Category Archives: International online counselling

Take a Punt on Online Support (Unedited version of article published in Therapy Today July 2014)

Working Online with Problem Gamblers

Hi, my name’s Jane Fahy and I’m the Clinical Services Manager for Gambling Therapy, a website that supports roughly sixteen thousand people around the world who either have a gambling problem or are close to someone who does. The work we do in Great Britain involves providing wrap around support for people accessing residential treatment in one of the Gordon Moody Association Residential Treatment Centres. We also educate and support their friends and families. Outside Great Britain we offer a range of services in different languages to supplement the face to face support provided by other agencies. We do this on our forums, in online groups, via e-mail or on our helpline.

The number of problem gamblers worldwide is hard to pin down for a variety of reasons that I won’t bore you with now….but generally speaking it’s accepted that between one and four percent of individuals that gamble have a gambling problem. Working with addictions is tough, ask any addiction specialist! On one hand your client wants to change, they’re desperate to, but on the other hand they are driven by a white hot desire to continue doing what they have always done. After all, it keeps them safe doesn’t it?

Some people struggle to understand how an addiction without the introduction of a foreign substance can hold an addict in its thrall in the same way as an addiction with the introduction of a substance. I mean I get it, why would you do something that cost every penny you had, destroyed your family and left you homeless unless you were high? So I suppose this leads us on to a discussion about what we mean by the term “high”, an altered state maybe….euphoria? Escape? All words I’ve encountered when working with problem gamblers.

How then is it that problem gamblers are unable to stop when they’re not actively gambling because surely the effects wear off quickly right? Wrong, the brain needs time to acclimate to working within a more “normal” range of stimulation, which can take a while! To put it in more simple terms, if you’d spent hours on a roller coaster and adjusted to such a high level of stimulation your head would spin for quite a while after you got off! So the cycle continues, the thoughts become more distorted and the gambler gambles until one day the cost is too high. That’s when I “meet” them 🙂

So how does it all work? Well, it’s kind of like a jigsaw puzzle that people coming to us for help put together themselves to form their own recovery picture. It’s a picture that changes depending on where someone is within their recovery and what they need on any given day. Accessing online services like ours means people can take a dynamic approach to their support and tailor their recovery so it’s personal to them. In practice that means that if the person accessing our site wants to talk to someone who’s “been there”, someone who’s bought the T-shirt they can do that. If people want to talk to a counsellor who can help them to explore the “whys” of their situation, they can do that too…kind of a pick and mix solution!

If we’re looking at the nuts and bolts of supporting problem gamblers online via an established website with a vibrant community, I guess we first need to look at online support in more general terms. What is it, and what is it our clients are getting from it? I view it in terms of the following categories:

  • Accessibility
  • Community
  • Anonymity
  • Flexibility

Accessibility – A client using online support can access that support at any time of the day or night irrespective of the time zone they’re in. Support can be accessed on a laptop, PC, Mac, on a tablet or even a phone. Effective and comforting assistance can be a coat pocket away!

Community – An online therapeutic community is a powerful entity. Many people who have accessed a support group talk about the feeling of acceptance that hit them like a wave when they walked into a room with others in similar situations. Now, imagine that room was a virtual room containing thousands of people from all over the world, all understanding at least part of your story, all wishing you well and offering you a hand across cyber space. Then that feeling of acceptance has the potential to turn into something altogether exceptional…maybe even overwhelming in its ability to wrap an individual up in a blanket of understanding.

Anonymity – As therapists we often hear clients talk about shame, the shame of an addiction, an experience or even a relationship. Part of the work we do is to break through that shame and allow our clients to express themselves freely through their experience of our unconditional positive regard. Understandably it can take our clients time to perceive our lack of judgement and feelings of warmth towards them which allows them to speak freely but what happens if they don’t have to look us in the eye? Kate Anthony, CEO at the Online Therapy Institute and Fellow of the BACP, refers to this as the online “disinhibition effect” a term initially coined by eminent psychologist J.Suler.  Anonymity allows clients to express themselves on a deeper level, perhaps more quickly than they would in a face to face setting and, if managed correctly by the therapist; this can lead to some very valuable work carried out over a relatively short period.

Flexibility – We all respond differently to different kinds of support and different people but sometimes it can be hard for us to be specific about what we need and what works for us. Without the need to maintain premises that can only be open at certain times, staffed by at least two people, usually more, when open for the sake of safety and often held back by physical constraints, online support is often more dynamic, lean and capable of rapid change than a land based practice. The range of services can be adjusted relatively quickly to meet the needs of those accessing them and feedback concerning what those needs are is often frank and forthcoming thanks to the aforementioned disinhibition effect. This means people accessing this form of support can choose from a wide range of help, some in real-time and some where the response is not immediate (as with forums), they can tailor to suit their personality and preference.

So we know why this kind of support works, but what specifically are the benefits and pitfalls of supporting problem gamblers in this way? Human beings are complex and problem gamblers are no exception, so when looking at how best to support them and deliver therapy we have to consider why they do what they do, what are they likely to respond to…most of all WHO ARE THEY?

I’ve come into contact with problem gamblers from all over the world who gamble on everything from poker to scratch cards…online or in a casino or betting shop…games that are legal or illegal…..alone or with others trapped in the same downward spiral. I guess the thing you need to know about problem gamblers is that there are no two the same. But what remains the same with all of them is the pain behind their actions. So, ok they’re all different but that doesn’t explain why supporting problem gamblers online works so well?

Well, let’s not beat around the bush, with addictions to substances there will be many occasions when the people accessing support won’t be in a coherent state, particularly if they’re in their home environments and early on in their recovery. Being coherent is something that’s a basic requirement when it comes to getting help online and, where no dual presentation exists; it’s something that people I’ve supported don’t generally struggle with.

Something that helps problem gamblers in recovery is the use of practical barriers. These can include handing over financial control to someone they trust, self excluding from land based venues or adding blocking software to a PC or mobile device. Many barriers involve the avoidance of triggers and one of the biggest triggers for many is walking past a bookies. For those of you reading this article from within the UK I’m sure you can imagine just how hard it would be in many of our towns and cities to plot a route somewhere that didn’t take you past a bookies? Whilst I don’t object to seeing bookies on our high streets, as I’m aware many people can, and do, enjoy gambling responsibly and recreationally, I have to feel for those that must feel they can’t escape from them. You don’t have to walk past a bookies, a casino, an arcade or a shop selling scratch cards to access help online so in a vulnerable moment the people we support relish the opportunity to connect and talk to us without taking that risk.

Of course it’s not possible to avoid all triggers, emotionally charged situations or vulnerable moments over an entire lifetime so in order to regain a sense of living a “normal” life in which avoiding triggers doesn’t play such a prominent part, problem gamblers may initially use online support as a safe and secure stepping stone back to the life they want. If we revisit the idea of the online therapeutic community that I mentioned earlier, the potential for the community as a whole to role model recovery and a return to normality is vast particularly for those who’ve completed residential treatment because leaving that bubble can be extremely daunting! The community also performs the very valuable function of acting as an ongoing safety net, always there if needed, never judging the individual in need.

Our virtual doors are open to male and female problem gamblers but something that I found surprising when I first started delivering online support was the number of women accessing the support when compared to men. I had wrongly assumed that problem gambling was a predominantly male concern…I guess I had an image of Del Trotter in my head standing outside the bookies clutching a betting slip and proclaiming “This time next year…” Needless to say, that’s not what I found and shame on me for making assumptions J Perhaps because of this common assumption women often hold off on accessing face to face counselling or group support but they seem more willing to engage with therapy online….maybe because they can choose whether or not to even disclose their gender at first. Maybe because they’re not walking into a room full of men, which they could be imaging will be the case, or maybe because they feel less judged online for being women who gamble for the reasons I’ve already mentioned. You might be surprised to learn that out of the 1868 most recent contacts, women made up roughly 46% of the people accessing the Gambling Therapy helpline or online groups.

Styles of gambling vary so much from country to country, as do attitudes towards gambling and the help available to problem gamblers. In countries such as the USA many people are used to getting support for a variety of reasons and help is readily available. However, in some other countries help might be limited and people in need of it may be being actively discouraged from seeking help outside of the family unit. Because we work in the way we do, with people from all over the world, we have to work in a truly transcultural way. We can’t know everything of cultural significance relating to every corner of the globe so we HAVE to work with the person on the other end of the screen without making any assumptions based on where they’re from. We find out everything we need to know about them, from them, and put the individual client at the centre of the process rather than being influenced, however subconsciously, by a cultural stereotype.

As with any personal development work it can be rewarding to reflect on our progress. Some use forums as a journal open for people with similar experiences to read and contribute to. Others use them to pose questions and support their peers. What is ALWAYS useful is to look back during vulnerable moments to see how far we’ve come.

So, that’s all from me, I’m sure you’ll agree that there is value in online support and see its potential particularly in terms of supporting problem gamblers. I hope you’ve enjoyed this small glimpse into our world. Thanks for reading 🙂 TTFN

 

Jane Fahy (MBACP)

jane@gamblingtherapy.org

Clinical Services Manager

Gambling Therapy, Part of the Gordon Moody Association

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