A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

ABSTRACT

Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.     

Care Coordination of Services for People Living with HIV: A Case Study of a Rural Clinic

Abstract

The healthcare landscape is changing with the development of integrated health care models across the country. Counseling is uniquely positioned to add to the continuum of services of integrated health by providing counseling and case management services through advocacy for clients. One particular chronic illness that remains highly stigmatized is HIV, which is slowly becoming more integrated into the larger healthcare system. This pilot study documents the process and experience of a hospital-based midwestern AIDS service organization in the development of innovative and unique services to address the needs of the HIV population in a rural midwestern state.     

Ethical Issues in the Provision of Online Mental Health Services (Etherapy)

ABSTRACT

A number of ethical issues involved in face-to-face therapy are examined in relation to online therapy (etherapy). Etherapy is defined and its strengths and weaknesses discussed. Specific ethical issues addressed include boundaries of competence, basis in science, avoidance of harm, confidentiality, avoidance of false or deceptive statements, forums, testimonials, solicitation of clients, fees, and informed consent. A concluding section briefly addresses legal issues, particularly interstate etherapy. It is recommended that federal licensing legislation be enacted, informed by the NASW, the APA, and similar groups.     

Grounding Online Prevention Interventions in Theory: Guidelines from a Review of Selected Theories and Research

ABSTRACT

Literature suggests that grounding online interventions in theory improves their success. This article reviews 10 theories selected from the fields of psychotherapy, social work, health promotion, gaming, and innovation dissemination that can be used for grounding the design, development, implementation, and evaluation of online interventions. Selected studies are reviewed to illustrate how these theories have been used in online human service interventions. After this review, an integrated theoretical approach for grounding online interventions is proposed along with guidelines suggested by the review.     

An Internet-Based Self-Help Program for the Treatment of Fear of Public Speaking: A Case Study

ABSTRACT

This article discusses the development of the first totally self-administered online CBT program for the treatment of a specific social phobia (fear of public speaking) called talk to me. The online program includes three parts. The assessment protocol gives the patient information about the problem, including impairment, severity, and the degree of fear and avoidance regarding the main feared situations. The structured treatment protocol ensures that the patient does not skip any steps in the treatment. The treatment protocol is a CBT program that provides exposure to the feared situation using videos of real audiences. Finally, the control protocol assesses treatment efficacy, not only at posttreatment, but also at every intermediate step. In this work we describe talk to Me and its practical application through a case study.     

Containing Violence: A Case Study Illustration of Bion's Container-Contained Model as Applied to Mother–Infant Intervention

Secure Beginnings is a program of psychotherapy for pregnant women with potential problems in the formation of the parent–child relationship including, in the extreme, infant maltreatment. The core of the therapeutic process is to help the mother recognize and think through unbearable thoughts and feelings rather than project expectations of abandonment, hate, helplessness or ridicule into her infant. Case material, from 18 months of treatment, is used to illustrate the Secure Beginnings approach. The case is a mother with psychosis and addiction who lost nine previous children to foster care.     

The Utility of Social Class,Race, and Gender in Clinical Practice: A Case Study Involving Intraracial Dyads

This article focuses on clinical work involving a male Black practitioner and a male Black client in which issues of social class, race, and gender were prominent in the treatment process. Three questions raised by the client early in the therapeutic encounter informed assessment, treatment, and the clinician's countertransference. Tenets from self-psychology, relational theory, intersubjectivity, and sociocultural factors relative to Black men are used to ground the discussion. Finally, the article illustrates why intraracial therapy should be understood in the context of the delivery of culturally competent services, highlighting how the intersection of a client's psychological issues, social class, race, and gender can emerge as functional features in psychotherapeutic work.     

Recovering Process from Child Sexual Abuse During Adulthood from an Integrative Approach to Solution-Focused Therapy: A Case Study

ABSTRACT

In recent times, strengths-based recovery approaches that focus on the present and build strategies that look toward the future have become popular. However, some cases require the consideration of experiences from previous stages of the clients’ development. This single-case study explores the psychotherapeutic process of a middle-aged woman who presented with a history of child sexual abuse (incest) and a long-term adult diagnosis of depression that was treated in public health services. This psychotherapy involved an integrative approach to solution-focused therapy; specifically, the approach proposed by Yvonne Dolan to work with adult survivors of sexual abuse, in conjunction with techniques and strategies from the transtheoretical model. Measures incorporating therapeutic working alliance and outcomes were administered over sessions. Results showed positive outcomes from this therapeutic intervention, which remained at 3-month and 12-month follow-ups. Implications for practitioners’ specialist practice in health services are discussed, given the complexity of comorbid mental health conditions with a history of child sexual abuse.     

Family Services: A Proposed Model for Coordinating Spouse Abuse Services

ABSTRACT

This article presents a proposed model to organize spouse abuse services within communities. It proposes that family service agencies take the lead in organizing and implementing the model program. The community team would consist of representatives from agencies and disciplines that serve spouse abuse families. The community would benefit from the coordination of both the direct services to affected families and the prevention and education activities designed to eliminate spouse abuse.     

Etherapy: A Training Program for Development of Clinical Skills in Distance Psychotherapy

ABSTRACT

This article describes a project by the Virtual Teaching and Cyberpsychology Laboratory of the National Autonomous University of Mexico developed to (1) implement a teaching program for clinical psychology students to learn therapeutic skills in providing online psychological services; (2) evaluate the students' acquisition of knowledge and skills in diagnosis via the Internet, case formulation of treatment, and adherence to treatment protocols; and (3) incorporate technologies for creating training settings and online professional services in order to develop the students' clinical competency in this treatment modality. A pilot study was conducted with 17 clinical psychology students in the first phase of the teaching program and 6 students during the second phase. Preliminary results indicate that students increased knowledge of Internet-based clinical interventions and improved in clinical skills. It is necessary to continue the evaluation of the teaching program with larger samples, and further research is suggested.     

Promoting Justice in the Delivery of Services to Juvenile Delinquents: The Ecosystemic Natural Wrap-Around Model

Caught between their child and doing the right thing, families of chronic juvenile delinquents often experience a series of injustices in the name of justice. Attempts by the system to correct the delinquency problem often result in the imposition of values and beliefs that negate the family's values, experiences and meanings of their child's behavior. The Ecosystemic Natural Wrap-around (E.N.W.) model attempts to respectfully account for the many influences that maintain problematic interactions, both internal and external, in the nuclear family of chronic juvenile delinquents. The model focuses on a variety of interventions at different levels and contexts, building on the strengths of the family, using the extended family and fictive kin networks, and clarifying the meanings associated with problematic behavior for the multiple players. The model proposed is an integrative theoretical approach, emphasizing systems theory and constructivism.     

The Therapeutic Action of Play in the Psychodynamic Treatment of Children: A Critical Analysis

This paper critically appraises the therapeutic action of play in psychodynamic child therapy and identifies obstacles to utilizing play therapeutically with children. An examination of the functions of action and verbal means of communication as well as their roles in shaping therapeutic relationships in treating children is provided in light of recent theoretical advances. The significance of engaging children directly through play and for redressing the balance between action and verbalization in child therapy is discussed.

The Quality‐Defining Process in Early Years Services: A Case Study

In this article we argue, through a case study in a large, urban local authority in England, that local stakeholders in early years provision express a variety of perspectives on quality but are constrained by a national framework which promotes an ‘official’ definition of quality. We offer a quality‐defining model that captures the role of both ‘official’ definitions and more pluralistic approaches to quality. Finally, we highlight mechanisms already in place in the structure of early years services that could offer social spaces for the quality‐defining process to take place.     

Introducing Technology in Child Welfare Referrals: A Case Study

Access to social services is important for the safety of children and ultimately for reunification of families involved in the child welfare system. The process of linking families to services, however, varies by caseworker and can be cumbersome and time consuming. The Department of Children and Family Services (DCFS) Needs Portal is an Internet-based intervention to improve the timing and quality of social service referrals in Los Angeles County We used a case study approach including in-depth interviews, direct observations, and user feedback obtained from the Needs Portal to (a) determine perceived benefits and barriers to adopting the Needs Portal, and (b) report how the flow of information between users and developers was used to adapt to user needs. Our analyses revealed four major barriers: (a) caseworker apprehension regarding new technology, (b) variation in communication styles by user type, (c) lack of technological infrastructure, and (d) competing workplace demands. Information sharing between developers and users has the potential to better meet the needs of users and ultimately maximize utilization of new technology. Although Internet-based interventions are designed to inexpensively and effectively coordinate services, emerging interventions may require in-person assistance and modifications in order to succeed.     

Overcoming Barriers to Homeless Delivery Services: A Community Response

Homelessness is one of the most pressing social problems today. The.lnstitute of Medicine defines the problem as a failure in the support systems created to prevent the problem and a tighter housing market. The assumption is that the support system should help to prevent the occurrence of homelessness. The Eastern Fairfield County area peiformed a study to look at the relationship between those services serving people who are homeless and near homeless to determine the availability, accessibility, and adequacy of services for homeless people. The study identified several barriers in the service delivery system. A strategy was then developed to address these barriers. This paper shows how a research process can facilitate a community response to a social problem. The paper presents the steps that were taken so other communities may replicate the process.     

Overcoming Barriers to Homeless Delivery Services: A Community Response

Homelessness is one of the most pressing social problems today. The Institute of Medicine defines the problem as a failure in the support systems created to prevent the problem and a tighter housing market. The assumption is that the support system should help to prevent the occurrence of homelessness. The Eastern Fairfield County area performed a study to look at the relationship between those services serving people who are homeless and near homeless to determine the availability, accessibility, and adequacy of services for homeless people. The study identified several barriers in the service delivery system. A strategy was then developed to address these barriers. This paper shows how a research process can facilitate a community response to a social problem. The paper presents the steps that were taken so other communities may replicate the process.     

Facilitating Online Learning Communities: A Comparison of Two Discussion Facilitation Techniques

ABSTRACT

The advent of the twenty-first century has brought a proliferation of web-based courses in higher education. While prior studies have examined the comparability of online and traditional courses, a better understanding of effective pedagogical strategies to enhance online learning is needed. This study compared two distinct approaches to facilitating discussions in relation to participation rates, interaction patterns, depth of cognitive processing, and learning outcomes in two sections of an online course. Significant differences were found between sections (N = 41) in the frequency and types of interaction among students as well as in learning outcomes.     

Online Synchronous Audio and Video Environments for Education,Training, and Human Service Delivery: A Review of Three Products

ABSTRACT

This application review describes the Internet Video Virtual Classroom (IVVC). The IVVC is a synchronous online environment where instructors can deliver course curriculum to students in real time and at a distance. Features of the IVVC that are described include video, audio, and text communication between participants, information sharing, facilitating participation, promoting group work, and documenting interactions. In addition, problems and limitations that can exist in the IVVC are discussed. Finally, to further illustrate the IVVC, three specific products (Adobe Acrobat Connect Professional, Elluminate, and Flashmeeting) are described.     

The Joy of Therapy: An Interview with Moshe Lang

This interview with Moshe Lang by Kim Bieber discusses his life work and formative years and what has helped to keep him engaged and enthused by psychotherapy and family therapy after some 50 years of practice. Moshe shares many stories about therapy and the importance of relationship, connection, autonomy, the joy of doing therapy, language, time, being collaborative, playful and humorous and always open to new learning.