Technology and Christian Counseling: Possibilies and Perils

Balancing a grande mocha in one hand and a briefcase in the other, Dr. Washington swings shut the door of her sports utility vehicle and heads toward the office, strategically pressing the remote control on her key chain to lock her car doors and activate the security system. At the office door, she swipes her magnetic key card, enters, goes directly to the wall panel to deactivate the electronic security system, and switches on the computers and photocopy machine. After checking her voice mail and e-mail, Dr. Washington sits to enjoy the last few sips of her mocha while reviewing her appointment schedule on her handheld electronic organizer. Another day at the Christian counseling office has beguna day filled with the possibilities and perils of technology. The technological revolution has brought unprecedented possibilities for Christian counselors.

At the dawn of this new millennium we can research diagnoses and treatment plans on the Internet, be supervised by a counselor on the other side of the globe, communicate instantly with colleagues and consultants throughout the world, bill insurance companies electronically, prepare PowerPoint talks for church groups and professional presentations, and study Scripture and theology with hyperlinked CD-ROM study aids. The possibilities are so vast that it is difficult to wrap words around what is happening in a short article such as this. But armed with my word processor, spell checker, autosave and autoformatting features, and electronic grammar advisor, I charge ahead with the taskhoping that my Windows operating system wont crash today and my surge protector will do its job. In a recent review of the scientific literature, I described three waves of technology for counselors. 1 In a flurry of uncreative thought, reinforced (sadly) by my work in the ivory tower, I labeled these Wave 1, Wave 2, and Wave 3 technologies. Wave 1: Well-Established Technologies Like Dr. Washington, many counselors use certain well-established technologies routinely.

These technologies typically involve routine office management tasks such as word processing, billing systems, facsimile machines, photocopying, telephone answering systems and voice mail, pagers, and database management. A recent survey of California psychologists suggests that about three fourths use computers, three fourths use a FAX machine, half use a pager, 65% have access to a photocopy machine at home or at the office, and 40% use computerized voice mail.2 Wave 1 technologies have more possibilities than perilsthey are not particularly dangerous. These office management technologies don't typically affect what happens inside the counseling office and may even free counselors from mundane clerical tasks so they can concentrate more intently on counseling relationships. The possibilities increase with Wave 2 and Wave 3 technologies as do the perils. Wave 2: Partially-Established Technologies Wave 2 technologies have greater direct impact on our clients than Wave 1 technologies, and should be considered partially established in that some counselors, but not most, use them. Examples of Wave 2 technologies include using computers to assist with: test administration or interpretation, play therapy with children, interviewing and diagnosis, therapy or supervision by e-mail (or telephone), and so on. There are many possibilities with these technologies. Computerized test scoring is more accurate than hand-scoring and can provide counselors with interpretive printouts thus giving them access to leading experts in the field of test interpretation. Computerized interviewing guides the counselor or client through a series of questions and decisions to help formulate a diagnosis. Clients are sometimes more candid when responding to a computer than when responding to another human being, thus increasing the accuracy of diagnosis. Computerized interviews can also help identify mental health needs before they become difficult to manage.

Imagine walking into your physicians office in the year 2002. As you sit in the waiting room, you are given a handheld electronic device and asked to answer a series of questions. Your answers are compiled, compared with data from normative samples, then sent electronically to your doctor before the appointment begins. At some point during the appointment, your physician says, Some of the symptoms youre experiencing suggest a mild form of depression. Would you be interested in talking with a counselor about your situation?Scary? Well, maybe a little. But the possibilities for early detection, prevention, and treatment are worth considering. Computers can also be used to facilitate counseling methods. Many play therapists use computers to help engage children in the treatment process. Rehabilitation therapists find computers useful in helping their clients regain certain cognitive functions. Are you feeling nervous as you read about the possibilities technology may bring to the counseling office? If so, I commend you. Peril walks hand in hand with possibility.

We will consider two significant perils later. Wave 3: Emerging Technologies Some technological innovations have only begun to influence the work of counselors, but we will be hearing more about them in coming years. These will dramatically affect the counseling process itself, thus increasing both the possibilities for innovation and the perils of misuse. Examples of these Wave 3 technologies include videoconferencing, Internet services, and using virtual reality in treatment of anxiety disorders. Videoconferencing, also known as teleconferencing, allows two-way communication through TV monitors. Though early prototypes required satellite connection between TV monitors, telecommunications can now be transmitted more economically through telephone lines and Internet connections.

These recent advances have made videoconferencing increasingly affordable and, as a result, we are seeing a surge in telehealth (using the methods of videoconferencing to provide health services from a distance). Telehealth holds promise for reaching underserved areas with needed medical and mental health services. Have you heard of Headworks? How about Russell Razzaques CyberAnalysis Clinic? Emotions Online? Counseling Café? McAnally Online Christian Counseling? Pastoral Consultation Services? You guessed itthey are all counseling services available over the Internet. You can even pay to have hypnotherapy over the Internet (how does that work?). Whether we are skeptics, enthusiasts, or somewhere in between, we must acknowledge that online counseling is here and growing quickly. Virtual reality combines computer hardware and software to simulate real life experiences by presenting computer-generated graphics and sounds that are a response to the movements and responses of the individual using the software. Virtual reality has already been used to treat the fear of heights and to help clients learn appropriate social skills, and more applications will be forthcoming. Like genetic engineering in medicine, Wave 3 technologies have the potential to shake the ethical foundations of our professions while simultaneously creating possibilities of great good.

*Perils*

Are these waves of technology the serene whitecaps of seascape on canvas, or are they pummeling tidal waves destined to destroy us? I suggest these waves of technology are good, like ocean waves, so long as we respect their danger. Among the dangers are potential ethical problems and the risk of slipping into a technology of healingmentality as Christian counselors.

*Ethical Problems*

Is it ethical to FAX confidential client information to another counselors office? Should therapy records be stored on a computer network? If I lose client information because my computer disk crashes, have I behaved unethically? Is it ethical to provide weekly counseling by telephone? Should e-mail be used for clinical supervision? Is a licensed counselor in Nebraska eligible to provide services via the Internet to someone in Alabama? The answer to these questions can be answered with a big shrug. No one seems to know. My colleagues and I recently surveyed 1, 000 practicing psychologists, asking them to respond to 40 different behaviors related to technology. The 420 respondents who returned completed questionnaires indicated how often they engaged in each behavior and their beliefs about the ethics of each behavior.3 Here is where the big shrug comes inrespondents did not know if most of the behaviors were ethical or not. Over half of the 40 items received equivocal ratings on the ethics scale.

This, of course, is a monumental problem. Our technologies have grown faster than our ethical guidelines and, as a result, we don't have professional standards to know if something is ethical or not. So what are we to do as Christian counselors? The second best thing we can do is to get busy crafting ethical standards for how we will handle these emerging technologies. We should get started! The best we can do is to follow the words of Jesus, commonly known as the Golden Rule. In everything, do to others what you would have them do to you; for this sums up the Law and the Prophets(Matt. 7:12). Put another way, how would I feel if I were the client in this situation? Would I feel comfortable having my counselor retrieve messages from an answering machine if other support staff were also listening? Would I want my confidential therapy records stored on a network, even if the records were password protected? Would I want to receive counseling services via a 900 number or over the Internet? While these questions defy simple answers, they are worth considering.

*Technology of Healing*

Perhaps the greatest danger we face as technology begins to saturate the work we do is what a colleague of mine has referred to as the technology of healing.4 Just think about all the professional forces we have swirling about usmanaged care, empirically-validated treatment procedures, manualized treatments, short-term interventions, and now technological innovations. All these forces have potential for good, but each can deceive us into thinking that counseling works primarily because of the techniques and technologies we employ. One client has a phobia, so what do we do? Systematic desensitization. Another has a clinical depression, so we apply cognitive therapy for depression. What if a client in Argentina wants our services? Soon we can use the Internet or telehealth to provide help. Technology and techniques .

We must be careful, or else we will stumble into the fallacy that we are called to deliver the right techniques at the right time. Techniques are important in counselingaccounting for as much as 15% of the reason why people get better. 5 But we are not just technicians. We are called to relationships that heal. Approximately 30% of counseling effectiveness is due to the so-called common factorsa counselors ability to connect and empathize with the client. If we learn techniques or value technology at the expense of relationship, we have taken one step forward and two steps back. Henri J.M. Nouwen recounts an ancient East Indian proverb in which four brothers each learn a new science.6 They come together at an appointed time and place to demonstrate their knowledge. Online counselor is always available to help you out.

The first takes a bone fragment from the jungle floor and uses his science to create flesh. The second uses his science to put hide on the animal. The third puts limbs on the creature, and the fourth breathes life into the nascent beast. Without thinking through the consequences, the brothers have created a hungry lion that devours them before vanishing into the jungle. It is a story about technology and healing. The technologies we create can devour us if we do not respect their destructive power. We must cling to our calling while embracing the possibilities that technological advances bring. Online counseling is always available to help you out.

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