Newsletter February 2015

 The ISMHO Newsletter is published for members of The International Society for Mental Health Online.  

Please feel free to share this newsletter with all those interested in staying up to date on the world of mental health online.

Articles and other contributions to ISMHO's newsletter from members and individuals in the telemental health industry around the world are most welcome. Please email us at admin@ismho.org if interested.

Upcoming International Conferences

ISMHO affiliation with TherapySites.com. 

About TherapySites: Websites for Therapists

TherapySites specializes in creating websites that are engaging, professional, cost-effective, and extremely simple to maintain, helping mental health professionals successfully market and manage their practice online. The TherapySites package includes everything necessary for a professional online presence, including basic search engine optimization (SEO), integrated email & editing tools, credit card processing, and online appointment notifications, all with no contracts or setup fees and unlimited technical and customer support. For more information, contact us at 866-288-2771.

 For a limited time until January 31st 2015. ISMHO members get $39/mo for a full year with promo code NewYear15. For more information about how to start building an online presence, visit http://www.TherapySites.com. Check in with ISMHO.org homepage for more special offers to come just for ISMHO members.

ISMHO Board Member Feature: ISMHO Member at Large, Dr. Beverly Fierro

While I had an extensive background in Health Science and Education, I preferred a holistic approach which encompassed mental health. As I became increasingly aware of the millions of people struggling to cope with mental health disorders, particularly at a time when access to appropriate medical and psychological services was becoming quite challenging, my research focus turned to potential solutions. 

My doctoral research led me to groups being formed online to support members reporting diagnosis of mental health disorders, in particular, mood disorders. The online group members cited improvement in diminished feelings of isolation, access to current information, empathy and support as compelling reasons for their active participation.  It was at this time, while further exploring internet options for these participants, that I discovered ISMHO.

ISMHO is a cutting edge organization for mental health professionals and for students planning to enter the field, and for those wanting access to the latest findings and events the industry provides. The United States Armed Forces began adopting online psychotherapeutic services and many others are following that model of service as internet counseling services have entered the mainstream and will continue expanding into the future.

As an educator, counselor and writer, I offer support to the organization through my continued research and mentoring of students entering the field.  ISHMO provides the professional organizational support everyone entering the field or continuing in the field will need.  We continue to grow and increase our offerings to the mental health online industry on a global level, addressing the needs and demands across the world. 

ISMHO Professional Member Feature: Dr. Kathy McMahon, Psy.D.

Dr. Kathy McMahon, Psy.D., is a licensed psychologist in Massachusetts, and has worked with couples on relationship and sexual issues for the past quarter century. She founded Couples Therapy Inc, where she practices internationally online, and in Western Massachusetts, and trains clinicians to work effectively in online couples counseling. Her special interests include the struggles of international couples, neuro-atypical bonds (such as high-functioning Autism, and ADHD), application of couple therapy principles to an online platform, and effectively treating couples intensively in two- and three-day formats. She teaches in the doctoral program in Clinical Psychology at Antioch University New England and in the graduate program at Cambridge College in Cambridge, MA. Her work has been features on CBS - New York. She is also a proud member of ISMHO. She can be reached at KathyMcMahon@hush.com.

 Describe the most exciting work you have done.

At this point, I’m seeing couples internationally online.  This is a particularly exciting development, because it requires a level of training and technical expertise that I’ve developed over time.  Thorough assessment of the couple’s dynamics is essential.  I do that online as well.  Many of the couples I see do not have access to English speaking therapists, never mind someone specializing in couples and sex therapy.  These couples live completely different lives than people in similar professions in the U.S.A. They have typically much more domestic labor and childcare help, as well as greater stressors in their mobile lifestyle. They also typically commit to employment contracts for a period of time, and sometimes this involves employment contracts as a couple, and housing accommodations, as in the case of international teachers.  This makes marital distress, and the desire for separation or divorce even more complex than it would ordinarily be.

What are you currently working on?

At this point, I am reaching out to, and training licensed psychotherapists who are interested in developing expertise in working with couples online. I’m in the process of creating a network of colleagues within the United States that will allow me to refer to qualified professionals in states where I’m not personally licensed. We’ll develop a premier network of professionals devoted to these couples both within and outside the USA.  I’m particularly interested in bilingual and trilingual professionals, and those with expertise in working with particular ethnic identities.  It’s an exciting time to be a couples therapist online.

How do you envision mental health online growing internationally?

There is no question that couples living outside the USA need services, and particularly services by clinicians that are familiar with the special needs and lifestyles of the international couple.  I’ve taught cross-cultural sensitivity and ethnic differences to marriage and family therapy graduate students at several New England schools of psychology over the years. Not knowing things is often not the problem in working successfully with these couples.  To quote Mark Twain: "It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so." Sometimes I’m juggling three understandings of problematic rituals or symbols:  My own, the husband’s, and the wife’s, as each of us is from a different culture or country. While our common language is English, it might not be the native language for anyone but me.

Questions such as:

  • How do we discipline our children?
  • What are the proper roles for men and women, (both in the cultures they come from and the country they currently live in)?
  • What are “comfort foods?”  Foods we eat to feel calm and relaxed?
  • Which holidays do we celebrate?  Why?
  • Do we invite friends to our home? Meet in a café?

These questions should be answered by all couples in a thoughtful way, but when you are dealing with International Couples, the pressure to systematically explore them in a safe atmosphere is crucial.  A wife might spend hours cooking a dish she believes is “traditional” for her husband, who, it turns out, would rather eat a burger.  Or one believes that having a child sleep in their bed is the norm, until they are weaned, while their partner wants to bottle feed and keep them in their own beds.  And sometimes it is the wife that’s advocating the bottle and a bed to herself!

There is all sort of confusion within the couple about the meaning of things like gender roles, appropriate sexual behavior (including extra-marital affairs), and “what emotions mean,” for each of them.  International couples smash all sorts of stereotypes, because they often have to be special sorts of people to even BE international couples. The therapist must cultivate a discipline of carefully examining fundamental assumptions, assumptions that, for cultural reasons, may be outside of their field of awareness.

Working with International Couples around the world takes particular skills and knowledge to provide clinically effective help.

What has been the most challenging aspect of working in mental health online?

There are many.  For me, a big one is getting either close enough to both people (via the camera), or a sufficiently robust web connection that allows me to detect subtle facial expressions.  That’s easier to do with an individual, than with two people in front of one camera.  The second challenge is temporal, that is finding the appropriate time to see people.  To date, I’ve worked with international couples from all over the world, and this can make scheduling a challenge. While12 hours ahead (such as China) makes it easy to figure an appointment time, there are some countries that don’t have Daylight Savings Time, so even a simple switch like that can become problematic!

When I see people at 11 pm (their time), because that is the only reasonable time for me, (mid-morning my time), I have to appreciate the fact that their internal clocks are dramatically different than mine while we’re in session. They are ready for bed, while I’m starting my day. 

Another challenge is turning people away, when I know they need help…recognizing the limitations of working online.  For many of them, I know they can’t just turn to the therapist down the street, because there isn’t one. The training I’ve done has made me wary of working with couples “in crisis.”  I set up pretty rigorous requirements for the couples that see me online, including the online questionnaire I mentioned earlier, that can take each of them hours to complete. I know how therapeutic it can be, but it still requires a lot from each of them. It is important that they understand that the online work I do is every bit as rigorous, and perhaps more so, than the face-to-face couples therapy or intensive retreats I do with couples. I need to determine in advance that they can benefit from my help.

Are there words of advice can you provide for inspiring mental health professionals interested in beginning their practice online?

Get a lot of training.  Don’t think if you’ve Skyped with friends, you can do online psychotherapy.  And don’t use a non-HIPPA compliant service like Skype.  Online work is similar to the Harlem Globe Trotters.  They have to be incredibly good basketball players to look as comic and goofy as they seem. Online work requires you to be better than average.  You are at a distinct disadvantage by not being in the room with the couple, feeling them emotionally, sensing the subtle changes and emotional shifts that happen.  That has to be compensated for by exceptional diagnostic and clinical skills.  You have to be bold enough to ask “Are your eyes tearing up right now?” when you can’t exactly be sure.  And everyone has to realize that “retrieving the lost connection” is part of the process, that replaces things like “finding parking.”  It is a balancing act where the “optimal” on-line experience is sometimes elusive, but getting closer every year.

All ISMHO members are welcome to be featured in ISMHO's member feature. If interested in being featured please email us at admin@ismho.org.

How to Get Started as an Online Therapist.

-By ISMHO President, Jay Ostrowski, MA, LPC/S, NCC, DCC, ACS 

Advances in technology, reimbursement, security and public adoption have made it more and more appealing to be an online therapist. Mental health providers are increasingly joining the telehealth revolution. Research has shown conclusively that quality mental health care can be provided online with high client satisfaction. If you are ready to begin counseling online, here are some suggestions on how to get started.

  • Focus on the service more than the setup. Most people new to online therapy spend too much time choosing technology and trying to set up the perfect online practice. Focus instead on the primary service you’d like to provide, like video therapy, and obtain a technology that meets that need the best. Think through what you and the client will need for the video portion. This will feel a little clunky at first, but it will help you decide immediately if the video venue is for you. Once you've demonstrated that to yourself you will feel confident investing in the right technology to cover additional needs like scheduling, billing, messaging, etc.
  • Map your processes. Make a flow chart of how you will obtain the required paperwork and payment. Outline how you will connect with the client online in a secure manner and how you will handle other business processes. Review this with a colleague or mentor to identify and address areas of improvement. However, you don't need to over engineer the process. It is better to let your client know this is a pilot project and give yourself the freedom to iterate.
  • Get training and certification. While it seems simple to turn on a webcam or camera phone and see a client, there a number of known risks to online therapy that are covered in quality training programs. For instance, how would you handle a client who is suicidal or psychotic? Are you aware of the laws and requirements in your jurisdiction? According to a recent survey conducted by myself of US mental health licensing boards, a vast variation was found in the laws governing online practices between psychologists, counselors and social workers. There is also a lot to consider in the setup of the client and therapist’s technology and setting to bring about the best experience.
  • Get a mentor. While you may be tech savvy, starting an online service is significantly different from in-person services. A mentor can help you get started more quickly, offer advice on the technology to choose, answer questions about applying your training to your specific scenario and provide needed energy and encouragement.
  • Develop your niche. There are many people who do not have access to professional mental health services. Find out who comes in contact with clients, who needs a referral and develop that relationship. The quickest way to create an online referral stream is to contract with an agency that has a shortage of mental health providers.

Once you have started to see a few clients, focus on how to sustain your new practice by developing office routines and referral streams. Starting anything new can feel overwhelming.  Online practice is still a relatively new phenomenon but as most technological advances, it is progressing rapidly. This rapid progression allows room for almost all mental health professionals to get started with an online practice without much delay or hindrance. Giving service priority over set up, keeping track of process as with any independent business, having the appropriate training and certification, following a mentor to prevent too large a learning curve and locating a niche for your practice are just the broad outline to starting an online practice. Remaining patient, knowledgeable and organized with the launch of an online practice as any other will help to maintain a stable online practice.

ISMHO Outreach 

Prostor is the citizens’ association from Belgrade, Serbia, that has been active in the field of mental health since 2010. In Serbia, Mental health is cited as the second largest public health problem after cardiovascular disease and only this year, decades after other parts of Europe, reform of mental health system has finally begun. The public opinion and attitudes toward persons with mental health problems are highly negative, due to the lack of information and approach of the media when reporting on the subject. These facts result in complete rejection by family members, surroundings and the society as a whole. The mission of Prostor is to provide psychosocial and economical support to persons with mental health problems in the community and develop these programs toward full recognition by the local authorities, as well as to raise public awareness, change wrong attitudes and behaviors.

At present, Prostor is looking for international partners in order to spread the word, exchange experiences and get support for the development of their programs.

Prostor focuses mainly on the development of services in the local community, outside of the psychiatric institutions, following the Community Mental Health model, practiced in many countries. Through collaboration with Belgrade municipalities, they are delivering different services to people with mental health problems. Some of the main activities are: psychosocial support (art therapy, psychotherapeutic group, development of the Hearing voices approach to self-help groups and education of professionals), economic empowerment (selling art works and products on fairs and online, applied arts training), radio show “The voice of madness in the air” (regional collaboration), as well as different rising awareness and de-stigmatization activities (round tables, public events, media coverage).

Some of these activities will be partially financially supported, but the financing is not stable and big part of the activities is carried out on voluntary basis. The donors and foundations are often not interested in the subject of mental health and are not providing financing for their projects. At the moment, all of their projects are finished and they hope to be able to find finances for next year.

If you are interested in learning more about Prostor's programs and mission please visit Prostor.org.rs. and/or contact Mina Aleksic, President at Prostor at minaleksic@gmail.com. Any and all donations/contributions are welcome.

Trending in ISMHO Forums

John Houchens of University of North Carolina Chapel Hill  asks:

Cost of Online Counseling:        

Hi all,
I am a graduate student at University of North Carolina Chapel Hill researching online counseling. If you don't mind responding, I am wondering how much is the going rate for different kinds of online therapy.
- Email?
-Video Conference?

Thank you!
Taylor Houchens
Graduate Student at UNC Chapel Hill
Rehabilitation Counseling and Psychology

Give some more feedback to John and other students interested in pursuing counseling online. Post your own topics and questions in the ISMHO forums to start a discussion with other students, professionals and organizations in the mental health online field at http://ismho.org/international-forum/.