Advances
in computer technology significantly modified interpersonal 1communication
(McCrickard & Butler, 2005), most influentially through the Internet (Castelnuovo,
Gaggioli, Mantovani, & Riva, 2003). Few components of contemporary
society find exemption from its impact, including mental health
counseling (Granello, 2000). The Internet provides a means for lending
emotional support to literally millions of individuals through the
services of professionally trained, licensed counselors. Otherwise
underserved clients, including a large population of immigrants, can be
reached through this innovative medium (Chang, 2005; Mallen, Vogel,
Rochlen, & Day, 2005; McFadden & Jencius, 2000).
Former Soviet Union (FSU) citizens represent a substantial number of
immigrants in the United States. Some researchers (e.g., Ginsberg, 2002;
Lashenykh-Mumbauer, 2005) report that this group represents one of the
most rapidly growing immigrant populations. This paper reviews the
efficacy of Internet counseling and discusses the provision of services
to immigrants from the FSU.
FSU
immigrants’ view of mental health services
During
the final decade of the 20th century following the fall of
the communist regime, political and economic upheaval became major
factors in the decision to immigrate (Green, 2004). Russian speaking
immigrants came to the Unites States to escape religious persecution, to
reunite with their families, to improve their economic status, and to
escape political chaos as the countries of the FSU struggled to maintain
independence (Green, 2004; Lashenykh-Mumbauer, 2005). Upon arrival,
immigrants faced many obstacles while adjusting to life in the United
States, including language barriers, loss of personal and occupational
status (Fenelly & Palasz, 2003; Yost & Lucas, 2002), lack of knowledge
of the American health care system (Brod & Heurtin-Roberts, 1992; Green,
2004), culture shock and related health problems (Chow, Jaffee, & Choi,
1999), and family, social and relationship issues (Aroian, Spitzer, &
Bell, 1996; Ginsburg, 2002). Historically, this population refrained
from seeking counseling; however, many impediments to successful
adaptation can be resolved through mental health services.
Traditional Western mental health, legal, and psychological services
were typically unheard of in the Soviet Union. Many who immigrated to
the United States lived at one time under Communist rule, where
virtually all aspects of life were controlled by the government (Bloch &
Reddaway, 1985). The Communist Party’s control of the health care
system, including medical and psychological services, was used to its
political advantage (Bloch & Reddaway, 1985). Medical ethics, such as
placing the client first, were essentially non-existent and client
records were subject to review and seizure at the whim of the government
(Chodoff, 1985). This lack of confidentiality contributed to distrust of
the health care system by Soviet citizens (Veatch, 1989).
Green (2004) suggests that suspicion of mental health
services continues to exist. Many former Soviet citizens believed that
the stigma of being diagnosed with a psychiatric disorder would result
in severe economic distress or negative social consequences that might
even lead to imprisonment (Bloch & Reddaway, 1985). Furthermore, these
individuals find it difficult to reveal emotional concerns to a stranger
for payment (Goldstein, 1984). These attitudes and the relative lack of
information regarding availability of services in America contribute to
the current underutilization of services by this population (Yakushko,
2005). Minimal referrals made by current health or mental health
services system further impact this population’s under use of
professional services. Chow, Jaffe, and Choi (1999) attribute such low
referrals to the lack of recognition by the health care system of the
FSU immigrant population.
Studies indicate that citizens from the FSU seek emotional support from
their family, friends, or religious leaders more often than from mental
health care professionals (Chow et al., 1999; Green, 2004; Sohng & Song,
2004). Evidence supports the notion that this population does not
readily seek consultation and they access conventional mental health
services less than the majority culture (Chow et al., 1999). Consistent
with studies of other groups (Chow et al., 1999; Segal & Mayadas, 2005;
Sue & Sue, 1990), FSU immigrants who do use mental health services
mainly either self-refer or are guided by friends and relatives. Members
of cultural and ethnic minority groups, in general, typically seek
services as a last resort, therefore, prolonging unnecessary suffering
(Segal & Mayadas, 2005).
Although many of these immigrants traditionally use
personal networks to resolve emotional issues and only seek help after
exhausting personal resources (Chow et al., 1999; Ginsburg, 2002; Segal
& Mayadas, 2005), those who do enlist professional services may be
inhibited to share personal information. For example, research supports
associations between lack of communication about domestic violence,
immigrant status, and the failure of mental health counselors to engage
in direct questioning (Crandall, Senturia, Sullivan, & Shiu-Thornton,
2005; Rodrigue, Sheldon, Bauer, & Perez, 2001). Horne (1999) points out
that domestic violence is a private issue among FSU immigrants and they
tend to maintain problems within the family and away from outsiders.
Moreover, few resources existed in the Soviet Union for battered women.
In a study by Crandall et al. (2005), women survivors of domestic
violence from the FSU stressed their collective lack of awareness of
U.S. laws and services available to women in this situation. Gender role
expectations within the Russian speaking community and deficient
knowledge of present domestic violence services further contribute to
survivors’ feelings of isolation. Language deficits, the lack of
outreach, and the paucity of culturally appropriate resources in the
United States prohibit many survivors from seeking support.
Career adjustment issues represent another significant component of the
adaptation process for FSU immigrants (Yost & Lucas, 2002; Zunker,
2002). Most do not understand business concepts such as contract work,
temporary work, and work with benefits because the Soviet system
historically provided full time jobs and free health care and lodging to
each citizen (Yost & Lucas, 2002). For many, one‘s identity is defined
by occupation and when the occupational standing is compromised, a sense
of role shock contributes to feelings of uselessness, frustration and
anger (Westwood & Ishiyama, 1991). For immigrants from the FSU, these
feelings may be even more severe because this is typically a more highly
educated group, relative to other immigrants, and many previously held
professional and technical positions (Fenelly & Palasz, 2003; Yost &
Lucas, 2002).
In summary, FSU immigrants experience communication
barriers, loss of occupational status, personal and family background,
and ethnic identity. Moreover, the pervasive culture of privacy and
silence contributes to guarding personal information because of fear of
exposure, past experience with oppression, and mistrust of authority (Brod
& Heurtin-Roberts, 1992; Green, 2004). To develop rapport, counselor
must gain knowledge about both general and specific immigrant
experiences and the adjustment issues faced by these particular
immigrants as they assimilate into American culture. Only when mental
health counselors establish credibility and sensitivity with this
population will FSU immigrants come forth with sufficient information
and cooperate with the guidelines of intervention (Kirkcaldy, Siefen,
Witting, Schuller, Brahler, & Merbach, 2005).
Web
based counseling
The counseling profession, which showed gains in the
utilization of technology over the last four decades (Granello, 2000),
expects continued increases in a variety of formats of web counseling
services across the next 10 years (Norcross, Hedges, & Prochaska, 2002;
Shaw & Shaw, 2006). The Internet offers an array of possibilities,
including the potential to reach large numbers of clients with
counseling and information services.
Web counseling as defined by the National Board for
Certified Counselors (NBCC, 1997) represents “the practice of
professional counseling and information delivery that occurs when
clients and counselors are in separate and remote locations and utilize
electronic means to communicate over the Internet” (p.1). According to
Grohol (1999), web counseling utilizes the power and convenience of the
Internet to allow simultaneous, as well as time delayed, communication
between an individual and a professional, primarily through e-mail
(Ainsworth, 1999). “Chatting” occurs with both the client and the mental
health counselor online at the same time, simulating conversation by
alternately exchanging text. Videoconferencing, an ideal mode for
counseling, allows for a dynamic conversation through the use of two-way
audio and full motion video. According to Manhal-Baugus (2000), this
modality most closely approximates face to face counseling.
Preliminary research supports the efficacy of web
counseling. Several studies report that outcomes of these services
parallel those of traditional face-to-face therapy (Cook & Doyle, 2002;
Kovalski & Horan, 1999). Although many studies used relatively small
sample sizes, the research supports web counseling as a beneficial
modality (Egan, 1998; Mallen et al., 2005; White & Epston, 1990). Murphy
and Mitchell (1998) point out that a written format, such as email,
promotes understanding of issues by allowing the client time to
formulate a clear and definitive problem statement. Moreover, this
format enables clients to reread their own text, thereby facilitating
the opportunity for greater reflection and emotional clarity in their
communication. Additionally, Day and Schneider (2000) indicate that some
people are more expressive and truthful in letters and over email than
they are in person. In fact, one study has found that people were more
likely to admit alcohol abuse over the telephone than in a face to face
interview ( Kobak et. al., 1997). Therefore, web counseling engenders
honesty and feelings of safety and may serve some groups better than
face to face modalities ever did.
Methods of web counseling vary in terms of frequency, mode of
communication, cost schedules and methods of payment, all of which are
established by counselor preferences and client needs (Manhal-Baugus,
2000). According to the International Society of Mental Health Online
(2000), Internet-based mental health services frequently compliment
traditional counseling. For example, counselors use electronic mail to
respond to specific questions or concerns between sessions. According to
Mollen and colleagues (2005), some counselors practice exclusively
online.
Web counseling provides a number of innovations for
individuals unable to, or who otherwise refrain from, engaging in more
traditional modes of counseling. For example, mental health service
provision is made available to those who live in remote areas or who
have a more secluded lifestyle. An additional benefit for this group
includes a reduction in feelings of isolation. People with disabilities,
who are homebound, also benefit from such services. Moreover, some
individuals, particularly FSU immigrants, may prefer the anonymity of
web counseling, rather than having to engage in a face-to-face
encounter.
According to Lee (2000), web counseling affords clients with
a choice in therapeutic setting. For example, those who are economically
disadvantaged can use computers in public libraries, churches, or
schools to interact with counselors at other locations. The immigrant,
rather than meeting in the potentially alienating or intimidating
confines of the professional office, can engage in a counseling session
in more familiar surroundings. Furthermore, distance counseling via
computer technology opens up new opportunities for those who have been
marginalized due to social or economic circumstances. Additionally, as
Fenichel et al. (2002) point out, benefits of web counseling also
include unrestricted availability and greater accessibility than
traditional services, allowing for more immediate access when motivation
for change is strong. Moreover, the anonymity inherent in web counseling
allows the individual to more readily introduce potentially embarrassing
or uncomfortable concerns (Young, 2005). Manhal-Baugus (2000) and
Fenichel and colleagues (2002) also point out the benefit of
affordability, since online therapy is typically less expensive than
traditional formats.
Despite the host of possibilities for web counseling,
counselors must be aware of practical concerns, potential disadvantages,
and ethical issues, including confidentiality, procedures for managing
emergency situations, and the lack of conveyance of nonverbal
information, such as gestures, facial expressions, and tone of voice (Fenichel
et al., 2002). Currently no federal legislation exists to regulate
online therapists. Moreover, there are impediments to developing
relationships with clients who are never seen in person (Day &
Schneider, 2000). In order to comply with professional demands for
competency, counselors who wish to take advantage of the apparent
potential in web counseling must be aware of the benefits and detriments
of this medium and should seek training in these and other areas, such
as technology and ethics (Love, 2000; Robson & Robson, 2000).
Putting it all together for Former Soviet immigrants
Technology plays a substantial role in American society and
the emergence of web counseling necessitates technologically competent
mental health professionals (Manhal-Baugus, 2000). The Internet provides
the possibility of connecting people from a variety of cultures
(McFadden & Jencius, 2000) and web counseling affords a resource for
reaching FSU immigrants, in particular, who underutilize the mental
health care system (Chow et al., 1999). These immigrants, many of whom
hesitate to openly discuss emotional and personal matters (Crandall et
al., 2005; Green, 2004), may find the anonymity of this modality very
appealing.
A primary objective of counseling involves reaching those
individual who are out of the mainstream and in need of support (Mollen
et al., 2005). Web counseling provides a means to meet this objective
for FSU immigrants who are not comfortable with an in-person, one-on-one
relationship with a mental health professional because of fear, stigma,
or lack of knowledge of mental health services (Chow et al., 1999;
Crandall et al., 2005; Green, 2004). Web counseling provides an
opportunity to reach this otherwise often unreachable population.
To date, most web counseling research has involved Caucasian
college students, with little attention to other groups (Mallen et al.,
2005). However, one study bears mention. Chang, Yeh and Krumboltz’s
(2001) study of Asian American students yielded support for online
services. One particularly salient finding was that 75% of those seeking
treatment did so between the hours of 5 PM and 9 AM. This lends credence
to the notion that these types of services represent a viable option for
those unable to secure services outside of normal office hours.
Implications for counselors
The Internet provides a viable tool for mental health
counselors to offer services to clients with different cultural
backgrounds, including Russian speaking immigrants in the United States.
In addition to general concerns, such as informing clients of the
benefits and risks of web counseling, following the boundaries of
competence, evaluating the appropriateness of the client for this type
of service, specific interventions must be chosen to match the cultural
and experiential needs of immigrants from the FSU. The following
addresses strategies and concerns specific to this population.
Language Issues
Many FSU immigrants may not be fluent in English language
skills. Therefore, counselors serving this population should ensure that
all communications, such as those on web sites and in text messages, are
offered in Russian as well as English. Translations to Russian must be
completed by a professional who is both proficient in the grammatical
nuances of both languages and who has a working knowledge of the mental
health care system in general.
Confidentiality
An essential element in any counseling process includes the issue of
confidentiality. Mental health counselors must be aware of the common
lack of trust between FSU immigrants and health care professionals. To
minimize problems in this area, counselors need to spend ample time
explaining confidentiality. This is of particular concern, considering
that many FSU immigrants had friends or family members who were
victimized as a result of the close affiliation between the mental
health and political systems. Therefore, these clients must be
thoroughly advised of the ethical and legal ramifications of breaching
confidentiality in the United States.
Career counseling
Counselors can expect that FSU immigrants will be
preoccupied with their economic status, especially new arrivals and
those who held positions of prominence in their former country.
Consequently, career counseling may play a significant role in the
counseling process. For counselors who have not achieved competency in
this area, referrals to other professionals may be in order to assist
clients with occupational transitions.
Domestic violence
Online counselors are a valuable resource for victims of
abuse. Russian speaking survivors of domestic violence have expressed a
need for appropriate assistance (Crandall et al., 2005). Web counseling
may be the only way for these women to communicate with a trusted
professional who can provide direction for their concerns.
Referrals and collaborative work with other colleagues
The online counselor must to be prepared to address the probable lack of
familiarity with the American health care system and assist clients with
these concerns. Serving as a trusted confidant, the counselor can
provide referrals to health care professionals and services. Counselors
must also be willing to collaborate with other mental health
professionals to ensure, for example, the maintenance of cultural
sensitivity in online service provision. The tool that serves the client
also supports professional alliances on their behalf, for the Internet
affords collegial collaboration on a worldwide platform.
Conclusion
As technology continues to expand as an integral tool for
all professions, it affords the field of counseling a viable adjunct to
multicultural counseling. Although a relatively new notion, evidence
supports online services as a substantial, cost-effective medium, which
provides increased accessibility and yields consumer satisfaction. When
appropriately and professionally offered, web counseling reaches those
who might not otherwise seek or obtain these types of services.
Immigrants from the former Soviet Union represent one such group.
Although it raises concerns in some respects, the inherent
absence of non-verbal cues in web-based counseling, particularly those
that are suggestive of race or ethnicity, may neutralize immigrants’
perceptions of power differentials, therefore fostering the impression
of a more egalitarian relationship. Moreover, the anonymity of web
counseling allows clients to deal with therapeutic issues in the privacy
and comfort of their own environment.
As with all counselors, those who engage in online service
provision must have achieved proficiency in counseling theory and
practice. Additionally, they require training in working with culturally
diverse groups. As electronic media continues to evolve, the scope of
reaching others becomes boundless and the potential for better meeting
the needs of a diversity of clients increases. It is crucial that the
profession explore web counseling as a means for meeting the needs of
special populations, such as FSU immigrants, while remaining aware of
the cultural nuances that impact these services.
References
Aroian,
K., Spitzer, A., & Bell, M. (1996). Family stress and support among
former
Soviet immigrants. Western Journal of Nursing Research, 18,
655-679.
Bloch, S., & Reddaway, P. (1985). Soviet psychiatric abuse: The
shadow over world psychiatry. New York, NY: Westview Press
Brod, M., & Heurtin-Roberts, S. (1992). Older Russian émigrés and
medical care. The Western Journal of Medicine, 157,
333-338.
Castelnuovo, G., Gaggioli, A., Mantovani, F., & Riva, G. (2003). From
psychotherapy to e-therapy: the integration of traditional
techniques and new communication tools in clinical settings.
CyberPsychology and Behavior, 6, 375-381.
Chang, T. (2005). Web counseling: prioritizing psychoeducation,
self-help, and mutual help for counseling psychology research
and practice. The Counseling Psychologist, 33, 881-890.
Chang, T., Yeh, C. J., & Krumboltz, J. D. (2001). Process and outcome
evaluation of an on-line support group for Asian American male
college students. Journal of Counseling Psychology, 48,
319-329.
Chodoff, P. (1985). Ethical conflicts in psychiatry: The Soviet Union
vs. the U.S. Hospital and Community Psychiatry, 36, 925-928.
Chow, J., Jaffe, K., & Choi, D. (1999). Use of Public Mental Health
Services by Russian Refugees. Psychiatric Services, 50,
936-940.
Cook, J. E., & Doyle, C. (2002). Working alliance in online therapy as
compared to face- to-face therapy: preliminary results.
CyberPsychology and Behavior, 5, 95-105.
Crandall, M., Senturia, K., Sullivan, M., & Shiu-Thornton, S. (2005).
“No way out”: Russian speaking women’s experiences with domestic
violence. Journal of Interpersonal Violence, 20,
941-958.
Day, S X., &
Schneider, P. (2000). The subjective experiences of therapists in
face-to-
face,
video, and audio sessions. In J.W. Bloom & G R Waltz (Eds.),
Cybercounseling and Cyberlearning: Strategies and Resources for
the
Millennium
( pp. 203- 218). Alexandria, VA: American Counseling Association.
Egan,
G. (1998). The skilled helper: A problem-management approach to
helping. Pacific Grove, CA: Brooks/Cole.
Fenichel, M., Suler, J., Barak, A., Zelvin, E., Jones, G., Munro, K., et
al. (2002). Myths and realities of online clinical work.
CyberPsychology and Behavior, 5, 481-497.
Fennelly, K., & Palasz, N. (2003). English Language proficiency of
Immigrants and Refugees in the Twin Cities Metropolitan
Area. International Migration, 41, 93-125.
Ginsburg, I. (2002). Marital satisfaction, patterns and spousal
interaction, and individual ways of coping among Russian
Immigrants. Dissertation Abstract International, 65, 10-B.
Goldstein, E. (1984). “Homo Sovieticus” in transition: Psychoanalysis
and problems of social adjustment. Journal of the American
Academy of Psychoanalysis, 12, 115- 126.
Granello, P. (2000).
Historical context: the relationship of computer technologies and
counseling. In J.W. Bloom & G R Waltz (Eds.), Cybercounseling and
Cyberlearning: Strategies and Resources for the Millennium ( pp.
3-16).
Alexandria, VA: American Counseling Association.
Green,
T. (2004). Russian children and families. In R. Fong (Ed.),
Culturally Competent practice with immigrant and refugee
children and families (pp. 289-308). New York, NY: The Guilford
Press.
International
Society for Mental Health Online. (2000). Suggested principles for
the
online
provision of mental health services.
Retrieved March 25,
2006, from
http://www.ismho.org/suggestions.html
Kobak, K.A., Taylor, L.,Dottl, S.L., Greist, J.H., Jefferson, J. W.,
Burroughs, D., Mantle, J.M., Katzelnick, D.J., Norton, R., Henk,
H.J., & Serline, R.C. (1997). A computer-administered telephone
interview to identify mental disorders. Journal of the American
Medical Association, 278, 905-910.
Kovalski, T. M., & Horan, J. J. (1999). The effects of Internet based
cognitive restructuring on the irrational career beliefs of
adolescent girls. Journal of Cognitive Psychotherapy,
13, 142-152.
Lashenykh-Mumbauer, V. (2005). Difficulties of acculturation and coping
strategies of recent Non-Jewish Russian immigrant women in the
United States of America.
Dissertation
Abstracts International, 65, 11-B (UMI No. 3153761).
Lee, C. C. (2000).
Cybercounseling and empowerment: Bridging the digital divide. In J.
W.
Bloom & G. Walz. (Eds.), Cybercounseling and cyberlearning:
Strategies
and
resources for the millennium
(pp. 85-95).
Alexandria, VA: American
Counseling Association.
Love, J. S. (2000).
Cybercounselors v. Cyberpolice. . In J. W. Bloom & G. Walz. (Eds.),
Cybercounseling and cyberlearning: Strategies and resources for the
millennium
(pp. 339-360).
Alexandria, VA: American Counseling Association.
Mallen,
M. J., Vogel, D. L., Rochlen, A. B., & Day, S. X. (2005). Web
counseling: reviewing the literature from a counseling psychology
framework. The Counseling Psychologist, 33, 819-
871.
Manhal-Baugus, M.
(2000). E-Therapy: Practical, Ethical, and Legal Issues.
Augusta State
Univ. Ed Dept.
Retrieved March, 25, 2006, from
http://cybercounsel.uncg.edu/articals/etherapy.htm
McCrickard, M. P.,
& Butler, L. (2005). Cybercounseling: a new modality for counselor
training and practice. International Journal for the Advancement of
Counseling,
27,
101-110.
McFadden,
J., & Jencius, M. (2000). Using cyberspace to enhance counselors’
cultural transcendence. In J. W. Bloom & G. R. Walz (Eds.),
Cybercounseling and Cyberlearning: Strategies and resources
for the Millennium ( pp. 67-83). Alexandria, VA: American
Counseling Association.
Murphy, L. J., & Mitchell, D. L. (1988). When writing helps to heal:
E-mail as therapy. British Journal of Guidance and
Counseling, 26, 21-32.
National Board for certified Counselors. (1997). Standards for the
ethical practice of WebCounseling. Retrieved March
25, 2006, from
http://www.nbcc.org/ethics/wcstandards.htm
Norcross, J. C., Hedges, M. , & Prochaska, J. O. (2002). The face of
2010: A Delphi Poll on the Future of Psychotherapy. Professional
Psychology: Research and Practice, 33, 316-322.
Palesh, O., Salzman, K., & Koopman, C. (2004). Internet use and
attitudes towards illicit Internet use behavior in a sample of
Russian college students. CyberPsychology and
Behavior, 7, 553-558.
Robson, D., &
Robson, M. (2000). Ethical issues in Internet counseling. Counseling
Psychology
Quarterly, 13,
249-257.
Rodriguez,
M. A., Sheldon, W. R., Bauer, H. M., & Perez, E. J. (2001). The factors
associated with disclosure of intimate partner abuse to
clinicians. Journal of Family Practice, 50, 338-344.
Segal, U., & Mayadas, N. (2005). Assessment of Issues Facing Immigrant
and refugee. Families. Child Welfare, 34, 563-583.
Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in web
counseling: assessing current practices with an ethical intent
checklist. Journal of Counseling & Development, 84,
41-53.
Sohng, S., & Song, K. (2004). Korean children and families. In R. Fong
(Ed.), Culturally Competent Practice with Immigrants and
Refugee Children and Families (pp. 81- 99). New York, NY:
The Guilford Press.
Sue, D. W., & Sue, D. (1990). Counseling the culturally different:
Theory and practice. New York: Wiley.
Veatch, R. (1989). Medical ethics in the Soviet Union. The Hastings
Center Report, 19, 11-15.
Westwood, M. J., & Ishiyama, F. I. (1991). Challenges in counseling
immigrant clients: Understanding intercultural barriers to career
adjustment. Journal of Employment Counseling, 28,
130-143.
White, M., & Epston, D. (1998). Narrative means to therapeutic ends.
New York: Norton.
Yakushko, O. (2005). Mental health counseling in Ukraine. Journal of
Mental Health
Counseling, 27,
161-170.
Yost, A., & Lucas, M. (2002). Adjustment issues affecting employment for
immigrants from the former Soviet Union. Journal of Employment
Counseling, 39, 153-170.
Zunker, V. G. (2002). Career counseling: Applied concepts of life
planning. Pacific Grove, CA: Brooks/Cole.
Gulnora Hundley,
Doctoral Student, Department of Child, Family & Community Sciences,
College of Education, University of Central Florida.
Linda Robertson,
Doctoral Student, Department of Child, Family & Community Sciences,
College of Education, University of Central Florida; Correspondence
regarding this article should be sent to: Gulnora Hundley, P.O. BOX
140945, Orlando, FL 32814 E-mail:
gulz24@yahoo.com .
