A newer version of the platform is available. Please refresh the page.
Sign Up to Get information about Sales & Events Click Here
A newer version of the platform is available. Please refresh the page.
By John Riolo, Ph.D.
https://www.youradvocateonline.com
Table of Contents:
The Impact Of The Internet on the Direct Social Work Practitioner
Source: https://www.youradvocateonline.com/internet_socialwork_one.html
Titles or headlines can sometimes be misleading. If you think this article is about online therapy, it is not. Oh, I believe that online therapy will be a significant factor in the future, however there will need to be some improvements in the technology. Such improvements are inevitable. What is less certain is whether the political acceptance will occur as soon. This includes but is not limited to resolving some of the fears, the licensing and jurisdictional problems, as well as malpractice concerns.
However, the Internet has already made profound changes in the way social workers communicate with each other. The genie is out of the bottle so to speak for good or ill depending on your point of view and it is unlikely to be put back. A recent example is the communication that has occurred between social workers around the world as a result of the September 11th world crisis.
Not that long ago the only way for social workers to collaborate with each other was face to face, by telephone or through snail mail. Each of these methods were time consuming and expensive in that it took time away from seeing patients/clients. Whether we travel to a conference, schedule a phone conference or mail letters it’s that much time that is not available to see patients. And for the private practitioner or the fee for service practitioner that means time that is not compensated.
To address some of the more complicated problems of professional affiliations social workers as well as other professionals formed organizations such as NASW, clinical societies, federations and other groups that relied on elected and or hired professional organizers, managers facilitators, lobbyists to assist us in dealing with some of the necessary tasks of developing standards, providing continuing education and representing our interests. Although invaluable and necessary, one problem with relying on this method exclusively is that it has the potential to lead to a whole infrastructure of non-practitioners whose job it is to meet the needs of the practitioners. No doubt these facilitators are dedicated for the most part, but when non-practitioners have the exclusive role of representing practitioners there is a danger that some things will get lost in translation so to speak.
Additionally due to the limitations of the communications media available these groups tend to become localized along geographical lines. We tend to get chapters set up by state or region and communication between social workers nationally is done almost exclusively through intermediaries. On some issues this may work well, but on others not so well. Additionally, there is the added expense of redundancies. And of course there is always the potential danger that the intermediaries might forget that their job is to represent the practitioners and develop independent vested interests of their own. This is not to imply nefarious motives, but merely an observation on the behavior of people and organizations.
While it is highly unlikely that the above methods of communication will ever be totally replaced, the Internet offers alternatives that are faster, more convenient, and less expensive for many. But of greater importance, the Internet tends to make it more practical for practitioners to have direct communication and share vital information with each other over long distances first hand without intermediaries, which reduces the problem of things getting lost in translation.
With the click of a mouse, any one of us can access the Internet to use any number of search engines and get more information on almost any topic we select. There are literally hundreds of websites dealing with therapy in general and social work in particular. Of course some of the information out there is not supported by research, erroneous or just plain junk, but the same can be said for the old traditional journals, newsletters etc. The responsibility is always on the reader to separate out the “good stuff” from all the junk. And there is a lot of pure junk available. The Internet just puts more information, the good and the bad at our fingertips.
But beyond that, I think even more important is that the Internet has reframed the nature of our collegial relationships. At one time due to the same time and cost constraints mentioned above in order for colleagues to work together they had to be in reasonably close proximity. Of course scholars and academics collaborated via snail mail and telephone, but the average direct practitioner relied upon the occasional telephone conference and mostly face to face (F2F) meetings for consultation, supervision and just sharing of experiences. Advocacy efforts for our patients and ourselves were for the most part delegated to the professional groups and organizations mentioned above.
All of that is changing and the pace of change is rapid. Increasingly solid and long standing collegial relationships are forming Online through listservs and bulletin boards, Professional chat rooms etc. Social workers are meeting and discussing a variety of issues from complicated case situations, business practices, marketing and how to advocate for themselves.
These collegial relationships are no less meaningful than F2F. For myself, over the past couple of years, I have developed online relationships with colleagues that I have never met in person that are every bit as strong and meaningful as any other. And we have accomplished some things together that could not have been done without the ability of social workers from Maine to Alaska and beyond to join forces.
While some of you have heard about the Secret Shopper practice and that at least one MCO has agreed to stop this unreliable and unethical research method, it was not the Secret Shopper so much or that it was stopped that is important, but how it was stopped. Providers working together on the Internet took the initiative and did not merely leave the advocacy to the intermediaries.
Of course with any new technology there will be difficulties and new challenges. There are potential for abuses that must be identified. It will upset some established ways of doing things which may cause some discomfort among those who wish to maintain the status quo. However, the status quo can rarely be maintained even if we wanted to maintain it. All things change including social work. We are on the cutting edge.
The Impact Of The Internet on the Direct Social Work Practitioner Part 2
Source: https://www.youradvocateonline.com/internet_socialwork_two.html
In my last article I wrote about how the computer and the Internet has made changes in the way social workers network and communicate. We are at just the beginning of these changes. Any direct practitioner with a computer and an Internet connection has literally at their fingertips a connection to colleagues worldwide. No longer is it essential that a direct practicing social worker go through an intermediary structure to share ideas, network and to lobby for their interests.
I touched very briefly on the subject of online therapy. However, I doubt that I will be actually conducting online therapy myself in my career. Not because I don’t believe in its potential, but I believe that there are a number of obstacles to overcome and I don’t see it happening in the next couple of years before I retire. These obstacles include the technological and the conceptual.
There are many limitations in the technology, as it exists today from the speed of Internet connections to insuring privacy to adequate assessment. However, it would be short sighted to claim that, because there may be limitations in technology today that won’t be resolved in the not too distant future. Any technological tool that all of us use almost without a thought once had serious practical limitations and nay-sayers were convinced would never be practical. From the automobile’s early problems, which prompted the call “Get a horse” to the party line of the telephone, our every day conveniences/necessities were once experiments of questionable practicality. The cell phone was once a comic strip fantasy as in Dick Tracey or the phone in a shoe as in the 60s TV show Get Smart. Even Bill Gates once predicted that there would probably be a need for only a few thousands personal computers worldwide. Every technological advance we have was far from perfect in its early stages and had to be refined and perfected. There is absolutely no reason that the technology to make online therapy practical and effective will not also be developed.
The conceptual obstacles are less certain of being overcome. However, I would bet that they also would be solved. The question is how long will that take? I see two distinct but related conceptual obstacles: the mind set of practitioners and legal/ethical problems due to the slower pace of change in laws and standards compared to technological change.
Most of us were trained to believe that doing therapy required face-to-face (F2F) contact. We were taught that visual contact and observations were essential for a therapeutic relationship that dealt with complicated thoughts and feelings. No doubt such F2F contact is helpful, but is it essential? Is it impossible to communicate emotions and feelings as well as complicated concepts in writing? However can anyone read one of Shakespeare’s sonnets and still claim that one cannot express emotions in writing? OK few of us can write like Shakespeare, but what about the many letters between John Adams (2nd President of the US) and his wife Abigail? The fact is that before modern transportation people naturally communicated complicated concepts, thoughts, feelings and emotions in writing. It was the only practical way over any distance. Therefore, if complex communications were once successfully conducted with pen and paper and the speed of such transmissions were no faster than the fastest sailing ship or horse, there is no reason to believe that it can’t be done via computer over the Internet even with the current technological limitations. In fact, it is being done now but those who practice in that manner are taking some risks.
Currently most of our state licensing laws and regulations stipulate that the practitioner must be licensed in the state where the therapy is delivered. Failure to abide by such standards could result in the practitioner subjecting themselves to licensing board violations, ethical charges and malpractice. But if I practice in Rhode Island and the patient is in Alaska, where is the therapy actually being delivered? At the moment our laws and practice standards are not up to speed with the realities of the Internet and cyberspace and the technological age. Understandably licensing laws and ethical standards need to be somewhat conservative and be cautious of untested fads in order to protect the public. However, while such changes move at a slower pace than technology, our standards must move nonetheless to keep up with changing developments. When more practitioners become more comfortable with computers and it’s benefits, while understanding the risks and limitations, the standards will evolve.
While actual online therapy will move at a steady if slow pace, social work education over the internet will move at a faster pace. Although still in its early stages, social work training is being done online by a number of established organizations. Schools of social work currently are making courses available on line. For example at Rhode Island College School of Social Work, a number of selected courses have been conducted either totally online or in combination with in class instruction. Prof. Bell Evans has taught courses in Supervision and Administration. Prof. Frederic G. Reamer taught an Ethics courses online. I recently taught a cause in Crisis Intervention and Brief Treatment with students who participated both online and in a regular classroom. It offers viable alternatives to students who are unable to travel regularly to a designated location and lose time from work.
Then there is Continuing Education Online. With licensing laws comes the mandate of continuing education. However, while attending conferences and workshops has some advantages, for the direct practitioner it often means the expense of travel, parking and most important when at a professional conference you are unavailable to see patients which means unearned income. There are distinct advantages to online continuing education. Many Online CE workshops can be taken at the practitioner’s convenience day or night at home or office and without missing valuable patient hours.
As more training is done online, practitioners will develop increased comfort and familiarity with the Internet. A move to do therapy online will then begin in earnest.
Psychotherapy and The Global Economy
Source: https://www.youradvocateonline.com/global_economy.html
When I embarked on a trip to Southeast Asia, I concluded that since I was going to the third world, I needed to take all the necessities of civilization with me. Consequently, I grossly over packed. The reality is that even in Cambodia most of the luxuries we are accustomed to in the US can be obtained. Some times you will pay a little more but often you can purchase items for less then at home.
Many services are dirt-cheap. I recently got a very good hair cut for a dollar ($1.00 US.) My barber threw in a face and upper body message gratis
Many services are dirt-cheap. I recently got a very good hair cut for a dollar ($1.00 US.) My barber threw in a face and upper body message gratis. I gave the fellow a 50-cent tip and you would have thought he won the lottery. Skilled labor is cheap in the third world. That is one reason why we in the west are losing so many manufacturing jobs to the Pacific Rim. Even high tech jobs once considered “safe” are being outsourced overseas. For example, if you experience problems with your computer and call the company 800 number there is a good chance that a customer service representative in India will answer your call.
India! Why not India? It may be third world but they have a large English speaking professional class. Including those with world class training in technical, medical, human service and mental health fields. A growing number of organizations that provide medical services where we send our medical records sub-contract the service. The physician or health care provider dictates their notes and the transcription is done overseas. Workers with the clerical skills required for the task are readily available in third world countries for a fraction of the cost in the USA. Electronic files can be sent down the street or across the world at the same speed.
How deep can outsourcing penetrate into white-collar and professional jobs?
Some argue that it is only a matter of time until mental health professionals, such as therapists or marriage and family counselors are also faced with their services being outsourced to Asia and India. Is this possible within the next few decades? Could Professionals who are willing to work for a fraction of the fees charged by US therapists use email, telephone, web conferencing and video therapy to conduct therapy at a distance?
I am willing to bet that most of my colleagues will laugh (nervously) at my question. How is that possible, they will say? Psychotherapy needs to be face to face to be effective. See The Impact Of The Internet on the Direct Social Work Practitioner Part 1 and Part Two.
Judging by the technological standards of today my colleagues may be right.
There are many limitations to on-line therapy as it is currently practiced, such as slow Internet speed, poor quality audio files and grainy, blurry video files. Yet consumers are adopting the practice at a rapid rate. For example, Google lists 50,400 links for the keyword online therapy. The technologies that deliver online therapy are improving rapidly. What is to stop consumers from selecting an on-line therapist from overseas?
Patients won’t do it my colleagues will say. Really? Well why not? Therapy today can cost the consumer up to $100 per hour and in some cases, more. Many of my colleagues claim that they are experiencing difficulty reaching an income level commensurate with their education, training and status. They lament the efforts of managed care companies to keep prices down through their negotiation for discounted rates.
What is to stop the next level of cost containment? Suppose you are a working or middle class person and have a personal problem. You have choices of course. You can go to see a prominent psychotherapist and pay $100+ privately or you can go online and talk to a therapist who will claim to have just as reputable credentials who may located anywhere in the world for 10 or 15 dollars.
It is often said, “You get what you pay for.” Well that is often true. But, it is also true that the price of something is not always a true indication of its value. The question will be what choices will consumers make and what factors will influence their decision?
If psychotherapists can convince consumers that their personal and face-to-face therapy is worth it despite the fact that it may cost 5 or 10 times as much than there is no problem. Analogies are never perfect but what comes to mind is when the eastern block country of what was known as Yugoslavia, tried to import the Yugo car in the US. It sold for much less than any American, European and Japanese car yet it did not sell. The problem was the Yugo was so inferior to its competitors that it was no bargain.
If this analogy holds for online psychotherapy then my colleagues have little to fear. Consumers will see Yugo psychotherapy for what it is. But will that analogy hold? Can we really say that a) face to face therapy is clearly superior b) will always be so despite constant improvements in the technology and c) consumers will be willing to pay the difference in cost even if there we definite superior qualities to the F2F therapy.
I am old enough to remember a time before ATMs, automated telephones systems. etc. I did not like ATMs and when I called on the phone I wanted to talk with a real person or see a human bank teller. However, over time I got used to the convenience of the automated systems. I came to understand that the labor costs made these new innovations inevitable. As much as I did not like it I did not want to pay the fees associated with organizations that had high labor costs since those cost invariably got passed on to me. And, in time I got to appreciate the convenience of such technologies.
Will consumers see benefits in online psychotherapy with therapists physically located thousands of miles away? Only time will tell but if I were to bet I would say yes to a large degree. Of course there will be many dangers associated with global centered psychotherapy. Not the least of which is the protection of privacy difficult today but will be more difficult and complicated in a global market. Standards of course will be difficult to maintain but they are difficult now.
Now I have used India as an example because English is widely spoken and they do have a high number of educated citizens. However other countries in the so-called third world are possibilities as well. English is taught in schools in many Asian countries. True at this time there are not many licensed mental health professionals inn Asia but that can easily change. Also since they are in other countries licensing may not be a stringent requirement. As it stands today many of my colleagues claim all one needs is empathy.
Imagine psychotherapy for about $10 a session! It will be most interesting to see how psychotherapy will be delivered in the next generation or two.