Considerations and Strategies for Teaching

Online Counseling Skills: Establishing

Relationships in Cyberspace
Heather Trepal, Shane Haberstroh, Thelma Duffey, &
Marcheta Evans
As technology advances and the use of online counseling becomes
more routine, attention must be paid to instruction regarding online
counseling skills. The authors present considerations for teaching basic
online counseling skills to masters-level counseling students. Recommendations are made for helping students to establish and maintain
therapeutic relationships online. Suggestions specific to counselor
preparation and future research are provided.

Computer technology and the Internet have been advancing at a

staggering pace in the United States (U.S. Department of Commerce
[USDOC], 2004). National population surveys estimate that more than
60% of U.S. households use the Internet for information, entertainment, and communication (USDOC, 2002, 2004). Recognizing the
power of this forum for communication, counselors have begun to
use the Internet as a resource to provide online counseling services
(Evans & Hawkins, 2002; Heinlen, Reynolds-Welfel, Richmond, &
Rak, 2003; Rochlen, Zack, & Speyer, 2004). Furthermore, online
counseling is emerging as a distinct form of practice, as evidenced
by the development of ethical guidelines by the American Counseling Association (ACA; 2005) and the National Board for Certified
Counselors (NBCC; 1998). It is important to note that the Center
for Credentialing and Education, the newest credentialing arm of
the NBCC, has established a Distanced Credentialed Counselor certification (Center for Credentialing Education [CCE], 2006). These
measures have been developed to ensure standardization of online
and distance counseling practices as well as to assure the public that
counselors who use distance technologies adhere to a specialized set
of ethical and practice codes. It has been suggested that if demand
for online services continues to increase, then graduate training
programs should incorporate aspects of online counseling (Mallen,
Vogel, & Rochlen, 2005). However, despite the growth and emergence
of online counseling as a distinct form of counseling practice, little
research exists that overviews training models that are best suited
for this type of clinical medium (Chester & Glass, 2006).
Heather Trepal, Shane Haberstroh, Thelma Duffey, and Marcheta Evans, Department
of Counseling, Educational Psychology, Adult & Higher Education, The University of
Texas at San Antonio. Correspondence concerning this article should be addressed to
Heather Trepal, Department of Counseling, Educational Psychology, Adult & Higher
Education, The University of Texas at San Antonio, 501 Durango Boulevard, San
Antonio, TX 78207 (e-mail: heather.trepal@utsa.edu).

2007 by the American Counseling Association. All rights reserved.

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Counseling Skills Development

It can be argued that the supervised development of effective counseling skills is the capstone of masters-level counselor preparation
(Egan, 1998). Counseling proficiency can be conceptualized along
a developmental trajectory, for which basic attending and responding skills serve as the foundation for advanced practice (Carkhuff,
1987). In addition, the standards of the Council for Accreditation
of Counseling and Related Educational Programs (CACREP; 2001)
indicate that counselors must understand the full spectrum of
helping relationships, including facilitating therapeutic conversations, establishing counseling goals, designing interventions, and
terminating the counseling relationship (Section II. 5.b.). There
are several models available to teach students these progressive
domains of effective counseling practice (Carkhuff, 1987; Ivey &
Ivey, 2007), and current research has illustrated that masterful
counseling is best conceptualized as a synergism between effective relational skills and complex case conceptualizations (Little,
Packman, Smaby, & Maddux, 2005). Thus, counselor educators
can develop their students clinical acumen through close supervision of counseling behaviors while progressively challenging
them to use more complex thinking about their clients. Given
that the Internet has emerged as an outlet for communication
and clinical practice, how can counselor educators best prepare
students to interact online in a way that honors the aforementioned assumptions?
In most counselor education programs, students receive didactic
instruction about the components of basic counseling skills and
are then offered opportunities to engage in supervised counseling
practice (M. E. Young, 2005). Because few counselors and counselor
educators have been formally trained and certified in online counseling skills (CCE, 2006), we highlight strategies for adapting some
basic counseling skills involved in establishing and maintaining the
therapeutic relationship (e.g., the use of language, questions and
reflections, and effectively opening and closing sessions) for online
practice. To illustrate students use of online counseling skills, we
selected examples from actual chat sessions that were conducted
during two separate courses at two large southwestern universities.
One course involved internship students in providing five supportive
chat counseling sessions to newly admitted graduate students. The
students and clients in this group both gave their voluntary informed
consent, as defined by the Institutional Review Board (IRB) at the
university to have their confidential information reported. That is,
students were willing to participate in the study, realizing prior to
consent that their nonparticipation would not incur penalty. The
other course included students who portrayed counselor and client
roles through a role-playing format (i.e., not discussing actual or
personal material). For this course, IRB approval was obtained to
report confidential, archival data.

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Foundations and Principles of Teaching Basic Online

Counseling Skills
Our collective experience in teaching, researching, and supervising
online counseling (Evans & Hawkins, 2002; Haberstroh, Parr, Bradley,
Morgan-Fleming, & Gee, in press; Haberstroh, Parr, Gee, & Trepal,
2006; Haberstroh, Trepal, & Parr, 2006) indicates that students may
initially express concerns about the practice of online counseling.
Foremost, students may perceive online counseling as not being real
counseling (Haberstroh et al., in press). Online counseling is relatively new, and as with any novel approach, trepidation may exist
about the legitimacy of this type of interaction (Heinlen et al., 2003;
Lebow, 1998; Robson & Robson, 1998). For example, individuals may
know about the dangers associated with chat rooms and some of the
problematic things that can happen in them (e.g., child perpetrators,
anonymous identities, money scams), and, therefore, might be biased
against the basic validity of Internet-based counseling (K. S. Young,
2005). Therefore, students have often asked us, Does online counseling really work? To answer this question, it is helpful for counselor
educators to consider and communicate to students the evidence
related to online counseling.
Brief Review of Online Counseling Literature
Numerous studies have examined the effectiveness of Internet counseling for a variety of clinical concerns. In essence, Internet-based
counseling has been shown to be effective in alleviating symptoms of
depressive disorders (Christensen, Griffiths, & Jorm, 2004), anxiety
disorders (Kenardy, McCafferty, & Rosa, 2003; Lange, Van de Ven, &
Schrieken, 2001; Rassau & Arco, 2003; Richards, Klein, & Carlbring,
2003), and various somatic issues (Strom, Pettersson, & Andersson,
2000, 2004; Tate, Wing, & Winett, 2001). Furthermore, researchers
have found that clients rate online clinical relationships favorably
(Cook & Doyle, 2002). However, Chester and Glass (2006) noted that
small sample sizes and the rapid progression of technology may limit
the generalizabilty of study results to the growing population of online
clients and counselors. It has been noted that online counseling is
contraindicated in cases where clients need to be hospitalized or have
suicidal ideation or display personality disorders (Stofle, 2001). Other
researchers have cautioned that the lack of nonverbal information in
online counseling practice may interfere with or limit the establishment of a therapeutic relationship (Cook & Doyle, 2002; DeGuzman
& Ross, 1999; Rochlen et al., 2004).
As an interactive form of writing about emotions and problems, online counseling may harness similar processes that underpin journaling about troubling thoughts and emotions. A considerable research
base has found that therapeutic writing is a powerful medium for
enhancing client growth and well-being (Campbell & Pennebaker,
2003; Penn, 2001; Pennebaker, 1997; Soper & Von Bergen, 2001).
Asking students to think about the therapeutic benefits of writing in

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a diary or journal may help them draw parallels between these practices and online counseling. Furthermore, when discussing online
practice with students, it may be helpful to illustrate all the ways
that online counseling could be used. For example, chat or e-mail
sessions could be used as adjuncts when clients are unavailable to
attend face-to-face sessions because of illness, family obligations, or
travel. Therefore, before beginning actual online counseling sessions,
students should review the current literature and practice guidelines
related to online counseling (CCE, 2006; NBCC, 1998). Finally, to
prepare students for online interaction, we suggest that instructors
host an online dialogue about research and practice of online counseling with students, using courseware (e.g., WebCt, Blackboard) chat
rooms or message boards.
Ethical and Procedural Considerations for Online Counseling
In its newest published ethical guidelines, ACA (2005) addresses the
use of technology in counseling. A full review of these guidelines is
beyond the scope of this article, but it is essential that counselors
(a) ascertain the legal and ethical requirements of their jurisdiction
and that of the client; (b) assess clients knowledge and ability related to technology; (c) determine clients access to private locations;
(d) discuss confidentiality, security, and encryption; and (e) provide
clients alternate methods of communication in case of technology
failure. ACA requires that all confidential communication occur via
encrypted channels. Basically, encryption is a mathematical process that converts text, video, or audio streams into a scrambled,
unreadable format when transmitted over the Internet. Counselor
educators may find the information at http://www.verisign.com and
http://www.rsasecurity.com helpful in explaining the concepts of
encrypted communication. Finally, as a course assignment, we recommend that students create an informed consent document that
is based on the ACA ethical codes related to informed consent and
online counseling and upload them to the class Web site for perusal
(see Appendix for a sample informed consent document).
Online and Face-to-Face Counseling: Intersections and Divergence
As with any form of counseling, establishing an online therapeutic
relationship involves negotiating professional boundaries (Hermansson,
1997). Typically, counseling students are trained to facilitate face-toface therapeutic interactions. In contrast, cyber counseling sessions
may differ considerably because (a) significant time may elapse between
responses and (b) the sessions may occur via synchronous or asynchronous channels. Synchronous communication is a distance-based
conversation that occurs in real time and may be facilitated via chat
rooms, real-time video, or telephone. Asynchronous conversations
are accomplished through e-mails, message board postings, or video
e-mails, where there may be a significant amount of time between
responses. It has been noted that synchronous communications may

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produce more immediate, direct responses, whereas asynchronous

communications allow for more reflection and purposeful responses
(Davidson-Shivers, Tanner, & Muilenburg, 2000). In addition, it has
also been suggested that synchronous discussions lend themselves
to social interactions, whereas asynchronous discussions may be
more task-oriented (Im & Lee, 2003/2004), suggesting that different
forms of communication may serve different purposes. This article
focuses on how counselors can respond effectively in synchronous,
text-based counseling sessions.

Case Examples of Online Skills

As previously stated, initial online conversations may center on the
clients familiarity and comfort with using Internet-facilitated counseling services. Before beginning any counseling session, we recommend
that students and clients review and digitally acknowledge posted
informed consent documentation. Because of time considerations, any
questions related to informed consent, security, or technology should
be facilitated via e-mail prior to the actual synchronous online sessions. To illustrate this process, in the following dialogue a student
and client review informed consent procedures.
Student counselor: Hello, Linda (pseudonym). Welcome to our first session. At
this time, if you would review an e-mail I sent you this morning; it has the
informed consent form attached that you should print out and review. I will
be waiting here for you. Let me know if you have any questions.
Client: I have already printed the informed consent and signed it, so I am
ready.

In the above session, the student did not need to spend an

hour typing informed consent procedures because the client had
downloaded and read the form. Therefore, the dialogue could focus
on questions or elaboration of the policies and procedures. After
conversations related to informed consent have concluded, the
session can begin. In the typical sequence of traditional counseling
processes, initial conversations between client and counselor may
evolve from small talk to more therapeutic discussions. However,
research has found that synchronous online counseling occurs at a
much slower pace than face-to-face sessions (Haberstroh et al., in
press). For example, the process of online counseling requires both
counselors and clients to take more time responding to one other.
The main difference between online (synchronous) and traditional
counseling is that it takes place in written form. Thus, there may
be less time available for small talk. Because online counseling
may be a novel interaction for the client, initial conversations could
center on discussion of the cyber environment. For example, the
following transcript illustrates how a student moved from small
talk to discussing presenting problems with her client:
Student counselor: Hello. My name is Jane Doe. I am a counseling student
under the supervision of Dr. Sally T. Smith [pseudonym] at the university.

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I am so glad you are a night owl and willing to meet online this evening.
Client: It is nice being able to have access to a service like this.
Student counselor: Jessie (pseudonym), can you tell me something about your
experience and comfort level with our online services?
Client: Well, I have no prior experience. This is actually my first time using
this service. I am pretty comfortable using this site because I feel that it
must be a secure site since it is part of the university system.
Student counselor: I am glad to know that you feel comfortable and are willing
to try something a little different. Do you have anything in particular pressing on your mind or that you would like to discuss this evening?

In the above example, the student counselor explores the clients

comfort level with online counseling prior to beginning the actual
counseling session. Therefore, in opening online sessions, we recommend that students are taught to (a) discuss reactions, experiences,
and comfort with online counseling; (b) review ethical and confidentiality statements that have been reviewed and digitally signed by the
client; and (c) begin to discuss presenting issues.
In addition to skills and procedures related to opening online
sessions, other considerations should be addressed when training
students. In counselor preparation programs, students are taught
not only to focus on verbal messages in sessions, but also to monitor nonverbal behaviors (Ivey & Ivey, 2007; M. E. Young, 2005). The
absence of nonverbal information online may create some anxiety
for students because they perceive that they are unable to read their
clients body language or to see how a message is being received.
Thus, online counseling involves a unique set of skills and tolerance
for ambiguity when interacting in an environment that is devoid of
nonverbal information.
Online Skills to Address the Absence of Nonverbal Feedback
Nonverbal behaviors are critical in human relationships, accounting
for a considerable amount of the variance in communication (Highlen
& Hill, 1984). Specifically, nonverbal interactions are essential in counseling relationships for (a) gauging how clients are feeling or reacting,
(b) pointing out discrepancies between verbal and nonverbal behaviors,
and (c) bringing immediacy to the counseling sessions (Highlen & Hill,
1984; M. E. Young, 2005). In online counseling, nonverbal behaviors
take on another form. Students can be instructed to model the effective use of nonverbal behaviors in cyberspace by intentionally writing
their thoughts and feelings and encouraging their clients to do the
same. For example, students should be trained to convey affect with
words and symbols (e.g., <<smiling>>, <<grinning>>, <<blushing>>).
To illustrate this practice, a student wrote the following statement
in session: Nice to meet you, Sam [pseudonym].*shakes hand* My
name is Mark [pseudonym]. . . . How may I be of help today? In this
example, the student was able to convey a common expression of
greeting that otherwise would have been lost online. Thus, the student
should begin to become aware of and communicate her or his feelings
and nonverbal behaviors in sessions and begin to experiment with
different ways of conveying nonverbal behavior online (e.g., describ-

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ing affect and reactions, using emoticons, and asking the client for
clarification) until they have developed a repertoire of responses. It
has been suggested that, in addition to an emphasis on conveying
nonverbal behavior, students should receive additional training on
empathic online communication and the use of emoticons to share
feelings and thoughts, which can help counselors in the online environment (Mallen et al., 2005). Finally, it is important for students to
become aware of the unique forms of language that have evolved in
tandem with the World Wide Web.
The Language of Online Communication
Language takes on a unique form in many cultures, and cyberspace is no
exception. One need look only as far as the nearest high school students
cell phone to attempt to decipher a range of text message language that
has become commonplace. Ever evolving online language has become
commonplace for individuals as they communicate via text messaging,
e-mail, and chat rooms. Counselor educators and students need to
familiarize themselves with common and popular online abbreviations
such as LOL (laugh out loud), ROTFL (rolling on the floor laughing), AFK
(away from keyboard), as well as the use of emoticons or characters to
convey emotions (i.e., :-( = sad or annoyed; :) = happy; (::[ ]::) = a bandaid used to represent help). Furthermore, these abbreviations and online
expressions may vary with age and experience. For example, more recent
idioms include abbreviations such as POS (parent over shoulder), WU
(whats up?), 411 (information), and references to current video games
and songs. Sites such as http://www.netlingo.com/emailsh.cfm and
http://www.microsoft.com/windowsxp/using/windowsmessenger/
emoticons.mspx provide an overview of common terms used online, and
students should be encouraged to review them periodically.
Clients who are attracted to online counseling may be familiar with
online forums such as chat rooms, online groups, and message boards
and may communicate in this manner with ease and fluidity. Just as they
would with any client who uses an expression that is not understood,
students should ask the client about the meaning of such expressions.
Online terms come in and out of vogue and, depending on factors such
as age and familiarity with format, may vary immensely. The following
dialogue is an illustration of the use of online language:
Student counselor: How are you doing today?
Client: m doing fine how bout u???

In this example, the client shortened I am to m and you to u.

During the session, the student continued to use proper English, and
the client wrote in shorthand. Relevant class discussions could center
on the professionalism of using Internet shorthand, and research is
needed to evaluate how the counselors use of language online affects
counseling sessions.
In addition, it is important that students are aware of multicultural and
diversity issues relative to client communication patterns. More specifi-

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cally, counselors may consider how connection is formed and expressed

within and across cultures and how such expression can be facilitated
online. At the same time, although it is important for students to avoid
stereotyping, competent counselors consider the role that culture, race,
or gender may have on the connections formed through online counseling and on the ensuing relational challenges that may occur.
In summary, when attempting to establish online counseling relationships, students need to become aware of common obstacles,
including unfamiliarity with the online environment, exploring alternative ways to convey nonverbal information, and giving attention to
the unique use of online language. Once counselors have navigated
the factors that are unique to online counseling, they can begin to
use other basic interviewing and counseling skills.
Effective Use of Questioning and Probing
Effective questioning assists counselors in gaining a deeper understanding of their clients stories and may facilitate creative ways for clients to
think about their problems. However, students often show an overreliance on questions (M. E. Young, 2005) and may barrage a client or lose
focus in the session. It is crucial for students to stay focused and ask
a minimal number of questions in an online environment because of
the slower pace (Haberstroh et al., in press) of the counseling sessions.
Asking a flood of questions while a client is considering responses to
previous questions may confuse clients about the direction and focus
of the session. Because of these dynamics, we theorize that productive online sessions almost singularly focus on one topic, exploring it
in depth. In the following example, a student responds to her client
in an empathic fashion, prompting the client to discuss a tumultuous
friendship in more depth.
Student counselor: It sounds like youre receiving messages, definitely adding to
the confusion and anger. As much as you are comfortable, can you describe
the difficulties with your friend, which led to the conflict?

The client continued to write about her emotional reactions to the

friendship, and the student followed with the statement,
Student counselor: You clearly feel very betrayed and likely devastated. You
mentioned you had been best friends for 3 years. How are you coping with
all of this?

In this example, the student acknowledged the clients concern by

using clear reflection and well-formulated questions. Also, the student
intermingled reflective responses with her questions, communicating
her understanding of the potential emotions involved while concurrently
asking the client to think more deeply about the situation. Thus, the
client was asked to clarify personal thoughts on the problem as well
as to clarify the coping mechanisms used.
Similar to the instruction of real-time counseling skills, online counseling also relies on well-placed questions, perhaps even more so because

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of the focused nature of sessions. Because typing is a slower process

than talking, content that can take 1 hour in a traditional session can
easily be condensed to 20 minutes online. However, students also have
access to a running transcript of the session to peruse. This process
may help the student to efficiently craft questions because she or he
does not need to remember the specifics of session content (Haberstroh
et al., in press). It is important, however, in online counseling to focus
very clearly on identified issues, and we recommend that students
judiciously use questions to help guide the session.
Effective Use of Reflective Online Counseling Responses
Accurately reflecting the content, meaning, and feelings of client statements is a cornerstone of counseling practice (Ivey & Ivey, 2007; M.
E. Young, 2005). In online practice, it is essential that clients perceive
that they are being understood by their counselor. Because counselors cannot convey warmth through body language and eye contact,
online sessions tend to cover small, focused amounts of material, and
well-placed reflective responses are critical to effective online practice.
Because of the nature of online counseling and lack of body language,
reflections of emotion may become more complex because counselors
can only assume what clients are feeling on the basis of text alone.
This dynamic is best negotiated when clients and counselors have
permission to check the accuracy of their statements and to modify
them as needed. The following example shows how a student reflected
the emotion and content of her clients statements:
Student counselor: It sounds like this was a deep and personal relationship that
you thought was built on mutual trust and respect. The effects of such an
abrupt and hurtful ending of the relationship can be devastating. It sounds
like you definitely miss her, even though you are angry right now.

Given that the client and student were interacting miles apart, with
no body language to guide the session, the student was still able to
convey a range of emotions, from sadness to anger, and was able to
be in the moment with her clients anger.
For students who are first learning online counseling skills, we recommend that they use very few open-ended questions and rely more
on reflective responses. This is due in part to the limited amount of
content that can be covered in session as well as the potential for a
session to become a disjointed question-and-answer exchange.
Closing the Session
Effectively and smoothly closing an online session requires students
to be aware of time constraints and to allow for ample opportunity
processing at the end of the session. We recommend that students
begin closing 10 to 15 minutes before the session is scheduled to
end. This allows time for reflection and keeps the session from ending
abruptly. In the following examples, the students briefly summarize
the session, express enthusiasm about continuing the process, and
schedule the next counseling session:

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Student counselor: Sam [pseudonym]: It was nice working with you this evening,
and I look forward to our next session on Saturday and hearing about any
progress or further exploring this or other concerns with you.
Client: All right.
Student counselor: *End of session*

In the above example, the student deliberately ends the session

by placing asterisks around the closing statement. In the following
example, the student gives the client the opportunity to share any
thoughts about problems that have emerged during the session that
need attention.
Student counselor: It sounds like you are still working through this in many
ways and hopefully our time together will be helpful to youat least to express your thoughts and feelings. Did anything else come up for you during
this session that we need to discuss before our time is completed for today?
Please let me know at the conclusion of any session if you are having an
especially difficult time. If not, then I would like to schedule our session
for next week. Mornings are great for me any day, but Friday of next week.
I also have some afternoon times if necessary.
Client: Mornings are great for me, too. How about next Wednesday at 9:00?
Student counselor: That should work! I will see you then. Im glad we could
spend this time together today.
Client: I am, too. I will talk to you next week.

In summary, counselors can learn to facilitate a productive online

counseling session by attending to several variables that are unique
to this form of communication. Specifically, we recommend that counselor educators assist students in becoming more familiar with online
counseling and the cyberspace environment. For example, students
should acquaint themselves with the ACA ethical codes (see ACA, 2005)
regarding online counseling; they should also develop and practice
basic counseling skills (e.g., attending to nonverbal behavior, using
questions, reflecting, closing the session), making slight modifications
for the online environment. More research is needed on the topic of
online counseling skills. As the demand for online counseling services
continues to increase (Mallen et al., 2005), counselor educators can
and should encourage students to become aware of the differences in
communicating in cyberspace (e.g., language issues, condensed messages) in the hope that a basic understanding of the communication
culture will enhance the online counseling relationship.

Discussion
The focus of this article has been on teaching counselor trainees basic
skills for establishing and maintaining a counseling relationship in an
online environment. Future research could best focus on how these
and other basic skills can be delivered more effectively in an online
environment. The counseling skills needed for relationships that exist in real time may differ markedly from those needed in the online
environment. Research is needed to evaluate relationship building
skills in cyberspace, such as how the counselors use of language online affects sessions. In addition, research is also needed to evaluate

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the role of basic relationship skills in asynchronous conversations.

Future studies might also investigate specific teaching methods that
can be used in preparing counseling students to interact online. Because relationship skills provide the basis for counseling, we hope
that future research in this area will begin to address these basic issues and then move on to establish ideas and techniques regarding
teaching other more advanced counseling skills relative to sessions
that occur in cyberspace.

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Appendix
Sample Informed Consent
This document overviews informed consent procedures for conducting online counseling
relationships as recommended in the ACA Code of Ethics (American Counseling Association, 2005). We suggest that the following statements are included in addition to the standard
informed consent documentation when providing online services. Following each statement
we note the section of the ACA Code of Ethics that we addressed.
For online counseling to be effective, the following elements need to be in place to help ensure
a productive working online counseling relationship:
Prior to beginning services, I will need to establish that online counseling is permitted
by relevant statutes and codes of practice in our respective locations (Section A.12.e.). I
may need to consult with relevant state and legal authorities to determine the feasibility
of offering online counseling to you (Section A.12.f.). This may delay the beginning of our
work together. I will inform you of the rights and limitations that I discover (Section A.12.
g.4.). If online counseling is not viable, I will work with you to find local resources and
information (Section A.12.c.).
On my Web site, I mention the intention to accommodate individuals with disabilities.
Please let me know how I can better accommodate you (Section A.12.h.6.).
I have provided links to my licensing and certification boards (Section A.12.h.3.) and
links to national crisis hotlines (Section A.12.g.9.). I also regularly check the site to verify
that the links are working. Please let me know if you find a nonworking link so that I can
change it (Section A.12.h.1.).
In the initial screening and assessment process, we will overview your presenting concern
and physical, intellectual, and emotional capabilities to determine if online counseling is the
best counseling approach for you. Online counseling has many benefits that may include
increased convenience, a sense of confidentiality, the ability to reach people in remote
locations, and evidence supporting its usefulness for a variety of concerns. However,
there are limitations that include technology failures, lack of nonverbal communication
dynamics, potential for not receiving immediate feedback for a referral and assistance
(Section A.12.a.), and the very remote chance that information may be intercepted by a
third party (Section A.12.g.1.).
It is imperative that you are capable to use online services. This would include having a
working knowledge of computers, e-mail, and chat software programs (Section A.12.b.).
In addition, it is essential that you understand that our nonverbal communication may be
limited, text sessions may occur at a slower pace than face-to-face conversations, and
there may be some delays in our conversations (Section A.12.a.). Thus, online counseling practice may be most beneficial for clients not experiencing severe emotional crisis
(Section A.12.b.).
Related to access to our sessions, our services are hosted on an encrypted server.
However, certain individuals may have authorized access to our records as part of their
regular duties. As of November 2006, these individuals are [List of employees with access]
(Section A.12.g.2.). I make every attempt to keep our conversations strictly confidential.
Likewise, I ask that you determine who has access to your computer and electronic information from your location. This would include family members, coworkers, supervisors,
and friends. I would encourage you to communicate only through a computer that you
know is safe, i.e., wherein confidentiality can be ensured. Please make sure to fully exit
all online counseling sessions and e-mails (Section A.12.g.3.).
All of our chat and e-mail communication is encrypted with 128 bit encryption. This means
that our messages are scrambled so that it is nearly impossible to decode them if they
are intercepted by an unauthorized third party (Section A.12.g.5.). Furthermore, I only
communicate via encrypted channels with clients. The use of my regular e-mail is for
general questions (e.g., appointment times) only, and I will not respond to personal and
clinical concerns via regular e-mail (Section A.12.g.6.).
Our counseling sessions will be stored on the server for [indicate length of time], after
which point they will be permanently destroyed (Section A.12.g.7.).
(Continued on next page)

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Appendix (Continued)
Sample Informed Consent
If we experience a technical failure or difficulty, you may contact me at [office number]
or by pager at [pager number] so that we can communicate by telephone (Sections
A.12.g.8.; A.12.h.2.).
Furthermore, if I am not available and you are in an emergency situation, please call 911
or contact the crisis hotlines listed on my Web site (Section A.12.g.9.).
Because we may be separated by distance, culture, language, and time zones,
please be aware that our communication may be hindered by these differences. It is
important that we dialogue about these issues at the beginning of our time together
(Section A.12.g.10.).
Online counseling may not be covered by your insurance carrier. Please check with
your insurance carrier to determine insurability for this type of counseling (Section
A.12.g.11.).
If you are a minor, I will need to obtain written signed consent from your legal guardian
(Section A.12.h.5.).

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