Online counselling services in Australia –the challenges of a new vehicle for an old Art.

Renee Gedge,Lecturer, School of Computer Science and Software Engineering [HREF1], Monash University, 900 Dandenong Rd, Caulfield east, 3125 [HREF2], renee.gedge@infotech.monash.edu.au

Abstract

This paper reports the results of a survey of Australian-based  on-line counselling services and discusses the potential advantages and disadvantages of this type of service. Unique practical and ethical problems may arise for therapists and  clients, particularly where a service has a global rather than local focus. Conversely, on-line counselling provides opportunities for the provision of services to client groups who would otherwise probably not use a counselling service. Methods of online counselling currently in use were found to vary from insecure email exchange  to real-time web video conferencing. Payment methods, fee structures, security measures, acknowledgement of ethical  problems, legal disclaimers, and apparent authenticity of practitioners also vary widely even within the small Australian practitioner base. The possible impact of these variables on issues including ethics and client confidence are discussed.
 
 

Introduction

One of the enormous growth areas in Internet applications has been  in the provision of health care information and advice. Sixty million people worldwide searched the Web for health care information in 1998 (Maheu, 2000). Two years later, a Harris Poll in April 2001 found that almost 100 million Americans looked for health information online.  Mental health is no exception - many people turn to the Internet for support and information on life problems and personal growth. This paper focuses on the current state of  fee based on-line counselling sites originating in Australia.
    There are a plethora of internet facilities which can provide forms of counselling - such as peer support groups for specific problems, message forums, and IRC chat rooms. Peer based on-line discussion and therapy groups have been present on the Internet for over a decade, with some of them mediated by a professional counsellor. On line counselling (also known as e-therapy)  is a natural extension of this, involving a one-to-one interaction between a client and a person purporting to offer a professional counselling service.
    On-line counselling may be free or fee-based, but either category raises a number of important implementation and ethical issues. On-line counsellors seem even less subject to the somewhat inadequate controls operating to control counselling businesses in the physical world. Even for qualified professionals, the effectiveness of on-line counselling as a clinical method has hardly even begun to be evaluated (Maheu & Gordon, 2000). For some potential clients, access to on-line services is either currently unavailable or they lack the computing skills to avail themselves of such services.

 Despite these concerns, fee based online therapy appears to be a growth industry. There are  strong indications that it is increasing the current client base for therapy by making services available or appealing to populations that previously would not use them. John Grohol, past president of the International Society for Mental Health Online (ISMHO), and a  prominent academic and therapist, told the online journal New Therapist in 2000 that he expects the number of on-line therapy providers to grow from the then current 300 worldwide to over 5,000 by 2005. (in Dunaway, 2000). Numbers in Australia are currently small, with the recent comprehensive search reported here identifying 20 fee-for-service sites.

Implementation of on-line counselling.

On line counselling is currently present in three basic forms:
1. Email  question and response  - with many sites offering discounts on  multiple emails.
2. Chat programs such as ICQ, in which an appointment is made and generally paid for before counsellor and client "meet" on line, using solely text based exchanges for a specified amount of time. This is evolving into secure Web based messaging.
3.  Video or audio links in which counsellor and client are visible over a web based camera. However,  synchronous video based consultations seems to be more fantasy than reality at present, particularly on Australian based sites.
Counselling sites may offer a variety of facilities. Sussman (1998) reported a diverse range of US based therapy sites. At the most sparse and probably unethical end was a site with an anonymous "therapist," who solicits e-mail to which he or she then responds to for $20. Other sites offer prepackaged intervention programs using workbooks or videos as well as online interaction. There is at least one site offering this type of service in Australia, with free email support once a self-help package for alcohol abuse is purchased.  Other sites are extensions of the physical world practices of registered psychologists, or psychiatrists. Many sites offer choices of E-mail, private "chat" rooms, telephone, a few offer real-time  audio or video, with one even offering a "virtual office which adds a dimension of objective presence" (Counselling at Distance).
 

What factors differentiate on-line counselling from traditional counselling?

Some characteristics of on line counselling are definitely advantageous to either client or provider, whilst others are either disadvantageous or controversial.
Advantages:
Practically speaking, online counseling offers accessibility and convenience to many clients. Costs are usually lower than face-to-face counselling due to reduced overheads. The lack of travel  requirements means improved access to services for people in remote areas or  people who are housebound due to disability or family commitments. People who travel extensively and/or who have time constraints may utilize on-line therapeutic services because they can be accessed from wherever they happen to be.
 Others who may prefer on-line therapy are people who are ambivalent about therapy, or uncomfortable with the traditional model of counselling. These range from people who are mildly uncomfortable with talking about their problems face-to-face, to people suffering from serious mental health conditions, such as agoraphobia, social phobias or anxiety disorders. A London psychiatrist surveyed patients with obsessive-compulsive disorder and phobic anxiety disorders and found that 91% preferred receiving services via interactive voice response, the Internet, or home computer over face-to-face treatment (Graham, 2000).  However, many professionals would dispute whether it is in the clients best interest to use services which allow them to continue in possibly harmful behaviours.
Disadvantages:
In fact, there is widespread concern about on-line counselling in professional circles, especially  regarding issues such as:
- the potential for unqualified individuals to take advantage of vulnerable people.
- the possibly inferior nature of counselling possible over such a medium.
- the possibility of  people with serious disorders such as violent or suicidal impulses being sidetracked from getting urgently needed help.
It is evident that on line counselling differs from traditional counselling in many ways. One of the most intriguing aspects of this is that many characteristics seem to be either good or bad, depending on a variety of factors such as the nature of the client, the problem, and the expertise of the counsellor.  The characteristics of on line counselling which seem to be significant are as follows:

Absence of visual and auditory cues.

With the qualified exception of video-conferencing (discussed later), on line counselling lacks visual and auditory cues. Traditional counselling  relies heavily on characteristics such as tone of voice, facial expression, body language, eye contact  and even silences to communicate information that words may be unable to.  Simple examples of this are the person who speaks loudly and rapidly, but says they are relaxed, or the person who slumps in their seat looking dejected but says they are fine. These are just the tip of an iceberg of non-verbal communications the client would usually convey.   This absence of visual and auditory clues also produces a strong sense of invisibility and anonymity which together often produce disinhibition in on-line communications. Grohol stated: "People's communications on the [Internet] are more disinhibited than they are in real life…Clients get to the point in e-therapy in the first correspondence." (in Dunaway, 2000).  Invisibility means the client does not have to worry about how they look or sound, nor do they have to cope with seeing the therapists reaction. This is an interesting parallel to traditional psychoanalysis, in which the analyst sits unseen behind the patient, allowing the patient to say anything they wish  without feeling inhibited by the analyst's reaction. This disinhibition is also reflected in the prevalence and success of telephone crisis counselling which operates with limited physical cues. However, in common with the telephone, communicating only with typed text allows people to suppress or cover up parts of their identity or even assume an imaginary identity without fear of being "seen through".
Invisibility and disinhibition of course may affect therapists as well as clients. It has been pointed out by a number of researchers in the field (eg Pelling, 2001) that it can be very difficult for clients to assess the legitimacy of on line counsellors. There is some evidence that para-professionals, often considered unqualified for other counselling positions, are looking to online counselling for business opportunities. Metanoia , a website associated with the ISMHO,  purports to offer a independent consumer guide to Internet therapists, and has developed  a  Credentials Check for therapists listed through their site.
 

The counselling environment.

The counsellors office environment will generally ensure privacy and lack of interruption to the session. A client participating in a session from their home could be subject to many different interruptions, including those that will threaten the privacy of  the session, such as household members entering the room. Conversely, clients may be far more comfortable in their own home, or an environment of their choice over which they feel a strong sense of control.
 

Asynchronous communication.

Two noticeable feature of many email counselling services are a promised maximum response time (often a few days), and a limitation on the  number of emails which will be responded to within a certain time frame. For the client, experiencing delays of days between their possibly momentous (for them) disclosures or insights and the therapists response may be quite uncomfortable.  This may be accentuated by the perceived immediacy of Email - that it can be received within seconds of sending. Even using a chat program , delays of seconds to a minute may be common. Conversely, the time it takes to type a response, or the knowledge that a response to this email will cost you $40 may both tend to encourage deeper reflection than a spontaneous verbal reaction.
 

The fantasy therapist

Transference and countertransference are important aspects of psychotherapeutic work. On line this can become even more important and difficult to control.  When clients visit a counsellor in their office, they immediately learn a lot about them. Physical characteristics such as gender , age, ethnicity, office décor, qualifications on the wall, and the myriad of other details give an overall picture of the person. Conversely, often the only information you have about an online therapist is a name and/or one (self-selected) photograph. This will tend to result in the client "filling in the gaps" with imagined qualities and characteristics, shaped  by their own needs.  These may create an idealized or even at times a demonized counsellor.
 

Recordability.

E-mail, chat sessions, and videoconferencing can be recorded and saved to a file, and several sites give clients directions on how to save their chat sessions. This is in marked contrast to traditional therapy in which the therapist will take notes for their own use, and the client generally relies on their memory of the session. Whilst clients can and do request copies of the therapists notes, this is not common practice. Client recordings of sessions may create new problems such as a client forwarding emails from their counsellor to others. These emails would very likely be tailored specifically for the clients situation and may not be applicable to another person. They also may become effectively public material without the therapist ever having intended them for a public forum. However, from the clients point of view, recorded sessions allows them to review the session later and possibly gain much more therapeutic benefit.
 

Unreliable technology.

Computers and computer networks often fail to deliver an acceptable level of service in areas such as response time or error rate and sometimes fail completely. Whilst an occasional missing email would create some difficulties, disruption to chat or video sessions would be far more intrusive and potentially distressing to clients. One Australian site has reverted entirely to email based counselling, stating that disruptions to the service had made chat sessions untenable.
 Only one Australian site, Sydney based "Webcounselling"  included a policy on their web site addressing this problem. The policy allows for the rescheduling (at no cost) of sessions interrupted within 10 minutes of commencement, a discount applying to a subsequent session if the interruption occurs between 10 and 45minutes, and any time lost to interruption after 45 minutes is added to a subsequent consultation.
 

Confidentiality and security.

Client confidentiality is a major concern in the provision of counselling services. Clients who reveal their most deeply felt and/or possibly shameful (to them)  thoughts and feelings may well fear the deliberate or accidental disclosure of these. Written records or more recently computer based electronic records have been subject to exacting ethical requirements with regard to storage and disclosure to others. Therapists rooms are generally set up to ensure considerable privacy for the client, with private rooms, locked filing cabinets, and password protected computer programs. Internet communications however, are not secure. TCP/IP by design is not a secure protocol, and all data that travels between the client and counsellor is exposed to potential hackers unless the therapist and client use additional security measures. Most commonly used Email and  Instant messaging systems do not support authentication and encryption.
 Several Australian sites carry warnings  to clients that forms they submit regarding their problems are not secure. Others assure clients their system is secure, whilst others do not even acknowledge the problem. Although secure systems are available for both email and chat programs, they are not in widespread use. Encryption of Email requires both client and providers to download and set up the software and this may discourage users. Some sites  utiIize products such as ZixMail which enables the exchange of encrypted and digitally signed communications using existing email systems. Some sites use SSL (Secure Sockets Layer) for forms which provides security for information, including credit card numbers. However, a number of Australian sites which used this technology came up with errors such as expired certificate, and messages that the site name and the certificate name did not match - unlikely to inspire confidence in a person seeking confidential communications.
Browser -based secure instant messaging systems are becoming available in response to concerns about confidential communications between and within businesses, and some Australian sites are using these. Although largely text based at present, audio and video support also exist. Compatibility has been a problem with most security solutions -  both parties must be using the same software. However, there are now moves towards standardization with the Session Initiation protocol for Instant Messaging and Presence Leveraging Extensions (SIMPLE) standard. This proposed format enables users to use the Internet for voice exchanges and establish conferences.
 

Efficacy of on-line therapy

Given the known problems and the lack of studies to date, it is very difficult at present to make any definitive statements about the efficacy of online therapy. Many counselling sites carry statements to this effect, some warning that they do not believe it can be as effective as face-to-face counselling. However, a few studies of the use of  telepsychiatry and interactive television show  comparable efficacy to traditional psychotherapy (Yellowlees, 2001). It does seem that the biggest single factor working against on-line counselling is the lack of visual and auditory information. Instant message software is currently undergoing rapid development, including video support, allowing the transmission of real-time video. Interestingly, video mediated web counselling may destroy what is most appealing for some clients and even some therapists - anonymity and invisibility. As Suler asks" How will the ability to see and hear other people on the internet change cyberspace? Will people WANT to give up those spaces that lack face-to-face cues but are rich in imaginative ambiguity?"  (Suler, 2000). Nevertheless, many therapists see low-cost video conferencing as the complete solution to on line counseling’s problems (Dunaway, 2000). However, this ignores the seemingly  obvious problem of lack of physical presence. Clasping a hand, or passing a tissue to a weeping client is a common experience for many counsellors and one that virtual reality is a very long way from duplicating. Studies have also shown that many people are uncomfortable in video mediated communications,  even aside from factors such as video and audio quality (e.g. Fish,Kraut & Root,  1993, Gedge & Abramson, 2001). Full screen video mediated counselling may not be the panacea that some counsellors expect.
 

Ethical and professional  guidelines and codes of ethics.

A number of major national and international bodies have produced guidelines and/or codes of ethics for practitioners providing internet based counselling services. These include The Australian Psychological Society, the premier professional body  representing psychologists, The American Counseling Association, the American Psychological Association and the National Board of Certified Counsellors. A consultative group of the British Association for Counselling and Psychotherapy in their Guidelines make the point that rather than requiring less qualifications, online counselling may require further specialized training and experience.
 

Globally versus locally focused services.

As with many Internet services, national boundaries may seem somewhat irrelevant to the practice of online counselling. However, unlike many other businesses a local presence may be the biggest single factor which causes a client to choose a service. There have been no studies published to date which examine this within the Australian context but many on-line sites are extensions of physical world clinics and practices,  and local clients are often encouraged to seek face-to-face counselling. Familiarity with local culture and prevailing national situation is probably also  an important factor in establishing a sense of rapport between therapist and client.However, one Australian site has published an interview conducted with an overseas client, who had previously had an online therapist based in the US. This therapist's charges had become prohibitive and the favourable exchange rate was the major reason for the client seeking a therapist in Australia.
If both client and counsellor are physically located in the same place, local laws may apply to the counselling relationship. However, counsellors may be based in different states or countries from their clients, and there is no international law governing these type of transactions. In the event that something goes wrong, at the present time, there is probably little or no legal recourse against the counsellor. One Australian counsellor specifies that he cannot counsel US resident clients due to laws operating in the US.
Another major legal issues for both providers and clients is the question of professional insurance cover and health fund coverage for on-line services. At present, it seems that unless the insurance cover explicitly excludes such services, professional malpractice insurance probably still applies. However, no test cases appear to have been conducted to date. Health funds are still grappling with the implications of on line health services.
 

Current situation in Australia

During the early part of 2002, a search was conducted for Australian based on-line counselling services. Multiple different keywords and search engines, including Australia specific engines, were used. Numerous  free and fee based services based in Australia were identified. Most free services are additional new initiatives for existing community or church based services.A total of  20 fee-for-service sites originating in Australia were identified (There are probably others, but they are certainly not easy to find). Many of the sites were identified with a physically based service.  Of these, NSW had the largest number with 7, Victoria had 4, 2 in Qld, one each in Tasmania, ACT, and S.A. The other Australian hosted other sites had no location identification.Table 1 summarizes aspects of these sites, including counselling method, security provision for the clients counselling data, identification of service provider and statements of qualifications, the presence of legal disclaimers and ethical guidelines, and the fee structures.
Australian based services varied along many dimensions, from  highly professional sites with strict ethical guidelines and secure session and payment  facilities to dubious sites with no identification of any practitioner. Most sites offers email exchanges (85%) , with 8 services also offering chat either solely (15%)  or in addition (25%), and one offering videobased counselling. Several sites promised secure chat lines and video counselling in the near future, but for several the promised date of arrival had already passed. Only 4 sites (21%) provided secure email or chat options.
Of the 20 sites, three (15%)  had no identifying details whatsoever for the providers.
Nearly all Australian providers require payment in advance, although some offer free initial sessions. Payment was generally by credit card, but only 8 (40%) specified secure payment options. Many failed to point out the lack of security to clients, or dealt with it by using normal postal service.  Two providers used an escrow service where payment must be authorized by the user once they were satisfied with the service. Legal disclaimers were used by 11 sites (55%), whilst 14 (70%) has some sort of statement about client rights and or limitations of the online counselling method.
A couple of the sites specified policies to deal with late/missed appointments. One highly commercial site specified that the counsellor would allow five minutes for lateness but will then be obliged to charge a cancellation fee of AUD $30 if the appointment was missed or cancelled. Another site specified cancellations must be made at least 1 hr before or full fee charged.
Some sites took considerable pains to distinguish their services from others . For example one  service was directed at the population of gay , lesbian, cross dressing and sex change clients. The counsellor advertised themselves as uniquely experienced, being a male to female change themselves. Other services took a spiritual or holistic approach to counselling. Others were highly commercial , with one using advertising such as " Accomplish all your goals" "Transform stress to success". A number of sites had a global focus, with links to currency converters and tables of International time zones, whilst others specified Australian clients only.
 
 
Site Name/URL State Method Session Security ID/verifiable
Qualifications
Disclaimer/
Ethical_Guidelines
Fees(Aus$)
Security 
http://www.users.bigpond.com/kulander NSW Email
Chat
? none mentioned Address,
Quals
No Discl
No E.Guide
15 p/email, 80p/m
55 p/h 150 p/m Escrow service
http://www.solutions.net.au/
~bobrich/intercouns.html
VIC Email encryption (cryptext.) address, photo, Quals ** No Disclaimer
Full E. Guide
40 p/email 
Paypal
http://goodelyfe.healingwell.com/
counselling.htm
ACT Chat (ICQ) ? none mentioned Address, 
No ver quals
Statement of client rights Variable
No security
http://users.senet.com.au/~sluchich/  S.A.  Email
webcam
? none mentioned Address, photo
Quals
No Discl
No E. guide
55 p/h
no security? 
http://www.CB-Counselling.com.au/ NSW Email ? none mentioned Address, photo
Quals
Disclaimer
Short e-guide
80 p/ 2 emails 
320 p/m
? no security?
http://www.nswcounsellingservice.org/ NSW Email
chat
Not secure No id, no address
no quals
Disclaimer
Short e-guide
? free
65 p/h? 
security
http://www.webCounselling.com.au/ NSW Chat Betweenus software Photos
quals
Disclaimer
Full e-guide
70 p/h
netregistry
http://www.4counselling.com.au NSW Email
Chat
secure  No id, no address
Quals?
Disclaimer
Short statement
40 p/email 
2 p/minute
secure
http://www.psychelp-sos.com.au/ NSW Email ? none mentioned Address, photos
Quals
No discl
No e-guide
20 registration + fee
no electronic pay't
http://www.jspencer.com.au/serv02.htm VIC Email ? none mentioned Address, id,
Quals
No disl
No e-guide
10-15 p/email
no electronic py't
http://www.geocities.com
/aussiecounsellor2000/
? Email ? none mentioned Photo, no address
Quals
Disclaimer
Short e-guide
40 p/email
escrow service 
http://www.heritagecounselling.homestead.com/ ? Email ? none mentioned Id, no address
Quals
No disclaimer
Short e-guide
45 p/email, reducing
secure 
http://www.angelfire.com/md2/
Counsellor/index.html
NSW Email Not secure(warning)

 

Id, Address
quals 
Disclaimer
Full e-guide
44 1-4 emails reducing
no electronic pyt
http://www.delphient.com.au/dream VIC Email none Id, address
Quals
Dislaimer
No e-guide
35 per dream
secure
http://www.netpsych.net.au/ VIC Email
Chat
none Id, Quals Disclaimer
Short e-guide
Varied
Secure 
http://members.ozemail.com.au/~tarim/counselling/ ? Email
chat
none Id, no address
quals 
Disclaimer
Short eguide
50 for 7 emails
50 p/h? secure 
http://www.suzannebarr.com.au/index2.htm QLD Email none Id, address,
quals
Disclaimer
Short e-guide 
Unspecified
? secure 
http://www.maranatha.com.au/online-counselling/ QLD Email none Id, address, photos, quals Disclaimer
Short e-guide
50 for 5 emails
http://www4.tpgi.com.au/users/bms2/ ? Chat ? Id, photo, quals Short e-guide Unspecified
?
http://www.ontas.com.au/journeys  TAS Email secure Address,id,photo
quals
No discl
No e-guide
25 p/email
70 p/h email
secure 

Table 1. On counselling services based in Australia.
 

Example services.

The following five examples illustrate some of the features of current on-line counselling in Australia.
 

 WebCounselling, NSW (http://www.webCounselling.com.au/).
Webcounselling is a Sydney based service which appears to take the on-line enterprise very seriously. They have a page devoted to outlining the ethics of on line counselling, and  address the question of qualifications very prominently. This site has an international focus, with provision for currency and time conversions. The counselling method is via chat , and the service uses encrypted software Betweenus to protect client session data. The client also receives a new IP address each time the service is used. The IP address is e-mailed to the client by the therapist a short time before the appointment. The software allows the client to save all of chat session but clients are warned that the material is not secure (ie not encrypted) once saved. The  senior psychologist Bernard Coady  said "We're aiming the service at professional people who feel intimidated by the thought of  going to counselling. The Internet provides the anonymity and a sense of control over the  process which you don't get in face-to-face counselling," …"We don't see Internet counselling as appropriate for somebody with a mental illness. It's good for people going through a life transition"( Coady, 2000) .
 

Journeys, Tasmania. http://www.ontas.com.au/journeys
The on-line service is an extension of an existing counselling practice based in Hobart , and goes to considerable lengths to establish credentials. There is a photograph of the principal counsellor, a description of his qualifications (social worker), and what this means within the Australian context. He also includes an extensive explanation of his therapeutic method. The Hobart practice is advertised as available for local people and organisations in face-to-face form. Several "stages" of counselling are offered, beginning with a free downloadable self help questionnaire. An E-mail response to the questionnaire, described as secure,  costs  $25.00. The final stage is an E-mail counselling session of one hour costing $70.00. This must be booked by appointment.  Payment is by credit card only via a secure encrypted credit card system. The site includes a statement that a dedicated secure chat line will also be available in the future
 

McArthur Counselling service (http://www.nswcounsellingservice.org/).
This site had a lot of typographic and grammatical errors, and no address or identification for any individual or organization. There are three vignettes of counsellors, with only a first name, no photograph and  qualifications are vague. There was a very brief reference to confidentiality, but no implementation details. All of this did not inspire confidence. Different levels of service were offered, including free on line chat with a counsellor. However, several attempts to register for this service failed and the advertised  fee-based secure chat line was also not operational at time of writing.
 

Susan  Luchich, S.A. (http://users.senet.com.au/~sluchich/ )
This site advertises confidential internet counselling from anywhere, and face-to-face counselling in Adelaide,  South Australia. Qualifications are specified along with a lot of personal information including personal references. This was the only Australian site which offered counselling via video link, specifying that the client must have microphone, web-cam and supporting software. The site gave information about alternative time zones for making appointments.
 

Dr Bob Rich,  Vic (http://www.solutions.net.au/~bobrich/intercouns.html)
This site gave a lot of personal information  including qualifications. The counsellor no longer used a chat room as too many attempted sessions had been disrupted.  The site used an Email encryption program, Cryptext , which the counsellor would send to clients. Payment was either by post or registration with PayPal. This site was hosted by a commercial web hosting service, Angelfire which generated advertising banners. This was the only Australian site which had a WebAssured Seal of Assurance – an Internet facility that monitors on-line business credentials. However, when clicked on, it appeared that membership was not current.
 

Conclusion.

On-line counselling in Australia is currently a small and largely email- based enterprise, with a few chat based services. Further surveys are required to collect actual usage data. As with many businesses on the Internet, neither size nor location are necessarily important. Counselling clients are no longer confined to the service just down the road.  The greatly increased choices  of time, place and method in on-line counselling may well open up this area of human services to a brand new population. However, strategies specific to the Internet medium are required to encourage clientele (Patterson,& Byrnes, 2000). It is vital  for clients to feel a sense of confidence and trust in their on-line counsellors. Those sites with no photographs or identification of any sort seem to fly in the face of this and look unlikely to succeed. Security for client data and payment also need to be addressed seriously.  It is difficult to imagine a client talking or typing about their deepest fears or secrets with no reasonable guarantee of confidentiality. Potential problems exist for counsellors and clients where serious mental illness or life crises are involved. Referrals to crisis services and salient warnings about the limitations of on-line counselling are required on counselling sites. Integrating a new on-line counselling business with an existing counselling business is an emerging model and whilst it involves challenges,  is probably generating business on and off-line for some practitioners. Cheap and readily obtainable on-line video may significantly increase the client base, although for many people it would still not be the first choice for therapy. However, increasingly e-therapy is likely to be seen as a significant supplement to existing services.
 
 

References

 
Coady,B. (2000)  Interview with ZDNet Australia, October 2, 2000.  (Accessed 5/2/02).Available online. [HREF1]

"Online Counselling" - Counselling at Distance - (Accessed 8th March,2002.)  Available online [HREF2]

Dunaway, M. O. (2000). "Assessing the Potential of Online Psychotherapy". Psychiatric Times  17(10).

Fish, R.S., Kraut, R.E, & Root, R.W. (1993). "Video as a technology for informal communication". Communications of the ACM, 36(1),  48-61.

Gedge,R & Abramson,D (2001) "The Virtual Tea Room – experiences with a new type of social space." Proceedings of CRWIG, Seventh International Workshop on Groupware, Dharmstadt.  IEEE.

Graham, C., Franses, A., Kenwright, M. & Marks, I. (2000). "Psychotherapy by computer". Psychiatric Bulletin 24:331-332.

International Society for Mental Health Online (2000).  Suggested principles for the online provision of mental health services. ( Accessed 7th April,2002). Available online. [HREF3].
 

Maheu, M. M., & Gordon, B. L. (2000). Counseling and therapy on the Internet. Professional Psychology: Research and Practice. 31(5), 484-489.

Metanoia – ABC of Internet Therapy. accessed 25th Feb,2002  Available online [HREF4]

New Therapist (2000).: Online therapy-A minefield of treasures.May/June.2000 accessed Aug. 31, 2001. Available Online. [HREF5]

Patterson, K. & Byrnes,R. (2000) "The Witches Brew - A Recipe for Internet Business Success". Paper presented at AusWeb2k -The Sixth Australian World Wide Web Conference,Cairns.

Pelling, N. & Renard, D. (2000), Counselling via the Internet: Can it be done well? The  Psychotherapy Review, 2(2), 68–72.

Suler, J. (2002). "The basic psychological features of cyberspace". In The Psychology of Cyberspace Accessed Feb 24th, 2002. AvailableOnline: [HREF6]

Sussman (1998). Counseling Today, June 1998. Publication of the American Counseling Association.

Yellowlees, P.(2001). Your guide to e-health : third millennium medicine on the Internet. University of Queensland Press.
 

Hypertext References

HREF1
http://www.webCounselling.com.au
HREF2
http://www.angelfire.com/sk/OnlineCounselling
HREF3
www.ismho.org/suggestions.html
HREF4
http://www.metanoia.org
HREF5
www.newtherapist.com/grohol7.html
HREF6
www.rider.edu/users/suler/psycyber/basicfeat.html

Copyright

Renee Gedge, © 2002. The authors assign to Southern Cross University and other educational and non-profit institutions a non-exclusive licence to use this document for personal use and in courses of instruction provided that the article is used in full and this copyright statement is reproduced. The authors also grant a non-exclusive licence to Southern Cross University to publish this document in full on the World Wide Web and on CD-ROM and in printed form with the conference papers and for the document to be published on mirrors on the World Wide Web.