Saturday, August 07, 2010

Counselling by text

The NZ Herald reports on the findings of the Health and Disability Comissioner where text messaging for counselling is dangerous:

"A young man committed suicide after his counsellor told him by text message not to take his medication, provided he was undergoing regular counselling.

Acting Health and Disability Commissioner Rae Lamb, in a finding issued today, said the case highlighted the importance of consulting other health professionals working with a person, the dangers of providing advice by text message, and the risks associated with "no suicide" contracts."

While not wanting to take away at all from the fact that suicide is tragic, always, what I am going to do is an intellectual argument here on text not being.
The counsellor involved was unethical. There was a lack of assessment and a lack of professional boundaries. One might have said counselling is dangerous, or that this specific counsellor in this particular situation was dangerous.

To pit texting within a context where it can be considered seriously, it needs to be noted that it is an extremely common practice now. It is not just for the young and it is not just for trivial interactions. It is a serious application. SMS text messaging is the commonest use of mobile phones, is used by 53% of people world-wide, and is now the most widely used data application on the planet.
At some stage it would be used for giving wrong advice.

All conversations have the potential for error ...all mediums through which messages can be conveyed whether face to face, phone, letter, or SMS, have given wrong advice at some time with tragic consequence.

Text/SMS messaging has its own foibles, and rather than demonizing it, there is need to attend to the particular factors and foibles with regard to it's use for counselling (and hence my PhD in this field).

1. Messages are brief. 160 characters per message, and a cost per message encourages brevity. With brevity there is less information on which to base any advice. This brevity need not restrict an ongoing conversation. As with a verbal conversation, an utterance may be short, the conversation may be longer.
2. Beyong brevity, the medium also shares less information. There are fewer paralinguistic and non-verbal cues, and the ones that are there are ambiguous. Slowness to respond may say as much about the state of the telephone network service provider as the person sending a message.
3. The medium may be chosen because of 2. While I have something difficult to say, I may be able to construct my response more deliberately , more carefully, because the medium provides me time to compose myself and my message.
4. The apparent anonymity along with 1,2 and 3, has a disinhibiting effect. Things can be said in a forthright tone that would not occur face to face without checking for more obvious cues.
5. Identity flexibility (Suler, 2005) is associated with 4, 3 and 2. I can elect how I present myself by text. Male, female, young, old, gay, straight, happy, sad, attentive, distracted.
6. Absent presence (Gergin, 2002)
6. In entering into text, attention is shifted, reality moves. One is no longer attentive to the present but engages with an invisible other. At the same time, in the virtual space of talking with someone silently, in conjunction with 1,2,3 and 4 this inokes imagination as to what is going on, it involves projections; the world engaged by text becomes surreal- it is what i perceive it to be. It creates a space in which I am not fully here, or there, but somewhere else instead. I'm not sure that this isnt always a condition of counselling regardless of the medium. I have compassion invoked- I try to appreciate the world view of the other...however with text I have so much less to go on, projections (or assumptions) in the absence of cues increase.
7. Flexibility of anytime. I don't have to wait for the person to be ready to respond with messaging, they can get back to me when they are able, and i can leave the message when i think of it.
8. Flexibility of anywhere. Its where you are, its in your pocket. It doesnt matter where they, or I, are currently situated.
9. Digital traces allow for messages to be kept, this allows for a pocket full of evidence that one is connected in the world, strategies and affirmations can be as close as one's pocket.
10. Associated with 8 is that messages that are unpleasant are also as close as one's pocket, and associated with 7, they can also be intrusive. Strategies to manage these can be taught.
11. Privacy in spite of the sense of intimacy is questionable. In hitting send, errors can be made. As with 9. there is risk of others accessing ones phone and its messages. Messages can be intercepted. Message are visible to network service providers, or police (with warrant).
12. Its affordable. Financial costs can be kept small. Whether charged by the text, 20 cent per message by major providers in NZ today, or on a preplay plan allowing unlimited or very generous texting such as 2000 texts for ten dollars, texting is a cheaper option than being charged over a dollar a minute for a call. In addition texting does not have the transport or opportunity lost costs that might occur with an appointment.
13. The microskills of counselling such as empathy, active listening, sensitive confrontation, translate into the new medium (Haxell, 2008). An empowerment approach of being strength's based can also be identified within text counselling as performed (at least at Youthline NZ)

Gergen, K. J. (2002). The challenge of absent presence. In J. E. Katz & M. A. Aakhus (Eds.), Perpetual contact, mobile communication, private talk, public performance (pp. 227-241). Cambridge: Cambridge University Press
Haxell, A. (2008). Cn I jus txt, coz I don wan 2b heard: Mobile technologies and youth counseling. Paper presented at the Ascilite; Hello! Where are you in the landscape of educational technology? Retrieved January 23, 2010, from
Haxell, A. (2010). Empowerment in tight spaces: Youth counselling in a text-messaging medium. Paper presented at the E-Youth Multidisciplinary Conference Balancing between opportunity and risk.
Suler, J. R. (2005). The Psychology of Cyberspace Revised edition version 2.2. from