The increase in mobile device ownership and usage — primarily smartphones and tablets, in that order — has been remarkable for all segments and age groups of the U.S. population. The independent market research company eMarketer estimated that just under 2 billion people worldwide would own a smartphone by the end of 2015. Although tablet ownership and usage is generally lower than that for smartphones, the figures are still impressive. Worldwide and U.S. tablet sales for 2015 were estimated to reach 1 billion and 156 million, respectively, which represents a doubling of worldwide sales when compared with 2012 figures.

Among some other U.S. trends in mobile device usage and social networking as reported by various sources:

• Mobile device ownership and social media usage have increased for all age groups (Pew Research Center, 2015).
• Smartphones and tablets are used more than any other electronic device by children ages 4-14, prompting the toy division president of market research firm NPD to conclude that “technology devices are as much staples for American families as traditional toys” (NPD, 2014)
• Increased mobile device usage by children has prompted some schools to adopt hybrid learning BYOD (Bring Your Own Device) policies (Ed Tech, 2015).
• Almost one-third of adult smartphone owners say they couldn’t imagine living without their smartphone (Pew Research Center, 2014, 2015).
• Young people, “minorities” and those with lower socioeconomic status (SES) levels are likely to be “smartphone dependent” for Internet access (Pew Research Center, 2015).
• The highest rates of social networking were reported by young adults, African Americans and those with higher levels of SES and/or education (Pew Research Center, 2014, 2015).
• Approximately 51.5 percent of millennials in higher education settings report using their smartphones to monitor their personal health (Domo, 2015).

Incorporating mobile devices into counseling

Professional usage of mobile devices by counselors has not sufficiently reflected an awareness of or capitalized on the dramatic shifts in the ways in which large numbers of the U.S. population currently communicate, learn, socialize and obtain, manage and share information. Put differently, counseling, counselor education and wellness promotion strategies have not, for the most part, kept pace with the way that people currently live in and interact with their immediate and larger world. The benefits of actively integrating mobile devices into the teaching and practice of counseling are numerous. These benefits include:

• Portability
• Flexibility
• Effectiveness at embracing multiple learning styles and multiple “intelligences” because of the inherent kinesthetic, auditory and visual components of mobile devices
• Ability to be customized to match the developmental level, culture, etc., of the target group
• Range of standard accessibility features
• Effectiveness with a wide range of cohorts, not only “digital natives”
• Engaging and interactive nature
• Potential to enhance brain neuroplasticity and neurogenesis
• Ability to use a single device with an individual or group of clients/students
• The ever-increasing plethora of high-quality apps that are free or low cost, many of which can be used across same-system mobile devices

Put another way, an informed use of mobile devices in counseling, counselor education and wellness promotion can significantly increase the size, creativity and effectiveness of our intervention toolboxes. The importance of meeting our clients and students where they are should not be minimized.

Despite the multiple potential benefits of incorporating mobile devices into our work as counselors, there are some primary challenges regarding their use. These include:

• Reduced counselor experience, confidence and competence, as well as limited research on the use of technology (especially mobile devices) that might enhance our work as counselors
• The less robust nature of mobile devices compared with computer-based software applications
• The general “functional fixedness” of counselors
• Concerns regarding confidentiality
• Concerns that technology will depersonalize the counseling experience
• Privacy concerns
• The “digital divide”

Current project: Goals, genesis and focus

The goal of our current multiyear mobile device and app curation project is to explore ways in which iOS and Android mobile devices and related apps can be used to enhance counseling and therapy, counselor education, training and wellness promotion. Initial emphasis was on the iPad. The hope is that the results of the project will significantly streamline the app search process for counselors, human service and other allied health providers, counselor educators, trainers and counselor education students, and increase the ways and frequency in which mobile devices are purposively integrated into our work. We also hope project results might be useful to and accessed by laypeople to increase their overall well-being.

At the onset of the project in fall 2013, it was estimated that there were more than 1 million apps in Apple’s App Store, with approximately 500,000 of these apps developed specifically for the iPad. Identifying counseling and wellness-related uses of mobile devices and related apps proved to be an arduous and time-consuming process, even when the literature of related fields such as education, special education and communication was considered.

Because the initial project focus was on wellness promotion, an important early step was to identify a wellness model to provide the conceptual foundation for app exploration and selection. After reviewing a variety of models, we adopted the landmark multilayered Indivisible Self Model developed by Jane Myers and Thomas Sweeney (2004).

This Adlerian-compatible, holistic, three-tiered factor structural model includes the unified indivisible self, representing a person’s overall well-being, as its first factor. This is followed by five second-order factors: the creative self, the coping self, the social self, the essential self and the physical self. Finally, these second-order factors are composed of a combined total of 17 third-order factors. For example, the creative self is composed of the following five third-order factors: thinking, emotions, control, work and positive humor.

The current project enthusiastically adopted this model, with minor revisions, because of its evidence-based foundation, its holistic, broad-based definition of wellness and its contextual perspective.

In revisiting the Indivisible Self Model, however, it became clear that some adjustments were needed to reflect current counseling practice and literature. More specifically, this entailed a more inclusive definition of gender identity and the addition of brain health, sleep and sexual orientation as third-order factors. Finally, all third-order factors were further operationalized into a set of “fourth order” categories. Although these factors were not empirically identified, they provided a much-needed structural rubric for the project’s selection of counseling/wellness-enhancing apps and tablet-specific tools. Toward this end, we made every effort for the project to be guided by and to remain as true as possible to the writings and concepts put forth by the architects of the Indivisible Self Model, while simultaneously reflecting current practice and knowledge.

App selection process

It became clear at the outset that a structured four-stage discovery and vetting process was required to cull through the plethora of App Store apps and ultimately identify counseling/wellness-enhancing apps for inclusion in the project.

The first stage, Identification, consisted of app searches within counseling and related fields. The procedure entailed arduously culling through the App Store using related keywords, categories and leads obtained from our literature and online searches, monitoring “best new app” listings and exploring other apps offered by the developers of apps we had already identified as promising.

After an app was identified, the Discovery process began, which involved taking several factors into consideration before the potential app progressed to the next stage. Factors included app reviews and user ratings, App Store developer descriptions, price, file size, in-app purchasing, free version restrictions, user suitability ratings (e.g., age), whether the app was accessible on the iPhone, iPad or Apple Watch, the app’s version history and the developer’s attentiveness to required fixes. If these features were deemed to be satisfactory, the app was determined to be ready for further examination in the Analysis stage.

During the Analysis stage, surviving apps were subjected to more robust scrutiny, as we “checked under the hood and kicked the tires.” The apps’ user friendliness and intuitiveness came to be of utmost importance. Relevance and quality of fit with the Indivisible Self Model also came into play, as did the apps’ level of versatility, customizable options and value-added features such as trend analysis, syncing/interfacing with other devices, integrated cloud storage and note-taking/journaling elements. If the app was for children, the degree of available parental control became important, as did the inclusion of follow-up questions, activities, resources or tips for parents.

Exclusionary factors included apps that focused on self-diagnosis, hypnosis or “hookups”; were sexualized; contained an excessive amount of grammatical or spelling errors; appeared to be pushing an agenda or product; cost more than $10; or contained excessive in-app purchasing or excessively intrusive ads. At the end of this stage, we determined whether an app provided sufficient value to warrant downloading or purchasing it to be tested in the project’s fourth and final stage.

In the Selection stage, we test drove downloaded and purchased apps by using actual or hypothetical data to make an informed recommendation about each app’s inclusion or exclusion in the project. For example, we considered ease and reliability of operation, usage restrictions, customizability and information saving/syncing. In this final stage, we raised the bar to reassess each app’s relative value by conducting an informal cost-benefit analysis and determining the extent to which its concept, design, functionality and operation were unique in comparison with similar apps in its category.

The hundreds of hours spent identifying and vetting apps have thus far yielded more than 350 high-quality apps — and counting — that enhance counseling and wellness. It is important to note that the majority of apps that survived the rigorous four-stage evaluation process and ultimately received the project’s stamp of approval were originally developed for purposes unrelated to counseling. It quickly became apparent to us that it was important not to be dissuaded by an app’s stated or intended purpose. To be maximally effective, this necessitated holding any tendencies toward app-specific functional fixedness in check so that each app could be creatively evaluated through an objective and unbiased lens. Put differently, it was critical for the project investigators to deconstruct each potential app, peeling off the layers to highlight its bare-bones core components. This careful mining process was critical in revealing multiple gems.

Case vignette and app-related interventions 

To demonstrate how mobile devices and related apps can be utilized in many ways during the counseling process, consider “John,” a hypothetical case study created to demonstrate app-related counseling and wellness promotion interventions and their potential effectiveness.

John is a talented budding lawyer who is determined to become the youngest partner in his firm. He often heads to work early and leaves late, sacrificing quality sleep and nonwork-related social activities to achieve his goal. John presents to counseling with several areas of concern. Specifically, he states that his lack of “real friends,” absence of nonwork interests and neglect of his overall health and wellness have significantly contributed to his life feeling out of balance.

John says that he:

• Spends the majority of his time working at the office or at home
• Eats on the go, typically consuming fast food on a regular basis at his desk, picking up something on his way home from work or skipping meals entirely
• Has no time to exercise, although he has a gym located in his apartment building
• Consumes caffeine regularly to keep up with his job demands and increasingly consumes alcohol to help him relax
• Can’t recall the last time he had fun since moving to this area

John and several of his presenting concerns are good candidates for mobile/app-related interventions, particularly because he offers that he never leaves home without his smartphone and prides himself on being the most tech-savvy employee at his firm. Additionally, he consistently mentions his overall lack of time to address many of his highlighted areas of concern.

John acknowledges that he has neglected his health and put the rest of his life “on hold” in his pursuit of making partner and achieving career success. At several points, he also brings up his overall lack of discretionary time and his perceived inability to attend to his overall wellness. John agrees to give OWAVES (a free app for iPhone, iPad and Apple Watch) a try to evaluate, track and change his current habits.

In response to John’s specific requests for assistance in expanding his social world and interests, he is introduced to the Meetup app (a free app for iPhone, Apple Watch and Android). This app provides users with a community-based way to nurture existing interests, rekindle old passions and explore new locally based activities through its listing of various social and interest groups in the area. John is particularly drawn to this app because he has mentioned an old love of ballroom dancing, a desire to reconnect with this “community” and an increased willingness to meet new people outside of his work environment.

Additionally, John has expressed a wish to reduce his alcohol consumption and explore other ways of relaxing that are compatible with his busy lifestyle. For this, he downloads and agrees to experiment with several mindfulness strategies, especially those that don’t require a large time investment. He is especially drawn to the bite-size mindfulness practices of the Smiling Mind app (free for iPhone, iPad and Android).

John’s insights and positive outcomes

In response to the counselor’s request that John track his daily activities using OWAVES and make efforts to use Smiling Mind and Meetup over the next two weeks, John achieves some insights and realizes some positive outcomes. First, he recognizes that taking time for lunch and eating mindfully actually increases his productivity in the afternoons. He begins to increase his sleep, waking refreshed in the morning. This results in time for exercise before work, decreased stress and less perceived need to use alcohol as a relaxant.

After four weeks, John takes small daily breaks dedicated to relaxation strategies, often using one of the bite-size Smiling Mind meditations. In the process, he increases his alertness during the day, decreases his need for caffeine and frees up some evening hours for social activities. John also uses his newly available time in the evenings (due in part to his increased daytime work productivity) to begin testing the waters with the Meetup app, searching for local groups that pique his interest.

Special considerations 

This hypothetical case was designed to highlight the app selection and implementation processes and the potential impact of app-related counseling interventions. Additionally, our intention is to encourage counselors to take a “blended” approach to incorporating technology into their work.

The incorporation of technology in general, and mobile devices in particular, into our counseling practice does not have to be an all-or-nothing proposition. Such interventions can enhance and supplement — not necessarily replace — traditional counseling.

It is important to note that, first and foremost, John’s goals and fit for technology-incorporated counseling practice were considered. John was an ideal candidate for this type of intervention because of his age, presenting issues, comfort and access to technology, openness to its utilization and perceived lack of time to incorporate other strategies to improve his level of wellness.

App selection 101: Practical applications for counselors

Given the limited body of literature on the use of technology in general and mobile devices in particular in the counseling process, the following recommendations are offered to facilitate informed decision-making by counselors and other allied health providers when assessing the selection and incorporation of mobile devices and apps into their practice.

First and foremost, the provider should take into consideration the needs and goals of the client or student. As with any intervention, intentionality should be the driving force that guides the decision-making process. The app under consideration should be in the best interests of the client or student, taking into account his or her presenting issues and goals. Other factors such as developmental level, age suitability, cultural identification (broadly defined) and client degree of familiarity, experience and confidence in using technology should also be considered.

Although we live in a technological age that is constantly changing, the digital divide has become increasingly important. Client or student access to the considered app, as well as to the technology required to support use of the app, both inside and outside of the counseling session, are important factors that need to be considered. In addition, because confidentiality and privacy of the information generated within most apps cannot be guaranteed, this should be discussed prior to use. Any counselor who intends to utilize apps or other technology-related resources within the counseling process should strongly consider delineating such information in his or her informed consent.

Finally, counselors interested in integrating mobile devices, apps or other technologies into their work are advised to examine clients and students through the lens of their current stage in the counseling relationship and process. The Stages of Change Model (1994) developed by James Prochaska, John Norcross and Carlo DiClemente can also be useful in this regard. These factors may be critical in determining whether the individual will be responsive to and is appropriate for the technology-based intervention being considered.

We invite you to join our growing Twitter and Facebook communities
@Apps4Wellness, @Apps4Counseling and online at apps4counseling.com to access our App of the Month tweets and related online postings, which provide counseling/wellness-related usage ideas, app tips, case studies and sample products using the spotlighted app. We also encourage you to share with us your favorite counseling/therapy, training or wellness-enhancing apps or specific mobile device uses. Please be advised that by submitting your app or mobile device use recommendations, you are giving us permission to post your submitted information on one or all of the Apps4Counseling sites (Twitter/Facebook/website) in the way that it was submitted.

Finally, we invite you to contribute to our international research in this area by taking our brief survey at surveymonkey.com/s/N7339P6. Requests to receive project updates by email can be made at the end of the survey or by going to surveymonkey.com/r/2GFY8BZ. Alternatively, the survey or request for project updates can be accessed by scanning the QR codes on page 58 of the February issue of Counseling Today.

 

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Maxine L. Rawlins is a professor and coordinator of the Counseling Technology Center in the Department of Counselor Education at Bridgewater State University in Massachusetts. Contact her at mrawlins@bridgew.edu.

Elizabeth A. Hughes is a recent graduate from the CACREP-accredited mental health counseling program at Bridgewater State University. She is currently working as a mental health clinician.

Letters to the editor: ct@counseling.org