Have you wondered what are the advantages or disadvantages of using online therapy? Or have you been curious as to what avatar therapy in Second Life is all about?
This week, DeeAnna Merz Nagel, LPC, DCC, co-founder of the Online Therapy Institute, will be answering these questions and more!
DeeAnna has been practicing online counseling since 1999. Some of you may also know her by her twitter handle TherapyOnline.
DeeAnna is a psychotherapist, consultant and international expert regarding online counseling and the impact of technology on mental health. She specializes in text-based counseling and supervision via chat and email.
This week, DeeAnna Merz Nagel, LPC, DCC, co-founder of the Online Therapy Institute, will be answering these questions and more!
DeeAnna has been practicing online counseling since 1999. Some of you may also know her by her twitter handle TherapyOnline.
DeeAnna is a psychotherapist, consultant and international expert regarding online counseling and the impact of technology on mental health. She specializes in text-based counseling and supervision via chat and email.
DeeAnna’s Avatar in Second Life
Without further ado, DeeAnna, what made you decide to pursue a B.S. in Mental Health and Human Services and an M.Ed. Rehabilitation Counseling? (and subsequently to focus on online counseling and the impact of technology on mental health)?
The B.S. program at Georgia State University was very experiential and I had the opportunity to participate in 6 placement practicums at the undergraduate level. The Rehabilitation Counseling degree at the University of Georgia was a different angle on skills I had already learned and gave me well-balanced case management skills as well as a foundation in both physical and mental disabilities.
I became interested in online counseling in 1999 when I visited a few health bulletin boards myself. I was sick with respiratory symptoms and doctors could not diagnose me. The people on the bulletin boards were extremely supportive and I learned about the power of online support. That was the time when online e-clinics were just coming on the scene. I also joined the International Society for Mental Health Online (ISMHO) – at that time so I learned from the pioneers in the field.
Can you briefly describe your career trajectory?
Uh, briefly? No. LOL. I worked in many settings in Georgia for the first 15 years of my career including my own organization that offered forensic services and services via state funding to families and children in the social service/foster care system. I maintained a small private practice online.
When I relocated to New Jersey I decided to concentrate on my passion. I began a small face-to-face practice and continued my online work, as well as consulting and training about online therapy.
I understand that you specialize in internet addictions. Is it helpful to work with people who are addicted to the internet via the internet or does this modality make it even harder for them to cut back on their addiction?
As with any intervention, it is based on the individual. There are times when working online is beneficial to someone who has compulsive behaviors with regard to the internet because it is an opportunity to model healthy use of the internet.
Having worked with addictions of all types over the years, the addictive process is very similar but of course there are differences. With some addictions, abstinence make sense, but with other addictions, not so much. Computers and technology are such an integral part of our social fabric now that to expect someone to never log on may be unrealistic, particularly if the job requires it.
How/when did you decide to co-establish the Online Therapy Institute (OTI) and can you explain what was the motivation behind this?
I was the President of ISMHO in 2005 and Kate Anthony was the President in 2006. Having known each other or years online and then meeting at the American Psychological Association (APA) conference in 2005 we knew there was a synergy and we talked about collaborating on writing projects and trainings.
We established OTI because we felt that the field needed a global organization that could move as fast as the technology. Many organizations get bogged down with board rules, decision making processes, government sanctions, or corporate culture.
We wanted to be able to create resources like our ethical frameworks in such a way that we could solicit the public’s feedback and also amend the frameworks as necessary. We believe in the power of Web 2.0 and extending the conversation through social media.
What percentage of your therapy is face to face vs. online? And what percentage of online is skype, email, second life etc.?
50% of my time is spent with clients the other 50% focuses on consultation and training of other professionals. I see between 5-10 clients a week in my office. Most of my in-person clients have, at one point or another, engaged in a session via technology- phone, email or chat. I utilize videoconferencing for professional consultation but I find that the technology is not always dependable enough for psychotherapy sessions, although this is changing rapidly.
This is also based on personal preference. I have practiced online for over 10 years and my specialty is text-based therapy- using language and writing to elicit the therapeutic bond. Our book, 
Therapy Online: A Practical Guide is about text-based therapy. I also contract with an EAP that offers asynchronous (email) counseling to clients.
Therapy Online: A Practical Guide is about text-based therapy. I also contract with an EAP that offers asynchronous (email) counseling to clients. What role do you feel the avatar itself plays in the therapy or therapeutic relationship?
Again, this is very individual. For some people, the avatar is an extension of their personality, for others, the avatar may represent a different part of the self. Kate and I have written extensively (as have others) about the power of the use of avatars and we compiled a good reference list here: Interested in Avatar Therapy? This Might Help!
What do you feel are the key pros and cons of conducting therapy online vs. face-to-face?
Not everyone is suitable for online therapy, either by preference or through therapist’s screening. But technology can be used, in my opinion, to enhance any therapeutic relationship with resources such as online articles, blog posts and between-session emails, online journal writing and self-help programs- podcasts and YouTube videos- therapists and helping professionals, including coaches, can utilize technology in many ways – dipping into the “Technology Toolbox”, if you will.
Other clients will relish deep and thought provoking asynchronous opportunities that can only be found through email therapy. This is akin to letter writing in the days of Freud and Jung. Still others love the perceived anonymity of being online through email and/or chat.
There are the other advantages of use of time, rural areas where resources are scarce or being able to seek services more comfortably due to a disability. Cons include the lack of visual or aural cues that some people prefer. Many issues can arise if the therapist is not trained properly.
What career advice would you offer to upcoming MSW graduate students who would like to add online counseling to their portfolio of skills?
Become educated through reading materials, join networks, and participate in training. Encourage your professional organizations (local, state, regional, national, international) to embrace the idea of augmenting traditional psychotherapy with technology. Make online therapy the topic of a research paper.
My understanding is that as cool as avatar therapy is or could be, the vast majority of the population has not expressed interest in this modality. Is this true?
I don’t think it is a lack of interest as much as a lack of knowing. 10 years ago we talked about the Internet in general in this way. 60 years ago, it was the television. It takes time for new technologies to catch on, especially in a field that has not historically attracted people who embrace technology.
The military is using avatar therapy with soldiers coming back from the war and medical students are learning in virtual world settings. People with autism and asperger’s are using virtual worlds to teach social skills and substance abuse addiction is being treated in aftercare settings in virtual worlds.
What do you predict as the key trends in the online therapeutic arena?
I will be talking about this in my presentation at the Psychotherapy Networker Symposium this year – The Future of Psychotherapy. Clearly, I think that the use of avatars and virtual reality settings will become a huge part of behavioral health intervention, with research to back it up.
Make sure to check out Got clients? Learn about cyberculture! This is a post about DeeAnna’s talk on Therapy’s Digital Future at the 2013 Psychotherapy Networker Symposium.
Thanks so much, DeeAnna for taking the time to provide us with this interesting glimpse of the online counseling world.
As always, please feel free to ask any questions or make any comments. Your feedback is most appreciated :)
Dorlee, thanks for tracking DeeAnna down for an interview. I hope people check out the OTI site and Tilt Magazine. DeeAnna, thanks for the reminder of Freud and Jung corresponding. Freud also did a self-analysis that was written and mailed to Dr. Fleiss (I think.) So text-based therapy has a longstanding place in the psychodynamic tradition!
Hi Mike,
It was my pleasure 🙂 Yes, the OTI site and Tilt Magazine are wonderful resources!
Thanks so much for sharing that interesting info about Freud!
Best,
Dorlee
Hi Dorlee,
This is a very interesting post about a fascinating topic.
I am thinking of utilizing more online applications for my career transition consulting practice. There are some people and some situations that could respond very well.
I’d also love to hear/see/attend DeeAnna’s symposium presentation about the Future of Therapy.
I am intrigued by the analogy she makes to letter-writing for Freud and Jung. One of my beliefs is that letter-writing can be transformational.
I intend to read more about her work as a result of your blog. Thanks!
Terry
Hi Terry,
Thanks for sharing your plan of employing more online applications for your work.
I too would love to hear/see DeeAnna’s presentation… here is the link for information about it: http://www.mentalhealthonthewebblog.com/?p=183
I like your idea of letter-writing being transformational. I’d love to hear more about it:)
Thanks so much for your enthusiastic feedback,
Dorlee
Fascinating interview!
Dee, people often ask me about the malpractice concerns/malpractice coverage issues for practitioners who are doing online therapy–especially exclusively online therapy (as opposed to “hybrid” therapy, e.g., a mixture of face to face and online). I confess I know nothing about how those issues come into play. Can you illuminate me (us!) about this?
Hi
A couple of additional comments to posts here- regarding the art of letter writing and email therapy- here is an article you might find of interest- The Writing Cure: http://www.onlinetherapyinstituteblog.com/?p=898
With regard to malpractice insurance- you need to call your carrier and ask specifically if you are covered to conduct online therapy and whether or not you are covered if you cross state lines. The answer is sometimes vague and never the same (in my experience). I will be doing a teleseminar about online therapy with CPH @ Associates insurance in Feb so stay tuned! We also have a thread going in the forum at OTI:
http://onlinetherapyinstitute.ning.com/forum/topics/looking-for-liability
What about the online system like moodgym, ecouch, or clarifylife which seem to be free but there are others that are not free.
The complaints are always that they are impersonal and fake.
But then they are cost effective but in a way perhaps more effective because they force you to just focus on the issue.
I’m confused about online therapy. Sometimes it means a person is behind the scenes, sometimes not. sometimes it is just coursework.
I saw this that made me curious.
http://www.clarifylife.com/online-therapy.html
I have not seen the tools shown in the blog. Those pictures seem fascinating.
What program are they from?
Thank you, Sam5 and David for visiting 🙂
As you may have noticed, this interview with DeeAnna is one that I conducted back in January…therefore, I’m not sure about her availability in terms of being able to respond to your questions.
I’m hoping DeeAnna can step in…I sent her an email alerting her and asking her to step in when she has a free moment.
In the interim, perhaps you could try asking clarifylife.com, moodgym and ecouch to clarify what/who they are (no pun intended).
Based upon my very quick google search for moodgym and ecouch, they appear to be some sort of preprogrammed interactive style of therapeutic interaction. The mere fact that they are preprogrammed makes me question their quality/validity…that said, CBT is one modality that lends itself to such a possibility.
The type of online therapy that DeeAnna was referring to would consist of traditional therapy albeit via skype or email (or another method of non face to face communications) and unless the therapist was conducting the therapy pro bono, there would be a charge (just as there is a charge when you see a therapist face to face).
Take care,
Dorlee