Surf into My Office
By Angela Kennedy (American Counseling Association)
Published on Counseling Today, June 2005, An American Counseling Association Publication
Using the slogan “Better health begins with better mental health,” Jef Gazley has set out to establish a one-stop shop for health care and education on the World Wide Web. Owner of AskTheInternetTherapist.com, Gazley and his staff of mental health professionals, doctors, nurses, chiropractors, and alternative healers provide counseling, advice and guidance to individuals via the Internet.
Gazley is a licensed counselor and hypnotherapist with more than 30 years of experience as a psychotherapist. He holds a certification for distance counseling from ReadyMinds and is a trainer for that company’s Distance Credentialed Counselor program. In addition to his work on the website, he also is a private practitioner in Scottsdale, Arizona.
Gazley’s initial website launched eight years ago with his partner in private practice, was limited strictly to online counseling. In 2000 however, he added the general health component, creating a virtual clinic atmosphere complete with web-based, self-help discussion groups; a library of “suggested” movies, music, and books; and an online media store selling audiotapes, e-books, books and videos.
“We thought it was really important to look at holistic care and be able to have the possibility of clients accessing two or three clinicians all at once to talk about health problems,” he said. “Our goal is to treat the whole person. We can provide economical online therapy sessions with several specialists simultaneously, or individually, to help with both mental health and physical health concerns.”
Including Gazley, nine licensed counselors and seven health professionals make up the AskTheInternetTherapist.com medical team. Based on their computer skills and equipment, clients can contact the online counseling team through audiovisual technology such as a webcam or microphone using MSN Instant Messenger, or Yahoo Instant Messenger, through closed chat rooms, via e-mail, or by phone. Payments are made directly to the counselor with a credit card or through a secure server such as PayPal.
“E-mail is the most popular form with the clients,” he said. “We get about 20 e-mails a day from individuals seeking free services (and) five to eight paying, new clients a day. That’s a whole lot more than we have seen in the past couple of years. It’s been a very slow build.” On average, he said, for every new client session, the site sells about three mental health videos. The hour-long videos cover a range of topics from Post-Traumatic Stress Disorder to parenting to drug addiction to family dysfunction. The videos show Gazley discussing the origins of the problems as well as symptoms, dynamics, and treatments. Originally designed with clients in mind, Gazley said today more than half the tapes and DVDs are sold to hospitals, clinics and libraries.
The move to cyberspace
Gazley was initially reluctant to consider using technology to practice counseling. “I thought it would be dehumanizing,” he said. “I came kicking and screaming into the computer age.” In fact, he said he didn’t touch a computer until his billing accountant left and he needed to oversee the billing for his private practice.
“At that time,” he said, “there were ideas for programs where clients could seek an automated form of therapy, and that idea sounded horrible to me. But I could see using those as tutoring programs that would act as an addendum or homework for face-to-face counseling. I don’t think it’s an either-or proposition… For the most part, we’re doing triage and education (through the website). Almost everyone that I see online, I also refer them to a local counselor.” Gazley added that he usually gives clients his initial assessment of their problems, and then encourages them to seek a professional or specialist in their area for an in-person session.
Gazley also finds that he has to adapt, depending on the communication method being utilized. “Each particular medium, whether it’s e-mail, phone, or webcam, brings something that you can’t get from the other and also has some limitations as well,” he said, “With audio-visual, I’m able to see the clients’ emotions and body language, but on the phone you sometime pick up some things in the voice that you wouldn’t face-to-face. (And) one thing that surprised me, because initially I thought that e-mail would be very, very limiting, is that I tend to pick up a whole lot of things through writing. I find myself working about three times harder online. You have to really strain yourself to pickup those nuances. I focus much more on how I say things in print and how it could be misinterpreted.”
Although acknowledging that counselors must have good written communication skills to successfully provide therapy via e-mail, Gazley noted that counselors can be taught to perform distance counseling proficiently. “There are some clients and some clinicians who will work in one medium better than another,” he said. You have to find what works best for you and the client.”
Addressing question of licensure, online therapy
Referring clients can be difficult for online counselors because, for the most part, they are not familiar with the area in which the client is located. Gazley hopes to establish a network of resources and referrals in the future. He is currently recruiting counselors from across the country to join his cyberpractice. His goal is to have a representative from every state in the nation on his team of mental health professionals, not only to provide a broad range of referrals but to prepare for possible state laws regulating online therapy and restricting online counselors from “crossing” state lines
Licensure is one of the biggest controversies surrounding online therapy. Many states have only recently begun to regulate “live” counseling practices and have yet to address the area of technology and cybercounseling. Gazley and his team practice according to the laws of their own state, Arizona, instead of the laws where each of their online clients resides.
“There is still the question of where the therapy is really coming from,” Gazley said. “Is it being done in my office –which is what I think – where people come visit me by phone or e-mail, or is it happening in the client’s state or somewhere in between? I tend to come from the old school of private practice, which is the idea of opening a private practice and people coming to you and taking responsibility for their health. The Internet has really leveled the playing field. It has given us back more a sense of freedom (that we had) before managed health care, and I think that is huge. I like the idea of clients being responsible for their own health care.”
With online therapy, he pointed out, clients control how long they want to stay and what kind of medium they want to work with. In general, he said, online clients are also more committed to changing, progressing and doing homework. “Paying directly is a part if that,” Gazley said. “They are more equal partners in the process.”
Online colleagues
Carol Agnew and Audrey Jung are cyber staff members of Gazley’s team. Agnew, a Licensed Mental Health Therapist, has worked online for the last year. After having a child in the spring of 2004, she wanted to find a way to supplement her income while working at home. After completing a distance counseling course, she joined AsktheInternetTherapist.com. During the week, Agnew is a supervisor for the Homer-Based Family Therapy Program in Michigan. She works online in the evenings and on weekends.
“Some months I am very busy,” she said. “Other months I only have one or two e-mails. It has been increasing though. Online counseling is great for people who only need one session. They write, get their questions answered and go on with their life. I have gotten a few clients that outside the range of issues that I usually work with. This has challenged me to stretch myself to find a way to help these people. It inspired me to once again do some research to find the latest ideas on these issues and reacquaint myself with some other modes of therapy.”
Jung, a certified counselor with a private practice in Arizona, also wanted to try online counseling because it would allow her to spend more time at home with her young children. “I remember struggling with my decision to stay (at home),” she said. “It was difficult for me. I missed the challenge of using my professional mind.” She found it difficult to complete continuing education credits while she wasn’t working, she said, but knew that she had to keep her credentials updated because she would eventually return to work.
“I was reading an article in the National Board of Certified Counselors newsletter. It discussed the World Health Organization and their request that American counselors find a way to reach over the great divide to provide services in countries that really needed help, like the Doctors Without Borders program,” Jung said. “The NBCC then discussed the ReadyMinds training program for distance counseling, and I thought to myself, ‘This is it! I can blend two things that I love to do – surfing the web and helping people – and do these things from home.’ I was able to arrange for my husband to care for our children, I took the training, and I solved my CEU problem!”
Jung prefers using e-mail in her online therapy sessions. Before working online, she used e-mail at home as part of her primary communications with others. “I’ve had deep, personal conversations with others via e-mail, kept in contact with family and friends via e-mail and, therefore, e-mail counseling seemed to be the next extension.” It helps, however, when online clients are comfortable expressing themselves with the written word, she said. “When they struggle to express themselves or do so in too general a manner, the process can be more difficult,” Jung said. “But then again, this is true for face-to-face counseling as well.”
Jung added that she enjoys having the opportunity to mull over clinical issues in-depth when working with asynchronous clients via e-mail. “I feel creative when I can come up with alternative methods to relay clinical concepts, like poetry, quotes from literature and songs.” she said.
All three counselors mentioned two of online counseling’s major benefits. First, the Internet provides a cloak of anonymity for clients. Second, it is easily accessible for the masses. Thanks in large part to the built-in convenience and confidentiality, more people are seeking professional help or searching for effective self-help information online.
“Average, everyday people use online counseling as a way to help them through their life without being embarrassed or stigmatized by going into an office and sitting in a waiting room,” Agnew said. “I think it offers a lot of new and exciting opportunities for our profession.”
Jung agreed, “I believe that the Internet will further legitimize the field of mental health and allow more individuals the opportunity to seek services,” she said. “Change often makes people nervous. Bringing the field of counseling online is a huge change to the mindset of traditional psychotherapists. There is a lot to be addressed and debated, I am sure. But what I am also very clear on is that relationships are forming online, people are discussing very deep, personally conflicting issues online, and people are seeking support services from others online as well.”
For more information or to contact Gazley about becoming part of this cyberteam of health professionals, e-mail jef@asktheinternettherapist.com.
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