists-in-training from various
graduate programs volunteered to conduct a one-time-only online session
with a client. The therapists-in-training were told that the client was real, but
the client was a confederate. Because of the issues described previously, the
researchers used a confederate to ensure the ethicality of the experiment. All
therapists were debriefed immediately after the study and informed about the
project’s deceptive component. Although the responses are not from a genu-
ine client, the statements are realistic and the therapists-in-training
responded to the comments as if they were real. Throughout the transcript,
we comment on the skills used in the session and on how counseling psychol-
ogists can effectively communicate with clients in an online environment.
Intentionally, there have been no changes in punctuation or spelling to the
transcript. This was done to maintain the session’s authenticity and to
illustrate how typographical errors must be dealt with during online sessions.
Tara: Hello
Counselor: Hi Tara
Tara: Hows it going?
Counselor: Welcome. as far as I know you have been informed but I still want to
make a couple of points clear
Counselor: and it is going fine..:-)
Tara: okay
Counselor: we will only have one session and it will be online through typing
Tara: Okay.
Counselor: do you have any questions about the process or about anything else?
Tara: No, I am ready.
During this piece of the conversation, the therapist-in-training greets the

client and attempts to communicate a feeling with the smile emoticon :-). It is
unknown if the therapist-in-training is truly smiling at this point, but the
intention appears to facilitate a welcoming environment for the client. The
therapist-in-training also gives the client clear guidelines about the structure
of the online session. The researchers had informed the therapists-in-training
not to spend time on specifics regarding confidentiality because the client
had already been informed of this in the researchers’ informed-consent
document. Counseling psychologists conducting online sessions need to be

very detailed about the limits of confidentiality as well as the possible risks
and benefits to treatment.
In addition, a counseling psychologist would need to gain specific infor-
mation about the client, such as his or her name and address, in the case of an
emergency. As reviewed earlier, meeting clients online anonymously is
strongly discouraged, as there is no possibility to follow through with crisis
interventions or to refer the client to local resources (see Childress &
Assamen, 1998; Kraus, 2004; Suler, 2001). If the client were to indicate that
he or she is having thoughts of suicide and suddenly disconnect from the ses-
sion, a counseling psychologist would have no way of intervening for a client
who is anonymous and in an undisclosed location. However, if information
about the client, such as his or her name and address, were available, then
local authorities or mental health resources could be contacted to intervene.
Counselor: where would you like to start?

Counselor: what brough you here?
Tara: Well, the main reason I wanted to do this is that I have been feeling a lot of
stress lately, and it is effecting me differently than usual
Counselor: would you like to define the stress you are having more clearly?
Tara: I am having a hard time with classes and just studying in general.
Counselor: ok. it has been effecting your school work?
Tara: Yes, I can’t seem to focus for very long.
Counselor: what else? you have said that it is effecting you differently than usual?
what is the difference?
Tara: Well, on top of the school part, I seem to not be able to sleep like I use to.
Counselor: can you explain it more, please?
Tara: Well, when I lie down to sleep at night I stay up with my mind racing, like I
can’t get my head to fall asleep even though I want to.
Counselor: is there any specific thing (that you are aware of) that is preventing you
to go to sleep?
Tara: I just start to think about all the things I need to get done, and I start to think
about relationship stuff. If there is something I can worry about it seems to filter
into my head.
Counselor: what do you mean by relationship stuff?
Tara: Things between my roommates and me are as good as they were last year.
They are going out and having fun, and I just don’t seem to do that was well as
they do.
Tara: For some reason when I go out I get choked up and don’t really talk to peo-
ple, in a large group.
Counselor: how long have you been experiencing this?
Tara: Well, I have always been sort of shy, but it hasn’t been this bad until this
school year.
In the beginning of the session, the therapist-in-training relies on open-

and closed-ended questions to gain information about the client’s presenting
concerns; this is a skill typical to assessing clients in the preliminary stages
of an FtF setting (Hill & O’Brien, 2004; Ivey & Ivey, 2003). Because the
therapist-in-training is not able to view the client’s nonverbal cues, such as
noting the rate of speech, many of the questions are clarifying in nature to
gather specific details. For example, there is an attempt to get a better defini-
tion of stress from the client and one instance when the therapist-in-training
simply asks for further explanation. A question-answer format can often
occur in text-based online sessions, and this can be useful for gaining infor-
mation in the early stages of treatment. However, as will be seen, other skills
can be communicated during text-based sessions.
Counselor: how does it feel to be choked up?

Tara: Like there are things I want to say but I don’t because I am afraid I might
sound stupid or weird.
Tara: Either that or wish I had something good to say, usually the first one.
Counselor: so, it is like if I talk, people can perceive as stupid and weird
because...?
Tara: They might misunderstand what I am trying to say.
Counselor: so, it is like I may not express myself right and they may misunder-
stand me?
Counselor: what does it like to be misunderstood?
Tara: You try to explain yourself and it sort of draws to much attention to you.
Tara: it just makes me feel out of place I guess
Counselor: Tara, how do you feel now, at this moment?
Tara: sort of silly talking to you over the internet, but other than okay
Tara: It is just different that anything I have done before.
Tara: Not bad, just different.
Counselor: that’s ok. it is true fo me, too.:-) so, let’s go back to your previous
response. it is like I am trying to explain myself but can’t or been misunder-
stood and I just feel like I am out of place, like an outsider?
Counselor: is that right?
Tara: that is correct
During this section of the session, the therapist-in-training begins to

incorporate other skills to reach a deeper level of exploration with the client.
The therapist-in-training uses restatements and asks an immediate question
about how the client, Tara, is feeling at the moment. After the client responds
with a certain amount of discomfort, the therapist-in-training normalizes her
experience and self-discloses the difficulty of the session’s online nature.
Again, a smile emoticon is used to convey a sense of understanding, and a
restatement attempts to get the client moving again.
It is already noticeable that the therapist-in-training is attempting to build

a relationship with the client and is also forming a conceptualization of the
client’s presenting issues. The therapist-in-training offers an interpretation to
the client by asking if she feels like an “outsider” and begins to pursue the
possibility that the client may feel socially isolated. During online sessions,
counseling psychologists are encouraged to use the skills that are effective in
FtF sessions. The difference is that a counseling psychologist may need to be
more explicit in text-based sessions and may type certain feelings or reac-
tions that he or she might otherwise indicate with nonverbal cues.
Counselor: what does it like to be an outsider?

Tara: It stinks, for a lack of better words.
Tara: lol
Counselor: lol= what’s that?
Tara:oh...laugh out loud
Tara: sorry
Counselor: ok..:-)
Counselor: what was that loud laugh for?
Tara: just the fact that I used the term stinks to explain something to a therapist, I
found that funny for some reason.
Counselor: ok. I got it now. sorry. It stinks and I feel...?
In this segment, there is a clear example of the therapist-in-training’s lack

of online-communication knowledge. However, the therapist-in-training is
very quick to clarify the client’s statements to understand and comprehend
the language. A common symbol in CMC is lol, which stands for “laughing
out loud” or “lots of laughs.” Individuals who frequently communicate
online often use such symbols, and these are the types of nuances a counsel-
ing psychologist can experience and learn only through practice with the
technology. It should also be noted that just as clients in FtF sessions use cer-
tain words or phrases that might mean more to them than to other people, cli-
ents in online sessions may have similar tendencies. As in this session, when
in doubt, a counseling psychologist should clarify any comments or mes-
sages that cannot be understood. As can be seen, the clarification in the ses-
sion occurs quickly: The therapist-in-training uses an emoticon to communi-
cate understanding to the client and refocuses the session with a question.
Counselor: it stinks and I feel ..? tell me something

Tara: ah...rejected
Counselor: so i feel rejected
Tara: yes
Counselor: i feel rejected by...?
Tara: people in general, my roommates, ex boyfriend, other students that won’t

talk to me.
Tara: I feel left out.
Counselor: Tara, it really sounds like a stressful and difficult! It seems like a big
burden on your shoulders-the fear of the continuing rejection?
As the session gets back on track, the therapist-in-training continues to

probe the client for details about her feelings of rejection. In the final state-
ment above, the therapist-in-training empathizes with the client and adds an
exclamation point for the first time in the session, apparently to increase the
amount of emphasis on the statement. The therapist-in-training continues to
delve deeper into the client’s feelings by providing an interpretation and ask-
ing a follow-up question. In an FtF session, this type of empathy might be
communicated through some minor verbal or nonverbal cues such as an
emphatic look of concern, an auditory sigh, or the quick statement “Wow,
that seems stressful.” In the text-based environment, the communication of
affect and empathy must become more explicit, and there are several ways to
emphasize comments, including the use of capitalization and punctuation.
Tara: Well, I fear it, so I advoid the places where it can happen,
Counselor: so, i feel scared of being rejected by others?
Counselor: is it so?
Tara: yes, it is hard to say, but yes
Counselor: can you say ( i mean write..:-)?
Tara: write what?
Tara: I am confused, sorry!
Counselor: that’s fine. I just want you to express you fear of being rejected by
others?
Counselor: express you fear...
Tara: Oh, okay, I fear that others won’t like me and will reject me. I fear that a lot.
Counselor: OK. but it seems like also there is this part which is not comfortable
with this fear?
Tara: well, yes, I mean part of me wants to be part of the group, and out having fun.
Part of me is mad at the fear. I hate it.
Counselor: let’s focus on this fear of rejection. please, think about it a little. what
does that part (scared part) need?
Counselor: be that scared part!
Counselor: you are the part of Tara and you are scared of rejected by people?
Counselor: what do you need?!
Tara: I just need to be told that I am good and wanted, and valiadated.
Counselor: so, I need to feel worthy!.. is it so?
Tara:Yes! I need to know that I am worthy in others eyes.
This segment of the transcript demonstrates some of the limitations of

text-based communication. During this exchange, the therapist-in-training
and the client experience miscommunication as the therapist-in-training
attempts more dynamic interventions. The therapist-in-training begins to
write in the first person as if she were the client, which confuses the client
because the change in perspective is not explained. The therapist-in-training
is attempting to reach a level of immediacy by having the client involve herself
in an experiential activity in the here and now. However, the therapist-in-
training does not adequately explain the intervention, and it takes a second,
clearer explanation to redirect the client. Also, the therapist-in-training
begins to use parentheses for the first time in the session in an attempt to
make the messages more dynamic (by adding clarification during mes-
sages). The therapist-in-training continues to push for an experiential activ-
ity, and it is likely that some clients would not appreciate or adhere to this
type of intervention.
As in FtF sessions, a counseling psychologist will need to determine the
best interventions to use with his or her clients. Some clients may respond
well to cognitive-behavioral interventions, while others may respond well if
they are led through experiential activities. It is likely that the same process
will occur during online sessions, and it is possible that cognitive-behavioral
interventions will be easier to perform in this mode of treatment. As the
example above demonstrates, immediate types of interventions, although
certainly still possible, will take more time to develop and will likely require
more time to explain and set up in an online environment.
Online counseling may be promising for cognitive-behavioral techniques
aimed at distorted beliefs and discrepancies in the client’s thoughts. Distorted
beliefs and faulty thinking can be identified directly in the words typed by the
client, and a counseling psychologist can immediately ask the client to read
back the statements he or she typed earlier in the session. A counseling psy-
chologist could potentially refer back to sessions that occurred in the past if
transcripts have been saved; so the exact words a client used in previous ses-
sion could be compared against comments the client now states. A counsel-
ing psychologist can then lead the client through an exercise of typing out the
statement differently in a flexible and less restricted manner. Also, diagrams
of the cognitive-behavioral model could be easily shared as an e-mail attach-
ment, or the client could be referred to a Web page containing more informa-
tion about techniques in cognitive-behavioral therapy and the larger
cognitive model (e.g., Greenberger & Padesky, 1995).
Counselor: what do you need in order to see that in others eyes?

Tara: If they went out of their way to do something for, instead of acting like I am
not there, I would see it.
Counselor: what would it mean to you?

Tara: It would mean that I am someone worth paying attention to, that I am person
worth spending time with.
Tara: It would be great.
Counselor: so I AM a good person and I worth being together and I AM
VALUABLE..?
Tara: YES!
Counselor: how does it feel to not feeling in this way?
Tara: Yes I am!
Counselor: I am sorry. yes you are? can you explain it more?
Tara: sorry, it just felt good to say that I am worth the time of day...
Counselor: you need to help me and tell me what you feel about yourself? WHAT
DO YOU FEEL ABOUT YOURSELF?
Tara: I feel like I am a really great person that if people just took the time to get to
know me they would really like me.
The therapist-in-training continues to probe the client’s anxiety and self-

esteem in this segment. The therapist-in-training begins to use ALL CAPS to
emphasize specific points to the client. However, the therapist-in-training is
still using the first person, which is confusing the client. It is possible that the
client and therapist-in-training are feeling slightly frustrated at this point in
the session because of the miscommunication. The therapist-in-training
attempts to take charge of the session by asking “WHAT DO YOU FEEL
ABOUT YOURSELF?” By capitalizing the words, the therapist-in-training
indicates added emphasis and is strongly leading the client to focus on her
affect and feelings. The client then voices some feelings about being misun-
derstood and ignored. This also is a useful example of how various theoreti-
cal approaches (i.e., humanistic, cognitive-behavioral) that counseling
psychologists adhere to can be integrated within the online context.
Counselor: so, it is just they do not take the time?

Counselor: i feel like there is some more under that?
Tara: A lot of the time no, people just go about their day and never actaully stop
and talk to people.
Tara: Its how are you? fine, great, bye
Counselor: so, it is like I need more attention from people?
Tara: I get sick of being ignored by my roommates and classmates, so yes, I would
say that I need more attention form epeople
Tara: lots of typos,sorry...
Counselor: that’s ok..:-)
Tara: how do I ask for more attention without coming off as needy?
Counselor: I thought you have said you are also preventing yourself to talk in a
group because you may sound like stupid. so, do you see any connection
between staying back and being ignored?
Tara: yes, I do know, but I had not really thought about it like that until talking to
you.
Although the client has responded to the therapist-in-training’s question,

the therapist-in-training begins to suspect that there are underlying core
issues for the client. The client apologizes for her poor typing ability, and the
therapist-in-training responds with an emphatic reply, which again includes
an emoticon to communicate understanding and warmth. The client asks for
direct guidance from the therapist-in-training on how to get more attention,
but the therapist-in-training redirects the session by asking the client to create
a connection between her social anxiety and isolation. It is clear that the
therapist-in-training is making connections and conceptualizing the client’s
presenting concerns. Even though the session has consisted of a flow of text
back and forth, the therapist-in-training is assessing the client, recording rel-
evant information, and facilitating the client’s exploration into her lack of
close relationships.
Counselor: so, how do you feel about it now?

Tara: I feel like part of the problem is me getting in the way of letting things
happen.
Tara: Maybe I need to not force things and see what happens
Counselor: maybe... Tara, before wrapping the session I jys want to ask what you
meant by needy?
Tara: Well, I guess someone that anonies people because they are always wanting
attention
Tara: that to me is needy.
Counselor: do you feel like you are needy? or you will look needy if you want to
get more involved and get more attention?
Tara: I don’t feel needy, I don’t really bother people for attention at all, I just don’t
want to look that way if I get more involoved and get more attention from my
roommates, ect.
The therapist-in-training again brings the experience in the session to the

here and now. Most likely, the therapist-in-training is curious about the cli-
ent’s affect at this time and cannot evaluate this piece of the client without the
nonverbal cues. It is important for counseling psychologists working online
to continue to check with their clients as the sessions progress. It is entirely
possible that a client is tearful during this exchange, but the therapist-in-
training would never know unless he or she asked or the client offered the
information. Also, during a text-based online session, counseling psycholo-
gists can attend only to the client’s self-reports. In an FtF session, it is clear
when a client is tearful, but this cannot be readily assessed online. Some of
the assessments that counseling psychologists take for granted in FtF
sessions must become more overt and explicit in CMC sessions. Oftentimes,
in FtF sessions, therapists will ask clients to report their affect on a scale from
1 to 10, and the results are often surprising even when nonverbal cues can be
seen. Counseling psychologists working online should use this technique to
gauge the client’s level of affect to better understand his or her frame of
reference during the session.
In this segment, the therapist-in-training is aware of the time limit on the
session and begins to wrap up with the client. However, the therapist-in-
training inquires about the client’s thoughts regarding feeling needy. If the
therapist-in-training were to meet with this client again, it appears that this
would be a direction the therapist-in-training would explore. From the infor-
mation provided in the transcript, it appears that the client is uncomfortable
asserting herself and reaching out to others. This seems to be caused by her
fear of looking foolish or appearing too clingy to those around her. In this
segment, the therapist-in-training appears to become more comfortable with
the technology, and there is no misunderstanding between the two.
Counselor: Well, I would like to continue and explore it more but Tara, unfortu-
nately we have to stop. How do you feel now-after this very new experience?
and of course with your presenting concerns.
Tara: I feel like I have a map that I can start to work on, it is good, thank you for
being here.
Tara: I really don’t have too many concerns, it just felt good to get a lot of that off
my chest.
Counselor: well, thank you for being here, too..:-) It was great for me too. I feel
like you were really open and willingly to explore your concerns. I guess it
helped a lot! I mean you helped yourself..:-)
Counselor: good luck in your school work and relationships...
Tara: Well, thanks again
Tara: Bye
Counselor: bye
The therapist-in-training concludes the session and checks with the client
about the experience. Because this was a one-time-only session, the therapist-
in-training is aware that there will be no opportunity for follow-up. If this were
an ongoing client, a counseling psychologist would likely continue to gather
information and assess the client’s presenting concerns. The current informa-
tion from Tara in this session may not allow for a complex assessment, and a
treatment plan would need to evolve over the course of the following ses-
sions. The therapist-in-training offers several reassuring comments near the
end of the session and uses two emoticons to communicate a sense of connec-
tion with the client before saying goodbye.
SUMMARY
The above transcript, although partly scripted (the client was a confeder-
ate), offers a realistic example of how online counseling in a synchronous-
chat environment is conducted. It is interesting to note that the therapist-in-
training never supplied a name or any identifying information for the client.
The researchers did not give specific directions to the therapists-in-training,
in order to see how they would operate in the online environment. When con-
ducting online counseling, not only is it important to be direct about assess-
ing the client’s current affect, but it is also important for counseling psycholo-
gists to openly communicate with the client about his or her reactions to the
text in the session. The transcript also provides an example of how counsel-
ing psychologists could work to establish a therapeutic relationship, assess
presenting issues, and take early steps toward facilitating client exploration
and change.
An interesting future discussion for counseling psychologists is whether
learning derived from online-counseling sessions translates into changes in
the FtF world. Referring to the above transcript, one could ask, “If Tara does
learn to reduce her anxiety related to meeting people through online counsel-
ing, then will that learning transfer into real changes in her face-to-face
behavior?” It may be that a client’s learning, growth, and development from
online interventions do not produce real change in FtF environments. One
way in which counseling psychologists promote change is through modeling
behaviors for the client, and the online mode of treatment also seems to affect
this process. The transcript also illustrates limitations, as certain interven-
tions did not seem to translate well to text-based communication. Although
cognitive-behavioral therapy (CBT) interventions may be most easily
adapted to online counseling, CBT still requires monitoring the client’s
affect, which is more difficult online. In FtF sessions, counseling psycholo-
gists can visually assess the client; as this example demonstrates, however,
online-counseling psychologists would need to rely solely on self-report
from the client to assess minor or more serious issues such as substance abuse
or suicide. Counseling psychologists can develop skills to work with clients
online but will need to continue to explore if their interventions are
facilitating real emotional, behavioral, and cognitive change in their clients.
INTEGRATING THE SCIENCE AND

PRACTICE OF ONLINE COUNSELING
Online counseling is predicted to increase in the future (Norcross,

Hedges, & Prochaska, 2002), and it is important for counseling psycholo-
gists to continue to become involved in shaping and developing guidelines

for the training, supervision, and practice of online counseling. The research
reviewed in the previous article (Mallen et al., 2005) indicates that clients
accept online-counseling services and that they can experience symptom
relief. If consumers continue to demand these types of services, specific
training related to working with clients through distance-communication
technologies will need to be offered. This training should be approached in
two ways. First, counseling psychologists who have already completed grad-
uate education need continuing education courses or training in the nuances
of CMC and the specific ethical dilemmas of online counseling. Second,
counseling psychology graduate programs should begin to incorporate
online-counseling training into existing course work and practica so that new
professionals are ready to provide online-counseling services. We detail
these two approaches below.
Experienced counseling psychologists interested in providing online
mental and behavioral health services should receive training in communi-
cating effectively through distance technologies. This may include gaining
experience with new technologies, such as interpreting text messages written
through synchronous chat and assessing clients without the aid of nonverbal
cues. Counseling psychologists must also be aware of the legal and ethical
issues associated with providing online-counseling services. The most com-
mon concerns are providing services across state lines, crisis management,
confidentiality, and how best to market these new services. Those interested
in providing online services should continue to stay abreast of the new legal
and ethical issues related to licensure and jurisdiction with online counseling.
This article has presented information about the legal and ethical issues
involved in providing online mental and behavioral health services as well as
specific recommendations for online-counseling training. Exposure to this
information is a first step for counseling psychologists, but future structured
training is also needed through continuing education courses.
The second approach is to begin training in counseling psychology gradu-
ate programs. Currently, there are no structured means for training future
counseling psychologists to work in an online setting in graduate-level coun-
seling psychology programs. If counseling psychology graduate programs
begin training therapists to work in an online setting, we can offer several
suggestions. First, before therapists-in-training work in an online setting,
they should be accustomed to the technology that they are going to be using.
There are many nuances to CMC, and increased exposure to it can train thera-
pists to deliver messages with more depth. They would be well served by
gaining experience in various forms of CMC before attempting to conduct
counseling sessions online. For instance, this can be accomplished through
course work in a communication-related field and by seeking hands-on expe-
riences by using the technology to gain a clearer understanding of how com-

munication flows back and forth in synchronous chat. Another option is to
have therapists-in-training conduct online therapy sessions through role-
plays in conjunction with practicum classes. This approach would be similar
to an FtF role-play, which is a standard training tool in graduate counseling
programs.
Training should also begin early because results from the current litera-
ture (Mallen et al., 2005) indicate that experienced therapists are less likely to
acclimate themselves to the new mode of service delivery. With years of
training in FtF counseling skills, experienced therapists may be unwilling or
unable to translate these skills into a computer-mediated environment. By
integrating online-counseling training into the early stages of graduate cur-
riculum, we would expose therapists-in-training to the newer modes of treat-
ment before they get stuck in only an FtF-counseling mindset, which may
prevent them from adequately offering these services in the future.
Finally, as illustrated by the synchronous-chat transcript, it appears that
certain fundamental counseling skills translate more effectively to the online
setting. Specifically, it seems that cognitive-behavioral interventions might
be most promising in this domain. However, other techniques and interven-
tions might suffer from the lack of nonverbal cues and the potential misun-
derstandings from text-based communication. As more counseling psychol-
ogists get involved in providing online services, the foundation of knowledge
related to practical aspects of treatment will become more solid, and our
understanding of how best to implement online counseling will increase.
Counseling psychologists can use their specific training in the scientist-
practitioner model to determine the course of online counseling. They are in a
unique position to evaluate research findings and translate those findings into
practical techniques for online-counseling interventions. Counseling psy-
chologists can potentially extend their reach to serve new populations, but if
the field discovers that the mode of treatment is not effective, then counseling
psychologists have a responsibility to limit the practice of online counseling
to ensure that the treatment does not harm clients. If online counseling is
shown to be effective and worthwhile, then counseling psychologists can use
these modes of service delivery to serve the unifying themes of the field. The
practical aspects discussed in this article give counseling psychologists an
orientation to online counseling, but the heart of service delivery remains the
FtF clinical skills that counseling psychologists have learned throughout
their education and training.
APPENDIX
Additional Informed Consent for Online-Counseling Template
The distance involved in online counseling brings up specific issues in terms of

confidentiality and privacy. First, although specific measures have been taken to pro-
tect the information that will be communicated between you and your therapist
through encryption technology, the privacy and confidentiality of computer-mediated
communication cannot be 100% guaranteed. Your therapist will take every measure
to safeguard your information, but you should be aware that there is a very small
chance that information can be stolen from transmissions between yourself and the
therapist.
Second, it is possible that you may save the information discussed in your online
counseling session to your computer as a transcript, or print out this transcript to save
for your records. If you do decide to save this information, you are encouraged to take
steps to ensure that this information remains confidential as your therapist cannot be
responsible for the safeguarding of these materials. For instance, another individual
could access your computer and view the saved transcripts, or may locate print copies
of transcripts from your sessions, which likely contains sensitive material. Please take
steps to protect your confidentiality and do not assume that information on your com-
puter is private if others have access to the machine.
Third, because therapists have a duty to warn and to protect if there is an indication
that the client is a danger to themselves or others, there is a need for extensive contact
information so services can be delivered to you in the case of an emergency. For exam-
ple, if you demonstrate to your therapist that you have strong intent to harm yourself
or another, your therapist is legally and ethically bound to take action to protect every-
one involved. These potential services will be easier to implement if you were attend-
ing face-to-face counseling sessions because both you and your therapist would be in
the same location. To make the delivery of emergency services more efficient, please
provide the following information:
Client Name: ________________________________

Home Address:
Home Phone Number:
Cell Phone Number:
Work Address:
Work Phone Number:
Primary Physician: ________________________________
Address:
Phone:
Emergency Contacts
Local Police Department:
Phone Number:
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What are some of the practical aspects of online counseling addressed in the article?

What are some of the practical aspects of online counseling addressed in the article?

What model does the article emphasize in its discussion of online counseling?

What model does the article emphasize in its discussion of online counseling?

THE COUNSELING

Correspondence concerning this article should be addressed to Michael J. Mallen, Department of

ETHICAL AND LEGAL ISSUES FOR

The most common concern addressed in the online-counseling literature

the Ethics Code is not specific with regard to telephone therapy or

Danger and Duty to Warn

One of counseling psychologists’ primary ethical responsibilities in prac-

quate preparation and training to demonstrate competence in their selected

this may be cumbersome, it is a legal way to broaden the scope of a counsel-

dentiality (APA Ethics Code 4.02). For example, a counseling psychologist

Another issue surrounding confidentiality, specific to online counseling,

The ability to store what transpires between the counseling psychologist

Counseling psychologists can minimize these potential ethical and legal

encounters with a counseling psychologist. Although clear answers about

TRAINING ISSUES FOR COUNSELING PSYCHOLOGISTS

Clearly, not all counseling psychologists have an interest in providing

Computer-Mediated Communication Competency

Education and Supervision

Counseling psychologists are trained through graduate course work,

In addition, to facilitate the development of a trainee’s online-counseling

not be available if a crisis takes place or if immediate consultation is desired.

• Supervisors should encourage supervisees to gain experience in various online

The field of counseling psychology has emphasized multicultural compe-

understood because the cultural context is more difficult to comprehend

Here’s one advantage of online counseling that’s probably unique to me—I’m

Online counseling also brings up other questions related to cultural condi-

TECHNOLOGICAL ISSUES FOR COUNSELING

It is equally important to consider technological issues related to the

Johnstone, & Merrell, 2000). Research on videoconferencing as a mode of

Costs and Promotion

possess the same videoconferencing program. Because the general public

seling psychologist was not interested in providing online-counseling ser-

ONLINE-COUNSELING SKILLS IN SYNCHRONOUS CHAT

It would seem that text-based synchronous chat and asynchronous e-mail

conferencing technologies in their practice (VandenBos & Williams, 2000).

During this piece of the conversation, the therapist-in-training greets the

document. Counseling psychologists conducting online sessions need to be

Counselor: where would you like to start?

In the beginning of the session, the therapist-in-training relies on open-

Counselor: how does it feel to be choked up?

During this section of the session, the therapist-in-training begins to

It is already noticeable that the therapist-in-training is attempting to build

Counselor: what does it like to be an outsider?

In this segment, there is a clear example of the therapist-in-training’s lack

Counselor: it stinks and I feel ..? tell me something

Tara: people in general, my roommates, ex boyfriend, other students that won’t

As the session gets back on track, the therapist-in-training continues to

This segment of the transcript demonstrates some of the limitations of

Counselor: what do you need in order to see that in others eyes?

Counselor: what would it mean to you?

The therapist-in-training continues to probe the client’s anxiety and self-

Counselor: so, it is just they do not take the time?

Although the client has responded to the therapist-in-training’s question,

Counselor: so, how do you feel about it now?

The therapist-in-training again brings the experience in the session to the

INTEGRATING THE SCIENCE AND