ONLINE COUNSELLING AND ITS CHALLENGES

ALEX CHEW

COUNSELLING IN A FLAT WORLD

In his international bestselling book, Friedman (2007) suggested that horizontal collaboration and interdependency are some of the features arising from globalization in a ‘flat world’. The major ‘flatteners’ have been significantly attributed to the emergence of such major technological innovations from the World Wide Web, Google, mobile phones, PDAs to VOIP. It calls for a perceptual shift that is needed for countries, organizations and individuals to remain competitive in a global market where historical and geographical divisions are becoming increasingly irrelevant. The call for such a paradigm shift is not limited to a potential model of how businesses are conducted but on how helping services can be delivered, especially professional services such as those in the field of counselling. One can see a shift in the pattern of Internet penetration over the years moving in from the west to the east and therefore the demand for Internet related services, including online counselling, becoming a potential feature in this region for the future.

In 2002, Norcross, Hedges, and Prochaska had predicted an increase in online provision over the next 10 years as can be seen by the increasing number of people who have sought mental health information, emotional support, advice, and online counselling over the Internet.

In 2000, North America and Europe made up more than two thirds of the world’s population of

57

4

Internet users, whilst in 2008 Asia alone comprises nearly two thirds of the world’s Internet users. In Malaysia the number of Internet subscribers in 2004 was 2.9 million. The latest figures provided for June 2007 by the Malaysian Communications and Multimedia Commission (Suruhanjaya Komunikasi dan Multimedia - SKMM) put the number of Internet users at 14.9 million which gives a penetration rate of 59% of its current population. It ranked 9th in Asia, the top countries of Internet users are China, Japan and India. Overall, Asia has the largest number of Internet users with 578.5 million, Europe 384.6 million and North America 248.2 million although the penetration rate is only 15.3% compared to 73.6% for North America, and 48.1% in Europe. The three main languages used in the web are English 29.4%, Chinese 18.9% and Spanish 8.5%, making up 56.8% of the total languages that are used in the web. (Internet World Stats, 2009)

It goes without saying that with the ever potential increase of online helping services, there is a growing voice of concern to look into the efficacy of the different online mental and behavioural health services as well as a systematic inquiry into the dynamics and potential effectiveness of online counselling. There is also a growing concern that such services are delivered in an ethical and professional manner (Finfgeld, 1999; Murphy & Mitchell, 1998: Shapiro & Schulman, 1996; VandenBos & Williams, 2000, Mallen & Vogel, 2005) The International Society for Mental Health Online was formed in 1997 to promote the understanding, use and development of online communication, information and technology for the international mental health community. Since its inception, it has collected research articles regarding online counselling (http://www.ismho. org/res_bib.htm).

Chester and Glass (2006) noted that organizations and structures have emerged to support the growing trend in online counselling.

58

Guidelines for online practise have also begun to proliferate. For example, in 1997, the American Psychological Association (APA) published a statement on Internet services (APA, 1997) and two years later the American Counselling Association (1999), produced a document entitled “Ethical Standards for Internet Online Counselling”. In 2001, comprehensive guidelines were developed in the UK by the British Association for Counselling and Psychotherapy (Goss et al., 2001) and these were revised in 2005. Such guidelines also existed in countries including Canada and Australia. Practitioner handbooks also are being published such as Online Counselling: A Handbook for Mental Health Professionals (Kraus et al., 2004), Technology in Counselling and Psychotherapy: A Practitioner’s Guide (Goss & Anthony, 2003), and Online Counselling: A Handbook for Practitioners (Jones & Stokes, 2008). More and more training programmes that are specific to online counselling are also emerging. Such examples can be seen Counselling Online Limited (2009); Online Counsellors (2009) .

In 2000, a group of helping professionals, who were interested in the potential of the emerging Internet technology and as very experienced counsellors of BACP (British Association for Counselling and Psychotherapy explored and experimented to learn more about counselling through the Internet. This resulted in the setting up of the Counselling Online Limited whose website at http://www.onlinetrainingforcounsellors.co.uk/ to becoming one of the very first training organizations in UK to offer qualified professional counsellors further training in online counselling. This was followed by the establishment of ACTO (The Association for Counselling and Therapy Online whose web site at http://www.acto-uk.org/, to become a professional organization in 2007, to represent the interests of the growing numbers of online counsellors and therapists in UK. The

59

organization aims to promote, improve and advance online counselling and therapy, and to ensure the public that its members hold an appropriate qualification, work within a professional code of ethics and uphold the highest ethical principles in their online practise. It can said that in many ways online counselling will always be attempting to match an even faster pace of change with the arrival of the next phase of technological innovations.

THE CURRENT POSITION OF ONLINE COUNSELLING

Mallen and Vogel (2005) found that a significant challenge associated with online counselling and the various technologies involved in delivering its services is reaching an agreement regarding what is and what is not online counselling. They note that the use of distance communication technologies to deliver mental and behavioural health services has increased considerably over the past 10 years (Huang & Alessi, 1996; Sampson, Kolodinsky, & Greeno, 1997) and a variety of terms have been used to refer to these services, including e-mail therapy (Shapiro&Schulman, 1996), telepsychiatry (Brown, 1998), Internet psychotherapy (Stein, 1997), cyber-psychology (Schiano, 1997), cybertherapy (Stricker, 1996), and webcounselling (Bloom, 1998). They suggested that to be consistent with these definitions and the growing literature on distance-communication technologies, the term online counselling be used to encompass the growing variety of therapeutic services that are currently offered. They define online counselling as any delivery of mental and behavioural health services, including but not limited to therapy, consultation, and psychoeducation by a licensed practitioner to a client in a non-F2F setting through distance communication technologies such as the

60

telephone, asynchronous e-mail, synchronous chat, and videoconferencing.

A distinction between face-to-face (F2F) communication and computer-mediated communication (CMC) needs to be made. The ‘computer’ in CMC has become a misnomer given that what could only be achieved through a computer before, can now be achieved through mobile phones, PDAs, and digital TV amongst the increasing number of ‘wired’ products that is linked directly to the Internet. F2F implies that the communicators are physically present in space and time whereas CMC implies different locations and the people involved are communicating through one or in combination of the several distance-communication technologies, such as asynchronous e-mail, synchronous chat, audio/video conferencing and white-boards.

Asynchronous e-mail or online letter writing is the most common form of CMC. Statistics, extrapolations and counting by Radicati Group from August 2008 estimate the number of emails sent per day (in 2008) to be around 210 billion. 183 billion messages per day means more than 2 million emails are sent every second. About 70% to 72% of them might be spam and viruses. The genuine emails are sent by around 1.3 billion email users. (cited in Tschabitscher, 2008) E-mails are sent through one of many e-mail providers, such as Google, Hotmail, America Online, or Yahoo. Once an e-mail message is sent, the recipient can view it at his or her convenience and can respond likewise. Asynchronous means the communicators do not need to be online at the same time and because communication can occur between two people at irregular intervals of hours, days, or weeks. Synchronous chat is similar to asynchronous e-mail in that an individual composes a text message and sends it to the other person or persons. The recipient(s) is also online and immediately views the

61

message as it appears on the screen and a response is typed and sent back once the message is viewed and continues likewise until one party decides to leave the conversation. It is considered synchronous because the communication happens in real time. In e-mail and chat, it is useful to note that although text remains the main medium, the use of acronyms for brevity e.g. ‘c u l8r’ (see you later), ‘ lol’ (laugh out loud); and the use of smiley and emoticons are incorporated liberally, giving rise to its own unique form of communication. This may be partly due historically to the restrictions place on the number of characters allowed in the SMS (Short Message Service) for mobile phones, as well as the need to enrich text conversations with emotional expressions and in matching the speed of natural speech during synchronous chat.

Audio and videoconferencing may be less common than asynchronous e-mail and synchronous chat because not as many people have access to the required technology, but it provides a more dynamic communication between parties (Zack, 2004). We can see at present that this suggestion in 2004 is already changing with the increasing amount of bandwidth becoming available and the greater uptake in broadband. This is helped by developments in Internet browsers as well as more efficient audio and video Internet transmission e.g. Flash, VOIP etc. requiring less resources to perform better.

The next platform for synchronous online counselling that is currently making its presence felt and is being offered in some limited form is through an online 3D ‘virtual world’ like Second Life (http://secondlife.com/) thus adding ‘Avatar Therapy’ to the growing list of online counselling and therapy. Dr Craig Kerley, who advertised himself as a licensed psychologist from Georgia, USA (http://www.drkerley.com/avatartherapy.html) in his website is an example of a professional who

62

has a virtual office in Second Life. He defines the term "avatar" as describing one's personal manifestation in a virtual world. It may be the visual image you create for yourself, as well as the psychological character or persona you present to others.  Avatar-based cybertherapy provides a virtual approximation of traditional face-to-face therapy available in cyberspace. Although his is a virtual replication of a terrestrial therapy office, 3D virtual world may potentially offer many new direct directions in online counselling and therapy, where the use of fantasy role playing, skills rehearsals and acquisitions, etc. in psychodrama, dramatherapy in the treatment of PTSD, social anxiety etc. could be further explored.

Videoconferencing allows the sending and receiving not only text messages but ‘live’ video images as well as communicating through voice. Similar to chat, videoconferencing is considered synchronous because both parties need to be present during the communication. A major development in online counselling in using audio/video conferencing facilities has been the development of VoIP (Voice Over Internet Protocol) sometimes referred to as such as IP telephony, Internet telephony, broadband telephony, and broadband phone e.g. Skype (http://www.skype.com/intl/en/). In VoIP technology, the availability for conference calling means a number of people could engage synchronously in an audio conference which opens up possibilities for group related activities communicating through voice.

The author would like to use an illustrative example of an online counselling/therapy practise, which includes online client, online supervision, and online training. All areas of practise include elements of both asynchronous and synchronous methods as well as the use of text, audio/video, and whiteboards. In conducting online work, the deciding

63

factor of which technology to use is dependent not only on what software or hardware is available to the individual(s) but ascertaining the Internet service available where the client is residing and in the case of client work, the nature of the issues being presented. The use of e-mail forms the lowest common denominator for the lower end of the technological continuum. E-mail usage in online counselling/therapy, supervision and training is not limited to the actual text contents within the email but can include e-mail attachments as well and that may contain images and audio/video as well as links to other repositories e.g. their personal blogs, video archives etc. Administrative related activities e.g. scheduling sessions etc. are generally communicated through e-mails or instant messages delivered to Skype when offline. The use of audio conferencing is through Skype and is generally utilized for online individual and group supervision, small group teaching, academic tutorial support for individual student and/or group. A whiteboard is also utilized together with Skype to conduct creative arts therapy where projective and interactive image making, role playing, etc and other spatial and visual representation in groups are required. Text communications in Skype are used to enhance clarity where accent, poor sound quality or when audio breakdown occurs. It is also used for highlighting a URL link, book/article reference, and other resources that can be easily and accurately referred to after the session. Because of its ease in recording a video, audio and text session in Skype, this in itself can be a very useful resource for the client, supervisee and student in enhancing further reflection, providing raw data for future evaluation and research, evidence of personal learning and professional development as well as providing a professional and legal documentation of ones own professional practise. VoIP systems like Skype interface with the traditional public switched

64

telephone network (PSTN), thus group conferencing can be conducted not only just between computers with Internet connections using Skype but between computers and telephone, both landline as well mobile (handphone) services. This enables the author to connect with his clients, supervisees and students globally during periods when they do not have access to a computer or Internet connection or even when the demand for bandwidth compromises the quality of the call. Such subscribed features available are so cheap making it viable when it is zero or near-zero cost. The other benefit is the use of Skype to conduct and record interviews and discussions for podcasts, on online counselling and creative arts therapy–Therapeutic Airwaves (http://therapeuticairwaves. blogspot. com/) and Creative Frequency (http://creativefrequency. blogspot.com/). One of the potential uses of Skype which have yet to be explored and implemented is its adoption by crisis or mental health call centres such as the Samaritans, Befrienders, Childline etc. This is because of the features available, low cost and convergence with PSTN that Skype offers a viable alternative which may address some of the current difficulties in staffing a 24 hours centre that is locally and physically located.

SOME OF THE CHALLENGES FOR ONLINE COUNSELLING

Counsellors and therapists are strongly motivated towards such values as multiculturalism and the promotion of social justice (Ivey & Collins, 2003; Vera & Speight, 2003). Atkinson and Lowe (1995) propose that cultural competence in the counsellor is the ability to be culturally sensitive and to be aware of a client’s cultural background with a yearning to understand how it may influence the client’s experiences, affect, thoughts, and behaviours. It may be argued that the lack of visual

65

and nonverbal cues e.g. text based online counselling eliminates outer differences between a client and a counsellor/therapist, such as skin color, accent, age, and sex, and thereby potentially eliminate or reduce intrusion from common stereotypes about certain cultural groups; however, on the other hand stereotypes may be reinforced if there are no F2F cues to disconfirm those beliefs. It is interesting to note that from an unpublished study that the author had conducted (Chew, 2004) that even without physical or non-verbal visual cues, cultural cues can be observed in the use of text, reflected especially through manner of social greeting, values orientation, and cultural nuances of expression that is more akin to natural speech. This implies that text formation reflect the cultural signature of the individual in the absence of traditional visual cues.

The digital divide is a term used to describe the inequality of the Internet. Hoffman, Novak, and Schlosser (2000) stated that while everyone, in theory, has the ability to access and use the Internet, it is currently the more educated and affluent who do so. Online counsellors and therapists alike need to consider how they can promote social justice and to ensure services can be made available to the disenfranchised or underserved. Counsellors can be advocates for individuals without a strong voice in the community as well as extend services to populations that typically do not have easy access to treatment.

In USA, where most of the literature on online counselling is available, it is known that African Americans and Latinos use the Internet less frequently than do Whites (Hoffman et al., 2000; Tomás Rivera Policy Institute, 2002). They include access issues associated with socioeconomic conditions in these communities. This calls for an understanding of Internet use as a reflection of mainstream culture when exploring how to most

66

effectively service the underserved populations. Mallen, Vogel and Rochlen (2005) submitted that the online-counselling research thus far has involved predominantly white subject populations. They argue that it remains to be seen if online services are useful for people of colour. They strongly advise to avoid using the Internet as a “universal tool” to approach the various needs of diverse populations. In their experience, research extrapolated from mainstream subjects and mechanically applied to communities of colour misses its mark. For example, they cited many traditional psychological theories and practises of counselling are based on White American cultural values grounded in individualism, individual responsibility, and autonomy (Sue & Sue, 2003) and therefore issues related to race, ethnicity, and culture are rarely considered a salient component in treatment. Thus, attempts to use online counselling to address the needs of underserved populations may be ineffective if special attention to the comfort and use patterns of communities of color are not understood.

Videoconferencing, synchronous chat, asynchronous e-mail, and telephone communication are very different forms of distance communication, and important nuances are sometimes lost when studying these methods as a whole. It may be also be more fruitful to study and to explore various forms of online counselling separately. It would also be prudent for future researchers to compare the attitudes and behaviours among different racial, cultural or ethnic groups in response to the Internet and online counselling in determining the most effective means of making online counselling potentially available to a wider number of people in promoting wellness, especially in marginalized or underserved populations. (Prilleltensky & Prilleltensky, 2003).

THEORETICAL CONSIDERATIONS

67

Over the past ten years, the academic study of the psychology of online behaviour has contributed to the development of online counseling. There are many researchers currently exploring various aspects of online behavior and at the same time mainstream counselling and psychology journals are accepting more articles about online behavior. Professor of psychology, Azy Barak’s from the University of Haifa provides a comprehensive reference list with links to academic resources, which a counsellor can access in determining the theoretical state of the art in online counseling.

The development of an emergent theoretical framework for online counselling will to a large extent depend on how the practitioner has been informed by the theoretical perspectives of counseling that she or he has been trained in or exposed to. We see this within the current latest literature on online counselling. In their chapter on the ‘Theoretical aspects of online therapy’, Anthony, K and DeeAnna, M.N. (2010), had proposed that online therapy involves a different method of delivery to more traditional methods, but the therapeutic process remains the same and presented a theoretical point of view from a sampling of the three major theoretical orientations of psychodynamic perspectives, humanistic perspectives, and in using cognitive-behavioural methods. The authors explored and discussed some of the basic tenets in the therapeutic use of self, empathy, transference, counter-transference amongst others within the online environment. They conclude that an integrative approach to online therapy fit well suggesting that a counsellor can adapt a purist theoretical approach or draw on from various treatment techniques, depending on the counsellor, and what may be best for the client.

John Suler, the professor of psychology at Rider University New Jersey, suggested that there are at least three ways to conceptualise computer-mediated psychotherapy. Firstly, computers as handy tools to be incorporated into preexisting approaches, as in traditional face to face therapy, where the client and therapist communicate between sessions via e-mail, when the client uses

68

online assessment and experiential software as a supplement to the therapy, or from a second approach which consider the development of a variety of computer-mediated therapies, each focusing on a specific technology as the primary channel of therapeutic interaction, such as "e-mail therapy" and "chat therapy." The third approach, is conceptualising cybertherapy as an overarching framework for understanding the therapeutic elements of different communication modalities. He suggested that a comprehensive theory of online behavior must revolve around a psychological understanding of the basic communication dimensions of cyberspace and the effect of combining them in various ways, as espoused in his theoretical ‘Five Dimensional model of Online and Computer-mediated Psychotherapy’. He had earlier outlined in his chapter, ‘The Basic Psychological Features of Cyberspace - Elements of a Cyberpsychology Model’ from the same online book, ‘The Psychology of Cyberspace’, some of the unique psychological features of cyberspace that shape how people behave in this new social realm. Thus the different online environments upon which counseling and therapy may occur offer different convergence of these features giving rise to a distinct psychological quality which determines how people experience themselves and others. These features can be viewed as the fundamental elements of a conceptual model for a psychology of cyberspace and thus form the theoretical foundation for online counseling with individuals, groups and communities. He went on to highlight that the ten elements he had described are only part of the story, and reminded us that how people behave in cyberspace will always be a complex interaction between these features of cyberspace and the characteristics of the person. The model may also be used as a helpful framework for integrating ideas from other theories.

He concluded that integrated online counselling packages that combine many features of online environments - a "multimedia cybertherapy" - may be the strategy of choice for some clients. It seems that effective strategies for integration may be

69

pivotal to online counseling as in the effective ‘match’ between the client and the style of counseling, the personality of client and counselor and between the espoused theory and theory-in-use of the counsellor.

As advances are made in internet technologies, the methods for online counseling will also change. Traditional theories and techniques will be constantly integrated and new theories will continuously evolved.

CONCLUSION

In comparison to traditional face-to-face counselling, online counselling is still in its infancy, attempting to find its ‘feet’ and taking a ‘stance’ in the world. The difference for online counselling is that the technological ground upon which it is trying ‘walk on’ is constantly changing and changing at such a rapid pace where the average counsellor could find that the steep learning curve may just discourage them to update their skills and knowledge in this critical area of development in their own discipline. The future may call for a corresponding paradigm shift in other related areas of counselling. We may need to revaluate our current way of delivering counselling training, supervision and education as well. Current philosophical models of consciousness, of identity and of the ‘self’ based on a predominantly linear view of space and time, may be inadequate for the counsellor to draw from. The latter part of the presentation has highlighted glimpses of a small area in the web of interconnecting issues that we may need to be mindful of as he proceed in opening up whole new vistas for the reconstruction of counselling in a ‘flat world’.

REFERENCES

70

American Counselling Association (1999) Ethical standards for Internet online counselling Retrieved October 20, 2008, from http://www.angelfire.com/co2/counselling/ethical.html.

American Psychological Association (1997) APA Statement on services by telephone, teleconferencing and Internet Retrieved October 20, 2008, from http://www.apa.org/ethics/stmnt01.html.

Anthony, K and DeeAnna, M.N, 2010 Therapy Online: A Practical Guide London: Sage Publications

Atkinson, D. R., & Lowe, S. M. (1995). The role of ethnicity, cultural knowledge, and conventional techniques in counselling and psychotherapy. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counselling (pp. 387-413). Thousand Oaks, CA: Sage.

Barak, A. (2011). References Related to the Internet & Psychology Retrieved August 16, 2011, from http://construct.haifa.ac.il/%7Eazy/refindx.htm

Barak, A. (2011). Barak, A. (2011). Recent publication Retrieved August 16, 2011, from http://construct.haifa.ac.il/~azy/azy.htm

Bloom, J. (1998). The ethical practise of webcounselling. British Journal of Guidance & Counselling, 26, 53-60.

Brown, F. W. (1998). Rural telepsychiatry. Psychiatric Services, 49, 963-964.

Chew, A. (2004) An explorative study into online helping – Identifying effective online responses for young adults in a cross-cultural milieu through the use of ‘blind’ role-playing clients and interpersonal process recall (IPR) Unpublished raw data.

71

Chester, A. & Glass, C. (2006) Online counselling: a descriptive analysis of therapy services on the Internet British Journal of Guidance & Counselling, Vol. 34, No. 2, May.

Counselling Online Limited (2009) Online training for counsellors and psychotherapists. Retrieved October 20, 2008, from http://www.onlinetrainingforcounsellors.co.uk/.

Finfgeld, D. L. (1999). Psychotherapy in cyberspace. Journal of the American Psychiatric Nurses Association, 5, 105-110.

Friedman, T (2007) The world is flat : a brief history of the twenty-first century (2nd rev. and expanded ed) New York : Farrar, Straus and Giroux.

Goss, S. & Anthony, K. (2003). Technology in Counselling and Psychotherapy: a Practitioner’s Guide. New York: Palgrave Macmillan.

Goss, S., Anthony, K., Jamieson, A. & Palmer, S. (2001). Guidelines for Online Counselling and Psychotherapy. Rugby: BACP Publishing.

Hoffman, D. L., Novak, T. P., & Schlosser, A. (2000). The evolution of the digital divide: How gaps in Internet access may impact electronic commerce. Journal of Computer Mediated Communication, 5, 233-245.

Huang,M. P.,&Alessi, N. E. (1996). The Internet and the future of psychiatry. American Journal of Psychiatry, 153, 861-869.

Internet World Stats, (2009) Internet Usage in Asia: Internet Users & Population Statistics for 35 countries and regions in Asia Retrieved fromhttp://www.Internetworldstats.com/stats3.htm

Ivey, A. E., & Collins, N. M. (2003). Social justice: A long-term challenge for counselling

72

psychology. The Counselling Psychologist, 31, 290-298.

Jones, G., & Stokes, A. (2008) Online Counselling: A Handbook for Practitioners Hampshire: Palgrave Macmillian.

Kraus, R., Zack, J.S. & Sticker, G. (2004). Online Counselling: a Handbook for Mental Health Professionals . London: Elsevier.

Mallen, M.J., & Vogel, D.L., (2005) Introduction to the Major Contribution: Counselling Psychology and Online Counselling The Counselling Psychologist, 33, 761 – 775.

Mallen, M.J., Vogel, D.L. & Rochlen, A.B., (2005) The Practical Aspects of Online Counselling: Ethics, Training, Technology, and Competency The Counselling Psychologist; 33; 776.

Murphy, L. J., & Mitchell, D. L. (1998). When writing helps to heal: E-mail as therapy. British Journal of Guidance & Counselling, 26, 21-32.

Norcross, J. C., Hedges, M., & Prochaska, J. O. (2002). The face of 2010: A delphi poll on the future of psychotherapy. Professional Psychology: Research and Practise, 3, 316-322.

Online Counsellors (2009) Online training programme designed for practitioners who wish to explore and develop their online presence. Retrieved October 20, 2008, from http://www.onlinecounsellors.co.uk/.

Prilleltensky, I., & Prilleltensky, O. (2003). Synergies for wellness and liberation in counselling psychology. The Counselling Psychologist, 31, 273-281.

Sampson, J. P., Kolodinsky, R.W.,&Greeno, B. P. (1997). Counselling on the information highway: Future possibilities and potential problems. Journal of Counselling & Development, 75, 203-212.

73

Schiano, D. J. (1997). Convergent methodologies in cyber-psychology: A case study. Behaviour Research Methods, Instruments & Computers, 29, 270-273.

Shapiro, D.,& Schulman, C. (1996). Ethical and legal issues in e-mail therapy. Ethics & Behaviour, 6, 107-124.

Stein, L. D. (1997). Web security: A step-by-step reference guide. Reading, MA: Addison-Wesley.

Stricker, G. (1996). Psychotherapy in cyberspace. Ethics and Behaviour, 6, 175-177.

Sue, D.W., & Sue, D. (2003). Counselling the culturally diverse: Theory and practise (4th ed.). New York: John Wiley.

Suler, J., (2011) The psychology of cyberspace Retrieved August 16, 2011, from http://users.rider.edu/~suler/psycyber/psycyber.html

Tomás Rivera Policy Institute. (2002). Latinos and information technology: The promise and the challenge. Claremont, CA: IBM Hispanic Digital Divide Task Force.

Tschabitscher, H. (2008). How Many Emails Are Sent Every Day? Retrieved October 20, 2008, from http://email.about.com/

od/emailtrivia/f/emails_per_day.htm.VandenBos, G. R.,&Williams, S. (2000). The Internet

versus the telephone: What is telehealth, anyway? Professional Psychology: Research and Practise, 31, 490-492.

Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counselling psychology: Expanding our roles. The Counselling Psychologist, 31, 253-272.

Zack, J. S. (2004). Technology of online counselling. In R. Kraus, J. Zack, & G. Stricker (Eds.), Online counselling: A handbook for mental health

74

professionals (pp. 93-121). San Diego, CA: Academic Press.

75