Reviewer Professor Tim Bond
Old dogs: new tricks. This old dog has broken a habit in support of new tricks. I usually only review books that I have not previously read. I like to approach them with an open mind and reward my efforts for writing the review with extending my knowledge outside of my existing parameters. Instead I am reviewing a book that I have consulted many times, as I have been thinking about the ethics of providing counselling and psychotherapy online for various projects and publications. I use the word ‘consulted’ deliberately, because this does not mean that I had read it from front to back. Rather, I was guided by the contents page and the index in selecting passages relevant to whatever I was considering. On each visit my respect for the book grew as I was drawn further and further into the content, and I found myself struggling to stay focused in order not be drawn into the surrounding text, that so often seemed much more interesting than the task I trying to accomplish.
One of the aspects of this book that makes it so useful is the simplicity of its structure, so that it has a much greater sense of coherence than many edited collections. Part I opens with chapters about the relationship between psychotherapy and digital technology: for better or worse; understanding the relationship, and implications for training. Part II is comprised of five chapters about providing therapy through digital media. It considers the therapeutic alliance online, challenges and dilemmas in the online consulting room, issues around diversity that can be ‘lost in translation’, the use of avatars, and the practicalities of establishing an online practice. Part III considers working safely and legally online, in three chapters about working across borders and different legal systems, protecting children and young people, and concluding with ‘the way forward’.
Each chapter is followed by brief reactions from expert commentators that expand the number of perspectives from 14 authors to 28 contributors. This could have been disastrous to the coherence to the book, but instead the diversity of contributions combine to convey the excitement of a profession engaging seriously with the challenges and opportunities offered by working through digital technology. This therapeutic excitement is particularly well-communicated by the case studies in the second section, where new therapeutic processes that have been made possible by digital technology are described. The book also discusses the advantages of making the benefits of psychotherapy more widely available to people who are disinclined to use face-to-face therapy, perhaps prevented by cost, or who are facing physical obstacles to accessing more traditional forms of psychotherapy. For me this is the most rewarding section to read. Even though I have been working online since the early days of digital technology, with varying degrees of success and sometimes stumbling on my own ignorance or incompetence, these chapters offer fresh insights and open up new possibilities. They look at therapists’ perspectives of new technology that go beyond the excitement of novelty and superficial appreciations of new potential, to provide a more integrated and grounded overview based on therapeutically mature reflection. For example, it is no longer a useful question to ask whether a therapeutic relationship can be established or sustained online; the evidence is clear that it can, as proven by many practitioners. Instead, these chapters invite the reader to consider how the online therapeutic relationship is transformed by new media and the challenges and opportunities that this offers. The case studies provide concrete examples that ring true to my experience and, like the best case studies written in our professional field, take readers beyond their own experience to new possibilities and invite them to question their own assumptions.
As someone who has a long term interest in professional ethics I was particularly interested in Part III, ‘working safely and legally in the context of international law’. Again, the approach adopted in the book has generally stood the test of time very well. The technology may change and update at giddying speed but the principles and laws that underpin the chapters remains highly relevant. There are useful reminders that the legal approaches on either side of the Atlantic are different: there are potential dangers of infringing professional licensing requirements in the USA by offering online counselling or therapy, and there are different requirements concerning the security of health data. There is one issue, however, on which I have come to a different conclusion from the book: Weitz states that Skype is not designed to meet the security requirements of health-related information, nor can it satisfy the US requirements in this regard. We are agreed on these points: Ideally, it is better to use more appropriate platforms for psychotherapy, where these are available and acceptable to clients. However, I think the reservations expressed about Skype could also apply to other platforms, to some degree and, ethically speaking, the risks of using different platforms change with each update – or when the client’s or practitioner’s failure to update exposes them to risks. I caution clients about the desirability of more secure communications but will use Skype where the client considers its familiarity and accessibility outweigh the disadvantages. In the whirl of rapidly changing technology I think it is better not to become too fixated on any single platform, unless there is active evidence of leaks, poor security, or unwelcome intrusions. For example, since the publication of this book WhatsApp has become the most securely encrypted messaging service, sometimes even used by diplomats as more secure than their official communications systems. However this cannot eliminate interception by Spyware before a message is encrypted, or when it has been de-encrypted. Accessibility, ease of use and security have to be weighed against each other and held under constant review. Vigilance is the best protection; the latest WikiLeaks reminds us of the vulnerability of any electronic communication to well-resourced and determined intrusion.
I strongly recommend Psychotherapy 2.0 to anyone looking for practical and therapeutically informed guidance and information on providing therapy online.
Tim Bond is an Emeritus Professor at the University of Bristol, and a Visiting Professor to the University of Malta. He is a registered member of BACP. He researches and writes about ethical and legal issues for the talking therapies and is a consultant to BACP on the Ethical Framework for the Counselling Professions.