Distance Counseling i DISTANCE COUNSELING: PERCEIVED ADVANTAGES AND DISADVANTAGES AMONG CHRISTIAN COUNSELORS A Dissertation Presented to the Faculty of Liberty University In Partial Fulfillment of The Requirements for the Degree of Doctor of Philosophy by Anthony J. Centore March 2006 Distance Counseling ii Distance Counseling iii Abstract of Dissertation Presented to the Center for Counseling and Family Studies of Liberty University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy DISTANCE COUNSELING: PERCEIVED ADVANTAGES AND DISADVANTAGES AMONG CHRISTIAN COUNSELORS by Anthony J. Centore 2006 Chairperson: Fred Milacci D.Ed. Committee: David Jenkins Psy.D. Gary Sibcy Ph.D. Tim Clinton Ed.D Department: Center for Counseling and Family Studies Abstract The perceived advantages and disadvantages of distance counseling provision by email, online text chat, telephone and videoconference were investigated among 1863 Christian counselors. Participants completed a 148-item self-report survey measuring general, clinical, ethical, and practice management issues that have been proposed in recent literature as intrinsic advantages or disadvantages to distance counseling provision. In most cases, Christian counselors’ perceptions aligned with literature, with a moderate tendency to perceive disadvantages over advantages. By means of computing several exploratory one-way ANOVAs, counselor characteristics including reported age, gender, Distance Counseling iv professional status, counseling experience, proficiency with technology, and sufficient availability of clients in a counselor’s area to maintain a fulltime practice were investigated to determine whether these characteristics were associated with attitudes toward distance counseling. A post hoc analysis using LSD determined that counselor non-professional status, high proficiency with technology, and the insufficient availability of clients to maintain a fulltime practice were significantly associated with positive attitudes toward distance counseling mediums. This study serves as a base from which additional research can be conducted on counselor perceptions of distance counseling. Recommendations for further research are presented. Distance Counseling v TABLE OF CONTENTS CHAPTER ONE: THE PROBLEM ................................................................................... 1 Telephone Counseling .................................................................................................... 1 Online Counseling .......................................................................................................... 3 Internet Use............................................................................................................. 3 Computer Mediated Communication...................................................................... 3 Counselor Interest................................................................................................... 3 Emergence of E-Industries...................................................................................... 4 Early Online Counseling Websites ......................................................................... 5 Current Online Counseling..................................................................................... 6 Recognition by Professional Organizations.................................................................... 7 Uniqueness of Christian Counseling............................................................................... 8 Purpose of the Study ..................................................................................................... 11 Justification for the Study ............................................................................................. 11 Definition of Terms....................................................................................................... 11 CHAPTER TWO: LITERATURE REVIEW................................................................... 13 General Counseling Factors in Distance Counseling.................................................... 13 Safety..................................................................................................................... 13 Anonymity ............................................................................................................. 14 Social Stigma ........................................................................................................ 16 Selection................................................................................................................ 16 Accessibility .......................................................................................................... 17 Affordability .......................................................................................................... 18 General Counseling Factors for Text Based Distance Counseling............................... 18 Attention and Reflection........................................................................................ 20 Confession and Framing....................................................................................... 20 Objectivity and Externalization ............................................................................ 20 Associations and Insight ....................................................................................... 20 Accountability ....................................................................................................... 20 Ownership and Control......................................................................................... 21 Maximum Anonymity ............................................................................................ 21 Testament of Treatment Progress ......................................................................... 22 Summary of General Counseling Factors............................................................. 22 Ethical Issues in Distance Counseling .......................................................................... 22 Licensure within State Lines ................................................................................. 22 Licensure across State Lines................................................................................. 23 General Ethical Duties ......................................................................................... 25 Confidentiality....................................................................................................... 26 Suicidal or Dangerous Clients.............................................................................. 27 Clients in crisis. ................................................................................................ 27 Emergency Response. ....................................................................................... 28 Identifying Clients............................................................................................. 28 Counselor Identity............................................................................................. 30 Summary of Ethical Issues.................................................................................... 30 Crucial Clinical Issues in Distance Counseling............................................................ 30 Distance Counseling vi Rapport ................................................................................................................. 31 Rapport in text-based CMC. ............................................................................. 31 Counseling specific rapport.............................................................................. 33 Clinical Efficacy.................................................................................................... 36 Telephone counseling efficacy and satisfaction................................................ 37 Online counseling efficacy and satisfaction. .................................................... 38 The effectiveness of text based counseling........................................................ 38 Summary of Crucial Clinical Issues ..................................................................... 41 Practice Management in Distance Counseling ............................................................. 41 Finances.................................................................................................................... 42 Cost of Providing Distance Counseling................................................................ 42 Acquiring Clients .................................................................................................. 43 Desirability. ...................................................................................................... 43 Convenience...................................................................................................... 43 Marketing.......................................................................................................... 43 Receiving Payment................................................................................................ 44 Client desire for free services ........................................................................... 44 Insurance issues................................................................................................ 44 Billing options................................................................................................... 46 Online clinics & EAPs .....................................................................................