AbstractThis article presents the participant responses to a doctoral online support group conducted with The Palace software. The Palace allows for online chatting via the Internet, but adds a two-dimensional space that allows participants to be in a virtual room and represent themselves with various digital images. The study asked doctoral students to journal their experiences throughout a four week, online, support group experience. In addition, a debriefing session was held at the completion of the support group where research participants voiced their opinions on the strengths and concerns about running online support groups in this fashion. A summary of research participants journal entries and verbal responses to the online support group are presented.
Introduction
"Computers
and cyberspace become a type of 'transitional space' that is an extension
of the individual's intrapsychic world." (Suler,
1999) Designed by the federal government's Department Of Defense,
the Internet's purpose was as a communication system to be utilized in
the event of the nuclear disaster. Though that idea has long been
forgotten, the Internet continues to be one of the most efficient carriers
of transcontinental communication. Researchers in the field of interpersonal
communications (e.g., counselors) are starting to view the Internet as
an opportunity for applied research. This study is one of those applied
research experiences that examined real time communication in a virtual
environment using a software package named The Palace (The
Palace, Inc., 1998).
Suler (1998) wrote that there are eight basic features of cyberspace: (1) limited sensory experience, (2) identity flexibility and anonymity, (3) equalization of status, (4) transcending spatial boundaries, (5) time stretching and condensation (through chat rooms and email), (5) access to numerous relationships, (6) permanent records, (7) altered and dream states, and (8) black hole experiences. It is thought that these distinguishing features of cyberspace have contributed to the ever growing appeal of communication in cyberspace. This study examined interpersonal relations and general group processes in an online support group setting, where many of Suler's basic features of cyberspace existed.
Though much of the groupwork and social psychology theories may be applicable to online groups, some of these basic features of cyberspace alter the way groups interact online (Suler, 1998). Utilizing this electronic method of communication is helping social scientists understand how technology and psychology may overlap.
Traditional support groups
have been used to encourage and motivate individuals towards change and
self-improvement (Yalom, 1995).
Studies suggest that support groups may be one way of helping individuals
achieve certain aspirations and goals for personal growth and development
(Jacobs, Masson,
& Harvill, 1998). As technology advances, the idea of what
constitutes a support group setting expands, and the use of computer-based
self-help groups is being examined as a viable adjunct to current therapies
(Finn, 1995). The theoretical constructs
behind face to face group counseling are being researched for their relevance
to the online group setting. Weinberg,
Uken, Schmale, and Adamek (1995) found that Yalom's
Therapeutic Factors (1995) were perceived as present and essential
in an online group's effectiveness.
Purpose
The purpose of this pilot
study was to begin to examine how virtual support groups compare to face
to face support groups in both their content and processes. All participants
were familiar with basic group process and theory. All reported some
form of face to face group participation prior to the onset of this study.
This knowledge and experience allowed for both theoretical and applied
comparisons between various group settings. This study was intended
as a pilot study which examined individual's subjective responses to the
process, and sought to generate questions and hypotheses for future research.
Subjects
Based on their interest and
availability for the project, five doctoral students at the same
mid-western university were chosen as research participants. All
participants were doctoral students enrolled in the Counselor Education
program at the university, and were at various levels of program completion.
Each participant had different skill levels with respect to personal computing.
Screening was done via informed consent from each participant. Since
each participant were also researchers, they helped in establishing the
details for how the group would be conducted and were familiar with the
format and level of participation expected in the group. Each member
signed an informed consent form and understood that their participation
was voluntary and that they could withdraw at any time during the project.
The only requirement for membership was being a doctoral student who felt
they would benefit by giving and receiving support around doctoral student
issues. Four females and one male participated in this virtual support
group. The research team also included one Counselor Education faculty
member and two faculty members from the Instructional Technology Services
program who managed The Palace software. The faculty members did
not participate in the online support groups, but served as research consultants
throughout the project.
Instruments
The focus of this study was on the overlap between current technological capabilities and the concept of support groups. "Virtual" support groups were conducted over the Internet through a software package known as "The Palace" (The Palace, Inc., 1998). The Palace software allows for the creation of virtual locations where individuals conversed (via text and images) with one another. Similar to text-based chat rooms, The Palace supports graphical representations of both the location, and the participants. The graphical representation of individuals is known as an avatar. An avatar may be created with any digital image (e.g., cartoon, photograph, drawing). Along with these avatars, individuals use various "props" to supplement the representation of their avatar (e.g., clothing, beverages, hats, etc.). A participant's "voice" is represented by a "cartoon bubble" placed near their avatar. These bubbles contain the text which is typed by one participant and sent to other participants. There are several "bubble types" from which to choose. There is the "thinking bubble", the "excitement bubble", and the "permanent bubble". The Palace is interactive and allows for conversation between individuals or group members. Here is an example of how The Palace screen might look in an online group setting.
The Palace software has been
used mainly for recreational purposes; however, recently more practical
uses for The Palace are being examined (Melvin,
1997). This study used The Palace software to conduct an online
support group for doctoral students in a counseling program at a large
Midwestern university.
Methods
Participants' skill levels varied widely with regard to the use and familiarity of technology and The Palace software; therefore, several training and practice groups were conducted prior to the onset of the actual support group meetings. Participants practiced using the various functions of The Palace and became more comfortable with the technology. Issues which were raised during the training sessions included the understanding of "lag time" - the time which it takes for the computer to display the text once it is typed and sent. Also, keyboarding skills were raised, as some participants could type much faster than others. Learning to use the various aspects of The Palace software was also addressed. Each participant agreed that a practice session was necessary in order focus on the process of the technology and not on content and/or group process.
Next, a three-dimensional, virtual room with couches and beanbag chairs was created and designated as "The Beanbag Room". This room was specifically designed for this project and provided a relaxed virtual environment for the online support group project.
Finally, digital photographs were taken of all participants and designed as avatars (small digital images) for use in The Palace rooms during the online group sessions. Caricatures (small, cartoon-like pictures) were also created for each participant as an optional avatar to be used during group sessions.
Over the course of four weeks, group members met one hour each week in a virtual location to discuss various issues related to doctoral studies. Sessions were held every Wednesday from 2:00 - 3:00pm for four consecutive weeks during the Spring 1997 semester. A transcript from each of these support group sessions was recorded on the main computer. In addition to these transcripts, participants wrote a weekly personal journal entry where they reflected on their experiences with The Palace online support group. Finally, the five support group participants held a face to face debriefing session at the completion of the project. This debriefing session was audiotaped and transcribed to provide the final piece of data for this project. Prior to the debriefing session, participants were asked to individually brainstorm the strengths and weaknesses of running online support groups. In addition, they were asked to review their journals and reflect on any relevant issue that they would like to discuss during the debriefing time. The debriefing session lasted 90 minutes and many of the quotations used in this article are taken from the transcript of the debriefing session.
Little structure was provided
to group members regarding the topics or process of the online support
groups prior to the start of the group. No group leader was assigned
and no prior ground rules were provided. This lack of information/structure
was intentionally omitted in order to observe the natural course an online
support group may take without such instructions.
Results
The results of this study
were compiled in a summary style format which includes a number of direct
quotes from online support group participants. While no formal qualitative
analysis was conducted, four general themes were discussed by research
participants within their journals and during the debriefing session:
The Effects of Technology on Virtual Support Groups; Group Process and
Management in a Virtual World; Professional and Ethical Considerations
in Electronic Support Groups; and Recommendations for Online Support Groups.
These four themes and participant responses are discussed.
The Effects of Technology on Virtual Support Groups
Adaptation to technology. One aspect of this study examined how technology may have impacted the virtual support group. Each participant voiced both advantages and disadvantages to the technology. On several occasions, technical problems interrupted the natural flow of the group. The issue of technology must be considered an integral part of the online support group setting, since the entire group communication depends on the reliability of the technology.
One of the issues group members
addressed was the timing of communication with one another. Timing
often depended on typing speed, speed of the technology, and natural shifts
of interpersonal communication.
"I felt some group members were not able to participate at the same level as those who had faster typing skills.""Often, by the time I entered my thoughts, their appropriateness in the context of our conversation was past. Frustration!"
"I spent time trying to figure out how to participate in conversation without missing pieces while I was typing."
Another issue involved
actual technical difficulties over which the participants had little or
no control. For example, one session was delayed approximately fifteen
minutes because the local network server was not operational. Another
time, an off-campus participant lost their connection and were unable to
reconnect. These technical difficulties were frustrating to all group
members at one level or another.
"At the end of our group, one member had difficulty with their connection and was cut-off. What should a group do when this happens?""When we had technical difficulties, we at least had the advantage of all being local to one another. What would happen if we were in five different states?"
"For people who already have a fear of technology, a change like this [technical difficulty] can create tremendous anxiety, and truly affect the group process."
Finally, participants
discussed the advantages of using technology to operate an online support
group.
"This forum makes you be concise and to the point, which is often helpful. There is no wordiness . . . just simple reactions to situations.""At times, slowing down the pace and being forced to type responses rather than say them, made me more reflective about the conversation."
"Even though we knew one another, there is a level of anonymity that makes it easier to be more honest while in the virtual room than if we were face to face."
There are many technical
issues which need to be addressed prior to running an online group.
The most important consideration is to develop a contingency plan.
As one participant stated:
"If I were leading an online group, it would be important to have some type of protocol in place in the event that a technical problem made it difficult or impossible for the group to meet."
Participants in this
group discovered both frustration and freedom in the online world.
Anticipating both the advantages and disadvantages of these technical settings
would be an important first step in planning an online group. The
planning process should consider and address the costs and benefits of
an online group, keeping in mind the possibility of technical difficulties.
Group Process and Management
in a Virtual WorldGroup moderation. During the first group there
was no group moderator and everyone was free to participate however they
wished. This made it difficult to follow conversations and discuss any
one topic. The following groups were moderated by the use of a prop, a
small picture of a light bulb. When
an individual wished to speak, they moved the
light bulb over their head to indicate that they had the floor to speak.
After completing his/her comment, the speaker returned
the light bulb to the center of the room. This form of group
moderation was useful in keeping the group on a single topic and kept all
participants involved in the process.
"Taking time before the group started to figure out how to take turns made a big difference in how the group ran...clicking on the light bulb to signal that you were going to speak made the combination of typing and reading a lot less frantic.""The prop seemed to work especially well in terms of keeping the flow of conversation on one topic, and allowing those with slower typing speeds to be able to complete their thoughts while still relevant to the conversation"
"There were no more overlapping conversations or pressure to type fast."
It is suggested that
future groups develop some way to moderate group conversation online so
everyone is not attempting to talk or respond at the same time. The use
of a prop is one method, however, any method that would signal someone
has the floor to speak would be effective.
Furthermore, group members
decided that although the light bulb afforded the person an opportunity
to make more lengthy comments, other members could also give minimal
encouragers even without the light bulb.
"The light bulb worked well for long statements, but it was acceptable for other members to interject brief statements of agreement, thoughtfulness, or surprise without interrupting the process.""The person sharing was given short feedback as they were sharing. I found this process to be more interactive and quite effective."
This style of providing
minimal encouragers to the person speaking seemed to make the group more
Areal" for the participants. Future groups may want to set a group norm
which states that these brief words of encouragement or agreement would
be acceptable even when the floor was not theirs.
Online versus face to
face. The group members experienced differences between using
text-typing communication and what others have experienced in real life
group settings. Group members found it both frustrating and refreshing
to learn to use this new style of communication.
"One disadvantage is the inability to observe behavioral indicators. Not being able to observe nonverbal behavior made it more difficult to determine what was going on.""The medium was difficult to share personally for too long, but I enjoyed the simple, to the point feedback. This forum makes you be concise and to the point...this is often helpful."
"I missed the normal elements that I rely upon in communication. Without these vital cues it was often difficult to determine when someone wanted to speak , or didn't want to."
As the group discovered,
there may be advantages and disadvantages to this form of communication.
For some, the brief, concise comments meant more direct communication with
less tentativeness, for others, the lack of visual cues made the process
frustrating. It is possible to invent ways to incorporate pseudo-nonverbal
communication through various avatars, props or text. Perhaps the best
example of these pseudo-nonverbal communications is the advent of text-based
"smileys" or "emoticons." These emoticons are used to communicate one's
current state of emotion by typing several text characters together to
"draw" the nonverbal image. For example if you tip your head sideways and
look at these characters :-) you will see a smiley face, indicating someone
is happy or smiling. There are hundreds of these various emoticons that
can be used to convey nonverbal communication in a setting where that is
difficult to do - such as electronic communications. Future groups may
want to consider various ways to incorporate these pseudo-nonverbal communications
into the group.
Impact of avatars and
props. Throughout the group experience, members had a variety of ways
to virtually represent themselves. One of these options was a caricature
or a cartoon-like representation of members faces. Another was a
digital photograph of each participant, reduced in size to create an avatar.
In addition, members could choose not to use either of these representations
and choose an avatar available in the Palace software.
"I find it interesting that for the most part we relied on our photographs for representation, although some people played with some of the cartoon-like avatars, such as the monkey and penguin. I do not think the avatars made a significant difference in our interactions.""I never used my own face [photograph], but chose other avatars to represent myself. It did not seem to impede the process in any way."
"I am still hesitant to play around with the different avatars because I don't feel comfortable knowing if I could switch in and out of them as easy as some of the other members could."
"I am enjoying the different avatars we can use. If I were doing this again I would learn how to pull up an animal for my avatar. It could sometimes more accurately portray my thoughts and feelings than my picture"
The use of avatars did
not seem to impede the group process, although technological savvy seemed
to play a role in whether participants attempted to use alternative avatars.
Future groups may want to plan practice sessions to help members increase
their skill in using the avatars if they so choose.
Whisper function.
Use of the whisper function made it possible
for group members to have "private" conversations that were unknown to
the entire group, something that would not be possible in a face to face
group. When a group member "clicks" on another group member, they are placed
into private chat mode. The text they type appears in italics print
and is only displayed on their screen and not on the screens of other group
members. It would be important for future groups to discuss ahead
of time whether this function will be permissible. This group highlighted
the impact that whispering could have on trust and the group process.
"I felt awful doing it most of the time because I knew other people didn't know that I was whispering.""We feel awful now about the fact that you were whispering!"
"This could really affect trust issues in a group."
Effectiveness.
One of the questions that the researchers had when beginning the group
was how important the idea of face to face communication would be when
considering group effectiveness.
"I really struggled with the usefulness of this particular format and whether it was helpful or not. Had the circumstances been different, for example, if I were in a wheelchair and couldn't attend a group, this may have been much more helpful."Participants' comments reflected the difficulty in adjusting to the lack of face to face communication which impacted their ability to see the format as useful in a therapeutic setting. As a group leader, it is important to screen potential group members for their expectations about group process and what elements are necessary to have a group be helpful. In addition, further study regarding members' views about the helpfulness of a support group versus a therapy group may provide useful information as to what kind of group may work best with an online format."I think it would be difficult to run a therapy group in this kind of setting, just because of all of the interactions you would miss. Perhaps as a support group it would be more useful."
Professional and Ethical Considerations in Virtual Support Groups
The evolution of on-line or virtual groups has many implications for the future of group work. Computer based groups may provide opportunities for people with disabilities or geographically remote individuals to participate in support groups or group counseling. In addition, it also provides an opportunity for groups to be composed of participants from various parts of the country with similar concerns who otherwise would not have been able to meet. Despite all of its advantages, the use of computer based applications for counseling raises new ethical and professional issues. To date, there has been little systematic exploration of the use of computer networks in counseling (Sampson, Kolodinsky & Greeno, 1997).
Important ethical considerations include issues regarding counselors responsibility for the physical and emotional safety of their clients. Not only is this consideration part of the Ethical Code of counselors (ACA, 1995), but many state laws require that counselors have a duty to warn in order to protect their clients and/or potential victims from harm. These issues become extremely complex when the therapeutic setting is an online group. The logistical difficulties in carrying out this duty may prove daunting when the counselor and client reside in different states.
Proper credentialing of counselors also raises ethical issues as licensure laws are not consistent across states. The possibility of inexperienced, nonlicensed, or para-professional counselors conducting online groups raises the concern of client safety. It is not clear how licensure laws will apply to the Internet as state borders are crossed electronically. It is also not clear who will be responsible for monitoring complaints from clients residing in states that are different from the counselor. (Samson, Kolondinsky & Greeno, 1997) All of these issues are critical as the number of online helping professionals grows.
The issue of confidentiality
is pervasive in the face to face field of counseling, but takes on additional
importance as we consider the use of computers in conducting group counseling
sessions. Although there are methods that exist to help protect electronic
information, counselors need to be aware of the increased threat to confidentiality
(Sampson, Kolondinsky
& Greeno, 1997). Recently, the National Board of Certified Counselors
(NBCC) published the Standards for the Ethical Practice of WebCounseling,
which are guidelines to assist in the regulation of web counseling (NBCC,
1999). While these NBCC standards have raised great controversy
in the field, they are a first attempt at addressing a growing problem.
Although the NBCC does not condone WebCounseling, it developed these guidelines
and standards for a practice that is already occurring on a routine basis.
In addition, the American Counseling Association (ACA,
1999) has also established a set of ethical standards for Internet
online counseling. Movements by these counseling associations may be seen
as indicators of the increased use of the Internet for counseling related
activities.
Conclusions & Recommendations
This study examined the reactions of participants to an online support group using The Palace (1998) technology. The use of participants' personal journals and interviews formed the basis of the data for this article. In addition, this article raised some of the ethical and professional considerations associated with conducting online support groups and WebCounseling in general.
As in face to face groups, each participant experienced the group differently. Galinsky, Schopler, and Abell (1997) found similar results when they surveyed individuals on the strengths and weaknesses of telephone and computer groups. In this study, both positive and negative aspects to the online support groups were expressed. The following paragraphs summarize the participants' experiences and responses to the online support group.
First, each participant agreed that their participation in this format was different from various other group activities in which they have engaged. Tuckman's Group Stages (1965) (e.g., forming, storming, norming, performing, adjourning) were similar in the online group, but the process by which the group arrived at these stages varied from traditional group settings. The inability to see nonverbal cues, the necessity to engage in very brief interactions, and issues related to technology all affected the group process. It is difficult to generalize whether group process was affected positively or negatively -- it can be said that it simply was affected. Throughout the process there were examples of when the group enjoyed the online format, and other times when it seemed difficult and cumbersome. As with other group formats, it is necessary to consider the advantages and limitations of this format and make decisions about their impact on the effectiveness of a group setting. It may be that group process and group stage theories need to be adapted in order to be applicable to this new form of group communication.
Similarly, issues of group management and leadership needs to be examined prior to the onset of an electronic group format. Much of the group planning process (leadership definitions, ground rules, etc.) can be directly translated from current literature. However, the methods employed for implementation and enforcement of these pre-group concepts will need to be explored. The tools available to implement group process in face to face groups may not be feasible in cyberspace.
Finally, ethical and professional considerations should not be treated lightly. There are a variety of group issues which become more complex in the context of cyberspace. Concerns of confidentiality, anonymity, and participant safety are only a few of the considerations examined within this paper. The authors are confident, however, that a variety of other professional and ethical issues will arise from this electronic medium. Though the National Board of Certified Counselors has drafted initial considerations for online treatment, these suggested practices are not comprehensive and each case must be considered individually for its professional and ethical challenges.
Since this study is a pilot study, further study of online groups is necessary to help delineate the variety of challenges faced in this format. A major limitation of this study is the small sample size. Controlled pilot studies with multiple groups and more participants will help to better identify the advantages and limitations of electronic groups, as well as the various professional, ethical, and legal issues that may arise as a result of this format. Although participants reported that this support group was helpful, there is not enough evidence to suggest that this is a viable way to offer therapeutic services. The authors suggest more research on the effect of online groups be conducted prior to the use of this format in therapeutic settings.
The limitations of this pilot study included the restricted sample group of doctoral level counseling students, the confined geographic area of participants, only running a single group with a small number of participants, and the fact that none of the students had serious emotional disturbances. These limitations, along with various other confounding issues, make it difficult to generalize these experiences to other groups. However, the primary purpose of this study was to pilot an online support group in a controlled environment as a way to generate questions regarding the efficacy, applicability, and legal and professional issues associated with such a group.
Finally, helping professionals
must not fall into the trap of believing that simply because a technology
exists, it is useful. Whereas, technology may be an enhancement in
one group of participants, it may be a detriment to another. As counselors,
our professional code of conduct requires us to be prudent in our decisions
while keeping the best interest of our clients primary. Online therapy
is a new dimension in the field of counseling and needs to be approached
objectively and cautiously.
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David L. Delmonico is an Assistant Professor of counselor education at Duquesne University. Betsy Page is an Assistant Professor of counseling and human development services at Kent State University. Jacqueline Walsh is an Assistant Professor of counselor education at California University of Pennsylvania. Nadene A. L'Amoreaux is an Assistant Professor of counselor education at Indiana University of Pennsylvania. Carrie Daninhirsch and Rebecca S, Thompson are doctoral candidates in counseling and human development services at Kent State University. Correspondence can be directed to David L. Delmonico at delmonico@duq.edu