As campus psychologists go online, they reach more students, but may also risk lawsuits
Amy, a freshman at the University of Wisconsin at Eau Claire, thought something in her life had gone wrong, and she went to talk to a friend about it. The friend referred Amy not to a counseling center, but to a Web address that had been mentioned as part of a class orientation.
At the Web site, Amy found information about the university’s counseling center, including pictures of the counselors and pamphlets about topics like homesickness and drug addiction. She quickly found an e-mail address at which she could reach a counselor, and she fired off a vague note.
“I feel somewhat stupid even writing this but I need some help. ... Recently I made a very big mistake and I think I need someone to talk to.” The e-mail message led to a number of sessions at the counseling center.
Amy, who did not want to be identified nor to detail her problem, says she never knew the university had a counseling center until she saw the Web site. She says she probably would not have gone to the center if she had not first warmed up to the idea through the site. “When you go down there, you feel a little apprehensive,” she says. “You don’t want people to think you’re a psycho or something.”
Eau Claire’s counseling center is one of a growing number that are using the Internet to reach out to students, give them e-mail addresses to make contact with a counselor, and offer reliable information about therapeutic services and common conundrums that college students deal with, like questions about sexual orientation and alcoholism. The Internet is where students live these days, some tech-savvy counselors say. An online presence not only is vital to reaching students, but it also offers a discreet way for them to get help.
“It’s clear, listening to students, that this is what they want,” says Richard K. Boyum, a psychologist who created the counseling site at Eau Claire, mostly in his spare time. He frequently gets e-mail messages, like Amy’s, from students looking for help. “This encourages face-to-face interaction.”
But the Internet is a new, uncharted environment for a profession that has traditionally relied on face-to-face encounters.
Some college counseling centers are starting to offer therapy sessions through Internet video and question-and-answer advice services via e-mail. But many college counselors, even those who run Internet sites, wonder if that is taking online counseling too far. They say they would worry about maintaining student privacy online and protecting themselves from lawsuits.
“We’re not clear yet how the Internet environment will affect the therapy situation,” says Patricia M. Wallace, a psychologist who has written books about psychology and the Internet (she is also the director of distance education for the Johns Hopkins University’s Center for Talented Youth). “We don’t have in health care any framework for dealing with a patient or client in anything but face-to-face contact. You can ask questions about insurance. What are a doctor’s responsibilities? Is he liable for what he says? What if someone sends messages in his name? There are therapeutic and pragmatic issues that have not been assessed yet.”
What’s more, creating and running a site for a counseling office can be expensive, time-consuming work, and many counseling offices are short on both money and staff as it is. “With a lot of counseling centers, the question is, Where do you find the time? Where do you find the technical support? If it’s not a hobby of the director, it’s not doable,” says Robert Rando, who leads a committee examining technology and counseling for the Association of University and College Counseling Center Directors.
Information and Empathy
Eau Claire’s counseling site (http://www.uwec.edu/counsel) is one of the more comprehensive homemade sites out there -- and one of the most popular. Type “homesickness” into Google, and Eau Claire’s online pamphlet on the topic is the first item to pop up. In September of last year, the Eau Claire site got about 7,000 hits; now it gets about 23,000 a month.
In addition to the pamphlets, the site also features printable posters with inspirational slogans, schedules detailing the meeting times of various support groups on the Eau Claire campus, meditation pages that show pleasant pictures and play soothing music, photographs and biographies of the office’s counselors, and several ways to contact them.
The Eau Claire counselors hope that the site can both give students useful information at crucial times and encourage them to come in. “Students’ lives begin at about 5 p.m., when our office closes,” says Katherine Schneider, one of five psychologists and two interns who work in the office. Within the past year she has written a piece about pregnancy for the site, encouraging students not to face such a burden alone. She wrote the piece because a female student at Eau Claire, whom no one knew was pregnant, died last year after giving birth in a bathroom stall.
A rack holding print versions of many of the same pamphlets that are available online sits outside the counseling office, and occasionally a student stops to look sheepishly through the literature. But “students are reluctant to come in,” she says. The site is a way of saying, “Here we are -- we’ll give you a little bit for free.”
“Hopefully that will get them over the threshold and bring them in.”
Mr. Boyum started the site because of a request from a student he was counseling. Mr. Boyum gave the student, a computer-science major who was seeking help with relationships, “challenges” to meet between sessions. The student had seen the counseling center’s site, which was spare, and issued a challenge of his own: Make it better. Mr. Boyum accepted.
Mr. Boyum describes himself as “a bit obsessive-compulsive,” as he buzzes around the campus. During his free time, he channels much of that obsession and energy into the site -- more than 600 hours of his own time since May 2001. Much of the effort went into writing and editing articles for the self-help section, finding links, and checking to make sure everything works and is updated. Mr. Boyum usually avoids technology -- he didn’t buy his first computer until 1997 -- so he hired a student in the university’s technology-support office to do most of the Web programming and maintenance. He says the student has worked about 300 hours so far and is paid $8 an hour, half of which comes from the counseling budget.
Every aspect of the site is backed by a strategy or philosophy. Its stripped-down, simple graphics are meant to accommodate off-campus users without robust Internet connections. There are no pictures of students -- not even the backs of heads of models -- that might compromise a sense of privacy. There is, unexpectedly, a bar that gives the current time and temperature in Eau Claire. “That lets people know that the site is current and updated,” Mr. Boyum says.
New Services and Links
A handful of Web pages aim to serve as directories to sites like Mr. Boyum’s. One of the most complete and best known is the Student Counseling Virtual Pamphlet Collection (http://counseling.uchicago.edu/vpc). It is run by “Dr. Bob” -- Robert Hsiung, a counselor at the University of Chicago who has had a longtime interest in the Internet and therapy. The virtual-pamphlet collection links to counseling centers around the world, including Eau Claire’s, that have posted information about mental-health topics.
Like Mr. Boyum, Dr. Hsiung put together the site in his spare time. He says he would like to take his Internet interests even further and try offering individual counseling online, but so far the other counselors he works with at the University of Chicago have been uncomfortable with that idea.
CampusBlues.com performs a similar function, but with a commercial motivation. The site posts information about various mental-health issues, borrowing much of its material from colleges’ counseling sites. “The original idea was that schools would be interested in paying a subscription for this program,” says Bill Keefe, the founder of CampusBlues. But business was flagging, and he decided to offer the service free. Now he plans to make money by selling packages of telephone or in-person therapeutic services to college students. (A similar enterprise started working with colleges two years ago, but went out of business.)
Robin H. Holmes, director of the counseling and testing center at the University of Oregon, has set up a site that offers some self-help information and office phone numbers, but does not provide e-mail addresses for counselors. “In terms of liability, it would be a nightmare if you had a student writing in about suicide, and someone didn’t get to the message in time,” she says.
She also worries about the confidentiality of e-mail communications. She warns her student clients not to write her about topics discussed in therapy. “I think that you are in essence breaking confidentiality by urging a student to put confidential information on the Web.”
Most Internet territory remains uncharted for therapists. The Association of University and College Counseling Center Directors is just beginning to hammer out guidelines for counselors who want to use electronic media, says Mr. Rando, the chairman of the association’s technology committee. He says that conducting therapy sessions online would limit the amount of information available to the therapist, who would miss a range of nonverbal signals. Some people alter their personalities when they go online -- they can become more aggressive, or alter their gender, he says, which could affect a therapist’s analysis.
Privacy and liability are also concerns. “If I’m e-mailing someone, and I’m providing some therapeutic interaction, I’m functioning as a psychologist at that point,” Mr. Rando says. “I would assume I’m liable, and carry the same liability as if they were sitting in my office. I think it’s easy to forget that with some electronic communication.”
‘Brave New World’
The counselors at Eau Claire worry about these issues, too. P.J. Kennedy, director of Eau Claire’s counseling center, acknowledges that the Internet is a “brave new world” for counseling, and that lawsuits will someday define the profession’s boundaries online. But he says the Web site’s wide reach justifies its risk as an experiment and attempt to reach students.
Still, the office tries to control the risk: The site has a legal disclaimer, and the counselors limit the amount of online communication they have with students. When students write in with detailed descriptions of their problems, Mr. Boyum reminds them that e-mail is not a private medium and encourages them to visit in person. He sends only short, innocuous-looking messages, loaded with a sort of code. “Hope to see you soon” might mean “Don’t forget about our appointment next week.”
The whole idea of counseling through e-mail or Internet video or audio seems heretical to other members of the staff, like Ms. Schneider. “We do not provide counseling over the Web, and would not in my lifetime,” she says.
However, other colleges and universities are exploring that brave new world. Go Ask Alice is a popular online-advice column offered by Columbia University’s health center (http://www.goaskalice.columbia.edu).
The service addresses questions covering both mental and physical health, on topics such as Prozac, weight gain, and rashes in hard-to-talk-about spots. Getting a question answered, however, is a bit like winning the lottery: More than 2,000 questions are submitted every week, five of which get answered and posted for all to see.
The counseling center at Virginia’s George Mason University is even more adventurous. Hoping to provide a convenient service for students, the counseling center has set up a camera at a computer at its Prince William County campus, which does not have its own counseling center and is about a half-hour drive from the main campus in Fairfax.
Students could sign up for a therapy session at the remote campus and fax in their paperwork. The student then could sit down in front of the computer, don a microphone headset, and connect to a university counselor at a computer in Fairfax. The student and the counselor would see each other in digital video on the screens.
Ralph K. Roberts, the director of the university’s counseling center, says only one student has used the system so far. “That went very well,” he says, adding that his staff worried that the session would not be as personal as a face-to-face encounter.
“In many ways it’s not,” he acknowledges. “But you still get the body language, you get the facial expressions. It’s like the telephone, but you’ve got the images. It’s just about in real time -- there’s a little bit of a lag, but you get used to it very quickly.”
His technical-support staff has assured him that a third party cannot intercept the video transmission.
He is planning to expand the service to the university’s Arlington campus, and he already looks ahead to a different kind of counseling in the future, when the price of bandwidth goes down and technology in the average home expands. “A lot of students are going to have these cameras in their homes, and so ultimately we may be able to do home-to-campus counseling,” he says. “It is going to have a lot of implications in the future.”
http://chronicle.com Section: Information Technology Volume 49, Issue 12, Page A35
