© 2013 TRACY D. HALL ALL RIGHTS RESERVED INTERNET-BASED FAMILY THERAPY FROM THE PERSPECTIVE OF THE THERAPIST: A QUALITATIVE INQUIRY A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy August, 2013 Tracy D. Hall INTERNET-BASED FAMILY THERAPY FROM THE PERSPECTIVE OF THE THERAPIST: A QUALITATIVE INQUIRY Tracy D. Hall Dissertation Approved: Accepted: ______________________________ ______________________________ Advisor Department Chair Dr. Karin Jordan Dr. Karin Jordan ______________________________ ______________________________ Committee Member Associate Dean of the College Dr. Suzanne Mac Donald Dr. Susan Olson ______________________________ ______________________________ Committee Member Dean of the Graduate School Dr. Cynthia Reynolds Dr. George Newkome _______________________________ _______________________________ Committee Member Date Dr. Linda Perosa _______________________________ Committee Member Dr. Rebecca Boyle ii ABSTRACT The purpose of this qualitative, phenomenological study was to learn more about the process of Internet-based Family Therapy and to discover the advantages and disadvantages of using Internet-based Family Therapy as part of a practice. The overarching question asked, “How do therapists experience the phenomenon of Internet- based Family Therapy?” The sub-questions were: (1) How is Internet-based Family Therapy defined by therapists claiming to do it? (2) What are the presenting issues for Internet-based Family Therapy going forward? Heuristic Inquiry was used for data collection and analysis. Five participants were interviewed using online text-chat. Each participant had experience doing Internet-based Family Therapy and appropriate credentials. The core themes discovered were as follows: (1) The sites may be deemed not truly therapeutic. (2) The use of video is highly recommended in Internet-based Family Therapy. (3) More severe clients are contraindicated for Internet-based Family Therapy. (4) Face-to-face Family Therapy is better than Internet-based Family Therapy, however Internet-based Family Therapy is better than nothing. (5) The use of theory in Internet-based Family Therapy is much the same as in face-to-face Family Therapy. (6) The main concerns with Internet-based Family Therapy are confidentiality, crossing state lines & harm to self. A final interview dealt with Ethical dilemmas in Internet-based Family Therapy, Internet-based Family Therapy standards, limitations of Internet-based Family Therapy and handling harm to self or others when doing Internet-based Family iii Therapy. The findings are discussed, as well as considerations for therapists and directions for future research are suggested. iv DEDICATION This dissertation is dedicated to Dr. John Zarski and Dr. Patricia Parr. v ACKNOWLEDGEMENTS I would like to thank my committee members, Dr. Karin Jordan, Dr. Suzanne Mac Donald, Dr. Cynthia Reynolds, Dr. Linda Perosa and Dr. Rebecca Boyle. I would also like to thank Dr. Sajit Zachariah for his help early on in the process. Finally, thank you to my wife, Ashley, for her patience through this process. vi TABLE OF CONTENTS Page CHAPTER I. INTRODUCTION............................................................................................................1 Professional Acceptance and Governing Bodies.....................................................4 Purpose of the Study ...............................................................................................8 Statement of the Problem.......................................................................................10 Research Questions................................................................................................10 Subjectivities Statement.........................................................................................10 Dissertations...........................................................................................................14 Delimitations..........................................................................................................15 Terms.....................................................................................................................16 Summary................................................................................................................17 II. REVIEW OF THE LITERATURE...............................................................................19 Empirical Research................................................................................................20 Findings from Studies with Individual Clients......................................................21 General Technology and Psychology Issues..........................................................25 Enhancing Practice.................................................................................................26 Better Understanding.............................................................................................30 Internet-based Therapy: An Example........................................................30 vii CEO Phone Interview................................................................................34 Internet Therapist Text-chat Based Interview........................................................35 Technology and Therapy.......................................................................................36 Computer Assessments..........................................................................................40 General Internet-based Therapy Issues..................................................................41 Current Internet-based Therapy Techniques..........................................................43 Videoconferencing Therapy...................................................................................44 Therapy Websites...................................................................................................46 Guidelines for Internet-based Family Therapy......................................................47 Advantages.............................................................................................................51 Disadvantages........................................................................................................55 Ethical Issues.........................................................................................................60 Specific Ethical Issues...........................................................................................65 Fiduciary Relationship...............................................................................65 Disclaimers and Credentials......................................................................66 Confidentiality...........................................................................................67 Informed Consent.......................................................................................69 Duty to Warn..............................................................................................69 Emergency Services...................................................................................71 Inappropriate Relationships.......................................................................71 Efficacy..................................................................................................................72 Haberstroh Study...................................................................................................73 viii Summary................................................................................................................74 III. QUALITATIVE RESEARCH.....................................................................................76 Methodological Framework...................................................................................76 Heuristic Inquiry....................................................................................................77 Immersion..................................................................................................77 Incubation..................................................................................................77 Illumination................................................................................................78 Explication.................................................................................................78 Creative Synthesis......................................................................................78 Research Design.....................................................................................................79 Data Collection......................................................................................................79 Data Analysis.........................................................................................................82 Report of Project Piloting......................................................................................84 Website..................................................................................................................87 Participants.............................................................................................................88 Credibility..............................................................................................................89 Trustworthiness......................................................................................................90 Ethical Considerations...........................................................................................91