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Abstract

Oftentimes, the first half of a psychotherapy session is spent with the patient

recounting the events between sessions to update the therapist, leaving only half of the

session to analyze and work on the issues. An online therapy network could keep the

therapist current with the patients progress between sessions, allowing for more time to

discuss events and emotions during the scheduled session.

For this project I created a network (PsychSofa Beta) that patients and their

therapists could use to supplement traditional therapy. I interviewed and surveyed

therapists, patients, professors, and psychology students to gather input for the site. I also

considered issues such as privacy, anonymity, virtual identity, and legalities when

creating and modifying the site.

The PsychSofa will continue in Beta mode to assess how it can effectively

supplement in-person therapy. Further research is needed to determine if it can in fact

help therapists stay in touch with their patients between sessions and to what degree.


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The majority of psychotherapy appointments are scheduled on a weekly basis

with a therapist, allowing only one hour per week to try and untangle the knots of the

mind. Oftentimes, the first half of the hour is spent with the patient recounting the events

between sessions to update the therapist, leaving only half of the session to analyze and

work on the issues. In my experiences, and the experiences of many others, this creates a

problem, as there never seems to be enough time for actual progress.

After interviewing a number of current psychotherapy patients and therapists and

researching the topic, I have learned that there are various methods therapists have used

to help their patients keep in touch. Some patients are given pagers that they can use to

type in their emotions or use emoticons to send to their therapists. Others use email, text

messaging, or phone calls to communicate with their therapists. Still others keep a diary

that they share with their therapists; however, these diaries are not seen by the therapists

until the next scheduled session, so they do not address the problem of time spent to

catch up.

There is another issue with traditional, face-to-face psychotherapy. People who

have a difficult time expressing emotions and feelings in front of people still speak to

their therapists behind a barrier. This barrier also prevents progression in therapy as it

makes it difficult, or almost impossible, to get to the root of disturbances. However, many

of these same people who have issues with expressing emotions in front of people do not

have issues expressing themselves through instant messaging, email, blogs, or social

network correspondence.

This second issue, among others, has prompted a rise in online therapy and

online psychotherapy. Online therapy is usually hosted on a web site run by a


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psychotherapist or etherapists. The sites offer therapy via instant messaging, video

conferencing, phone counseling, or email sessions, and many offer these 24/7. Some of

these etherapists also have a facetoface practice, but all sessions are kept very

separate. PsychSofa Beta is designed to incorporate both online therapy tools and face-to-

face therapy.

Therapists I have talked with expressed a desire to have a way to connect to their

younger patients. According to a study by the U.S. Department of Health and Human

Services (2004), teenagers and young adults spend an average of 16.7 hours online

weeklymore than they do watching TV. This avid use of the internet provides an

excellent medium for therapists to connect to their younger patients. Therapists may want

to investigate the virtual identity of their patients and determine if that concept could be

an important part of their analyses.

There are many online therapy sites such as www.etherapistsonline.com,

www.livecounselors.com, or www.headworks.com, which all offer instant messaging and

email therapy. However, these sites only offer therapy online and none of these sites

incorporate therapy that is already in progress with a therapist.

I have created an online therapy network, PsychSofa Beta, that is a tool for

patients and therapists already in psychotherapeutic progress. Once patients are seeing a

therapist, they can be introduced to this network to supplement their face-to-face sessions

with things such as blogs, emails, forums, interactive expressions, SMS (text message)

updates, and profile creation. Through this network, patients can choose to be networked

to other patients who share life experiences or diagnoses and can interact with each other

in a safe virtual manner. Therapists will be able to check on their patients and stay


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current with their thoughts before a patient comes in for a face-to-face session. The

therapist can also interact with the patient online.

PsychSofa Beta users can network with other people and communicate behind a

virtual identity that so many online users find comfortable using. By creating this

system, I want to answer the question, Can an online therapy system successfully

supplement traditional therapy?


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Literature Review

Millions of Americans are using psychotherapy to deal with emotional

difficulties. Research suggests that psychotherapy decreases patients anxiety, depression

and the physical symptoms associated with these conditions (APA, 2008). The American

Psychological Association (2008) estimates that more than five percent or 15 million

Americans are dealing with depression or anxiety, and the majority of these people are

seeking help through psychotherapy.

Therapy used to mean going to a psychiatrists office, lying on a couch, and

revealing innermost thoughts and feelings. Currently, patients with emotional or personal

problems have a variety of methods for support: chat groups, religious counseling,

medication, and the most contemporary method, online therapy. However, online

therapy, while being the newest therapy, is also controversial, and there are issues that

must be addressed before it is fully accepted.

In our society in the United States where access to the internet is widespread,

computer-mediated psychotherapy (online therapy) has become a hot topic for

psychologists. Research is being done on who is using online therapy, the types of online

therapy, and what the advantages or disadvantages are from using it. The therapist is

challenged with determining if the patient is suitable for this type of treatment and

assessing whether the patient is benefiting from the treatment. Additionally, the legal and

ethical implications of using online therapy are being discussed and debated in order to

keep the patient safe and give him or her a feeling of trust.

There are those who are not advocates of online therapy, though. Dr. Sherry

Turkle (2007) warns of becoming tethered to our online devices. She believes that we


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are becoming one with our devices. She states that by having access to online or

technological support at all times, kids will not experience being alone, learn to be

responsible, or experience emotions (pg. 260).

Others advise that online therapy should not substitute face-to-face therapy but

could be used in concert with guidance from in-person therapy. Dr. John Grohol (1999)

asserts that E-therapy is not psychotherapy, nor is it psychological counseling. When e-

therapy is conducted via its preferred modality (e-mail, an asynchronous

communication), it allows both the client and the professional to fully reflect on issues

discussed previously (p.1). He goes on to state that without nonverbal cues, there is a

greater risk of misinterpretation of communications.

Types of Online Therapy

Online therapy introduces therapists and patients to different types of

relationships. Dr. John Suler (2000) has conceptualized a model to categorize these

relationships into five pathways of practicing online therapy. They include

1) synchronous/asynchronous, 2) text/sensory, 3) actual/imaginary,4) automated/interpersonal, and 5) invisible/present.

The type of therapy used would have to be designed for the individual client, and

there may be a combination of therapies used to address the needs of the client. It is

essential that the a therapist understand the different types of online therapy to be able to

assess which form is best to use with an online therapy patient. For this project, it is also

important to understand the different types of online therapy in order to create different


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types of tools within the system to provide a diverse array of options available to be used

for supplementation of face-to-face therapy.

Suitability for Online Therapy

One dilemma the therapist faces is determining who will be suitable for online

therapy. There are not any sets of guidelines or factors a therapist may follow to

determine whether a person is suitable, thus adding to the importance of the face-to-face

clinical assessment of an individual. Without proper assessment, online therapy could

possibly prove to be a detriment to an individuals progress in therapy.

Abbott, Klein, and Ciechomski (2008) emphasize that there is also a possibility

that online therapy could even be dangerous to those who are high-risk personalities for

things such as suicide, aggression, or self-harm. Individuals who possess psychiatric

disorders that trigger the experience of distorted reality, suicidal thoughts, a frequent rate

of comorbid psychiatric disturbances, or who are currently being sexually abused or

violently abused may be included in the category of individuals that are not suited for

online therapy. Though, after thorough assessment some individuals with these disorders

may benefit from online therapy.

Some individuals may prefer an online environment to communicate and may

also feel safer communicating thoughts and feelings through a text-only setting or a

setting, which retains a sense of anonymity. Suler (2001) asserts that a therapist must

assess and discuss which medium of communication will best suit the individual and also

consider the possibility that an individual may benefit trying a medium that is out of his

or her comfort zone. If an individual is very experienced on multiple online mediums,

the therapist may be able to utilize multiple environments for treatment.


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Cook and Doyle (2002) agree with this assertion and believe that some

individuals may prefer the anonymity of online therapy. They point out previous

research has indicated that individuals with certain personality characteristics, such as

introversion, and particular problems, such as panic disorder and agoraphobia, may prefer

the perceived anonymity and sense of control the internet offers (p. 103).

Another area of concern is the persons computer skills and access to the internet.

If a person does not possess adequate knowledge of computer systems or the ability to

easily navigate the internet, treatment could yield frustrations and diminish progress. A

person must have reliable internet access, the motivation to explore the internet and new

online communication environments, and adequate knowledge of computer systems. It

may also be possible that benefits from online therapy may be partly determined by a

persons familiarity with online communication. A person who already has online

relationships or is used to belonging to online groups and being involved in online social

activities already has practice communicating online and may transition into online

therapy better.

An individuals ability to read and write effectively can influence the potential

effectiveness of online therapy. According to Suler (2001) even if a person can navigate

the internet, if he or she cannot write clearly enough to communicate or interact, therapy

could be stressful or near impossible to make progression. If the person does not even

enjoy online communication, then that would also make online therapy progression

ineffective.

The gender of the patient may also affect his or her suitability. According to Tsan

and Day (2007) women typically have fewer stigmas about seeking therapy. They


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speculate that using online therapy may help men overcome the fear of appearing weak.

However, in a survey conducted at a large urban university, undergraduate psychology

and education students disproved that hypothesis. The survey did find that women have a

more positive attitude toward all modes of psychotherapy and that all participants

preferred traditional face-to-face to online counseling. Tsan and Day note, however, that

the participants surveyed were not necessarily currently in therapy

Issues for Consideration

One of the major issues facing all therapists is the lack of a visual to determine the

mental status of the patient. For example, the clients cleanliness, pupil dilation, and

demeanor may indicate his or her mental state or drug use. These clues would not be

evident in an online therapy session. Additionally, how are therapists to know if the

patient is being truthful or honest about his/her feelings? Tantam (2006) posits that an

unscrupulous or deceiving client may deceive a psychotherapist who relies completely

on the information from an online therapy session. The therapist should require a face-to-

face meeting at least once to make sure the client is, at the very least, the age, gender, and

ethnicity disclosed electronically.

Another issue would be the computer literacy of the therapist. The therapist

should be proficient in the use of the computer. Midkiff and Wyatt (2008) present the

following scenario.

A therapist may wish to send a document to the patient that will help him or her

keep a diary of emotions. If, using chat mode, the therapist struggles to both find

that document in the computers memory and then discover how to attach and


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send it to the client, the time involved in those tasks probably has intruded

significantly on the therapeutic interaction. (p. 316)

Additionally, Midkiff and Wyatt point out that therapists should be experienced in

the use of chat rooms and forums and the roles of avatars, emoticons, and backgrounds.

Without visual cues and body language, these online standards are important tools in

reaching the client.

The patients confidentiality is paramount to therapy. The therapist must protect

the privacy of the client, which is a daunting task in online therapy. The therapist should

incorporate encryption technology to provide a secure and private place to exchange

information. Midkiff and Wyatt (2008) warn that email messages may not reach their

destination but may be lost in cyberspace, hackers may invade the site, emails may be

sent to the wrong address, or that others may gain access to the therapists computer.

Professional organizations such as the American Counseling Association (ACA),

the American Psychological Association (APA), and the National Board for Certified

Counselors (NBCC) have established guidelines for online therapists to follow. They

maintain that WebCounselors should:

1. Review pertinent legal and ethical codes for possible violations emanating from thepractice of WebCounseling and supervision.

2. Inform WebClients of encryption methods being used to help insure the security ofclient/counselor/supervisor communications.

3. Inform clients if, how, and how long session data are being preserved.4. In situations where it is difficult to verify the identity of WebCounselor or Web-Client,

take steps to address impostor concerns, such as by using code words, numbers, orgraphics.

5. When parent/guardian consent is required to provide WebCounseling to minors, verifythe identity of the consenting person.

6. Follow appropriate procedures regarding the release of information for sharing Web-Client information with other electronic sources.

7. Carefully consider the extent of self-disclosure presented to the WebClient and providerationale for WebCounselors level of disclosure.


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8. Provide links to web sites of all appropriate certification bodies and licensure boards tofacilitate consumer protection.

9. Contact NBCC or the WebClients state or provincial licensing board to obtain thename of at least one Counselor-On-Call within the WebClients geographical region.

10. Discuss with their WebClients procedures for contacting the WebCounselor when he

or she is off-line.11. Mention at their web sites those presenting problems they believe to be inappropriatefor WebCounseling.

12. Explain to clients the possibility of technology failure.13. Explain to clients how to cope with potential misunderstandings arising from the lack

of visual cues from WebCounselor or WebClient. (Manhal-Baugus, p. 555)

Exploring the Virtual Identity

Vybrial et. al. submit that In psychology, identity is understood as a continual

experience of the individual self; of that persons uniqueness and authenticity, as well as

the identification with life roles and the experience of belonging to bigger or smaller

social groups (p. 171). They go on to explain that on the internet a persons physical

being is not present, only a virtual representation is present. The thoughts, ideas, and

fantasies that the person bestows on that representation on the internet is the virtual

identity. Some of the therapists I interviewed were interested in learning more about the

virtual identity of their patients and also stated that for some patients it seems to be a very

affecting part of their entire identity.

There are myriad possibilities when someone logs online. Dr. Sherry Turkle

(1995), who has studied and written numerous documents on online behavior, notes that,

When people adopt an online persona, they cross a boundary into highly-charged

territory. Some feel an uncomfortable sense of fragmentation, some a sense of relief.

Some sense the possibilities for self-discovery, even self-transformation (p. 260). These

personas are what therapists need to study, while at the same time, be wary of.


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Some patients may thrive in an anonymous session. Often patients may be too shy

or ashamed to reveal sensitive information in person. These patients may interact

virtually and allow the therapist to see what the true persona is. Others may transform

into alter egos that do not resemble the live patient. These alter egos could be aggressive,

belligerent, or even offensive (Tantam, 2006). Some adolescents could be experimenting

with these virtual representations also. Wallace (1999) maintains that trying out new

identities is valuable and an integral part of human development.

Patients and therapist involved in once a week traditional face-to-face

psychotherapy could benefit from an online therapy tool. The online therapy tool could

supplement the use of time within the face-to-face sessions, open up new ways of

expression, assist in exploration of the virtual identity, assist in convenience of space and

time, and also build a support network.

For the online therapy tool to be effective, patient suitability must be assessed and

the therapist must experiment with different types of online therapy to know which tools

within the online therapy system will be most effective. Patients and therapists must also

be technologically literate and have access to required technology and internet access.

It is apparent through secondary research that some people are using online

therapy effectively already, and it is also apparent that traditional face-to-face therapy can

be ineffective for those who require more time or different avenues for expression.


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Procedure for Creating Web site

I decided on my preliminary goals and ideas and created sketches of the network

for direction. Before creating the PsychSofa Beta, though, there were many issues that I

needed to investigate alongside the research on therapy practices, virtual communication,

and virtual identity.

It was important to investigate which tools would be useful on the network. I

began with blogs and email as the first tools. Three of the volunteer patients and myself

began blogs on Livejournal.com and shared the link with our therapists. I instructed the

therapists that they did not have to access the site, but it was available for updates

between sessions if they chose to read them. Two of the patients also began typing up

thoughts in emails and sending them to their therapists to be discussed in a face-to-face

session. After two-to-three weeks, the volunteers noted that their therapists were bringing

up points made in blogs and were commenting on the depth of expression of emotion.

The volunteers then noted that this encouraged them to write more, and for some therapy

sessions seemed to be heading into deeper territory.

The blog I had set up for myself was also SMS enabled. On a daily basis I would

send at least two text messages containing a maximum of 160 characters. Within a week I

was sending five or more text messages a day to the blog. My therapist noted that the

one-line messages were really adding up and giving him a quick glimpse into the ups and

downs of my moods and emotions from day to day.

After testing blogs and email and learning that enabling SMS on a blog was

helpful between sessions, I confirmed that these three options would be available on the

first phase of the network.


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With some knowledge of tools that would be good options on the network, I

created surveys (see Appendix A) and distributed them to therapy patients, practicing

therapists, psychology professors, and psychology students. While distributing surveys

and receiving survey responses, I began assessing platforms that could run the network.

After working with content management systems, wikis, and social media applications, I

decided that Ning.com offered the best options for creating prototypes.

I created the first version of the PsychSofa Beta prototype as an open network

with blogs, email, personal photo and video uploading, an events calendar, and instant

messaging. Once I received a survey response, I sent a link to the network to the

responder, so he or she could then look at the network and use the tools. Many

respondents wanted to discuss the project via phone or personal interview in addition to

filling out the survey.

After many interviews, survey responses, and meetings with people in the

psychology field and with therapy patients, I redesigned the prototype with higher

privacy settings, added forums and groups, user profile privileges, and new administrator

options. I then sent out this new design for a second review, but this time some

respondents decided to create accounts and test tools by becoming part of the network.

After a few weeks of having users on the network, I made revisions and created

PsychSofa Beta. Once I created the beta, I wrote an instruction manual (see Appendix B)

which I sent out to all users on the network. I instructed users to attempt to follow any

instructions on how to use a tool he or she had not yet used. If he or she could not get the

tool to work, I edited the instructions until there was success.


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As more users join PsychSofa Beta, it becomes more of a network, revealing

positives and negatives of the network. Users have been noting any problematic areas that

they find, and as the beta version of the network grows, I am exploring more options and

mending any glitches.


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Discussion

After preliminary interviews with a few therapists about the proposed network, I

used what they had suggested and my research to create a prototype and included

information and tools that I believed were necessary for the site to be successful. After

distributing the surveys and speaking with some of the respondents, I discovered new

information that was integrated into the site.

Most of the therapists I talked with or who responded to the survey were

undecided on whether the patient should remain anonymous or be allowed to reveal

personal information about him or herself. PsychSofa Beta includes a suggestion for

users to remain anonymous, and there are instructions requesting users not to use

identifying information, but it is still allowed if the patients decide they want to identify

themselves. It seemed to be an agreed response that it would be interesting to the

therapist to see if the patient decides to disclose information about him/herself despite

being advised to remain anonymous. Right now the network is closely monitored, and if

things seem to be going in the wrong direction, either way, I can alter settings.

On the one hand, how patients present themselves online may allow them to

create more of a virtual identity. On the other hand, anonymity could give people more of

an opportunity to feel hidden and they may, therefore, open up about their fears,

anxieties, and apprehension. Some therapists thought that not seeing the patients

physical response may be a hindrance; however, others see value in letting the patient

think about responses and communicate after deliberating on the question in addition to

real time question/response sessions.


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The respondents were surprisingly very supportive of the concept of online

psychotherapy in addition to face-to-face therapy. When asked about keeping a diary,

some respondents preferred blogging. There were various reasons given for that response:

I can type so much faster, less of a chance to get found on the internet instead of in the

top drawer of my dresser, my therapist can view it before our session, or I am always on

my computer anyway.

Follow-up responses from some of the survey respondents have been positive, and

there are currently patients using the system and sharing it with their therapists. I have

received the following responses: Sharing this with my therapist is cool because he gets

a deeper look into whats happening in my day and with my moods when Im not in a

session.

Even though my therapist does not respond to my blogs or comments, I like knowing

that he has read my thoughts before our next session.

Sometimes I print out the blogs so that I can bring up points in our next session.

Seeing that someone texted or blogged ten times a day was very revealing.

Many of the therapists expressed concern with live chatting, so right now chatting

is not allowed and neither is live video chat. With the exception of the therapists working

with sex offenders, it seemed that many of the respondents preferred the tools that

allowed some form of time delay in communication on the network. Some therapists

feared if they got too deep into an emotion on live chat it could be dangerous if

something went wrong with the technology and too easy for the patient to just turn it off

in the middle of discussions. These same therapists felt a network would supplement best


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and offer more insight if it mimicked the other social networks their patients are involved

in and was notably different than their face-to-face therapy.

I received responses from therapists in different fields of psychoanalysis, and

many of the therapists had ideas for tools that were very field specific. For example, two

of the therapists work with sex offenders and expressed how helpful a network would be

for their practices, but the needs of these therapists and patients are very different from

those in general practices.

There were also many differences between those therapists working with

adolescents and those working with adults on what would be most fitting for

supplementation. With all of the different needs, it seems that it would be most fitting for

field specific networks to be created to be helpful for each psychotherapy niche.

PsychSofa Beta is a prototype of a network that could be created for a psychotherapy

treatment niche.


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Conclusion

I aimed to create a network for therapists and their patients to see if it could

supplement face-to-face sessions. I did not design this site to replace face-to-face therapy;

in fact, it is important that in- person therapy be established before using the

supplemental site, so the therapist can put a face to an online voice.

The PsychSofa Beta will continue to be up and running to see if it can effectively

work as a supplement with in-person therapy. Further research will be needed to see if

does in fact help therapists stay in touch with their patients between sessions and to what

degree.

Additionally, some therapists have said they might use it to explore other areas of

psychology. One therapist is interested in how her patients communicate and present

themselves in online dating, others are interested in studying virtual identity and tracking

behavior, and some therapists want to use it to help with recovering sex offenders in rural

areas, using live monitoring and live chatting. The respondents are in agreement that it is

interesting to see which way a patient expresses him or herself the best. As one

respondent declared, The way you communicate defines you.


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Bibliography

Abbott, J.M., Klein, B., & Ciechomski, L. (2008). Best practices in online therapy

[Electronic version].Journal of Technology in Human Services, 26(2/4), 365-366.

American Psychological Association. (2008). A basic guide to depression.Medical

Library. Retrieved November 15, 2008 from

http://medem.com/medlb/article_detaillb.cfm?article_ID=ZZZDL37U2KC&sub_

cat=128

Cook, J.E., & Doyle, C. (2002). Working alliance in online therapy as compared to face-

to-face therapy: Preliminary results. Cyberpsychology & Behavior, 5 (2), 95-105.

Grohol, J.M. (1999). Best practices in etherapy. PsychCentral. Retrieved March 6, 2009

from http://psycentral.com/best/best3.htm

Manhal-Baugus, M. (2001).E-Therapy: Practical, ethical, and legal issues. [Electronic

version]. CyberPsychology & Behavior. 4 (5), 553-555.

Midkiff, D.M., & Wyatt, W.J. (2008). Ethical issues in the provision of online mental

health services (Online counseling). [Electronic version].Journal of Technology

in Human Services, 26(2/4), 314-321.

Suler, J.R. (2000). Psychotherapy in cyberspace: A 5-dimensional model of online and

computer-mediated psychotherapy. [Electronic version]. CyberPsychology &

Behavior. 3(2152-158), 553-555.

Suler, J.R. (2001) Assessing a persons suitability for online therapy: The ISHMO

clinical case study group. [Electronic version]. CyberPsychology & Behavior. 4

(6), 675- 679.


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Tantam, D. (2006). Opportunities and risks in e-therapy.Advances in Psychiatric

Treatment. 12, 368-374.

Tsan, J.Y., & Day, S.X. (2007). Personality and gender as predictors of online counseling

use. [Electronic version].Journal of Technology in Human Services, 25(3), 39-55.

Turkle, S. (1995).Life on the screen: Identity in the Age of the Internet. Boston:MIT

Press.

Turkle, S. (2007). Can you hear me now?Forbes.com. Retrieved November 4, 2008 from

http://www.forbes.com/technology/forbes/2007/0507/176.html

U. S. Dept. of Health and Human Services. (2004). Know What Your Child is doing on

the Internet. Retrieved May 1, 2009 from

http://www.family.samhsa.gov/monitor/internet.aspx

Vybiral, Z., Smahel, D. & Divinova, R. (2004). Growing up in virtual reality

Adolescents and the Internet. Society, Reproduction, and Contemporary

Challenges. Brno : Barrister&Principal. pp. 169 - 188.

Wallace, P. (1999). The psychology of the Internet. Cambridge: Cambridge

University Press.


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Appendix A

Surveys


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Therapist Survey

Hello. I am a graduate student at the University of Denver in the Digital Media programworking on a thesis project that incorporates digital media and psychology. Online

therapy already exists as well as face-to-face therapy, but they exist as completely

separate entities. My thesis project aims to find a middle ground in which one couldsupplement the other.

The main goal of my project is to create an online therapy tool that will supplement face-to-face therapy. I have designed an online network that people who are already in face-

to-face therapy can access with their therapists. Patients can use this network to do thingssuch as blogging, joining forums and digital support groups, uploading videos and

images, and creating a personal profile. Therapists can go online and access what apatient does on this network, which will allow the therapist to be updated on what

happens in the patients life between sessions and also have insight into the life thepatient lives online: the patients virtual identity.

As a professional in this field, your thoughts and opinions on this project would be very

valuable to me. I have listed a few specific questions, but any additional comments,suggestions or guidance would be very appreciated.

1. Are you aware of your patients involvement in online activity?

2. Of those patients involved with online activity, do you feel they have created avirtual identity?

3. Do you feel it is important to include an assessment of a persons online activitywhen making an overall psychoanalysis?

4. Do you already engage in digital communications with your patients (i.e. emails,text messaging, blogging, video conferencing, instant messaging)?

5. If you answered yes to question #4, how does it work for you? If you answeredno, would you be interested in incorporating it?

6. What tools do you think should be included on the network?

7. Are you interested in knowing what happens with your patients between sessions?


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Professor Survey

Hello. I am a graduate student here at the University of Denver. I am currently in the

Digital Media program, but I am working on a thesis project that incorporatespsychology. Since I am not a psychology student, I am looking for input on my project

from experts in the field.

The main goal of my project is to create an online therapy tool that will supplement face-

to-face therapy. Online therapy already exists as well as face-to-face therapy, but theyexist as completely separate entities. My thesis project aims to find a middle ground in

which one could supplement the other.

I have designed an online network that people who are already in face-to-face therapy canaccess with their therapists. Patients can use this network to do things such as blogging,

joining forums and digital support groups, uploading videos and images, and creating apersonal profile. Therapists can go online and access what a patient does on this network,

which will allow the therapist to be updated on what happens in the patients life betweensessions and also have insight into the life the patient lives online: the patients virtual

identity.

As a professional in this field, your thoughts and opinions on this project would be veryvaluable to me. I have listed a few specific questions, but any additional comments,

suggestions or guidance would be very appreciated.

1. Do you think the virtual identity is something to consider when doingpsychoanalysis?

2. Are you aware of therapists and patients who engage in digital communications(i.e. emails, text messaging, blogging, video conferencing, instant messaging)?

3. Do you think it would be helpful for therapists to be able to go online to see howthe patient is doing and see what is going on in his or her life between sessions?Why or why not?

4. What tools do you think should be included on the network?

5. What issues do you see as problems for an online therapy tool?6. If this type of online therapy tool is available, do you think it would be used?

7. What type of patients do you think would benefit from incorporating onlinecommunications in their face-to-face therapy?


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Psychology Student Survey

Hello. I am a graduate student here at the University of Denver. I am currently in theDigital Media program, but I am working on a thesis project that incorporates

psychology. Since I am not a psychology student, I am looking for input on my project

from experts in the field.


to-face therapy. Online therapy already exists as well as face-to-face therapy, but theyexist as completely separate entities. My thesis project aims to find a middle ground in

which one could supplement the other.

I have designed an online network that people who are already in face-to-face therapy canaccess with their therapists. Patients can use this network to do things such as blogging,

joining forums and digital support groups, uploading videos and images, and creating apersonal profile. Therapists can go online and access what a patient does on this network,

which will allow the therapist to be updated on what happens in the patients life betweensessions and also have insight into the life the patient lives online: the patients virtual

identity.

As a student in this field, your thoughts and opinions on this project would be veryvaluable to me. I have listed a few specific questions, but any additional comments,

suggestions or guidance would be very appreciated.

1. Do you think the virtual identity is something to consider when doingpsychoanalysis?

2. Are you aware of therapists and patients who engage in digital communications(i.e. emails, text messaging, blogging, video conferencing, instant messaging)?

3. Do you think it would be helpful for therapists to be able to go online to see howthe patient is doing and see what is going on in his or her life between sessions?Why or why not?

4. What tools do you think should be included on the network?5. What issues do you see as problems for an online therapy tool?6. If this type of online therapy tool is available, do you think it would be used?7. What type of patients do you think would benefit from incorporating online

communications in their face-to-face therapy?


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Patient Survey

Hello. I am a graduate student at the University of Denver in the Digital Media program

working on a thesis project that incorporates digital media and psychology. Onlinetherapy already exists as well as face-to-face therapy, but they exist as completely

separate entities. My thesis project aims to find a middle ground in which one couldsupplement the other.


to-face therapy. I have designed an online network that people who are already in face-to-face therapy can access with their therapists. Patients can use this network to do things

such as blogging, joining forums and digital support groups, uploading videos andimages, and creating a personal profile. Therapists can go online and access what a

patient does on this network, which will allow the therapist to be updated on whathappens in the patients life between sessions and also have insight into the life the

patient lives online: the patients virtual identity.

As a person working with a therapist, your thoughts and opinions on this project wouldbe very valuable to me. I have listed a few specific questions, but any additional

comments, suggestions or guidance would be very appreciated.

1. Do you engage in digital communications with your therapist, and if so, in whatform (text messaging, email, blogging, etc.)?

2. Do you feel you have enough time to talk with your therapist in a single session?

3. Would you feel comfortable networking with your therapist digitally?4. What issues do you see with anonymously networking with other people

concerning topics covered in therapy?

5. What tools on an online network do you think could help you in therapy?6. Which digital tools do you think you would take the time to update? -blog, email,

participate in online support groups and forums, and/or log into a network to

update your status in between sessions?

7. Do you feel you would communicate differently in a virtual environment? If so,would it be easier or more difficult for you?


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Appendix B

Instructions for Using PsychSofa Beta


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PsychSofa Beta Instructions

Getting On

Once you click to join on your email invitation, you will be directed to the site to createan account.

Create an account by filling in the requested information.

An email will be sent to you once the Chair (administrator) has approved your profile.Click the link from this new email, and you will be taken to your spot on the sofa.

Adding a Blog Post

Click on blogs in the navigational bar.

Click add a blog post.

Write your blog. Setting changes are available at the bottom of the page.

You can add text, links, images, and files to your blog post using the blog editortoolbar.

You can also select the privacy of your blog post to allow anyone on the PsychSofaBeta, just your friends on the PsychSofa Beta, or just you to view your blog.

You can save a draft if you are not finished writing the blog.

Creating a Group

Go to the Groups tab and click the link at the top right of the page to "Add a group."

Provide the requested information about your group and choose a name for your group.

Describe your group for members who are looking for groups to join.

On the right side of the page, choose which features your group will have, such as

comment wall, discussion forum, text box, and RSS reader.


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Set the privacy settings for your group.

You can allow anyone to join the group, or you can control membership. If youcontrol membership, new members will have to apply to join, and you can review

their request before they can join.

You can allow members to invite other people to join or allow people to requestmembership. If you turn off both of these options, the group will be invite-only, and

you will be the only one who can invite others to join the group.

Decide whether or not members of your group can send messages to the whole group.Click "Add Group" and your group will be added to the PsychSofa Beta.

Joining a Group

To join a group, go to the Groups tab. You can look through the existing groups and sort

them by most active, latest activity, most members, or latest created by clicking on the

"Sort by" menu.

Once you have decided on a group, click on its title. If the group is public, there will be a

link on the top right of the page to join the group. If the group is private, apply to join thegroup from the group's page.

Participating in a Forum

You can start participating on your PsychSofa Beta by checking out the discussion forum.To use the forum, go to the Forum tab and view the current discussions, or start your own

discussion by clicking the "Start Discussion" link.

To participate in a discussion, type your reply in the "Reply" box. Your reply will appearat the bottom of the discussion thread; scroll down to see it.

You can also reply directly to someone else's reply on a discussion thread. Click the

"Reply to this" link under any post and a reply box will pop open.


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Following a Discussion

Whenever you start or reply to a discussion, you will automatically follow the discussionby default. This feature allows you to see all replies and keep up with the discussion.

To follow a discussion, click the link to "Follow - Email me when people reply" on the

post's page. If you want to stop following a discussion, click on the "Stop Following"link. You will stop receiving email notifications about new replies to the discussion.

Managing a Discussion

To manage a discussion you started, locate the "Admin Options" box on the right side of

the page.

To edit the discussion you started, click "Edit Discussion."

To delete the discussion and all replies to it, click the "Delete Discussion."

Click "Close Discussion" if you want to close the discussion to any new replies.

Adding Videos

Go to the Videos tab and click the "Add Videos" link. The left pane shows the file

listings on your computer.

Drag the videos you want to upload to the right pane to add them to the upload list.

Videos must be in the following formats: .mov, .mpg, .avi, .3gp and .wmv. Using thebulk media uploader, you can add up to 30 videos at a time.

When you upload a video, the privacy setting is set to viewable by Anyone. You can

choose whether the video is viewable to Anyone, Just My Friends or Just Me. Tochange the privacy setting on a specific video, sign in to PsychSofa Beta, go to the video

detail page, and click the Edit Video link underneath the video.

You can change the default setting for uploading videos by clicking on the "Settings" linkin the box on the right column of any page. Then click on the Privacy tab on the left and

you will see options to allow "Anyone", "Just My Friends", or "Just Me" to see yourvideos.

You can also choose who can comment on your videos in "Settings." Changing this

setting will not change the privacy setting on any previously uploaded videos.


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You can also add videos to your PsychSofa Beta from other services including YouTube,GoogleVideo, and Hulu, by embedding them. Scroll to the bottom of the "Add Videos"

page and locate the section that says "Add videos from YouTube or GoogleVideo." Clickthe "Add Video" link.

Copy the HTML embed code from the YouTube, GoogleVideo, or other video sharingservice and paste it into the box.

Viewing Members on Your PsychSofa Beta

You can view all of the members on your PsychSofa Beta by clicking on the Memberstab.

Members are listed in order of most recent members by default, but you can sort them in

alphabetical order or in a random order by selecting the "Sort by" menu.

Adding a Friend

If you want to send private messages or invite someone to your groups or events, you can

add them as your friend on PsychSofa Beta. Once you add someone as a friend, he/shewill receive a notification that you want to be friends. He/she can choose to accept the

friend request or ignore the request.

To send a friend request to someone on the PsychSofa Beta, go to the profile page of thatperson. Click the "Add as friend" link under their profile photo. A confirmation window

will pop up. To add a note to your friend request, click the "Add a personal message"link.

Adding Twitter to your PsycSofa Account

To add your twitter account to your PsychSofa Beta account, go to twitter.com and createan account if you do not have one.

Once you are logged on to your account, go to your profile and click on the RSS feed

link, which is under the heading, to get the twitter URL. Copy the URL.

Go back to the sofa on the PsycSofa site and click Add RSS under the RSS heading.

Create a title for the RSS feed, paste the URL into the URL field, choose your settings,

and click save.

The feed should show up as soon as you click save.


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Controlling Your email Settings and Messages

PsychSofa Beta allows you to receive emails about new activity on PsychSofa Beta. Youwill receive email notifications when you have new private messages, new friend

requests, or when the PsychSofa Beta Chair sends a broadcast message. You can choosewhether you want to receive any of these notifications from the "Email settings" page.

You can also control who can send you a private message, and you can block anymember from doing so at any time.

Private messagesWhen you join PsychSofa Beta, you will automatically be able to exchange messages

with the Chair. In order to exchange messages with any other member of PsychSofaBeta, you must first become friends with that member.

You can block messages from any member on PsychSofa Beta. To block a sender, go

to your inbox and locate a message they have sent you. Open the message and clickthe "Block messages" link.

PsychSofa Beta notificationsYou will receive different types of notifications from PsychSofa Beta by default:messages sent to only you, to groups you belong to, to your events, to the whole

PsychSofa Beta, or messages people sent to all of their friends. You will also receivenotifications when you have new friend requests, when people you have invited join,

and when you have new comments to approve.

You can turn off any or all email notifications coming from PsychSofa Beta fromyour Email Settings page. To get to your Email Settings page, click on the "Settings"

link in the right column of any page.

Click on the "Email" tab. All of the different types of notifications will be displayed.

In the "social network" section, you can control the email notifications youreceive when messages are sent on PsychSofa Beta.

In the "Member Activity" section, you can control email notifications aboutactivity on PsychSofa Beta.

In the "Following discussions and blog posts" section, you can choose toautomatically follow discussions and blog posts you add to or those you reply to.


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You can stop following blog posts and discussions all at once by clicking "Clear

My Follow List."

If you don't want to receive any email notifications from PsychSofa Beta, checkthe box next to "None: I don't want to receive emails" at the bottom of the page.

Now you will only receive private PsychSofa Beta messages and broadcast

messages from the Chair when you log in to PsychSofa Beta.

Checking your Inbox for Messages

To check your messages on PsychSofa Beta, log in and click the "Inbox" link on the rightside of the page.

Sending a Private Message

You can send private messages to your friends on PsychSofa Beta. You can also

exchange private messages with the Chair of PsychSofa Beta, even if you are not friends.

To send a private message, click the "Inbox" link on the right side of the PsychSofa Betapage. Click the "Compose" link. Enter people by email address in the "To" field, or click

the "Choose from friends" link to select from your friends list on PsychSofa Beta.

To send a message to the Chair if you are not friends, go to their profile page and clickthe "Send a Message" link.

an online therapy network to supplement traditional therapy

Documents