Arlene Unger, Ph.D.

This week, Breakthrough provider and author, Arlene Unger, shares Part 2 of her series on internet counseling in the new millennium. This week she helps us understand the various therapeutic approaches that lend themselves naturally to video counseling.



Cognitive Behavioral Therapy (CBT)

Of the three therapies discussed in this section, Cognitive Behavioral Therapy (CBT) has been shown in more than 1,000 evidence-based studies to be the most effective in the long-term recovery of clients with anxiety, depression, obsessive-compulsive disorder and substance abuse issues.

CBT is predicated on the belief that the way we think, act and feel all work in conjunction with one another. Thus, our feelings can improve by changing what we are thinking and how we behave. When treating my online clients with CBT, I tune them into the unproductive thoughts and behaviors that are acting to maintain their problem.

One of my online clients couldn’t stop “what-ifing” in social settings. She had successfully convinced herself that something really bad would happen if she spoke up. Her catastrophic thoughts convinced her that she would look stupid and be mocked. These beliefs not only lowered her mood and esteem, but caused her to avoid social situations. I found that the use of online video along with the chat component (typing in a screen we both share online) helped this client not only identify her harmful behaviors/thoughts, but come up with “experiments” she could do that would challenge her beliefs, reduce her avoidant behaviors and increase her wellbeing.

During one of our video sessions, I asked her to watch herself in her own screen insert, as if she were addressing a group, while paying attention to her thoughts and movements. Video conferencing allowed both of us to witness her practicing and observe how her mood would change with each attempt. After a few trials, she was able to see the relationship between her physical symptoms, action, catastrophic thoughts and emotions.

With the use of online chat, she began to gradually replace her unhealthy ideas about public speaking with more adaptive attitudes.

Motivational Interviewing (MI)

MI is another type of behavioral counseling that lends itself well to online counseling because the client receives immediate feedback about their body language.  It is predicated on the idea that the client needs to first be comfortable in order to move through the stages of change. What better way to feel comfortable with an online therapist than in the safety and quiet of your own home?

The Harvard Mental Health Letter (along with many other publications) reported that MI has helped hundreds of people successfully conquer their addictive, depressive and stress related maladaptive behaviors.

Miller and Rollnick (1991) recognized that clients who need to make changes in their lives begin counseling at different levels of readiness.

In my work with one online client, I noticed that he wanted to take steps to change, but his compulsive hoarding behavior prevented him from moving forward. Using video chat helped us both see the kind of things he was holding onto that cluttered up his life and kept him feeling stuck.

I was able to ask him open-ended questions, provide affirmation and reflective listening as he watched his own mood shift in his screen insert. This helped him see that what he ultimately wanted in life was not supported by his daily activities.

One MI exercise that was very appropriate for video-chat was to ask him to reflect on a day in his life when he was doing the things that he really needed to do and compare that day to a present day. Since he was conferencing from his home, the client was able to show me things that he needed, and wanted, to complete, but hadn’t.

Helping him focus on the importance of change without judging him, gave the client the confidence to start looking forward with confidence and setting forth a realistic plan.

Emotional Brain Training (EBT)

Our zest for life can be easily hampered by how we process stress. Whether we want to believe it or not, stress can affect our basic lifestyle, both positively and negatively. It can sabotage our eating, sleeping, working, socializing and overall health; it can also motivate us to achieve more, do better, and think more clearly. Thankfully, our brains are complex and yet very malleable.

EBT (founded by Laurel Mellin, MA, RD) is very easy to deliver over the internet because it is a representational and solution focused training.  Video conferencing allows the client to see through their webcam how their release of feelings gradually leads their mind away from emotional chaos and towards greater balance. Video chat gives immediate feedback about client’s unrealistic expectations and to their receptivity to Mellin’s four basic neuroscience premises:

  1. My behavior now is the way my brain is “wired” now
  2. Wiring can trigger my joyful or stressful brain states
  3. Chronic stress keeps my brain state static as well as overloaded
  4. I can change my wiring and be joyful, grateful, secure and hopeful

A 30 year-old binge eater had lost her vibrancy and zest for life due to overeating. Video chat-based EBT not only helped give her a framework for working with all three parts of her neural circuitry: initial impulse to eat, as well as insight into her emotional and behavioral triggers.

By using the tools of self-acceptance and negative emotional ventilation she was able to turn off her drive to overeat 80% of the time after just a few sessions.

My next blog will demonstrate how I combine and use these techniques during video counseling. 

Dr. Unger, a licensed psychologist, has a busy private clinical practice in Dana Point, CA.  Arlene offers clients F2F and internet counseling/coaching. She lives with her spouse, Stefan Unger, Ph.D., Photographer/Web Designer of 34 years. They are blessed with 2 successful adult children and 2 grandchildren.  Arlene believes that no one gets through life unscathed and everyone from time to time needs a counselor/coach to help move toward positive change. Using a combination of neuroscience, mindfulness and CBT, Arlene has helped people with depressive, anxiety, anger, addiction, eating, pain, personal trauma and relationship issues. She is completing her second book on Mindfulness. Her first book is “Presence of Mind – Mindful Affirmations.”  Check out the scores of articles Arlene has authored listed on the Resources page on her website