SUPERVISING MARITAL THERAPY 22 Professional Issues in Counseling 2002, Volume 2, Article 3, p. 22-28 Supervising Marital Therapy on the Internet Supervising Marital Therapy on the Internet Davor Jedlicka, Ph.D. University of Texas at Tyler Glen Jennings Ed. D. University Affiliation This study shows a procedure for supervision of marital therapy on the Internet. The study began with a supervisory agreement specifying the relationship between the supervisor and supervisee. The hierarchy between the supervisor and the supervisee on the Internet depended primarily on the supervisor's experience rather than on the socially ascribed status. Online therapy and supervision occurred at a much faster pace than in conventional modalities without losing the quality of supervision. Based on these findings, online supervision may be considered for inclusion into the academic curricula for training of marriage and family therapists and of counselors who may desire to practice on the Internet. Supervising Marital Therapy on the Internet The use of the Internet for counseling individuals and couples grew rapidly in the 1990s (Cabaniss, 2002). For example, in June of 2002 Yahoo lists 3378 web sites promoting counseling clinics and individual practices. Out of this number 104 web sites were listed as “online therapy.” Yet at this time it is unlikely that any of these “online therapists” have had supervised training to prepare them for practice in this new medium (Cabaniss, 2002; Jedlicka & Jennings, 2001; Powell, 1998). Until supervisory processes are monitored to assure ethical expectations (DeTrude, 2001), the ethics of online counseling and therapy may remain controversial (Cabaniss, 2002; , 1999; & Herlihy, 2001). This study explores a supervisory process based on the participant observations of supervised, online, marital therapy. One participant observer in this study was a marital therapist holding a temporary license in the state of Texas, and the other was his certified supervisor. Because this study was experimental, neither the supervisor nor the supervisee claimed any credit for the time spent in supervision or with clients in this project. The goal of the study was to determine how to supervise marital therapy on the Internet to ensure that online therapy and supervision are ethical and effective. According to the ethical standards of the American Association for Marriage and Family Therapy (AAMFT) (2001) “marriage and family therapists practice in specialty areas new to them only after appropriate education, training, or supervised experience” (3.7). Practicing on the Internet seems to be enough of a departure from the conventional modalities to justify SUPERVISING MARITAL THERAPY 23 specialized supervision and training. In the absence of some supervised training, ethics and efficacy of the therapy on the Internet appear questionable. To remove some of that doubt, this study suggests a supervision process that can be monitored, evaluated, and considered for inclusion in academic programs. The Initial Supervisory Arrangements Before the study began, the supervisor and the supervisee entered into what may be the first supervisory agreement for marital therapy on the Internet. Without a precedent for stipulating the criteria for evaluation of the supervisee on the Internet, this supervisory agreement was based on the AAMFT’s (2001) ethical and pedagogical standards, while remaining adaptable to unforeseen contingencies. The object was to discern how a supervisor may benefit the clients and at the same time evaluate the performance of an online therapist. In other words, how does a supervisor observe the maturation process of a supervisee without the aid of videotapes? The resulting supervisory agreement encompassed some basic logistic requirements, while remaining more flexible than the experts recommend (Fox, 1983; Storm, 1997a). The agreement took into account that this was an experiment and not a conventional trainee- supervisor relationship. The agreement included five stipulations as worded below: 1. We agree that supervision will go forward to the best of our abilities, and that we will make ourselves available to each other at mutually convenient times at a place of supervision selected by the supervisor. 2. The records on each online client will be kept in accordance to the ethical standards of the AAMFT and the record keeping practices established at the Family Therapy Clinic at the Texas Woman's University. 3. The supervision will consist of case presentations based on presented problems and researchers’ responses. A record is to be maintained for supervisory purposes of all communication between the online clients and the researcher. 4. This agreement will become binding upon approval of the research by the Human Subjects Investigation Committee or an Internal Review Board on the Use of Human Subjects. 5. This agreement will inure for the duration of research project. Before announcing the study on the Internet, the Human Subjects Investigation Committee at The University of Texas at Tyler approved our proposed research project and the above agreement on November 7, 1997. Recruitment of Clients and Online Procedures The study was posted on the Yahoo's search engine as a web site entitled "Online Couple Counseling Study." The key search words listed were "marital therapy," “couples," "counseling," and "couple counseling." In six months, eleven couples qualified for and agreed to participate in the study. The recruitment lasted six months while online therapy continued until the last couple terminated the treatment. The shortest time online spent with a couple was four days. The longest exchange lasted 14 weeks. The average duration of online therapy was six weeks. SUPERVISING MARITAL THERAPY 24 The eleven participating couples were screened using a series of "yes" or "no" questions. These questions revealed that each couple currently experienced marital problems requiring therapy, but none were in counseling or therapy at the time they volunteered for the study. They also indicated that neither spouse was physically abusing the other, that no children were at risk of sexual or physical abuse, and that neither spouse was inclined toward violence or suicide. After the screening, each couple was directed to the informed consent agreement. The consent statement informed the clients of the research procedure in which they were to participate, of their rights as clients, and of the limitations to protect their confidentiality on the Internet. They were also informed that their counselor was working under supervision and that their information would be shared with the supervisor. To participate in the study, both spouses were required to sign and mail a consent form. The therapy began when the therapist sent an email to the couple asking them to explain their situation and to indicate what they expected from therapy online. This initial message, their responses to it, and all subsequent communications became a part of their record. The record was kept in the manner practiced at the Texas Woman's University Family Clinic at that time, meaning that the supervisee maintained a manila folder with the chronological record of each exchange between client and therapist. On the left-hand side of the folder was a form on which the superevisee recorded the date of each interaction with the couple. The right side of the folder included a complete chronological file of all the email sent to and received from the clients. In the study, all interactions, other than the informed consent form, consisted of email messages. Each time an email was sent or received the time and the date were recorded on a line of that form. The first item on the line was always the date the informed consent was received in the mail. The second item included the date the counselor first contacted the couple. After that, each contact by clients or the therapist was recorded until the last closing email from the therapist to the client. The Initial Supervisory Procedures These folders were used during the weekly, face-to-face supervision sessions. During these sessions, the supervisee would summarize each case orally. The folder served as verbatim evidence of the weekly communications with each client. The supervisor perused the written communication and the supervisee read selected passages. Sometimes the supervisor kept the folders to study before the next supervisory session. Even though the supervision involved only two or three cases per week, it was clear from the start that the traditional method of supervision was too slow for online counseling. On the Internet, the clients expected a response from their therapist the next day. The interaction between the clients and the counselor appeared equal to two or three week’s worth of accomplishment in face-to-face, office-based sessions. At that pace of interaction, the weekly supervision lagged behind the pace of the online therapy. Clearly, the weekly supervision was too slow, too little, and too late for the clients and for the supervisee. After the first month, the Internet became a medium of supervision. This change confirmed the view of those who argue that supervision in general is isomorphic to the process and the structure of therapy itself (Liddle & Saba, 1983; 1985). That is, supervision was conducted in the manner that the supervisee conducted the therapy. SUPERVISING MARITAL THERAPY 25 Online Supervisory Procedures After introducing the online supervision, copies of email messages in manila folders