Therapy, Coaching & Distant Healing via Technology

We offer articles from TILT Magazine and information related to online therapy, online coaching, online complementary and alternative modalities and cyberpsychology.

How Do I Start Using Technology in Counseling or Coaching?

September 27th, 2014   •   no comments   

innovasionResearch has proven that technology can be helpful in counseling and coaching. Clients can gain personal insights and change that they could not have easily taken place without technology. But few have talked about how to actually get started. Most clients are already searching for the magic App that will solve all of their problems. They just don’t talk to you about it. Apps can help enhance the growth of your clients if you use them for specific aims in time limited intervals. But whether you’ve been watching from the sidelines or have just thought about using technology in your work, you may wonder how to get started. There are some boundaries to keep us in line, but a lot of opportunities to make a big impact on our clients.

Using Apps in Counseling or Coaching
It can be overwhelming when you hear about the many Apps or online therapy platforms and the many applications for their use. There are so many ways in which technology can help people in counseling or coaching. The best way to start is to think about how technology could assist one client with one problem.

Most Apps fall into a few operational categories.

1. Tracking behavior numerically by counting something I did, such as the number of times I did the new technique I just learned.
2. Reminding me to do something or not do something, like compliment my spouse, even though I don’t feel like it.
3. Capturing my thoughts about the fight I just had with my brother-in-law who really gets on my nerves.
4. Connecting with others, like texting my progress to my best friend.
5. Leading me to change my thinking and behavior by asking me questions about my current state and reminding me of what and how I need to change.

Consider whether your client would benefit from tracking, reminders, capturing, connecting or leading. I bet they could use all of them, but restrain your inner hero and just pick one. Then get specific about how often you’d like that information to be gathered or used and what you and the client would do with that output. With these clear objectives in mind, you can search for apps used for these purposes on the comparison site to find the app that fits your needs.

It can be both exciting and awkward to introduce a new idea to a client, especially if it is new to you too. It’s a bit of a risk to recommend an app or an online service because a bad experience on these venues could cause the client undue distress and harm your credibility. To get comfortable with making a recommendation, try the technology for yourself first. You may find a personal benefit which would make for a compelling story that would appeal to those you are helping. The trial will also help you discover operational challenges your client might encounter which could help prevent early abandonment of the idea. Keep in mind some basic limitations like – privacy, security, ensuring the client is really on board and if it is really useful for the client’s goals. Using apps for one of these purposes may be just what they needed to make that breakthrough.

Distance Counseling and Coaching
When you are ready to provide distance counseling or coaching and have already received training and credentials, the best way to start is by asking your current clients if they’d like to meet online. If you haven’t had training, it’s a very good idea as there are a number of risks and protocols that you need to know to create both great outcomes and to protect yourself from known legal and ethical risks.

If you need a jumpstart to get clients using your online services consider creating a 2-3 min video of yourself walking the client through the set-up, scheduling and session experience. Make sure the video looks really good as it will be used by the client to decide whether they want to see you or not. This video could be hosted on your website and link provided to every current and prospective client to consider. You could also have two computers set up in your office to demonstrate what it would look like at the end of a session, if the client is interested.

Talk to colleagues and ask if they are using technology and how.

Using technology in counseling and coaching will take a little effort, but it’s worth the effort. While most clients usually embrace technology in practice, it may take a few trials for you to become more comfortable with a new way of working. It may take a few trials before you get it right, but the benefits can truly be life-transforming.

This article first appeared in the Winter 2014 issue of TILT Magazine ~ Therapeutic Innovations in Light of Technology.

Click here to read the entire PDF version of the Meandering through models of supervision and coaching article.

Jay Ostrowski is a Telemental health and marketing innovator with BHI created to help professionals choose technology. He lives in Charlotte, NC, USA.

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Expanding Healing in a Virtual World

September 21st, 2014   •   no comments   

Many of our colleaagues know that we have long been fans of avatar therapy. Since the early days of Online Therapy Institute, We have lectured and written about the concept of healing in a virtual world. In fact, the first issue of TILT Magazine~ Therapeutic Innovations in Light of Technology- featured an article about healing from childhood trauma utilizing tools in Second Life.

Now, several years later, we are expanding the concept of healing in a virtual world to include not just therapy, but coaching and energy healing. We offer several courses and certificates ranging from online therapy and online coaching to avatar identities and intuition. We also offer online Reiki courses so it only makes sense we create a safe and nurturing Reiki space in our virtual office.




Yes, Online Therapy Institute continues to have a presence in Second Life, now along with divisions, Online Aromatherapy Institute and Online Coach Institute.

What does that mean? We continue to have a skybox classroom as well as a wonderful new building with an ocean view. Information will be placed throughout just as before- think of this as a 3-D website. We will have a gazebo, lotus pool, Reiki room, consulting room and a roof patio for contemplation, meditation, writing or virtual parties.  The lotus pool  area will be surrounded by essential oils information too.

The new build is still a work in progress but come on over and take a looksee! We have moved our location to Independence Island, a Second Life island owned and managed by Virtual Ability, Inc. 

Our new Second Life address:

Not quite ready to for Second Life?

Dip your toes in on Facebook! We have two Facebook Groups that may be of interest to you!

Avatar Identities

Kybernetes Reiki

And of course, our Facebook Business pages-

Online Therapy Institute/Online Coach Institute

Online Aromatherapy Institute



For the love of…. Journals!

September 20th, 2014   •   no comments   

Love of Books imageInternet Interventions

Editor-in-Chief: Gerhard Andersson

Internet Interventions is the official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII).

The internet is increasingly used for delivering interventions aimed at improving mental and physical health. Internet interventions — often self-guided or partly self-guided — have in the past proven effective in treating a number of psychiatric conditions, including among others: depression, panic disorder, social anxiety disorder, insomnia, as well as more general medical conditions, such as headache, back pain, tinnitus and smoking cessation.

Today’s increased focus on internet interventions can be explained by its global applicability, and cost efficiency. Technological advances allow for novel intervention components, such as user-friendly visual screening instruments, video-based exposure therapy, interactive role-playing, automated reasoning models, all lowering the help-seeking threshold.

The aim of Internet Interventions is to publish scientific, peer-reviewed, high-impact research on Internet interventions and related areas, such as:

• Intervention studies targeting the promotion of mental health and featuring the Internet and/or technologies using the Internet as an underlying technology, e.g. computers, smartphone devices, tablets, sensors.
• Implementation and dissemination of Internet interventions.
• Integration of Internet interventions into existing systems of care.
• Descriptions of development and deployment infrastructures.
• Internet intervention methodology and theory papers
• Internet-based epidemiology
• Descriptions of new Internet-based technologies and experiments with clinical applications
• Economics of internet interventions (cost-effectiveness)
• Health care policy and Internet interventions
• The role of culture in Internet intervention
• Internet psychometrics
• Ethical issues pertaining to Internet interventions and measurements
• Human-computer interaction and usability research with clinical implications
• Systematic reviews and meta-analysis on Internet interventions.

This article first appeared in the Spring 2014 issue of TILT Magazine ~ Therapeutic Innovations in Light of Technology.

Click here to read the entire PDF version of the For the love of…. Journals article.

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TILT Magazine Issue 18

September 16th, 2014   •   no comments   


To download TILT Magazine Issue 18, click here.

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Meandering through models of supervision and coaching!

September 13th, 2014   •   no comments   

cybersupervisionThe starting point of this issue’s column was an exchange I had with an online supervisee. She isn’t a counsellor, but uses counselling skills in her role as team leader of family supporters within a charity. Let’s call her Liz. She was planning a short training on interpersonal skills for her team, and we were discussing possible inputs and models. Looking at what she had planned, I said that it reminded me of Egan’s ‘The Skilled Helper’. Liz did not know the model, so I briefly and perhaps simplistically mentioned ‘explore/ understand/ act’.

The response from Liz was: ‘Yes- that is exactly what’s needed. The team manage most of the time to help the clients explore and understand their issues, but then they don’t know how to act in the clients’ best interests’.

Dilemma – do I explore with Liz how to help the assistants to ‘know how to act’ or do I explain that actually it’s about what actions the client is going to take? In this supervision, I stayed with Liz’s agenda, which was enabling her team, who are not counsellors, and part of whose job is to take action – enable links between various agencies in particular. I did later email a paper about Egan’s model.

However, it started a train of thought about the use of Egan’s model as an online supervision tool. This was pushed forward by a presentation which one of the participants on the Diploma in Online Therapeutic Supervision gave recently. This was around the C.L.E.A.R. model developed by Peter Hawkins in the 80s (Contract, Listen, Explore, Action, Review). Those middle three stages are so reminiscent of Egan.

Hawkins produced this as a coaching model, which led me to consider online coaching and supervision. What do they have in common? I looked up various definitions of coaching, finding a number where if the words coach was replaced with supervisor, they would still make sense to me.

Coaching is unlocking a person’s potential to maximise their own performance. It is helping them learn rather than teaching them’ (Whitmore, 2004).

Coaching is a process that enables learning and development to take place and thus performance to improve. To be successful, a coach requires a knowledge and understanding of the process as well as a variety of style, skills and techniques that are appropriate to the context in which coaching is taking place’ (Parsloe, 1999).

I then explored various models of coaching as they might well be able to inform and expand my online supervision practice. Many of them have that same similarity to Egan. I am in no way implying that they are all borrowing from Egan; simply musing about the fundamentals of coaching and supervision. Three of the models were:

GROW – Goal, Reality, Options, Way forward /Wrap up
TGROW – Topic, Goal, Reality, Options, Way forward
OSKAR – Outcome, Scaling, Know how, Affirm and Action (so should it really be OSKAAR?) and Review

If I wanted to integrate any of these coaching models, what might be the constraints in online supervision? One is the apparent emphasis on outcomes. Sometimes supervisees (and supervisors) need time to go away from an online session and muse before taking any action. That’s where email supervision can really come into its own, as it builds in this time naturally. Perhaps I also shy away from the term ‘performance’ in the definitions. That may be disingenuous of me as there is a sense in which any role, even as an online counsellor, has a degree of performance in it.

A possible downside might be another emphasis, this time on identifying the goal of supervision. I do believe this is necessary if the supervision is not to be wishy-washy and aimless, though I might prefer to use the term ‘focus’. My niggling concern is that online, we sometimes are so quick to get down to work in both synchronous text and email supervision that we miss some of what I would call ‘walking around’ the focus. However, conversely, the inclusion in all the models of Know How, Options, Ways Forward avoids another pitfall in online supervision, of ‘talking’ around the issue, but never looking at its implication for practice.

I think that is why I feel drawn toward TGROW, as the initial T stage is about clarification of the reasons the Topic is important to the coachee/supervisee at this moment in time, and what impact it may have on the longer term vision (coaching expression) or process (supervision expression). It may uncover issues and a focus which is different from whatever the supervisee/ coachee thought they wish to bring to that online exchange.

Rereading the above paragraph, I realise I had in mind synchronous supervision, so another constraint may be the application to asynchronous exchanges. In email supervision the clarification may only be possible in a more general sense, as there is no immediate interaction.

The positive that I take from looking at OSKAR in particular is the inclusion of Review, which sits well with the Cyclical Model (Page and Wosket, 2002). This seems such a necessary part of supervision and again can be missing from email supervision simply because it is not synchronous. Yes, we carry out reviews of how the online supervision is going from time to time, but often miss the review of individual exchanges.

So where have my meanderings taken me? They have reminded me of the value in staying open to considering ideas and models from other similar fields, of weighing them up and taking from them aspects that may inform or improve my own online supervision practice. Not a bad day’s work.

This article first appeared in the Winter 2014 issue of TILT Magazine ~ Therapeutic Innovations in Light of Technology.

Click here to read the entire PDF version of the Meandering through models of supervision and coaching article.

Anne Stokes is based in Hampshire, UK, and is a well-known online therapist, supervisor and trainer and Director of Online Training Ltd. She can be contacted at


Downey, M. (2003). Effective Coaching: Lessons from the Coach’s Coach Knutsford Texere Publishing (TGROW)
Hawkins, P. & Smith, N. (2006) Coaching, Mentoring and Organizational Consultancy: Supervision and Development. Maidenhead OU Press ( C.L.E.A.R.)
Jackson, P. & McKergow, M. (2006) The Solutions Focus: Making Coaching and Change SIMPLE 2nd edition London Nicholas Brealey Publishing (OSKAR)
Page, S. & Wosket, V. (2002) Supervising the counsellor: a cyclical model 2nd edition London Sage
Whitmore, J. (2002) Coaching for performance 4th edition London Nicholas Brealey Publishing (GROW)

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Check out the Fall 2014 Issue of TILT Magazine!

September 12th, 2014   •   1 comment   



It’s been a nail-bitingly exciting time here at TILT Towers between issues!  Your Managing Editors decided to reach out to you, our readers, to help us keep the magazine going for the foreseeable future, and we held a Kickstarter campaign to achieve that.  Our goal of $5000 within three months was well met, including a generous contribution by Hushmail. We tell you the story of TILT’s creation, process and future in this issue, and we are also pleased to welcome Lyn Kelley to our Innovations column to talk you through the options available to start a crowd funding campaign of your own. The gratitude we feel to have received such support from colleagues, friends and strangers in supporting us really cannot be put into words. It was a great creative boost, and we hope that is evident in this latest issue.

Also in this issue, Darlene Ouimet tells us the exciting story of how her recovery from dissociative issues and chronic depression led to her sharing her journey via a website and subsequently a blog – and how this led to being contacted by award winning producer Robin Jay, with an invitation to be in her next self-help movie “The Secrets of the Keys” which is a prequel to her first movie “The Keeper of the Keys”.  Darlene writes of how she never imagined that her passion for reaching the world with her message of hope and healing would land her a movie deal! Her four and a half year journey, via “Emerging from Broken”, is an inspiration to us all.

Susie Mullens and Teresa Warner tell us of their work in the ongoing support of people in recovery via their innovative app A-CHESS.  A-CHESS is comprised of many features to help those in recovery and is currently being vetted as an evidence-based practice, theoretically based in Self Determination Theory (SDT) which focuses on how social and cultural factors facilitate or undermine people’s sense of volition and initiative, in addition to their well-being and the quality of their performance. A-CHESS has been well received by its users as part of their recovery programmes, enhancing the client’s treatment experience and improving client engagement.

Elsewhere we have all our usual regular columnists to keep you abreast of developments and work in the field, including CyberSupervision, Research, Views from the Frontline and of course our resident cartoonist!  Our Student Spotlight column features Thomas Tsakounis, who recently completed the Online Therapy Institute’s Reiki training, and who exemplifies the Institute’s mission to bring innovative ideas and practice to traditional ways of working to those with an open mind and a passion for delivering their services in a dynamic and sophisticated way.

Best wishes to all our readers for the autumn!

Kate and DeeAnna


Subscribe to read these feature articles:


Crowdfunding How Communities Pull Together

From Starting A Blog To Landing A Movie Deal…All On The WWW

“Tech Support” Using Technology To Support Ongoing Recovery

Cybersupervision, Marketing Toolbox, Student Spotlight and much, much more!


Go to TILT Magazine Archives!


Therapy Workshops Online – a new bonus for all Online Therapy Institute students!

September 10th, 2014   •   no comments   

Over the years, we have collaborated in many ways with our colleagues over at OnlinEvents!  Not only do we get together at face-to-face conferences whenever possible (easier for Kate than DeeAnna of course), we also meet at online conferences such as CESL (Counselor Education in Second Life) and even shared an island in Second Life for awhile.  John has filmed our Open Office hours, and Chat-Queen Sandra facilitated the live events for us.  John has also contributed chapters in two of our edited textbooks. Wherever possible, we share resources and put our heads together to work out how we can best serve our respective audiences in the therapy/coaching field and its related professions.


For example, the free-to-attend online interviews that John and Sandra so generously make available to practitioners worldwide are a staple of Online Therapy Institute (OTI) courses – whether as part of the fields of online therapy and coaching (such as Phillipa Weitz talking about the online therapeutic relationship) or more general issues in psychotherapy (such as Mick Cooper being interviewed about systematic outcome and process feedback).  Our students get alerted well in advance to these free events through their private closed Therapist Community on Facebook, and can use them in writing up their course assignments.

We were pleased to see the new development of Therapy Workshops from our colleagues – these low-cost online events have more of a workshop feel than an interview, while retaining all the learning philosophy that John and Sandra are rightly proud of – watch the video below to hear more about that philosophy.

One of the obvious bonuses of recording online interviews and workshops is that they are available online for evermore – and we have teamed up with OnlinEvents to ensure that our students now get FREE access to the back catalogue!  That’s over 200 educational CPD videos that our students can take advantage of, and the list grows every week!

If you’re already one of our students, you can sign up for your student membership here!  If you’re not, remember us when you are researching your training needs – remember, as well as free access to the OnlinEvents library, you also get a free subscription to TILT Magazine!

Thanks again to John and Sandra for their ongoing collaboration with us to meet the needs of those interested in our field – we look forward to many more years of it!

Cyberwork: The Irony of Attending Conferences to Discuss Virtual Work!

August 27th, 2014   •   no comments   

Kate continues with her regular column for the quarterly Journal of the BACP Workplace Division – this issue focuses on attending conferences.

The bringing together of professional minds at conferences is one of the joys of our work.  Conferences offer us learning opportunities, a networking event, and usually an element of socialising. Counselling can sometimes be a solitary way of working, and conferences allow us to diminish that somewhat and spread our wings a little.

However, at almost every conference I present at, someone points out the irony in travelling hundreds of miles to discuss being present virtually! This was certainly the case at the recent Practitioner’s Conferences in Leeds and London, at which I presented on taking services online and what you need to know about doing that.

Both were thoroughly enjoyable and successful events, and ones that also gave me pause for thought on how we can blend technologies to attend conferences as well as we can use technology to offer services to clients.  One of the more recent initiatives that BACP have taken is to explore further the concept of conferences being available both “in-room” and virtually – the annual Online Counselling and Therapy in Action (OCTIA) is a good example of this, with delegates at the venue in (usually) Bristol and also in attendance from (usually) their homes to watch a live stream of presentations and interviews over the Internet while holding discussions live in a chat room next to the video stream.

At a previous OCTIA conference in Manchester, I was able to present to a room of delegates at the venue, with my laptop in front of me.  Broadcast behind me on a screen was the view from my laptop perspective into the virtual environment of Second Life, where I was joined by colleagues from all over the world represented as avatars, who had their own chat facility with me via my laptop, plus the delegates in the room who were also in Second Life as avatars from their own laptops.  On another screen on the wall on my right was where I was shown live from the perspective of one of the other delegates in the room in Second Life, with the official OCTIA chat room being scrolled to the right of the video, where I was also taking part via audio and my laptop via text.

If that description sounds confusing, the point is that I was present in five different realities simultaneously, presenting worldwide.  This groundbreaking event reached four continents – Europe, the USA/Canada, South America and Australia – bringing them together to discuss the use of virtual and mixed realities in counselling and psychotherapy experientially.  Just attempting to explain that experience to you is messing with my head – actually designing it and doing it live was truly extraordinary, and an achievement I am immensely proud of, as are my colleagues at who managed the technological side of it all.

OCTIA 2010 (Virtual Environments)

So, in your professional capacity, are you and your workplace taking advantage of technology for your continuing professional development in addition to the expense of travel to live conferences?  Organisations are increasingly offering live streaming and chat as an alternative way of attending with the cost only being your time and your internet connection; or offering them at least at a discount at the full conference price.  Attending remotely is certainly a different experience than being there in person (and conversely much more exhausting somehow), but blended attendance at conferences is increasingly becoming the norm.

Online conferencing is something my students get introduced to at an early stage of their course, to enable them to take full advantage of what is on offer for their learning from the comfort of their sofa.  I also encourage students to attend live conferences where possible, as I believe that professional human interaction taking place both online and offline is what makes us rounded practitioners as the internet plays a bigger and bigger part in our lives and work.

I loved being in Leeds and London to meet, talk and learn with my colleagues, just as I love being online in a chat room as part of a computer mediated event.  Both ways of attending conferences are nourishing to us as practitioners, and each has its own nuances on how interaction with each other and the speakers takes place – neither better than the other. In fact, I think the main difference in having a experience of good quality is that the lunch tends to be better if physically present at the venue!

Download the .pdf! BC168_CAW Summer 2014_AW2_Final to Press_Cyberwork (1)

Left to My Own Devices

July 11th, 2014   •   no comments   

Wired to Worry 17 cartoonI love gadgets. I also love tracking data. You would think that I would be over the moon about all the cool personal fitness trackers on the market. Surprisingly, I am underwhelmed and I have spent some time reflecting on my lack of unreserved enthusiasm.

As a cognitive behavioural therapist, I frequently ask my clients to track their sleep, exercise, caffeine, thoughts, mood, diet and more. Even though research shows that tracking improves outcomes, it is still a hassle and compliance is often an issue. Letting clients know that some data is better than no data does help, but an easier way to collect that information would be a relief.

That brings us to the early adopters in the Quantified Self Movement who have started to develop some impressive technical solutions to the collection of behavioural data. If you are not already familiar with the term, Quantified Self refers to using technology (often using wearable sensors) to track behavioural data. Some examples of the devices that are making their way into the mainstream are Nike’s Fuelband, the Fitbit, and the Jawbone UP. These devices make data collection easy and can track sleep, steps taken, and even stairs climbed (in models that have an altimeter).

So, what’s my problem? I have decided that it boils down to the fact that many people see these devices as a solution to their motivation problems when, in fact, they simply assist you in tracking your progress. Activity trackers might simplify life for avid exercisers already tracking their progress with more complex systems. However, for someone who is ambivalent or precontemplative about making healthy behavioural changes, buying a personal activity monitor is unlikely to be enough to achieve their personal health goals. At the end of the day, that Fitbit or Fuelband doesn’t make the workout less painful or force you to keep running when you feel like packing it in.

The technology is wonderful and I look forward to future quantified self developments. The danger in misunderstanding that data alone does not equal behavioural change is the discouragement and mistaken belief that the individual has failed. As therapists, we can mitigate some of this damage by teaching our clients some of the many strategies that increase motivation, encourage persistence and help us cope with the inevitable failures on the road to better health.

This article first appeared in the Winter 2014 issue of TILT Magazine ~ Therapeutic Innovations in Light of Technology.

Click here to read the entire PDF version of the Left to My Own Devices article.

Christine Korol, PhD, is a cartoonist psychologist in private practice in Calgary, Canada, and the host/producer of a podcast on that provides free online anxiety and stress reduction education videos.

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Views from the Front Line: An Industry Perspective

July 6th, 2014   •   no comments   

Views from the front line USAislinn Enright and Mark Wallin represent SilverCloud Health in the UK and US respectively. As leaders in their field, producing and promoting engaging online health and wellness solutions, their roles require them to stay abreast of industry relevant matters. However, their geographic localities each present different issues and priorities, and occasionally divergent perspectives.

A View from the US

Mark Wallin, SVP, SilverCloud Health Inc.

Mark has U.S. and international experience with corporate healthcare and eHealth organizations, such as Aetna, WebMD and ICW AG. Driven by a passion for quality health outcomes, Mark has successfully operated or engaged in multiple entrepreneurial start-up and turnaround opportunities in healthcare technology.

Behavioural health in the US

In the United States, the burden of the cost of behavioural health care has traditionally fallen primarily to the patient and their families. Over the past twenty years, that has slowly begun to change, and more recently, in November 2013, ‘The Mental Health Parity and Addiction Equity Act of 2008’ (MHPAEA) legislation received the approval of Final Rules. [1]

The MHPAEA represents substantive change in coverage and reimbursement requirements. However, amid the evolving healthcare landscape in the U.S., the impact of this legislation may not be fully known until real-world tested, fully implemented and perhaps litigated.

Progress through technology

Progress is being made however! Behavioral health care in the US is beginning to more thoughtfully address matters of stigma, access and cost. Additionally, delivery of appropriate, timely, efficient and effective behavioral health care is being addressed through adaptive innovation and advances in the unique application of technologies.
For the last 15-20 years, online therapies have delivered basic levels of support with mixed results. More recently, highly creative strategies that engage the user and the therapist in an online therapeutic space have evolved. This blended approach provides care and support, combining human engagement with technology. These innovations can be used to extend clinical services, rather than attempt to replace them and offer clients with broader, easy-to-access options.

Such a breakthrough is well timed for the US healthcare market as it tackles the issues of cost and quality. In addition to providing low barrier access and quality outcomes on par with traditional therapeutic methods, these guided online health and wellness solutions are set to support and help stabilize the expanding behavioral health costs of health care in the United States.

1. United States Department of Labor, Employee Benefits Security Administration,

A view from the UK

Aislinn Enright, UK Director, SilverCloud Health

Aislinn worked within the NHS for 13 years as both a clinician and project manager, and more recently she has worked in private and non-profit organisations, within the mental health and primary care field. She has vast experience developing and implementing talking therapy services, primary care and long-term condition motivational services.

Mental health care in the UK

In health care, never have the concepts of effectiveness, efficiency and value for money been so important.
Apparently in response to the Quality, Innovation, and Prevention (QIPP) program’s aim to save £20bn by 2013/14, the UK government is now demonstrating commitment to telemedicine.

Telemedicine (or telepsychiatry as it is known in mental health) provides maximum benefit in terms of patient access, value for money and efficient use of resources. The 2011 Department of Health (DH) report; ‘Whole Systems Demonstrator Programme: Headline Findings’, suggested that 3 million people could benefit from telemedicine/telecare over five years.

Improving Access to Psychological Therapies

In the UK, the Department of Health developed an initiative called the Improving Access to Psychological Therapies (IAPT), now known as Talking Therapies, for adults aged 18-65 years with common mental illness such as depression and anxiety. IAPT offers patients fast access to a choice of psychological therapies in addition to ‘care as usual’. The service is provided in a step care approach, as recommended by the National Institute of Clinical Excellence (NICE) guidelines for depression and anxiety (DH 2004, amended 2007).
While the option for paid services is always available, anyone entering the IAPT service will receive free care through the National Health Service (NHS), depending on their need. However, many of these NHS Trust services are struggling to cope with capacity, often ending up with long waiting lists. Telehealth offers clinicians a solution that is both cost effective and resource-friendly and clients with an effective and easily accessible health and wellness solution.

A Clinical and Technological view

Derek Richards, Clinical Research Director

Derek Richards was responsible for pioneering the first online mental health community for students in conjunction with the Centre for Research in IT in Education (CRITE). Now, as Director of Clinical Research & Innovation at SilverCloud Health, Derek is very interested in the development, implementation and clinical research of technology delivered interventions for mental health problems. In particular interventions for high prevalence disorders such as depression and anxiety.

The future of technology evolves

In the last 15 years or so, the use of technology as a solution to meeting the needs of health and mental healthcare organisations has grown exponentially. It is a real privilege to be part of that history, and I continue to enjoy being witness to this blossoming field.

Cognitive Behavior Therapy protocols for the treatment of various mental health difficulties have predominated, especially in the delivery of interventions online. However, I recently came across some new research that uses psychodynamic psychotherapy for the treatment of depression and anxiety. This work originates from a highly reputable group in Sweden; Andersson, Carlbring, Johansson and their colleagues, from whom we are becoming used to seeing great things. This current work is based on a particular model of psychodynamic psychotherapy called ‘affect-focused’.

Affect-focused psychodynamic psychotherapy presents to clients a psychodynamic understanding of depression. The treatment seeks to help uncover unconscious patterns that contribute to emotional difficulties that may be interfering with different areas of one’s life, such as work and personal relationships. Once a client comes to understand these unhelpful patterns, they can learn to break them. The treatment includes provision of tools to prevent relapse.

The Swedish group has published three randomized trials of the treatment and has reported significant outcomes for participants (see reading list).

In my opinion this work, that began 15-20 years ago, was only a beginning. From the firmly grounded foundations of this valuable learning, inspiration comes from the significant technological advances that continue today… stimulating ideas for creative ventures of the future.

Watch this space!

The question of engagement

Technology has certainly advanced!

Treatments for various mental health problems are being delivered online and, for the most part, their clinical utility need not be questioned as the content is based on well-established behavioural and cognitive interventions. Also, if these interventions are supported, to allow something of the therapeutic alliance to feature in the treatment, outcomes improve.

Nothing surprising or new there … But what about the problem of dropout? Or, to turn it on its head; the question of engagement?

I think we can improve on the clinical utility of current technology to enable better client management, meet the needs of non-responders and ultimately improve outcomes.

We have the technological capability to include, as part of any platform, several ways of monitoring clients. This can be done simply, through the analysis of psychometrics collected routinely, or by flagging risk factors for any given client. For example, if client x has had a previous episode of depression. Monitoring can also involve tracking and comparing clients’ use of programme elements from week to week.

The automated tracking and easy reporting of simple online acts has enormous implications for understanding engagement and facilitating more accurate and timely support. The resulting feedback loop enables mapping of the clinical path most suitable for individual clients, including the possibility of removing the client from the programme and offering a more suitable solution if necessary.

Client monitoring has always been a central feature of the therapeutic endeavor. Not least for informing the appropriate clinical path for a client. It should not be lost when delivering interventions online and modern technology can, and should, promote this goal.


Johansson, R., Björklund, M., Hornborg, C., Karlsson, S., Hesser, H., Ljótsson, B., . . . Andersson, G. (2013). Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: a randomized controlled trial. PeerJ, 1, e102. doi: 10.7717/peerj.102
Johansson, R., Ekbladh, S., Hebert, A., Lindström, M., Möller, S., Petitt, E., . . . Andersson, G. (2012). Psychodynamic Guided Self-Help for Adult Depression through the Internet: A Randomised Controlled Trial. PLoS ONE, 7(5), e38021. doi: 10.1371/journal.pone.0038021
Johansson, R., Nyblom, A., Carlbring, P., Cuijpers, P., & Andersson, G. (2013). Choosing between Internet-based psychodynamic versus cognitive behavioral therapy for depression: a pilot preference study. BMC Psychiatry, 13(1), 268.

This article first appeared in the Winter 2014 issue of TILT Magazine ~ Therapeutic Innovations in Light of Technology.

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