The use of computer applications by counseling professionals has continued to steadily increase during the past 30 years (Sampson, Kolodinsky, & Greeno, 1997), with a particularly rapid expansion of computer use in the early 1980’s (Bowman & Bowman, 1998).  In these pioneering years of CRT use, counseling professionals concentrated primarily on the development of software programs designed to simulate therapists (Weizenbaum, 1965; Wagman & Kerber, 1978; Selmi, Klein, Greist, Johnson, & Harris, 1982), computer-assisted career guidance systems (Stevens & Lundberg, 1998 and Sampson, 1984), and computer-assisted testing and assessment (Sampson, 1986).

During the past decade, counseling professionals have shifted their focus on the application of computer-related technology (CRT) to counseling tasks that center on therapeutic intervention and counselor supervision.  Particular attention has been given to positive and negative aspects of using the Internet as a medium for service delivery (Bowman & Bowman, 1998; Eriksen, Artico, Schmitt, Quinn, Waters, & Wilson, 1997; Lindsay, 1988; Sampson et al., 1997; Steenbarger & Smith, 1996; Harper, 1999; Cabaniss, K., 1998; King, Engi, & Poulos, 1998; and Wilson, Jencius, & Duncan, 1997).

Although counseling via the Internet, typically referred to as "cybercounseling" or "webtherapy", has received so much attention lately, there has been scant exploration of (1) the extent to which counselors are using various other types of CRT in their work, and (2) other work-related tasks performed by counselors that could be aided by CRT.  As Harper (1999) points out, "Cybercounseling is not the only way counselors can use the Internet in their practice" (p.11).  Likewise, although therapeutic intervention may be the focal task that counselors perform in their work, CRT can help counselors perform many other work-related tasks included in marketing, record-keeping, and professional development.  Sampson, et al. (1997) suggest various potential uses for Internet-based CRT tools by counselors to accomplish specific work-related tasks:

Adapted from Sampson, Kolodinsky, & Greeno, 1997, except where noted

There are other, non-Internet-based CRT tools that counseling professionals may find valuable in their work:

Need for the Study

It is apparent from the above list that a great deal of technology is available for use by mental health professionals in a variety of work-related tasks.  The problem to date is we do not have an assessment of how much CRT tools are being used to accomplish specific counselor tasks (Cabaniss, 2001).  In addition, no trend assessment has been made concerning the variety of ways CRT might be used by mental health counselors and counselor educators to perform all aspects of their work, including therapeutic intervention and supervision, in the near future.  Without these assessments, educators and policy makers lack important information that could enable them to better design training programs for preparing professionals to upgrade their skills in order to remain competitive in a field struggling for independent identity.  These assessments would also help establish long overdue computer competency requirements and training standards for the next generation of counselors to meet the demands of a technologically sophisticated clientele.

Information concerning the extent and types of CRT use by counselors both now and in the next 10 years could also provide a foundation to help guide research into many of the issues raised by an ever-increasing use of the Internet as a vehicle for counseling service delivery (Cabaniss, 2001).  "By anticipating possibilities and problems, one can undertake more informed research and development efforts to help ensure that counseling on the information highway helps rather than harms clients" (Sampson, et al., 1997).

Methodology

The Delphi Method

Due to expense and time commitments necessary to bring together a group of individuals qualified to explore these issues, and the fact that exploration of these issues does not lend itself to the use of statistical, analytical techniques, the Delphi method was the most appropriate means of collecting data for this study (Linstone, 1978).  Delphi is a method of acquiring the opinions of a group of geographically dispersed individuals, considered experts in their occupational fields, who remain anonymous to each other throughout the data-gathering process.  The group of experts is referred to as the Delphi panel.  Panel members are sent a series of questionnaires, called rounds, which list a number of statements pertinent to the topic of investigation.  Statements are to be rated by the experts, and returned to the investigator for summarization.

After each round of questions, summary data, in the form of a median or mean response for each statement, are computed by the investigator, and relayed to the panel of experts in the subsequent round of questions.  Panelists are then asked to consider the summary responses of other members, give a new response to each statement, and provide reasons for non-compliance with the group rating.  This process continues until group consensus is reached or as dictated by the researcher (Dalkey, Rourke, Lewis, and Snyder, 1972).  After the last round of questions are returned and analyzed, panelists are provided the final summary results of their ratings.

There are many variations on the traditional Delphi first developed in the 1950’s for the RAND Corporation by Olaf Helmer and Norman Dalkey.  In a standard Delphi, the initial round of questions sent to the panel of experts are open-ended, allowing panel members the freedom to provide information that the investigator will use to create the Delphi questionnaire.  In a modified Delphi, this phase of the Delphi process may be completed by a committee of individuals representative of the Delphi panel prior to the beginning of the rounds of questioning.  A futures Delphi asks panelists for their opinions on matters that may occur in a future time frame.

Delphi Panelists

The present study employed a modified futures Delphi with a panel of 30 experts in the fields of counseling and computer technology (Cabaniss, 2001).  Nominations for the Delphi experts were acquired through a search of major publications in the fields of counseling and computer technology, posting formal requests to professional listservs on the Internet, requests made to departmental chairpersons at major U.S. universities, and by personal referrals.  Correspondences with Delphi panel members were conducted via e-mail.

Counselor and technologist nominees for the study were asked to have achieved the following description of expert status:

An expert may be defined as someone with special skills or knowledge evidenced by leadership in professional organizations, holding office in professional organizations, presenter at national conventions, published in recognized journals, etc.

Additionally, counselor nominees were asked to meet the requirements for and hold the title of National Certified Counselor and/or Licensed Professional Counselor in their state of practice or to have held such titles, and to have counseled individuals on issues of mental health for a period of at least five years.  Counselor nominees were required to possess expertise in at least one of the following four counselor categories:

• Counselor educators defined as persons currently employed by an accredited college or university to instruct master’s and/or doctoral-level students in counseling.
• Counselors who work in agency settings such as state mental hospitals, community mental health agencies, or large, corporate-owned mental health agencies.
• Counselors who work in private practice, either as an individual or with other individuals.
• Counselors who work in college or university counseling centers that help students with a variety of mental health issues.

In addition to having achieved the above description of expert status, technologist nominees were asked to possess demonstrated skills and/or titles in computer-related technology including, but not limited to: designing and/or developing web pages; computer programming; software development; knowledge of operating systems; network administrator; hold a computer science degree; background in engineering; instructional technologist; information systems manager; and/or database administrator.

This study’s Delphi panel consisted of 5 counselor educators, 7 private practitioners, 3 agency counselors, 8 counselors who work in university counseling centers, and 7 computer-related technologists, for a total of 30 panelists completing the Delphi Round 1 questionnaire (see Table 1).

Delphi Questionnaires

Questionnaires were developed for the Delphi study by committee members representative of the Delphi panelists, and posted in a web-accessible database by the study’s computer programmer (Cabaniss, 2001).  In an effort to achieve a more accurate understanding of the opinions expressed by the Delphi panelists, the research questions for this study were posed from several perspectives.  The Round 1 questionnaire asked panelists to rate 46 generic counselor tasks in 7 task categories for current and future use of CRT, and to provide specific examples of current and future CRT use in counseling.  The Round 2 questionnaire asked panelists to rate 7 new counselor tasks, including 1 new category of tasks, provided by them during Round 1, and to indicate frequency of use for 10 specific CRT tools.  The Round 3 questionnaire listed all 53 counselor tasks in 8 categories of tasks.  Panel members were asked to review their previous ratings of each task in consideration of group median ratings and make final ratings for how much counselors and counselor educators use CRT to accomplish the work-related tasks, both now and for the year 2008.  Finally, panelists were requested to select reasons for their final ratings of CRT use and non-use.

Results

Summarizations

It was during Round 3 that individual members of the Delphi panel of experts, after consideration of the median responses of other panel members, gave their final ratings of the completed list of 53 counselor tasks in 8 categories for use of CRT to complete those tasks, both now and in 2008 (Cabaniss, 2001).  Each task was rated twice—once for current and once for future use of CRT—using the following scale:

• 5 = Essential if it allows counselors to do things they never could do before
• 4 = Very Helpful if it significantly decreases effort, make things much more efficient, or improves the quality of the product or service
• 3 = Helpful if it makes the job easier to perform, but is not essential
• 2 = Not used, but would like to if CRT and/or the skills to use it are not currently available, but would be used if they were available
• 1 = Not used, and no need for if there is no interest in using CRT for the task, its use would be inappropriate for the task, or no desire to use.

Panel responses to the final Delphi Round 3 questionnaire task ratings were summarized using eight steps.  Results indicating counselor tasks accomplished with the help of CRT, both currently and for the year 2008, may be viewed in Table 2.  Tasks panel members rated as "2" for both time frames may be viewed in Table 3.

In Round 2, Part B, counselor panelists were asked to indicate how often they, personally, used the following 10 specific CRT tools for each of 7 counselor task categories by choosing "NA" for Not Applicable, "D" for Daily use, "W" for Weekly use, "O" for Occasional use, or "N" for Never use: e-mail, word processor, web, spread sheet, project management, graphics, animation, simulation, statistics software, or other.  Technologist panel members were asked to indicate how often they felt counseling professionals were using each of the 10 CRT tools.  Panel responses to the Delphi Round 2 questionnaire CRT tool usage ratings were summarized using four steps.  Results of Round 2 CRT tool usage ratings, grouped by CRT tool item, may be viewed in Table 4.  Round 2 CRT tool usage ratings, grouped by counselor task category, may be viewed in Table 5.

After Delphi panelists had given their Round 3 final rating of each counselor task for both current and future use of CRT, they were asked to indicate the following reasons for their final choices:  E = Efficiency means able to produce more with less effort, Q = Quality means able to produce a superior product or service; can do the job, and O = Opportunity means able to do things that may not have been previously possible, as reasons for using CRT.  For tasks for which CRT was not used, panelists were asked to indicated the following reasons: T = lack of Training to use, C = Costs of soft/hardware, S = no available Software, I = CRT is Inappropriate to task, or O = Other, please write in and reasons for not using CRT.

Panel responses to requests for reasons were summarized using four steps.  Results of current reasons for using CRT responses may be viewed in Table 6, and future reasons are summarized in Table 7.  Reasons for not using CRT are summarized in Table 8 for current ratings and Table 9 for future ratings.

Findings

This Delphi study addressed four research questions (Cabaniss, 2001).  Major findings are summarized below:

Research question 1:

How much do counselors and counselor educators rely on computer-related technology to complete job-related tasks today?

Answer:

It has been proposed that CRT can be used to assist counseling professionals in numerous ways (McFadden, 2000; Sampson, et al., 1997; Lundberg & Cobitz, 1999; Cabaniss, K., 1998; King, Engi, & Poulos, 1998; Wilson, et al., 1997; Stone & Turba, 1999; Hayes, 1999; and Stevens & Lundberg, 1998).  The data from this study suggest counselors and counselor educators are using CRT to assist them in over half (59%) of job-related tasks today (Cabaniss, 2001).  The experts in this Delphi inquiry indicated that counselors currently find CRT helpful in making 40% of generic work-related tasks (31 of 53 tasks) easier to accomplish, e.g., professional writing, preparation and delivery of advertising, and test administration and scoring.  In addition, the experts believe CRT to be very helpful in significantly decreasing effort, increasing efficiency, or improving the quality or services of another 19% (10 of 53) of work-related activities.  In all, the experts indicated that counselors and counselor educators currently rely on CRT to complete 59% of job-related tasks.  In addition, counselor experts who participated in this study reported at least weekly use of a variety of CRT tools in their work.

Research question 2:

Which counselor-related tasks are counseling professionals currently accomplishing with the help of CRT?

Answer:

All categories of work-related tasks are represented in current CRT use assessment with the exception of tasks concerning professional accountability (Cabaniss, 2001).  The experts in this Delphi study rated CRT use as helpful for: all counselor tasks listed related to marketing/client recruitment, report and record-keeping (paperwork), clinical assessment/testing, and consultation and referral; all but one task in supervision/training; and all but two tasks in professional development.  Half (50-57%) of the counselor experts expressed the opinion that CRT is not currently being utilized by professional counselors for most therapeutic intervention tasks, such as establishing rapport with clients, confidentiality discussions, evaluating presenting problems, and utilizing affective interventions, because CRT is inappropriate for these tasks.  In addition, these experts indicated therapeutic tasks involving the determination of treatment length and interventions using cognitive, behavioral, or a combination of therapeutic techniques were not currently being accomplished with the help of CRT due to a lack of available software.

In all, only 3 of 18 in-session intervention/therapy/counseling tasks and no tasks in professional accountability were thought to be currently accomplished with use of CRT.  However, the panel of experts suggested counselors would like to use CRT for these tasks if the technology or skills were available.

Research question 3:

What are specific ways in which counselors and counselor educators are currently using CRT in performing job-related tasks?

Answer:

Various CRT tools have been explored in the literature as potentially useful to mental health professionals in their work (Sampson, et al., 1997; Wilson, et al., 1997; Harper, 1999; and Myrick & Sabella, 1995).  Results of this Delphi study indicate counselors and counselor educators are utilizing a large variety of CRT tools in their work.  Delphi panelists gave 73 specific examples of current CRT use by counselors and counselor educators for work-related activities (Cabaniss, 2001).  These examples fell into three main categories.  The first category included the use of software for word processing, spreadsheets, statistical analysis, and publishing for tasks in marketing/client-recruitment, report and record-keeping, in-session intervention/therapy/counseling, clinical assessment/testing, and professional development.  The second category of examples included use of e-mail, both private and on professional listservs, for activities in therapy, consultation and referral, supervision/training, and professional development.  The third category of CRT examples involved use of the WWW, including websites, chatrooms, and teleconferencing, for tasks in marketing, therapy, consultation and referral, supervision/training, and professional development.  Panelists expressed caution about current CRT security issues where client data is concerned.

Research question 4:

How much and in what ways will CRT be used by counselors and counselor educators to do their work in the next ten years?

Answer:

The experts in this study forecast a significant increase in use of CRT by professional counselors in the near future.  It is expected that counselors will be utilizing CRT for at least 90% of their work, in all categorical aspects, including professional accountability (Cabaniss, 2001).  The Delphi experts indicated they believe counselors will find CRT very helpful in significantly decreasing effort, increasing efficiency, or improving the quality of services for 72% (38 of 53) of counselor tasks by the year 2008. CRT will be helpful in making the job easier to perform for another 21% (11 of 53) of work-related tasks.  In all, counselor and technologist panel members agreed that 92% of the work counselors do in 2008, including all task categories, i.e., marketing/client recruitment, report and record-keeping (paperwork), in-session intervention/therapy/counseling, clinical assessment/testing, consultation and referral, supervision/training, professional development, and professional accountability, and all but 4 individual generic tasks, will be accomplished with the help of CRT.  Three of the tasks for which panelists believe CRT will not be used were therapeutic activities, while the fourth concerned professional accountability.  However, experts in this study suggested that if the technology or skills were available in 2008, counselors would use CRT to accomplish these tasks as well.  The only reason given by half of the counselor experts for not using CRT in 2008 was that CRT is inappropriate for the specific task of confidentiality discussions with clients.

Finally, panelists gave 79 specific examples of how they believe counselors will use CRT in the near future (Cabaniss, 2001).  Panelists forecast increased software development and use of the WWW for the following: marketing of counseling services; demographic databases for research and statistics; electronic test administration, scoring, and diagnosis, as well as development of more self-assessment software; activities related to consultation and referral, supervision/training, and professional development; and therapy, both professionally and through psychoeducation/self-help.  In addition, panelists indicated their beliefs that: (1) audio/visual equipment will become more commonplace in web communications, and (2) expressed more optimism toward security issues related to future CRT use.  Although not explicitly stated by panelists, the occurrence of these two forecasts would alleviate most of the current objections to web use in therapy, and may explain the significant increase in future ratings of CRT use for therapeutic interventions/counseling/therapy work-related activities.

Implications and Recommendations

The experts in this Delphi study have expressed their beliefs that the following conditions exist in professional counseling concerning current and future use of CRT (Cabaniss, 2001):

1. CRT is currently an important and highly utilized part of professional counseling.  The results of this study suggest counselors are using a wide variety of CRT tools to accomplish tasks in many different aspects of the work they perform in helping others.
2. The use of CRT by professional counselors will continue to increase to the extent that by 2008, almost all aspects of the work counselors do will be accomplished with the help of CRT.

Based on these conditions, the following recommendations are made (Cabaniss, 2001):

1. Counselor education programs need to recognize the importance of CRT use by professional counselors in the work they do.  There has been a plea for more CRT skills training of student and professional counselors (McFadden, 2000; Sampson, et al., 1997; Eriksen, et al., 1997; Sampson, et al., 1997; King, et al., 1998; Hayes, 1999; Lundberg & Cobitz, 1999; and Stevens & Lundberg, 1998).  As Stone & Turba (1999) point out, counselor education programs are not currently incorporating minimal computer literacy standards or providing coursework to optimally train counselors in technological skills.  Counselors will need these skills in order to be proactive in developing the professional roles they play in the future.  By producing counselors inadequately trained in CRT use, we place them at a professional disadvantage in competing with, or being able to work in conjunction with, other mental health professionals who have acquired and are utilizing CRT to perform in what is increasingly becoming a technologically-driven society.

This study establishes the need to implement and promote computer skills training and competency assessment in counselor education programs.  Counselors are not currently receiving the training they need to utilize the technology available to them in ways that could result in making counselor tasks easier to perform and able to be more efficiently accomplished, and result in the production of qualitatively better service delivery.  Programs that are not providing adequate CRT skills evaluation are producing graduates who begin their work as professional counselors at a distinct disadvantage to other health care providers endowed with appropriate technological skills.  Those graduates must be burdened with the task of acquiring the technological skills they need on their own, in whatever haphazard manner they can, depending on available time and resources.

2. Although counselors are currently using CRT in limited ways to accomplish tasks involving therapeutic intervention, it is realistic to expect more extensive use of CRT in therapeutic tasks in the near future.  This presents counseling professionals with the need to conduct research investigating potential effects CRT use may have on the therapeutic process.  The literature is replete with calls for research to investigate potential important differences between therapeutic work accomplished with the help of CRT, as well as therapy conducted in more traditional ways in which technology is not utilized (Huang & Alessi, 1996; King, Engi, & Poulos, 1998; Wilson, Jencius, & Duncan, 1997; Sussman, 1998; Morrissey, 1997; Sampson, et al., 1997; Harper, 1999; and Myrick & Sabella, 1995).  The results of this study echo the pressing need for research into these concerns.

Herein lies a double challenge for mental health professionals.  Before we can research comparative differences in outcome effectiveness between therapy conducted with the help of CRT and traditional therapy,  i.e., face-to-face therapy, in which technology is not utilized, we must have a) a priori, clear-cut descriptions of which aspects of therapeutic interventions most likely produce specific outcome effects, and b) ways to objectively gauge therapeutic outcome effectiveness.  Increasing use of CRT offers both challenges and opportunities for us to expand our understanding of the therapeutic process by requiring us to closely examine which aspects of effective therapeutic intervention are uniquely "human" and why.  This understanding can help us develop objective criteria for training mental health professionals to help others, as well as provide us with valuable information concerning which techniques clients can learn to help themselves.  In addition, by more precisely defining the processes of therapeutic intervention, counselors can more objectively measure outcome effectiveness associated with a given technique.  We cannot, however, expect counselors who have been inadequately trained in CRT use to be able to conduct or produce qualitative research investigating these issues.

3. Finally, we are currently producing professional counselors who lack the necessary background skills in CRT to be able to adequately evaluate and/or guide the appropriate development of CRT used by counseling professionals.  Counselors endowed with appropriate CRT skills could become valuable teammates with computer programmers and technicians in creating and improving the quality and effectiveness of software and hardware used by counseling professionals and their clients.

Conclusion

Graduates of counseling programs cannot easily accomplish the above goals without increased development of CRT skills.  In order to ensure competent and standardized acquisition of the technological skills important to the work of counseling professionals, both now and in the future, counselor training programs must adopt mandatory evaluation of continuously updated minimal computer skills.  By so doing, professional counselors and counselor educators will be in a better position to take advantage of the opportunities offered by new technologies, to remain professionally competitive in an increasingly technological world, and begin meaningful research to proactively guide technology’s development and use by mental health professionals.

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The author wishes to gratefully acknowledge her doctoral committee at Virginia Polytechnic Institute and State University for their help and guidance throughout this research project:   Drs. David Hutchins, Jimmie Fortune (co-chairs), Hildy Getz, Virginia Reilly, and Sherry Lynch.  A special thanks to Dr. Murray Turoff, at the New Jersey Institute of Technology, for his valuable suggestions in the design and analysis  of this study's Delphi, and to Dr. Norman Dalkey for his useful comments.  Much gratitude goes to Dr. Glen Holmes, Virginia Polytechnic Institute and State University, for programming the online version of this study's Delphi questionnaires.

Katherine Cabaniss, Ph.D., is a graduate of Virginia Polytechnic Institute and State University, Blacksburg, Virginia.  She currently works and resides in southern Virginia, and may be contacted via email at kscphd@yahoo.com.