Journal of Indigenous Counseling Psychology(本土諮商心理學學刊), 15(2) (Chinese and English bilingual journal) Special Issue(本期專題): Telecounseling(通訊心理諮商)

Abstract

This issue is titled Telecounseling, which is discussing related issues. Taiwan is
world-famous for developing computer technology. In recent years, it has attracted much attention for its advanced semiconductor and Artificial Intelligence manufacturing technology, which the government has actively encouraged and supported. Although Taiwan has made significant progress in manufacturing computer hardware, there has been no corresponding
progress in software applications. The failure of government policies and regulations to adjust
with time may be one of the critical factors. These negative impacts are also quite evident in the development of Telecounseling. The articles in this Special Issue discuss the issues mentioned above in depth and suggest possible perspectives on the ethical and cultural issues involved. These perspectives may serve as a reference for the development of Telecounseling worldwide.

Full text

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第十五卷第二期 Vol.15, No.2
2024 年6月 Jun, 2024
國際標準期刊碼
ISSN: 2518-9921(On-line)
3006-4937(Print)
本期專題：通訊心理諮商
Special Issue: Telecounseling
中文-英文雙語期刊 Chinese-English Bilingual Journal

i
2024 年6月 學刊 第十五卷第二期
出 版 者：國立彰化師範大學輔導與諮商學系本土諮商心理學研究發展中心、台灣心理諮商資訊網、
世界本土諮商心理學推動聯盟
主 編：王智弘（彰化師範大學輔導與諮商學系）
嚴嘉琪（台中科技大學應用英語系）
夏允中（高雄師範大學諮商心理與復健諮商研究所）
編輯委員：（依姓氏筆劃序）
山谷敬三郎（日本北翔大學）
孔 燕（中國科學技術大學）
王沂釗（東華大學諮商與臨床心理學系）
王敏行（彰化師範大學復健諮商研究所）
王翊涵（彰化師範大學輔導與諮商學系）
氏家靖浩（日本仙台大學健康福祉學科）
白倩如（彰化師範大學輔導與諮商學系）
石隈利紀（東京成德大學學校心理學研究室）
吉沅洪（日本立命館大學綜合心理學部）
江光榮（華中師範大學心理學院）
安 芹（北京理工大學人文與社會科學學院）
芳川玲子（日本東海大學文化社會學部心理社會學科）
何少穎（福州大學應用心理學系）
吳明富（彰化師範大學輔導與諮商學系）
李玉嬋（臺北護理健康大學生死與健康心理諮商系）
李佳儒（新生醫護管理專科學校幼兒保育科）
李孟峰（華僑大學廈門校區心理文化學研究所）
李岳庭（臺南大學諮商與輔導學系）
李思賢（臺灣師範大學健康促進與衛生教育學系）
李維倫（政治大學哲學系）
谷建岭（四川大學社會學與心理學系）
卓紋君（高雄師範大學諮商心理與復健諮商研究所）
周文玫（University of Mary Hardin-Baylor）
周德慧（香港樹仁大學輔導及心理學系）
岡田守弘（東京醫療學院大學保健醫療學部）
岳曉東（北京首都師範大學心理學院）
林妙容（
暨南國際大學諮商心理與人力資源發展學系
）
林美芳（閩南師範大學教育科學學院心理系）
林俊德（臺中科技大學通識教育中心）
林梅鳳（成功大學醫學院護理學系）
林淑君（彰化師範大學輔導與諮商學系）
林淑華（彰化師範大學輔導與諮商學系）
林朝誠（臺灣大學醫學院精神科）
金樹人（臺灣師範大學教育心理與輔導學系）
姚 斌（西安交通大學心理健康教育與諮詢中心）
施達明（澳門大學教育學院）
施 鋼（中國農業大學心理素質教育中心）
柯志鴻（高雄醫學大學醫學系）
洪莉竹（臺北教育大學心理與諮商學系）
洪瑞斌（中國文化大學心理輔導學系）
胡中宜（臺北大學社會工作學系）
家近早苗（東京福祉大學）
孫頌賢（臺北教育大學心理與諮商學系）
孫繼光（彰化師範大學輔導與諮商學系）
翁開誠（輔仁大學心理學系）
馬喜亭（北京航空航太大學）
高淑清（嘉義大學輔導與諮商學系）
符 瑋（香港樹仁大學輔導及心理學系）
莊登閔（台灣師範大學社會工作研究所）
莊勝發（高雄醫學大學心理學系）
莊謹鳳（暨南國際大學原住民文化產業與社會工作學程）
許明珠（臺中科技大學通識教育中心）
許維素（臺灣師範大學教育心理與輔導學系）
連 榕（福建師範大學心理學院）
陳如湘（馬來西亞工藝大學輔導與諮商學系）
陳尚綾（彰化師範大學輔導與諮商學系）
陳易芬（臺中教育大學諮商與應用心理學系）
陳秉華（臺灣師範大學教育心理與輔導學系）
陳秋燕（西南民族大學應用心理學系）
陳美伊（彰化師範大學復健諮商研究所）
陳雪均（彰化師範大學輔導與諮商學系）
陳 復（東華大學通識教育中心）
陳斐娟（雲林科技大學技職教育研究所）
陳增堂（上海高校心理諮詢協會）
張勻銘（閩南師範大學教育科學學院心理學系）
張家群（美和科技大學社會工作學系）
張素惠（亞洲大學心理系）
張高賓（嘉義大學輔導與諮商學系）
張泰銓（彰化師範大學輔導與諮商學系）
張淑美（高雄師範大學教育學系）
張景然（彰化師範大學輔導與諮商學系）
張偉良（香港樹仁大學輔導及心理學系）
張德聰（政治大學教育學系）
張蘭石（閩南師範大學心理學系）
喬志宏（北京師範大學心理學部）
曾貝露（高雄師範大學教育學系）
程雅妤（西螺高級農工職業學校輔導室）
越建東（中山大學哲學研究所）
黃光國（臺灣大學心理學系）
黃宗堅（彰化師範大學輔導與諮商學系）
黃聖桂（東海大學社會工作學系）
楊明磊（淡江大學教育心理與諮商研究所）
楊 蓓
（法鼓文理學院人文社會學群生命教育課程）
葉光輝（臺灣大學心理學系）
葉怡伶（彰化師範大學輔導與諮商學系）
趙安安（中原大學心理學系）
鳳 華（彰化師範大學復健諮商研究所）
劉淑慧（彰化師範大學輔導與諮商學系）
劉嘉逸（長庚大學醫學系）
歐陽文貞（衛生福利部嘉南療養院高年精神科）
蔡素妙（銘傳大學諮商與工商心理學系）
鄧志平（彰化師範大學輔導與諮商學系）

ii
蕭宜綾（Department of Leadership, Technology, &
Workforce Development, Valdosta State
University）
盧怡任（陽明交通大學諮商中心、教育研究所）
駱芳美（School of Criminal Justice and Social
Sciences, Tiffin University）
謝文宜（實踐大學家庭研究與兒童發展學系）
謝麗紅（彰化師範大學輔導與諮商學系）
鍾 年（武漢大學哲學學院心理學系）
鍾 杰（北京大學心理與認知科學學院臨床與健康心
理學系）
鍾燕宜（中台科技大學文教事業經營研究所）
韓布新（中國科學院心理研究所）
韓楷檉（臺中教育大學諮商與應用心理學系）
簡晉龍（高雄醫學大學心理學系）
顏文娟（中山醫學大學護理學系）
羅家玲（彰化師範大學輔導與諮商學系）
審查委員：（依姓氏筆劃序）
林淑華（彰化師範大學輔導與諮商學系）
姚玉紅（同濟大學心理健康教育與諮詢中心）
姜兆眉 (台灣師範大學教育心理與輔導學系)
夏允中（高雄師範大學諮商心理與復健諮商研究所）
張雨霖 (台灣師範大學教育心理與輔導學系)
張淑美（高雄師範大學教育學系）
陳易芬 (臺中教育大學諮商與應用心理學系)
喬 虹 (台灣師範大學教育心理與輔導學系)
游淑瑜 (台北市立大學心理與諮商學系)
翟宗悌 (台南大學諮商與輔導學系)
劉威德（雲林科技大學技職教育研究所）
謝文宜 (實踐大學家庭研究與兒童發展學系)
韓布新（中國科學院心理研究所）
編輯助理：
朱時語（彰化師範大學輔導與諮商學系）
吳思言（彰化師範大學輔導與諮商學系）
周采華（彰化師範大學輔導與諮商學系）
鄭景文（彰化師範大學輔導與諮商學系）
封面畫作介紹：
作者：蔡錫和
素材：水彩
尺寸：16 開
題目：心靈故鄉
創作理念：藝術其實是治療人生無常的美好良方，
我在畫中呈現同中有異的視覺變化效果，增添觀
賞者的欣賞樂趣與想像空間，也呈現寫意繪畫多
元豐富的面貌及新感受……，三根電線桿代表光
明、希望、溫暖，現在、過去、未來……永無止境
編輯說明：
一、 本學刊創刊於 2009 年，原名台灣心理諮商季刊，2017 年更名為本土諮商心理學學刊，採電子形式出刊。2018 年曾
停刊一年，2019 年繼續出刊。稿件刊登順序，依審查完成日期排列。
二、 本學刊聯絡方式─地址：彰化市進德路 1號，國立彰化師範大學輔導與諮商學系轉「本土諮商心理學學刊」編輯委
員會；電話：04-7232105#2220/2208；電子信箱：jicpheart@gmail.com

iii
Jun, 2024 Journal of Indigenous Counseling Psychology Vol. 15, No. 2
Publisher: Center for Indigenous Counseling Psychology, Department of Guidance and Co
unseling,
National Changhua University of Education /Taiwan Counseling Net /
World Indigenous
Counseling Psychology Alliance
Editor in Chief: Wang, Chih-Hung (National Changhua University of Education)
Yan, Jia-Chyi (National Taichung University of Science and Technoly)
Shiah, Yung-Jong (National Kaohsiung Normal University)
Board of Editors
:
An, Qin (Beijing Institute of Technology)
Chang, Chia-Chun (Meiho University)
Chang, Ching-Jan (National Changhua University of Education)
Chang, Kao-Pin (National Chiayi University)
Chang, Nam-Sat (National Dong Hwa University)
Chang, Shu-Mei (National Kaohsiung Normal University)
Chang, Su-Hui (Asia University)
Chang, Te-Chung (National Chengchi University)
Chang, Thai-Tsuan (National Changhua University of Education)
Chang, Yun-Ming (Minnan Normal University)
Chao, An-An (Chung Yuan Christian University)
Chen, Fei-Chuan (National Yunlin University of Science and
Technology)
Chen, Fu (National Dong Hwa University)
Chen, Mei-I (National Changhua University of Education)
Chen, Ping-Hwa (National Taiwan Normal University)
Chen, Qiu-Yan (Southwest Minzu University)
Chen, Shang-Ling (National Changhua University of Education)
Chen, Viola Hsueh-Chun (National Changhua University of
Education)
Chen, Yih-Fen (National Taichung University of Education)
Chen, Zeng-Tang (Shanghai Psychological Counseling
Association of Higher Learning)
Cheng, Ya-Yu (National Siluo Agricultural Industrial High School)
Cheung, Raysen (Hong Kong Shue Yan University)
Chien, Chin-Lung (Kaohsiung Medical University)
Cho, Wen-Chun (National Kaohsiung Normal University)
Chou, Wen-Mei (University of Mary Hardin-Baylor)
Chuang, Deng-Min (National Taiwan Normal University)
Chuang, Sheng-Fa (Kaohsiung Medical University)
Chung, Yen-Yi (Central Taiwan University of Science and
Technology)
Deng, Chi-Ping (National Changhua University of Education)
Feng, Hua (National Changhua University of Education)
Fu, Wai (Hong Kong Shue Yan University)
Gu, Jian-Ling (Sichuan University)
Han, Bu-Xin (Chinese Academy of Sciences)
Han, Kai-Cheng (National Taichung University of Education)
He, Shao-Ying (Fuzhou University)
Hsiao, E-Ling (Valdosta State University)
Hsieh, Lih-Horng (National Changhua University of Education)
Hsu, Ming Chu (National Taichung University of Science and
Technology)
Hsu, Wei-Su (National Taiwan Normal University)
Hu, Chung-Yi (National Taipei University)
Huang, Shen-Kuei (Tunghai University)
Huang, Tsung-Chain (National Changhua University of
Education)
Hung, Jui-Ping (Chinese Culture University)
Hung, Li-Chu (National Taipei University of Education)
Hwang, Kwang-Kuo (National Taiwan University)
Ishikuma, Toshinori (Tokyo Seitoku University)
Ji, Yuan-Hong (Ritsumeikan University)
Jiang, Guang-Rong (Central China Normal University)
Jin, Shuh-Ren (National Taiwan Normal University)
Kao, Shu-Ching (National Chiayi University)
Ko, Chih-Hung (Kaohsiung Medical University)
Kong, Yan (University of Science and Technology of China)
Law, Fang-Mei (Tiffin University)
Lee, Szu-Hsien (National Taiwan Normal University)
Lee, Wei-Lun (National Chengchi University)
Lee, Yueh-Ting (National University of Tainan)
Li, Jia-Ru
(Hsin Sheng Junior College of Medical Care and
Management)
Li, Meng-Feng (Huaqiao University)
Li, Yu-Chan (National Taipei University of Nursing and Health
Sciences)
Lian, Rong (Fujian Normal University)
Lin, Chao-Cheng (National Taiwan University)
Lin, Jiun-De (National Taichung University of Science and
Technology)
Lin, Mei-Fang (Minnan Normal University)
Lin, Mei-Feng (National Cheng Kung University)
Lin, Miao-Jung (National Chi Nan University)
Lin, Shu-Chun (National Changhua University of Education)
Lin, Shu-Hua (National Changhua University of Education)

iv
Liu, Chia-Yih (Chang Gung University)
Liu, Shu-Hui (National Changhua University of Education)
Lu, Yi-Jen (National Yang Ming Chiao Tung University)
Luo, Jia-Ling (National Changhua University of Education)
Ma, Xi-Ting (Beihang University)
Okada, Morihiro (University of Tokyo Health Science)
Ouyang, Wen-Chen (Jianan Psychiatric Center)
Pai, Chien-Ju (National Changhua University of Education)
Qiao, Zhi-Hong (Beijing Normal University)
Sanae, Iechika (Tokyo University of Social Welfare)
Shi, Gang (China Agricultural University)
Shieh, Wen-Yi (Shih Chien University)
Sun, Chi-Kuang (National Changhua University of Education)
Sun, Sung-Hsien (National Taipei University of Education)
Sze, Tat-Ming (University of Macau)
Tan, Joo-Siang (Universiti Teknologi Malaysia)
Tsai, Su-Miao (Ming Chuan University)
Tseng, Lucia (National Kaohsiung Normal University)
Wang, Ming-Hung (National Changhua University of Education)
Wang, Yi-Chao (National Dong Hwa University)
Wang, Yi-Han (National Changhua University of Education)
Wu, Ming-Fu (National Changhua University of Education)
Wong, Kai-Cheng (Fu Jen Catholic University)
Yamaya, Keizaburo (Hokusho University)
Yang, Pei (Dharma Drum Institute of Liberal Arts)
Yang, Ming-Lei (Tamkang Univeresity)
Yao, Bin (Xi’an Jiaotong University)
Yasuhiro, Ujiie (Sendai University)
Yeh, Kuang-Hui (National Taiwan University)
Yeh, Yi-Ling (National Changhua University of Education)
Yen, Wen-Jiuan (Chung Shan Medical University)
Yit, Kin-Tung (National Sun Yat-sen University)
Yoshikawa, Reiko (Tokai University)
Yueh, Xiao-Dong (Capital Normal University)
Zhong, Jie (Peking University)
Zhong, Nian (Wuhan University)
Zhou, De-Hui (Hong Kong Shue Yan University)
Reviewers
:
Chang, Shu-Mei (National Kaohsiung Normal University)
Chang, Yu-Lin (National Taiwan Normal University)
Chen, Yih-Fen (National Taichung University of Education)
Chiang, Chao-Mei (National Taiwan Normal University)
Chiao, Hung (National Taiwan Normal University)
Han, Bu-Xin (Chinese Academy of Sciences)
Jhai, Zong-Ti (National University of Tainan)
Lin, Shu-Hua (National Changhua University of Education)
Liu, Wei-Te (National Yunlin University of Science & Technology)
Shiah, Yung-Jong (National Kaohsiung Normal University)
Shieh, Wen-Yi (Shih Chien University)
Yao, Yu-Hong (Tongji University)
You, Shu-Yu (University of Taipei)
Editorial Assistant:
Cheng, Gin-Wen (National Changhua University of Education)
Chou, Tsai-Hua (National Changhua University of Education)
Wu, Szu-Yen (National Changhua University of Education)
Zhu, Shi-Yu (National Changhua University of Education)
Introduction to the cover painting:
Author: Xi-He Cai
Material: watercolor
Size: A4
Title: Spiritual Hometown
Creative philosophy: Art is a beautiful remedy for
the impermanence of life. In the painting, I present
the effect of similar but different visual changes,
increasing the viewer's enjoyment and imagination.
It also presents the diverse, rich appearance and
new feelings of freehand painting. The three utility
poles represent brightness, hope, warmth, present,
past, future... endless
1. The journal was founded in 2009, formerly known as Taiwan Counseling Quarterly, 2017, changed its name to Journal
of Indigenous Counseling Psychology. It’s an online form. Each article is published in the order of date when the
manuscript was reviewed and accepted.
2. Contact us: Editorial Board of Journal of Indigenous Counseling Psychology, Department of Guidance & Counseling,
National Changhua University of Education. *Address: No. 1, Jin-De Road, Changhua City, Taiwan. R.O.C. Tel: 04-
7232105#2208 Website: jicp.heart.net.tw E-mail: jicpheart@gmail.com

v
15-2 目錄 （Content）
主編的話（From Editor in Chief）
GPT4o 可能成為諮商師嗎？通訊心理諮商的實務、法律與倫理考量（Could GPT4o
Potentially Become a Counselor? Practical, Legal and Ethical Considerations for
Telecounseling）
王智弘* 嚴嘉琪 夏允中（Chih-Hung Wang* Jia-Chyi Yan Yung-Jong Shiah）vi
通訊諮商實務的挑戰與建議：以實徵研究之回顧為基礎（Challenges and Suggestions for
Telecounseling Practice: Based on a Review of Empirical Research）
洪雅鳳（Ya-Feng Hung）1
臺灣通訊心理諮商審查的爭議、影響與解決（Telecounseling Censorship in Taiwan:
Controversies, Impacts and Resolutions）
林家興 林烝增
（
Chia-Hsin Lin Cheng-Tseng Lin）48
他山之石，可以攻玉：借鏡美國通訊心理服務規範（Using the Stone from the Other
Mountain to Polish Jade: Learning from Guidelines of American Telepsychology Services）
喬虹
（
Hung Chiao）88

vi
GPT4o 可能成為諮商師嗎 通訊心理諮商的實務 法律與倫理考量
王智弘* 嚴嘉琪 夏允中
摘要
科技發展的腳步越來越快，摩爾定律進入埃米時代，對話式人工智慧推出了 GPT-
4o 產品，應用科技來提供心理諮商與心理治療服務幾乎是一個不可抵擋的趨勢，不但延
伸了心理諮商服務的距離，也提供了更多元的服務型態與方式，在新冠疫情盛行時，通
訊心理諮商更是提供了絕佳的機會讓心理專業服務不間斷，道德經有云：「禍兮福之所
倚，福兮禍之所伏」，挑戰與機會、機會與挑戰常常是並存的，通訊心理諮商帶來創意
與便利，也同時會帶來技術、法律、倫理與文化層面的議題，本期以通訊心理諮商為題，
即在探討相關的議題，台灣以電腦科技發展聞名於世，近年來更以半導體與人工智慧的
先進製造技術深受矚目，更受到政府積極的鼓勵與支持，雖然在電腦科技的硬體製造上
如此進步，可是台灣在軟體應用上卻未有相對的進展，政府的政策與法規未能與時調整
可能是重要因素之一，此等負面影響在通訊心理諮商的發展上也相當明顯，本期文章針
對上述的議題有深入的探討，並針對其中涉及的倫理與文化議題提出可能的思考觀點，
或可作為通訊心理諮商在全球各地發展的借鏡與參考。本刊自第十五卷開始（2024 年3
月）已正式推出中、英雙語全文刊登版，無論來稿為中文稿件或是英文稿件，審查完成
刊登時都將以雙語全文刊登，此舉雖然編審費時，但出刊後獲得國內外學術界相當正面
的迴響，為繼續推動本刊的國際化，本刊自第十五卷第二期開始（2024 年6月），正式
邀請具有豐富國際發表經驗的本土化研究學者夏允中教授加入主編的行列，夏主編為英
國愛丁堡大學心理學博士，現任國立高雄師範大學諮商心理與復健諮商系教授，也是中
華本土社會科學會的理事長，曾擔任中華輔導與諮商學報的副主編與多次擔任 Frontiers
in Psychology 的專刊主編，本刊感謝夏主編的加入。期待本刊的嘗試與努力對亞洲與全
世界的本土社會科學、本土心理學以及本土諮商心理學能發揮具體的貢獻。
關鍵詞：通訊心理諮商、網路諮商、本土社會科學、本土心理學、本土諮商心理學
王智弘*
嚴嘉琪
夏允中
彰化師範大學輔導與諮商學系（ethicgm@gmail.com）
台中科技大學應用英語學系
高雄師範大學諮商心理與復健諮商研究所
2024 15 2 vi-xxxvii

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壹、台灣通訊心理諮商的發展脈絡
科技發展的腳步越來越快，半導體發展的摩爾定律進入埃米時代（黃佩君，2021），
人工智慧（Artificial Intelligence, AI）的研發成果更推動了科技應用的發展速度，應用科
技來提供心理諮商與心理治療服務幾乎是一個不可抵擋的趨勢，本文試以 2010 年為分
界點，探討通訊心理諮商在台灣的早期發展（王智弘，2019，2022）：早在 1996 年起
台灣已有網路諮商服務的提供，比如張老師基金會的「高雄張老師」中心在中山大學 BBS
站美麗之島（Formosa）推出「張老師與您談心板面」與 E-mail 網路諮商服務（彭武德，
1997），同時「心靈園地」網站也提供「心靈診所」網路諮商駐診服務； 1998 年2月
張老師基金會舉辦了台灣首次的「網路諮商工作研討會」，本文第一作者因被邀請主講：
「網路諮商的倫理議題」，進而踏入網路諮商的研究與實務領域，而於 1998 年 9 月 3
日創建了「台灣心理諮商資訊網」（www.heart.net.tw）網站群，並於 2000 年起在彰化
師範大學輔導與諮商學系開設網路諮商的大學部與研究所課程；「心靈園地」駐診專家
則在 2003 年成立以研究網路心理健康服務為宗旨的「台灣心靈健康資訊協會」，台灣
第一本網路諮商的專書也於 2009 年出版（王智弘，2009）。
回顧此一時期重要的網路諮商服務發展案例，包括（王智弘，2019）：在民間機構
方面，比如「台北生命線」推出了電子郵件的網路諮商服務（阮文瑞，1998），「台北
張老師」在 2001 年推出了網路聊天室的即時網路諮商服務，「華人心理治療研究發展
基金會」也在 2008 年推出「心療在線」線上諮詢收費服務（戴淑芳，2008）；在學校
機構方面，陸續透過建置輔導相關網站以提供網路諮商服務的學校包括：國立中山大學、
國立中央大學、國立陽明大學、嘉南藥理科技大壆、淡江大學、國立屏東教育大學等大
學，中小學部分則有如雲林縣輔導工作輔導團的網路諮商向日葵計劃等，都是開風氣之
先的校園網路諮商服務（王智弘，2009）；在政府部門方面，最早是 1999 年教育部委託
國立彰化師範大學社區心理諮商及潛能發展中心建置的「921 災後輔導與諮商資訊網」，
2003 年 SARS（Severe Acute Respiratory Syndrome，嚴重急性呼吸道症候群）疫情期間，
教育部委託中國輔導學會的「校園危機處理與 SARS 心理輔導諮詢網」，以及行政院衛
生署（衛生福利部的前身）委託中華心理衛生協會建置的「社區心理衛生危機處理與
SARS 心理健康諮詢網」，行政院人事行政局（行政院人事行政總處的前身）則於 2006
年建置的「公務人員網路諮商服務網」，行政院海巡署（海洋委員會的前身）建置的「溫
老師諮商園地」的網路諮商服務（王智弘，2006），而國防部在 2008 年亦為軍士官兵
架設了「國軍網路諮商服務網」（李耀杉，2008）以及教育部委託國立彰化師範大學建
置的「中輟復學輔導線上專家諮詢系統」（王智弘，2009），衛生福利部（以下稱衛福
部）國民健康署 2010 亦曾委託八里療養院建置「祕密花園青少年視訊諮詢網」以提供
青少年兩性教育相關諮詢服務，科技部（國科會前身）中部科學園區管理局 2010 亦曾

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委託台灣輔導與諮商學會建置「中科園區員工協助中心」網站，以提供中科進駐廠商的
員工協助方案網路諮商服務。
為探討早期網路諮商的整體發展狀況，就2007年全國性的網路諮商服務調查研究所
得，發現在全國 300 個網路諮商服務網站中（王智弘等，2008）：80.3%有提供輔導資
訊網頁型態服務；70.2%有提供 E-mail 型態服務；52.2%有提供留言版型態服務；29.8%
有提供討論區型態服務；12.9%有提供 BBS 型態服務；9.6%有提供聊天室型態服務；
4.5%有提供即時視訊型態服務；3.4%有提供線上測驗與評量型態服務；2.8%有提供網路
電話型態服務。可見不同型態的網路諮商服務皆在發展中。
通訊心理諮商的應用與發展在面對重大災害時確實是非常重要的助人資源，在天災
部分，除了前述的「921 災後輔導與諮商資訊網」之外，「八八水災心理健康資訊網」、
「八仙塵爆心理健康資訊網」、「26震災心理健康資訊網」等都發揮了救災的功能；而
在疫情部分，SARS期間的「SARS 心理健康資訊網」、「校園危機處理與 SARS 心理
輔導諮詢網」、「社區心理衛生危機處理與 SARS 心理健康諮詢網」所累積的經驗更是
在COVID-19期間發揮更大的防疫功能，比如2021年5月30日到6月30日之一個月期間，
諮商心理師公會全國聯合會發起「心宅配、心生活」網路心理間健康服務，贏得台灣民
眾的廣大迴響（羅綺，2021），但可惜的是，由於衛福部的政策限制造成當時能通過申
請而提供通訊心理諮商的心理師執業機構少之又少，造成政府政策與民眾需求的極大落
差，衛福部的法規立場引發學界與民間質疑的聲浪（林韋萱，2021）。
貳、台灣通訊心理諮商的法規爭議
台灣網路諮商的發展是從實務界開始，然後諮商教育界繼之開設網路諮商課程，學
界再進一步進行網路諮商研究，學會也在 2001 制訂了規範網路諮商的倫理守則條文，
無奈萬事俱備卻只欠東風：醫療政策卻不允許（王智弘，2019）。2017 年間並發生「心
療在線」線上諮詢收費服務被台北市衛生局要求停止的事件，引發各界的議論（林家興，
2018），此等台灣醫療政策對網路諮商的法規限制爭議，亦即林家興、林烝增（2024）
在本期「臺灣通訊心理諮商審查的爭議、影響與解決」一文中所指出：衛福部於 2016 年
9月1日發布規定心理師不得執行網路諮商之函釋，主張「…查心理師法並未准許心理
師得利用網路方式進行心理師業務，自不得任意為之」，是對心理師法的不當解釋，而
禁止心理師執行網路諮商服務，亦明顯損害民眾接受網路諮商服務之權益，因而有違法
違憲之疑慮。
相較美國與日本等國已合法實行網路諮商服務多年，雖在有關跨國通訊心理諮商所
涉及的法律管轄權議題上是仍有待處理的法律問題外，在其國內的執照制度下實施通訊

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心理諮商，被視為心理師的合法業務範圍，惟台灣主管醫療與諮商業務的衛福部卻以違
法視之（國家發展委員會，2017），其中關鍵在衛福部狹義解釋醫師執業「應在所在地
主關機構核准登記之醫療機構、長期照顧服務機構、精神復健機構或其他經中央主管機
關認可之機構為之」的規定（醫師法，2022）與心理師執業「以一處為限，並應在所在
地直轄市、縣（市）主管機構核准登記之醫療機構、心理治療所、心理諮商所或其他經
主管機關認可之機構為之」的規定（心理師法，2020），因此，衛福部一直限制醫師與
心理師對民眾的遠距醫療服務，此等政策一直引發爭論，加上 2017 年間發生的「心療
在線」被迫停止服務事件，民意更加沸騰，因而促成行政院數位政務委員唐鳳結合國家
發展委員會法制協調中心、資策會科技法律研究所與網路各界所建立的 vTaiwan.tw 數
位經濟法規線上諮詢平台，通過「醫師、心理師透過網路平台提供服務」的提案，並於
2017 年10 月 26 日於行政院召開討論會議，本文第一作者亦應邀在會中進行「網路在
台灣助人專業的應用回顧」之報告（王智弘，2017b），會議結論確認線上診療與線上諮
商的可行性與必要性，在經過 vTaiwan.tw 數位經濟法規線上諮詢平台持續推動下，衛
福部先於 2018 年 5 月 11 日公告《通訊診療辦法》，復於 2019 年 11 月 29 日公告《心
理師執行通訊心理諮商業務核準作業參考原則》，通訊心理諮商在台灣方被政府認可而
納入心理師的業務範圍（王智弘，2019），實施一年後，衛福部於 2020 年7月29 日重
新修正公布，但 2020 修正的版本卻更為嚴格，要求非醫療機構執行通訊心理諮商業務
應與醫療機構簽訂轉介合作計畫，還限制不能服務未當事人，精神官能症、精神病或腦
部心智功能不全患者等。林家興、林烝增（2024）認為衛福部在無法律授權下，還訂頒
比通訊診療辦法還要嚴格的通訊心理諮商規範，有違反法律授權和法律比例原則，並且
涉及不當限制心理師執業與民眾求助福祉的問題。此等法規限制的爭議問題其實在台灣
尚未被妥善解決。
參、台灣通訊心理諮商的實務與倫理議題
台灣實施通訊心理諮商除了要面對法規限制的爭議之外，也涉及實務運作與倫理考
慮的議題，美國全國合格諮商師委員會（National Board for Certified Counselor ［NBCC］）
於1998 年即提出網路諮商實務的倫理標準（Standards for the Ethical Practice of
WebCounseling），美國諮商學會（American Counseling Association［ACA］）也於 1999
年提出網路諮商的倫理標準（Ethical Standards for Internet On-line Counseling），台灣輔
導與諮商學會也於 2001 年的第二版倫理守則中增加第八章－網路諮商專章。通訊心理
諮商所涉及的問題甚廣，除了法律、科技介面與網路安全的問題之外，主要的倫理問題
可能包括（王智弘，2009，2023a；王智弘、楊淳斐，1998）：資格能力、專業關係、知
情同意與風險管控、心理衡鑑與技術使用、保密與預警、避免傷害、收費與廣告、當事

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人接受服務的公平性、以及多元文化與價值觀影響的考慮，其中文化議題本文將於下節
進一步加以討論外，其他上述有關法律、科技介面、網路安全與倫理等議題，都是實務
運作上需加以考量與因應的，因此，相應的實務指引就有其必要性。
喬虹（2024）在本期「他山之石，可以攻玉：借鏡美國通訊心理服務規範」一文中
所指出：美國推行通訊心理諮商有三項重要的基礎建設，其一是 1996 年制定之健康保
險便利與責任法案（Health Insurance Portability and Accountability Act, HIPAA）（Office
for Civil Rights, 2021），以確定個人健康資料之保存、傳送與處理之保密原則以及資安
規範；其次是民間企業據此法案以發展出可供醫療人員使用之商用通訊平台；其三是「美
國心理學會」於 2013 年與「州和省心理委員會聯合會」（Association of State and Provincial
Psychology Boards［ASPPB］）以及美國心理學會保險信託（APA Insurance Trust［APAIT］），
合作建置之通訊心理服務指引（Guidelines for the Practice of Telepsychology），今（2024）
年更推出修訂版。通訊心理服務指引共有八條，主題包括（APA, 2024）：心理師的資格
能力、傳遞通訊心理服務的照護標準、知情同意、數據與資訊的保密、數據與資訊的傳
輸與安全、數據與資訊的處置與技術、測驗與評量、以及跨法律管轄的實務工作等。除
此一通訊心理服務指引外，喬虹（2024）並提及美國心理學會於 2020 年疫情期間所發
佈的 通訊心理服務知情同意清單 （APA, 2020a）與 通訊心理服務的辦公室科技設
備清單 （APA, 2020b），而這兩份資料均已授權臺灣諮商心理學會加以翻譯而公布於
學會網站上（臺灣諮商心理學會，2020），再加上 通訊心理諮商/心理治療專業指引
（臺灣諮商心理學會，2022），可供台灣心理師執行通訊心理諮商的實務參考。
執行通訊心理諮商實務時，洪雅鳳（2024）在本期「通訊諮商實務的挑戰與建議：
以實徵研究之回顧為基礎」一文中，提出因通訊心理諮商具有虛擬空間的情境特性，可
能衍生的問題包括：治療設置的不易掌控、治療架構與界線的模糊、缺乏真實身體互動、
治療關係深度交流變得困難、倫理與保密性之疑慮等，而為因應此等問題，其提出：透
過事前評估是否合宜執行通訊心理諮商、通訊心理諮商前進行適切的準備、治療師在通
訊晤談前及晤談過程中強化特定的應對技巧、若由實體轉成通訊宜在轉換初期辨識諮商
關係的變化並儘早修復、治療師並應得關注自己的身心健康與倦怠感等，以因應可能的
挑戰與提升通訊心理諮商的成效。而相對於上述實務操作的考量，通訊心理諮商特別要
考量還有多元文化與價值觀影響的考慮。
肆、台灣通訊心理諮商的文化考量
科技在心理諮商上加以應用是一個自然的發展趨勢，比如晚近甚囂塵上的對話式人
工智慧程式（Conversational AI, Co-AI）聊天機器人 ChatGPT 深受矚目，對產業與社會
帶來很大的衝擊，其影響有待持續觀察，特別是其中所蘊含的文化與倫理議題（王智弘，

xi
2023a）。通訊心理諮商可能不若 Co-AI 與ChatGPT 所涉及的文化思維差距、文化話語
權、與文化殖民等議題，但有關著作權歸屬與侵犯的議題、資料的正確性與可用性的議
題、文化與價值觀之偏見與強加的議題、社會影響力的不當操作與深偽造假的議題、個
人隱私權與組織安全的保護問題、學術倫理的議題、資料治理的議題等，卻可能是心理
師在提供通訊心理諮商服務時可能觸及的倫理議題，歐盟繼提出「資料治理法」（Data
Governance Act）（European Parliament, 2022）之後，又於 2024 年1月11 日通過「資料
法」（Data Act）（European Commission, 2024），歐盟表示「資料治理法」旨在規範與
促進自願資料分享的流程與結構，而「資料法」則在釐清誰可以從資料中創造價值以及
在什麼條件下創造價值。可見在數位時代，資料的流通與運用已是全球性的重大議題，
涉及了權益、法規、倫理以及文化的各種複雜的考量。
由於 ChatGPT 與 Co-AI 在諮商上的可能應用包括（王智弘，2023a）：生涯諮商、
專家諮詢系統、線上評量系統、諮商輔助性資源、諮商師教育與訓練、生成個案紀錄等。
通訊心理諮商結合 AI 是極為可能的發展方向，特別是 GPT-4o 所展現的及時語音對話功
能令人驚訝（陳宜伶，2024），似乎更催化了此等可能，而本文關切的是無論通訊心理
諮商日後是否可能與 AI 合流，其中所涉及的當事人福祉與個人隱私等議題不能不加以
重視之外，其中可能蘊含的文化議題亦宜加以關切。通訊心理諮商的跨國界、跨區域特
性本即須有多元文化的考量（王智弘，2009），AI 的使用更可能引發文化與價值觀之偏
見與強加的疑慮。其中的可能原因包括 AI 演算法會因資料搜集方式、設備、標註人員
的偏見而受到影響（張良知，2023），語言模型的建立與訓練若主要來自單一語言的資
料庫，亦可能產生社會刻板印象、歧視、排除其他語言的觀點與文化內容、抑制其他語
言發展的問題（Zhuo et al., 2023）。以及運用於通訊心理諮商過程中可產生的價值觀偏
見與強加，無論是性別、家庭、宗教、種族、政治、經濟、生理、心理、精神、道德與
生命的價值觀（王智弘，2023a）。因此在實施通訊心理諮商服務時宜有文化適切性的考
量，也就是本土化的考量，宜尊重當事人的本土文化脈絡，提供相應的多元文化諮商服
務與本土化諮商服務，這也是本土社會科學（黃光國，2009，2015，2018）與本土諮商
心理學（王智弘，2009，2013，2014，2016，2017b，2020，2023b；王智弘等，2017；
林幸台、王智弘，2018；陳秉華，2017）所關切的重要議題。
伍、GPT4o 可能成為諮商師嗎
本期以通訊心理諮商為題，探討通訊心理諮商的相關議題，本期的三篇專題論文（林
家興、林烝增，2024；洪雅鳳，2024；喬虹，2024）各自從法律爭議、服務規範與實徵
研究的角度來探討台灣通訊心理諮商的發展與挑戰，台灣一直以科技島之姿而聞名於世，
近年來更以半導體與人工智慧的先進製造技術而受到全球矚目，相對於電腦科技硬體製

xii
造技術的進步，台灣在軟體應用上卻有明顯落差，或許與政府政策法規未能與時俱進有
關，對台灣通訊心理諮商經驗的探討可能也可為各國發展通訊心理諮商的參考與借鏡。
GPT4o 可能成為諮商師嗎？我想這是個全世界助人專業可能會關心的議題，其中最值得
關切的問題可能未必是科技層面，而是法律 倫理與文化層面，其中更涉及人工智慧治
理的議題，由於立法程序的速度與反應能力遠遠趕不上科技發展的速度，因此，雖然制
定相對應的 AI 法律規範仍不可免，但是更重要的是民間 AI 專業人員與企業的專業自律
以確立內部自我要求，也就是同時採取雙元倫理思維的策略，政府立法與企業自律雙管
齊下，以因應 AI 快速發展所引發的倫理議題（王智弘，2023a），在考量通訊心理諮商
的治理考量時，亦復如此，專業的倫理自律是因應科技快速變遷時代，最重要的治理策
略，也是諮商倫理判斷雙元模型之內元自我修為（王智弘，2018；Wang, 2022）。其重
要性比之於外元法律規範其實有過之而無不及。
陸、科技時代的倫理考量觀點
在快速變遷的科技時代心理師倫理自我要求的重要性更勝過以往，心理師在實務過
程中遭遇複雜倫理爭議時會經歷倫理判斷以進行倫理決策的過程，Van Hoose 與Paradise
（1979）曾取法柯爾柏格之道德發展論（Kohlberg’s stages of moral development; Kohlberg,
1964, 1981），提出倫理判斷的五級倫理思考模式，其五級思維為：第一級獎懲導向：倫
理決策的主要考量在行為後所帶來的賞罰結果；第二級機構導向：主要考量在任職機構
的制度規定與角色期待；第三級社會導向：主要考量在社會規範，包含法律規定與社會
輿論之要求；第四級個人導向：主要考量在個案的福祉，並以專業倫理自律為核心；第
五級良心導向：主要考量在自我道德要求及個人良心。由於 Van Hoose 與Paradise（1979）
五級倫理思考模式前三級層次為西方文化關注的外在客觀理性規範，依「助人專業倫理
雙元模型」（王智弘，2018；Wang, 2022）而言（如圖 1），是屬外元倫理；而其第四、
五層次則觸及良心判斷，其倫理思維則接近東方文化所關注的內在主觀自我修為，亦即
內元倫理，其觀點由秉持良心之自我修為出發，透過良善之動機、行動與結果，以求善
待當事人，此雙元模型，整合西方文化倫理觀由保護個案之五大權益、進而要求善盡助
人者之三大責任，以及華人儒家文化倫理觀中之盡己（自我修為）和推己（善待當事人）
的觀點，同時考量外在客觀理性規範與法規要求及內在主觀自我修為與良心考量，以完
成倫理判斷的思維歷程。

xiii
圖1
助人專業倫理雙元模型
註：引自「諮商倫理議題的過去、現在與未來」，王智弘，2018，載於蕭文、田秀蘭（主編），台灣輔導
一甲子，356 頁，心理。From ”An inclusive theory of ethics based on Chinese culture: The Duality Model
of Professional Ethics for Helpers,” by C. H. Wang, 2022, In A. K. Giri & S. C. Wu (Eds.), Cross-currents
of social theorizing of contemporary Taiwan, p. 192. Palgrave Macmillan.
將此一助人專業倫理雙元模型（王智弘，2018；Wang, 2022）與 Van Hoose 與
Paradise（1979）五級倫理思考模式相結合，並以服務性侵害受害個案之心理師為研究對
象，探討其面對法院傳喚出庭經驗的倫理判斷的思維過程（莊謹鳳等，2024），透過實
徵研究的分析所得，可得 心理師出庭之雙元倫理考量模型 如圖 2。
圖2
心理師出庭之雙元倫理考量模型
註：引自「心理師作為證人之本土化探討：性侵害議題出庭作證之倫理」，莊謹鳳、張素惠、程雅
妤、陳美伊、王智弘，2024，中華輔導與諮商學報，70，48 頁。
外在客觀理性規範
內在主觀自我修
為

xiv
從圖 2中可知心理師面對法院傳喚出庭時，其在助人專業倫理雙元模型的整體考量
包括（莊謹鳳等，2024）：1.傳喚出庭的衡量；2.專業知能的議題；3.知情同意的議題；
4.保密的議題，其中呈現心理師配合法院傳喚以選擇出庭，會同時考量外在法律規範的
罰責考慮，但更多是經歷內在良心的掙扎與為難，而展現出倫理雙元模型（王智弘，2018；
Wang, 2022）的考量。由此可知倫理思考的判斷歷程可能並非 Van Hoose 與Paradise（1979）
以及 Kohlberg（ 1964, 1981）所描繪之單元結構判斷歷程，而是呈現出雙元考量判斷歷
程。由此雙元考量判斷歷程的概念，我們可就本文前述通訊心理諮商的倫理考量內涵，
以建構 通訊心理諮商之雙元倫理考量模型 如圖 3。
圖3
通訊心理諮商之雙元倫理考量模型
因此心理師在進行通訊心理諮商之前需先評估是否要執行通訊心理諮商，首先要先
確認是否具備合格的執行資格與合乎法律管轄權的規定，並同時考慮案主的需要與福祉，
並評估自己執行通訊心理諮商的相關知能，依據專業倫理的自我要求以確認是否執行通
訊心理諮商；其次要告知案主進行通訊心理諮商的相關資訊與機構規定以進行知情同意
程序，並在進行通訊心理諮商的過程中不斷調整實務作為以求達到最佳服務效果；再其
次須注意相關的法律規定以確保案主的隱私與資訊傳輸之安全性，並秉持內在良心與道
德要求以協助案主；最後確認倫理決策的適切性以完成執行通訊心理諮商。此等雙元倫
理考量模型可作為心理師執行通訊心理諮商之參考。

xv
本期的通訊心理諮商專刊是本刊第四次以中英雙語全文刊登方式出刊，在歷經第十
四卷第三與第四期的試驗過程之後，本刊自本年第十五卷第一期開始（2024 年3月）已
正式推出中、英雙語全文刊登版本，無論來稿為中文稿件或是英文稿件，審查完成刊登
時都將以雙語全文刊登，文章的翻譯工作主要是由編輯委員會來承擔，雖然此舉造成編
審工作的負荷大增，但中、英雙語全文刊登版本出刊後，獲得了國內外學術界相當正面
的迴響，為繼續推動本刊的國際化，繼第十五卷第一期邀請嚴嘉琪教授擔任本刊共同主
編之後，本刊自第十五卷第二期開始（2024 年6月），再邀請具有豐富國際發表經驗的
本土化研究學者夏允中教授加入主編的行列，夏主編為英國愛丁堡大學心理學博士，現
任國立高雄師範大學諮商心理與復健諮商系教授，也是中華本土社會科學會的理事長，
曾擔任中華輔導與諮商學報的副主編與多次擔任 Frontiers in Psychology 的專刊主編，投
稿與編輯的經驗豐富，本刊感謝夏主編的加入。期待本刊的嘗試與努力對亞洲與全世界
的本土社會科學、本土心理學以及本土諮商心理學能發揮具體的貢獻。
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Could GPT4o Potentially Become a Counselor?
Practical, Legal and Ethical Considerations for Telecounseling
Chih-Hung Wang＊ Jia-Chyi Yan Yung-Jong Shiah
Abstract
The pace of technological development is increasing. Moore's Law has entered the Ångström
era. Conversational Artificial Intelligence has launched the GPT-4o product. Applying
technology to provide counseling and psychotherapy services is almost an irresistible trend. Not
only does it extend the distance of counseling services. It also provides more diverse service
types and methods. When the COVID-19 epidemic is prevalent, Telecounseling provides an
excellent opportunity to offer uninterrupted professional psychological services. The "Tao Te
Ching" says: "When disaster appears, blessing is right next to it; when blessing appears,
disaster lurks inside." Challenges and opportunities, opportunities and challenges often coexist.
Telecounseling brings creativity and convenience but also brings technical, legal, ethical, and
cultural issues. This issue is titled Telecounseling, which is discussing related issues. Taiwan is
world-famous for developing computer technology. In recent years, it has attracted much
attention for its advanced semiconductor and Artificial Intelligence manufacturing technology,
which the government has actively encouraged and supported. Although Taiwan has made
significant progress in manufacturing computer hardware, there has been no corresponding
progress in software applications. The failure of government policies and regulations to adjust
with time may be one of the critical factors. These negative impacts are also quite evident in
the development of Telecounseling. The articles in this Special Issue discuss the issues
mentioned above in depth and suggest possible perspectives on the ethical and cultural issues
involved. These perspectives may serve as a reference for the development of Telecounseling
worldwide. Starting from the fifteenth volume (2024, March), this journal has officially
launched a bilingual full-text version in Chinese and English. When reviewed and published,
manuscripts in Chinese or English will be published in bilingual full-text. Although editing and
reviewing this was time-consuming, it received a very positive response from academic circles
at home and abroad after publication. To continue promoting this journal's internationalization,
2024 15 2 vi-xxxvii

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starting from the second issue of Volume 15 (2024, June), this journal has officially invited
Professor Yung-Jong Shiah, a famous indigenous research scholar with rich international
publishing experience, to join the ranks of editor-in-chief. Editor-in-chief Shiah has a PhD in
Psychology from the University of Edinburgh, UK. He is a professor in the Graduate Institute
of Counseling Psychology and Rehabilitation Counseling at National Kaohsiung Normal
University and the president of the Chinese Indigenous Social Science Association. He has
served as deputy editor-in-chief of the "Chinese Journal of Guidance and Counseling" and as
the special issue editor of the journal "Frontier in Psychology" many times. This journal thanks
Editor-in-chief Shiah for joining us. This journal's efforts are expected to make a concrete
contribution to indigenous social sciences, indigenous psychology, and indigenous counseling
psychology in Asia and worldwide.
Keywords: Telecounseling, online-counseling, Indigenous Social Sciences, I
ndigenous
Psychology, Indigenous Counseling Psychology
Chih-Hung Wang ＊
Jia-Chyi Yan
Yung-Jong Shiah
Department of Guidance and Counseling, National Changhua
University of Education (ethicgm@gmail.com)
Department of Applied English, National Taichung University of
Science and Technology
Graduate Institute of Counseling Psychology and Rehabilitation
Counseling, National Kaohsiung Normal University

xxi
The Development of Telecounseling in Taiwan
The pace of technological development is accelerating. Moore's Law of Semiconductor
Development has entered the Ångström era (Huang, 2021). The advancements in Artificial
Intelligence (AI) have further accelerated the pace of technological applications. The
application of technology to provide counseling and psychotherapy services is almost an
irresistible trend. This article uses 2010 as a milestone to explore the early development of
Telecounseling in Taiwan (Wang, 2019, 2022a): Online counseling services have been
provided in Taiwan as early as 1996, such as the the "Kaohsiung Teacher Chang" center of the
Teacher Chang Foundation which launched "Teacher Chang's heart-to-heart talk with you" and
provided E-mail online counseling services at the Formosa BBS station of Sun Yat-sen
University (Peng, 1997). At the same time, the "PsychPark" website also provides a "Psychic
Clinic" online counseling service. In February 1998, the Teacher Chang Foundation held
Taiwan's first "Online Counseling Seminar." The first author of this article was invited to give
a lecture on "Ethical Issues in Online Counseling." Then he entered the online counseling
research and practice field, and created the "Taiwan Counseling Net" (www.heart.net.tw)
website group on September 3, 1998, and from 2000, he started teaching undergraduate and
graduate courses in online counseling in the Department of Guidance and Counseling, National
Changhua University of Education. In 2003, resident experts at the "PsychPark" established the
"Taiwan Association of Mental Health Informatics" to research online mental health services.
Taiwan's first dedicated book on online counseling was then published in 2009 (Wang, 2009).
Looking back on the essential online counseling service development cases during this
period, include (Wang, 2019): In terms of private institutions, such as "Taipei Lifeline"
launched an email online counseling service (Ruan, 1998), "Taipei Teacher Chang" in 2001,
the real-time online counseling service in the Internet chat room was launched, and the "Taiwan
Institute of Psychotherapy" In 2008 also launched the "Psychotherapy Online" online
counseling service for a fee in 2008 (Dai, 2008); In terms of school institutions, it has
successively established guidance websites that provide online consultation services, for
examples: National Sun Yat-sen University, National Central University, National Yang-Ming
University, Jianan University of Pharmacology and Science, Tamkang University, National
Pingtung University of Education and other universities, as well as primary and secondary
schools. For example, the Sunflower Project for Online Counseling of the Yunlin County
Counseling Guidance Group is the first campus online counseling service that has become

xxii
popular (Wang, 2009); in terms of government departments, the earliest was the National
Changhua University of Education (NCUE) commissioned by the Ministry of Education in
1999. The "921 Post-Disaster Guidance and Counseling Information Network" was established
by the Community Counseling and Potential Development Center of NCUE. During the SARS
(Severe Acute Respiratory Syndrome) epidemic in 2003, the Ministry of Education
commissioned the "Chinese Guidance Association" to establish "Crisis Management and SARS
Psychological Counseling Network", and the "Community Mental Health Crisis Management
and SARS Mental Health Consultation Network" has been established the Mental Health
Association in Taiwan that had been commissioned by the Department of Health of the
Executive Yuan (the predecessor of the Ministry of Health and Welfare), Executive Yuan
Personnel Administration Bureau ( The "Civil Service Online Consultation Service Network"
established by the Executive Yuan (the predecessor of the General Office of Personnel and
Administration) in 2006, and the "Teacher Wen Consultation Forum" established by the Coast
Patrol Office of the Executive Yuan (the predecessor of the Ocean Commission) In 2008, the
Ministry of National Defense also established the "National Military Online Counseling Service
Network" for non-commissioned officers and soldiers (Li, 2008), and the Ministry of Education
entrusted the National Changhua University of Education to build the "Online Expert
Consultation System for School Resumption Counseling" (Wang, 2009). In 2010, the National
Health Service of the Ministry of Health and Welfare (from now on referred to as the Ministry
of Health and Welfare) also commissioned Bali Nursing Home to build the "Secret Garden
Youth Video Consultation Network" to provide consultation on gender education for teenagers.
The Central Science Park Administration of the Ministry of Science and Technology (the
predecessor of the National Science Council) also commissioned the Taiwan Guidance and
Counseling Association to build the "Central Science Park Employee Assistance Center"
website in 2010 to provide online consultation on employee assistance programs for
manufacturers stationed in Central Science Park.
To explore the overall development status of early online counseling, based on the 2007
national online counseling service survey, it was found that among the 300 online counseling
service websites across the country (Wang et al., 2008): 80.3% provided counseling
information web pages. 70.2% provide E-mail type services; 52.2% provide message board
type services; 29.8% provide discussion board type services; 12.9% provide BBS type
services; 9.6% provide chat room type services 4.5% provide real-time video services; 3.4%
provide online testing and assessment services; 2.8% provide Internet phone services. It can
be seen that different types of online counseling services are under development.

xxiii
The application and development of Telecounseling are significant resources for helping
people in the face of substantial disasters. In the natural disaster section, in addition to those
above, "921 Post-Disaster Guidance and Counseling Information Net", the "August 8 Flood
Mental Health Information Net", "Baxian Dust-explosion Mental Health Information Net," "26
Earthquake Mental Health Information Net", etc. have all played a role in disaster relief; In the
epidemic section, during the SARS period, the "SARS Mental Health Information Net",
"Campus Crisis Management and SARS Guidance and Consultation Net", "Community Mental
Health Crisis Management and SARS Mental Health Consultation Net" The accumulated
experience will play a greater role in epidemic prevention during COVID-19. For example,
from May 30 to June 30, 2021, the Taiwan Counseling Psychologist Union launched the "Heart
Home Delivery, Heart Life" online psychological health service, which received a widespread
response from the Taiwanese people (Luo, 2021). Unfortunately, due to the Ministry of Health
and Welfare's policy restrictions, very few psychologists could apply for Telecounseling at that
time. This has created a massive gap between government policies and people’s needs. The
Ministry of Health and Welfare's regulatory stance has aroused skepticism from academic
circles and the public (Lin, 2021).
Taiwan Telecounseling Regulatory Controversy
The development of online counseling in Taiwan started with the practice, followed by
online counseling courses in universities, and then the academic community further conducted
online counseling research. In 2001, the Taiwan Guidance and Counseling Association also
formulated an ethics code to regulate online counseling. But "everything was ready but only
owe the east wind": medical policies of the government do not allow it (Wang, 2019). In 2017,
there was an incident where the Taipei City Health Bureau ordered the online counseling fee-
based service "Psychotherapy Online" to be stopped, which triggered discussions from all walks
of life (Lin, 2018). This controversy over the legal restrictions on online counseling under
Taiwan's medical policies is also known as Lin. & Lin (2024) pointed out in the article
"Telecounseling Censorship in Taiwan: Controversies, Impacts and Resolutions" in this Special
Issue: The Ministry of Health and Welfare issued a regulation interpretation on September 1,
2016 that psychologists are not allowed to perform online counseling, advocating that "... The
"Psychologist Act" does not allow psychologists to use the Internet to conduct psychological
services, and they are not allowed to do so arbitrarily." This is an inappropriate interpretation
of the Psychologist Act. Prohibiting psychologists from providing online counseling services

xxiv
would also obviously damage the public’s rights and interests in receiving them. Therefore,
there are doubts that it is illegal and unconstitutional.
Compared with the United States, Japan, and other countries, which have legally
implemented online counseling services for many years, there are still legal issues regarding
the legal jurisdiction involved in cross-border Telecounseling. The implementation of
Telecounseling under their domestic licensing systems is Okay. However, Taiwan’s Ministry
of Health and Welfare, which is in charge of medical and counseling services, regards the legal
scope of the business of psychologists as illegal (National Development Council, 2017). The
key lies in the narrow interpretation of the Ministry of Health and Welfare as “shall practice in
a medical organization, long-term care service organization, or a psychiatric rehabilitation
organization approved by and registered with the local competent authority or approved by the
competent central authority (Physicians Act, 2022) and the practice of psychologists in no more
than one location and such location shall be a medical institution, psychotherapy clinic, or
psychological counseling clinic approved by and registered with the local municipal or county
(city) competent authority or other institutions approved by the competent authority"
(Psychologists Act, 2020), therefore, health welfare The Ministry has been restricting the
telemedicine services provided by doctors and psychologists to the public. This policy has
always caused controversy. Coupled with the incident in 2017 when "psychotherapy online"
was forced to stop its services, public opinion became even more heated. This prompted
Executive Yuan Digital Councilor Audrey Tang to combine with the National Development
Council, the vTaiwan.tw digital economy regulations online consultation platform established
by the Legal Coordination Center, the Science & Technology Law Institute of the Institute for
Information Industry, and the Internet community passed the proposal of "doctors and
psychologists provide services through the Internet platform." A discussion meeting was held
in the Executive Yuan on October 26, 2017. The first author of this article was also invited to
report on "Review of the Application of the Internet in Taiwan's Helping Profession" (Wang,
2017b). The meeting concluded that online medication and online counseling are feasible and
necessary. Under the continuous promotion of the vTaiwan.tw digital economy regulations
online consultation platform, the Ministry of Health and Welfare first announced the "Rules of
Medical Diagnosis and Treatment by Telecommunications" on May 11, 2018. Then, on
November 29, 2019, the "Rules of implementing Telecounseling services by Psychologists"
were announced. Telecounseling was recognized by the government in Taiwan and included in
the business scope of psychologists (Wang, 2019). One year after its implementation, the
Ministry of Health and Welfare announced that it was re-revised on July 29, 2020. Still, the

xxv
revised version in 2020 is even more stringent, requiring non-medical institutions to perform
Telecounseling services to sign a referral cooperation plan with medical institutions, and also
restricts the service from being unable to serve patients with neurosis, mental illness, or brain
and mental functions—incomplete patients, etc. Lin and Lin (2024) believe that the Ministry of
Health and Welfare, without legal authorization, also promulgated Telecounseling
specifications that are stricter than the Rules of Medical Diagnosis and Treatment by
Telecommunications, which violates legal permission and the principle of legal proportionality
and involves improper restrictions on psychologists—issues of professionalism and public
welfare. The controversial issue of these regulatory restrictions has not yet been adequately
resolved in Taiwan.
Practical and Ethical Issues in Taiwan Telecounseling
In addition to facing disputes over regulatory restrictions, implementing Telecounseling
in Taiwan also involves issues of practical operation and ethical considerations. In 1998, the
National Board for Certified Counselors (NBCC) proposed Standards for the Ethical Practice
of WebCounseling, and the American Counseling Association (ACA) also proposed Ethical
Standards for Internet Online Counseling in 1999. The Taiwan Guidance and Counseling
Association also proposed a particular online counseling chapter (Chapter 8) to add to the
second edition of the Code of Ethics. Telecounseling involves a wide range of issues. In
addition to the legal, technological interface, and network security issues, the main ethical
issues may include (Wang, 2009, 2023a; Wang & Yang, 1998): qualifications, professional
relationships, informed consent, risk management and control, psychological assessment and
technology use, confidentiality and early warning, harm avoidance, charging and advertising,
fairness of services received by parties, and consideration of the impact of multiculturalism and
values. Cultural issues will be further discussed in the next section of this article. Other matters
related to law, technology interface, network security, ethics, etc., must be considered and
responded to in practical operations. Therefore, it is necessary to put forward corresponding
practical guidelines.
Chiao's (2024) article in this Special Issue, "Using the Stone from the Other Mountain to
Polish Jade: Learning from Guidelines of American Telepsychology Services ”pointed out:
The implementation of Telecounseling in the United States has three critical infrastructures:
One is the Health Insurance Portability and Accountability Act (HIPAA) (Office for Civil
Rights, 2021) enacted in 1996 to determine the confidentiality principles and information

xxvi
security regulations for the storage, transmission and processing of personal health information;
Secondly, private enterprises will use this bill to develop commercial communication platforms
that can be used by medical personnel; The third is that the American Psychological Association,
the Association of State and Provincial Psychology Boards (ASPPB), and the American
Psychological Association Insurance Trust (APA Insurance Trust, APAIT) jointly developed
Guidelines for the Practice of Telepsychology in 2013 and released a revised version this year
(2024). There are eight Guidelines for the Practice of Telepsychology, covering topics such as
(APA, 2024): psychologist qualifications, standards of care for delivering Telepsychology
services, informed consent, confidentiality of data and information, transmission and security
of data and information, data and information processing and technology, testing and evaluation,
and practical work across legal jurisdictions. In addition to this Guidelines for the Practice of
Telepsychology, Chiao (2024) also mentioned the "Informed consent checklist for
telepsychological services." (APA, 2020a) and "Office and technology checklist" issued by the
American Psychological Association during the 2020 epidemic. for telepsychological services”
(APA, 2020b), The Taiwan Counseling Psychology Association has been authorized to
translate and publish both of these materials on the association’s website (Taiwan Counseling
Psychology Association, 2020). Coupled with the "Professional Guidelines for
Telecounseling/Telepsychotherapy" (Taiwan Counseling Psychology Association, 2022), it can
be a practical reference for Taiwanese psychologists to perform Telecounseling.
When implementing Telecounseling practice, Hung (2024) proposed in the article
"Challenges and Suggestions for Telecounseling Practice: Based on Empirical Research" in this
Special Issue that because Telecounseling has situational characteristics of virtual space,
possible problems include difficulty in controlling the treatment setting; the blurring of the
treatment structure and boundaries, the lack of actual physical interaction, the difficulty of in-
depth communication in the therapeutic relationship, the doubts about ethics and confidentiality,
etc. In response to these problems, it was proposed through pre-evaluation whether it is
appropriate to perform Telecounseling and before Telecounseling. With proper preparation, the
therapist should strengthen specific coping skills before and during the communication session.
Suppose the person switches from physical to communication. In that case, it is advisable to
identify the changes in the consultation relationship at the early stage of the transition and repair
them as soon as possible. The therapist should also pay attention to his own body and mind.
Health and fatigue, etc., are needed to cope with potential challenges and improve the
effectiveness of Telecounseling. Compared with the above practical considerations,
Telecounseling must also consider the impact of multiculturalism and values.

xxvii
Cultural Considerations of Taiwan Telecounseling
The application of technology in counseling is a natural development trend. For example,
the recently popular conversational artificial intelligence program (Conversational AI, Co-AI)
chatbot ChatGPT has attracted much attention and greatly impacted industry and society. Its
impact remains to be continuously observed, especially the cultural and ethical issues contained
in it (Wang, 2023a). Telecounseling may not be as involved in the cultural thinking gap, cultural
discourse rights, and cultural colonization issues as Co-AI and ChatGPT, but issues related to
copyright ownership and infringement, the accuracy and availability of data, cultural and value
bias and imposed issues, improper manipulation of social influence and deep fakes, protection
of personal privacy and organizational security, academic ethics, data management, etc., maybe
something that psychologists may touch upon when providing Telecounseling. Regarding
ethical issues, after the EU proposed the "Data Governance Act" (European Parliament, 2022),
the "Data Act" (European Commission, 2024) passed on January 11, 2024. The EU stated that
"Data Governance Act" aims to standardize and promote the process and structure of voluntary
data sharing. At the same time, the "Data Act" clarifies who can create value from data and
under what conditions. In the digital age, the circulation and use of data have become a major
global issue involving various complex considerations of rights, regulations, ethics, and culture.
Since the possible applications of ChatGPT and Co-AI in counseling include (Wang,
2023a): career counseling, expert consulting system, online assessment system, counseling
auxiliary resources, counselor education and training, and generation of case records.
Telecounseling combined with AI is a highly possible development direction. In particular, the
real-time voice dialogue function demonstrated by GPT-4o has been surprisingly impressive
(Chen, 2024), which seems to catalyze this possibility further. This article is concerned about
the potential future of Telecounseling, particularly its possible merger with AI. In addition to
the issues such as the well-being of the parties and personal privacy involved, we must also pay
attention to the cultural issues it may contain. The cross-border and cross-regional nature of
Telecounseling inherently requires multicultural considerations (Wang, 2009). AI is more
likely to cause doubts about the bias and imposition of culture and values. Possible reasons
include that the AI algorithm will be affected by the bias of data collection methods, equipment,
and annotators (Chang, 2023). Suppose the establishment and training of language models
mainly come from a single language database. In that case, it may also produce social
stereotypes, discrimination, exclusion of perspectives and cultural content in other languages,

xxviii
and inhibition of the development of different languages (Zhuo et al., 2023), as well as the value
bias and imposition that can occur during the Telecounseling process, whether it is gender,
family, religious, racial, political, economic, physical, psychological, spiritual, moral, or life
values. Therefore, when implementing Telecounseling services, cultural appropriateness, that
is, indigenization considerations, should be considered. The indigenous cultural context of the
parties should be respected, and corresponding multicultural counseling services and
indigenous counseling services should be provided (Wang, 2023a). These are also essential
issues of concern in the fields of Indigenous Social Sciences (Hwang, 2009, 2015, 2018) and
Indigenous Counseling Psychology (Chen, 2017; Lin & Wang, 2018; Wang, 2009, 2013, 2014,
2016, 2017b, 2020, 2023b; Wang et al., 2017).
Could GPT4o Potentially Become a Counselor?
This Special Issue is titled Telecounseling and explores issues related to Telecounseling.
The three unique papers on this issue (Chiao, 2024; Hung, 2024; Lin & Lin, 2024) discuss it
from legal disputes, service specifications, and practical research perspectives to discuss the
development and challenges of Telecounseling in Taiwan. Taiwan has always been famous as
a technology island. In recent years, it has attracted global attention for its advanced
manufacturing technology of semiconductors and artificial intelligence. Compared with the
advancement of computer technology and hardware manufacturing technology, Taiwan’s
software has a noticeable gap in application, which may be related to the failure of government
policies and regulations to keep pace with the times. The discussion of Taiwan's Telecounseling
experience may also serve as a reference for various countries in developing Telecounseling. Is
it possible for GPT4o to become a counselor? I think this is an issue that the helping professions
worldwide may be concerned about. The most concerning issues may not necessarily be at the
technological level but at the legal, ethical, and cultural levels. Artificial Intelligence
governance is also involved. Since the speed and responsiveness of the legislative process are
far behind the speed of technological development. Therefore, although the formulation of
corresponding AI legal regulations is still inevitable, what is more important is the professional
self-discipline of private AI professionals and enterprises to establish internal self-requirements.
That is to say, the strategy of dual approach to ethical thinking is adopted at the same time, with
government legislation and corporate self-discipline taking a dual approach to responding to
the ethical issues caused by the rapid development of AI (Wang, 2023a). The same is true when
considering the governance considerations of Telecounseling. Professional ethical self-

xxix
discipline is to respond to the era of rapid technological changes; the most critical governance
strategy is also the internal self-cultivation within the duality model of counseling ethical
judgment (Wang, 2018, 2022b). Its importance is even greater than that of external legal norms.
Ethical Considerations in the Technological Age
In the era of rapid changes in science and technology, psychologists' ethical self-
requirements are more critical than ever. When psychologists encounter complex ethical
disputes in practice, they will go through the process of ethical judgment to make ethical
decisions. Van Hoose and Paradise (1979) once took the approach to Kohlberg's stages of moral
development (Kohlberg, 1964, 1981) and proposed a five-level ethical thinking model for
ethical judgment. Its five-level thinking is: The first level of punishment orientation: the
primary consideration in ethical decision-making is the reward and punishment consequences
after the behavior; The second level of institutional orientation: mainly considers the
institutional regulations and role expectations of the institution where you work; The third level
of societal orientation: the primary consideration is social norms, including legal regulations
and the requirements of public opinion; The fourth level of individual orientation: mainly
considers the well-being of the individual case, with professional ethics and self-discipline as
the core; The fifth level of conscience orientation: mainly considers self-moral requirements
and personal conscience. Since the first three levels of the five-level ethical thinking model of
Van Hoose and Paradise (1979) are external objective rational regulation that Western culture
focuses on, according to the "Duality Model of Professional Ethics for Helper" (Wang, 2018,
2022b) (e.g., Figure 1), is external ethics. The fourth and fifth levels involve conscience
judgment, and its ethical thinking is close to the internal subjective self-cultivation that Eastern
culture focuses on, that is, internal ethics. Its perspective starts from the self-cultivation of
conscience and through the motivation of good, actions of good, and results of good to treat the
clients well. This duality model integrates Western cultural ethics, from protecting individual
clients' five welfare to requiring three responsibilities of professional helpers. It also
incorporates the views of doing one's best (self-cultivation) and pushing one's own (treating the
clients well) in Chinese Confucian cultural ethics. At the same time, external objective, rational
norms, and legal requirements, as well as internal subjective self-cultivation and conscience
considerations, are considered to complete the dual thinking process of ethical judgment.

xxx
Figure 1
The Duality Model of Professional Ethics for Helpers
Note. From "An inclusive theory of ethics based on Chinese culture: The Duality Model of
Professional Ethics for Helpers," by C. H. Wang, 2022, In A. K. Giri & S. C. Wu (Eds.) Cross-
currents of social theorizing of contemporary Taiwan, p. 192. Palgrave Macmillan.
The Duality Model of Professional Ethics for Helpers (Wang, 2018; Wang, 2022b) is
combined with the five-level ethical thinking model of Van Hoose and Paradise (1979) and
takes psychologists who serve sexual assault victims as the research object. Discuss the thinking
process of his ethical judgment when facing court summons to appear in court (Chuang et al.,
2024). The " Duality Model of Ethical Consideration for Psychologists Appearing in Court "
can be obtained through the analysis of practical research, as shown in Figure 2.
It can be seen from Figure 2 that when a psychologist is summoned by the court to appear
in court, his overall considerations in The Duality Model of Professional Ethics for Helpers
include (Chuang et al., 2024): 1. The measurement of the summons to appear in court; 2. The
issue of professional knowledge; 3.The issue of informed consent; 4. The issue of
confidentiality shows that psychologists cooperate with the court summons to choose to appear
in court. They will also consider the punishment and liability considerations of external legal
regulations. Still, more often, they experience the struggle and embarrassment of inner
conscience and show Consideration of the Duality Model of Professional Ethics (Wang, 2018,
2022b). It can be seen from this that the judgment process of ethical thinking may not be the
unit structure judgment process described by Van Hoose and Paradise (1979) and Kohlberg
(1964, 1981) but presents a dual consideration judgment process.

xxxi
Figure 2
Duality Model of Ethical Consideration for Psychologists Appearing in Court
Note. From "Indigenous Study of Psychologists as Witnesses: Ethical Considerations of
Testifying in Court on Sexual Assault Issues, " by J. F. Chuang, S. H. Chang, Y. Y. Cheng, M.
I. Chen, and C. H. Wang, 2024, Chinese Journal of Guidance and Counseling, 70, p. 48.
Based on the concept of dual consideration and judgment process, we can construct the
"Duality Model of Ethical Consideration for Telecounseling," as shown in Figure 3, based on
the ethical consideration connotation of Telecounseling mentioned above in this article.
It can be seen from Figure 3, before performing Telecounseling, psychologists must first
evaluate whether to perform Telecounseling. They must first confirm whether they are qualified
to perform Telecounseling and comply with the legal jurisdiction regulations. They must also
consider the needs and well-being of the client and evaluate the relevance of performing
Telecounseling themselves. Be knowledgeable and able to confirm whether to perform
Telecounseling based on the self-requirements of professional ethics; secondly, inform the
client of the relevant information and institutional regulations for Telecounseling to conduct
the informed consent process and continuously adjust practices during the Telecounseling
process to achieve the best service The effect; secondly, we must pay attention to relevant legal
regulations to ensure the privacy of the client and the security of information transmission, and

xxxii
Figure 3
Duality Model of Ethical Consideration for Telecounseling
uphold the inner conscience and moral requirements to assist the client; and finally confirm the
appropriateness of the ethical decision-making to complete the implementation of
Telecounseling. This Duality Model of Ethical Considerations for Telecounseling can be used
as a reference for psychologists to implement Telecounseling.
This Special Issue on Telecounseling marks the fourth time our journal has published full
text both in Chinese and English. After the trial process of the third and fourth issues of Volume
14, this Journal has been published since Volume 15 of this year, starting from the first issue
(March 2024), and a bilingual full-text version in Chinese and English has been officially
launched. Whether the manuscript is in Chinese or English, it will be published in bilingual
full-text after review and publication. The editor mainly does the translation of the article.
Although this move has dramatically increased the load of editorial work, the bilingual full-text
version in Chinese and English has received positive responses from domestic and foreign
academic circles. To continue to promote the internationalization of this Journal, following the
first issue of Volume 15 invited Professor Jia-Chyi Yan to serve as the co-editor in chief of this
Journal, starting from the second issue of Volume 15(June 2024), the Journal invited Professor
Yung-Jong Shiah, a famous indigenous research scholar with rich international publishing

xxxiii
experience, to join the ranks of editor-in-chief. Editor-in-chief Shiah has a PhD in Psychology
from the University of Edinburgh, UK. He is a professor in the Graduate Institute of Counseling
Psychology and Rehabilitation Counseling at National Kaohsiung Normal University and the
president of the Chinese Indigenous Social Science Association. He has served as deputy editor-
in-chief of the "Chinese Journal of Guidance and Counseling" and as the special issue editor of
the journal "Frontiers in Psychology" many times. We are grateful for editor-in-chief Shiah for
joining our editorial board and anticipate that our journal's efforts will contribute significantly
to the fields of Indigenous Social Sciences, Indigenous Psychology, and Indigenous Counseling
Psychology in Asia and worldwide.
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1
通訊諮商實務的挑戰與建議：以實徵研究之回顧為基礎
洪雅鳳*
摘要
通訊諮商的發展已有 50 年，近年因新冠肺炎（COVID–19）疫情而加速其發展。原
本當事人與治療師習於實體的面對面諮商，在疫情封鎖令的影響下不得不轉換為通訊諮
商。不少研究指出通訊諮商的工作同盟與效果相似於實體諮商，然從實體轉換到通訊諮
商的經驗探究則多指出當事人與治療師皆感受到許多負面影響。通訊諮商的挑戰除了通
訊設備及空間帶來的干擾，也因其在情境和本質上與實體諮商的差異而衍生出不少實務
上的挑戰，包含治療設置的難以掌控、治療架構與界線的模糊、在虛擬空間晤談缺乏真
實身體互動、非語言訊息不足造成治療性存在的淡薄等等，本文旨在透過近年通訊諮商
相關實徵研究的結果及相關文獻的論述，梳理通訊諮商的現況、成效、治療實務上的挑
戰以及應對之道的建議。
關鍵詞：治療性存在、面對面諮商、視訊晤談、通訊諮商、新冠肺炎
洪雅鳳* 臺中教育大學諮商與應用心理學系（yfhung@gm.ntcu.edu.tw）
2024 15 2 1-47

2
壹、前言
2019 年開始全球的人們在新冠肺炎（COVID–19）的蔓延下，改變了社交互動、購
物、就醫等等生活方式。在各國社交距離限制的政策下，心理治療與諮商的工作一度受
限，然疫情籠罩
讓
人們普遍更焦慮、更需求心理協助，因此在倉促急迫下各國也放寬通
訊諮商的限制，而加速了通訊諮商的發展。筆者在這期間也經歷實體轉換為視訊諮商、
視訊督導的服務經驗，面對服務形式突然轉換感到惶恐，因此開始探究此主題，也
發現不 少學者關注疫情期間的轉換經驗，本文即是結合自身實作經驗、相關文獻及研
究結果的產出，翼望能提供通訊諮商實務工作的參考。
由於科技的進步目前通訊諮商多以視訊形式為主，因此在本文中會依論述的流暢交
替使用通訊與視訊二詞，同時考量通訊諮商與通訊治療相關文獻的引用，諮商與治療、
心理師和治療師二詞亦交替使用。此外，由於不同國家對通訊諮商的法規可能不盡相同，
不同的實徵研究可能也會因為研究參與者與研究方法而影響研究之信效度，因此本文在
報告實徵研究的結果時，筆者會儘量報告該研究的相關訊息，以利讀者判讀該研究的結
果及可能的文化差異。
貳、通訊諮商的界定與發展現況
一、通訊諮商的界定
通訊諮商（Telecounseling）的「tele」 意指「透過
遠距離
傳送」，因此也譯成遠距
諮商，近年來因 COVID–19 的影響，讓遠距醫療（telehealth）或遠距心理健康（telemental
health）成為發展中的新技術（Robertson, 2020）。通訊諮商在早期稱為電子諮商（e-
counseling）或線上諮商（online counseling），其發展可追溯至 1972 年10 月在一個計算
機通訊的國際會議上，在兩所大學之間首度演示了線上諮商（Wardell , 2008）。電子諮
商可界定為當事人與治療師在不同地點或遠距時，透過電話、互聯網和遠距會議等電信
技術媒介的諮商方法（Sanders & Rosenfield, 1998），因後來多使用到互聯網的技術，也
稱網路諮商（cyber-counseling）。通訊諮商又可區分成同步及非同步，同步指當事人能
在遠端與治療師進行即時交流，例如通話或視訊會議，非同步則指雙方無法即時交流，
例如 EMAIL 文字訊息的互動。
回顧相關文獻，通訊或遠距諮商/治療的相關名稱有「remote counseling/psychotherapy」
（Probst et al., 2021; Stadler et al., 2023）、「distance counseling/psychotherapy」（Robertson,
2020; Sandel, 2021），若特別強調運用的媒介則有「audio counseling」（Day & Schneider,
2002）、「video-delivered psychotherapy」(Fernandez et al., 2021)、「videoconference-based

3
counseling」（Stubbings et al., 2013）。上述這些都相對於傳統的面對面諮商（face to face
counseling）、實體會面「embodied encounter」、「in-person psychotherapy」（Probst et
al., 2021; Stubbings et al., 2013），本文統一以實體諮商稱呼。
二、通訊諮商實務現況與研究
臺灣在 10 多年前也有不少關於通訊諮商的實徵研究，不論是一次單元模式（張勻
銘等，2012）、不同理論取向（許維素等，2007；彭信揚，2009）、或是比較網路即時
諮商、電子郵件諮商與實體諮商（李偉斌等，2008；許維素等，2010），都發現通訊諮
商有其成效，並且與實體諮商的成效相近，不過當時因通訊設備不若現在如此發達，有
的研究是特別針對電子郵件諮商進行探究，王智弘等（2008）也指出，當時通訊諮商的
發展仍有各種的困難與限制，例如人力與經費不足、電腦與諮商技術、相關專業人員缺
乏網路諮商在職訓練等等的問題。
而2019 年底開始 COVID–19 疫情造成人們各種的心理困擾，病毒的快速傳播、死
亡人數的急速上升，引發了焦慮、無助、悲傷的情緒，造成人們的不安也促使精神疾病
的發作或惡化（Szlamka et al., 2021）。各國考量民眾需求與安全，多放寬原有的通訊諮
商規範，例如美國開放從業人員可在住家上線提供服務，甚至有些州也容許僅有聲音但
無影像的服務可申請保險費用（Wehrwein, 2020），臺灣也在 2019 年年底通過《心理師
執行通訊心理諮商業務核准作業參考原則》（衛生福利部，2020），讓通訊諮商合法化。
通訊諮商在疫情期間成為支援民眾心理健康的重要方式，也因此大量的從業人員都面臨
在短時間內需調整治療的服務形式。一項針對美國 768 位治療師的調查研究指出，在
COVID–19 前，有 39%的治療師使用通訊治療，其它多數治療師對此都有擔憂，只採用
實體的形式；然而在 COVID–19 大流行期間，幾乎所有治療師（98%）都使用廣泛的通
訊科技與被隔離的當事人交流，包括短訊、電話、視頻會議，甚至虛擬實境方式（Sampaio
et al, 2021）。即便是患有嚴重心理健康問題（如思覺失調障礙、中重度雙相情感障礙、
重度憂鬱症、物質使用障礙、邊緣性人格障礙、自殺或創傷後的人群壓力症候群）也和
一般求助人群有相似的轉換率，甚至其通訊治療的出席率還高過實體治療（Miu et al.,
2020）。也因為大量的通訊諮商實作，近三年（2020 年至 2022 年）有關通訊諮商的研
究和論述如雨後春筍般開展，筆者統整可分為：比較通訊與實體諮商的各種議題
（Greenwood et al., 2022; Zainudin et al., 2021）、探究通訊諮商的實作（Barker & Barker,
2021; Sampaio et al., 2021; Szlamka et al., 2021）、諮商關係或工作同盟（Chen et al., 2020;
Dolev-Amit et al., 2021; Geller, 2020; Mccoyd et al., 2022; Sayers, 2021）、治療或諮商成效
（Bennett et al., 2020; Carbone et al., 2021; Szlamka et al., 2021; Zeren et al., 2021）、當事
人或治療師經驗（葉寶玲等，2021；Barker & Barker, 2021; Hanley & Wyatt, 2021）等等。

4
其中也因疫情之故，有些研究即時取材，探究從實體轉換到通訊諮商的當事人或治療師
經驗（洪雅鳳、楊久芳，2022；Ahlström et al., 2022; Emran et al., 2022; James et al., 2022;
Lewis et al., 2021; Lokai et al., 2021; Stadler et al., 2023; Stefan et al., 2021; Werbart et al.,
2022）。
參、通訊諮商效果的探究
有關通訊諮商成效的探究，筆者從所閱讀的文獻將研究大致歸納為三種類型來說明。
一、單純探究通訊諮商的研究
通訊諮商成效的探究，目前多數研究指出是具備良好效果的。針對 COVID–19 爆發
期間所提供的通訊諮商服務進行調查，結果顯示儘管當事人遇到各種的挑戰，但依然認
為通訊諮商相當有幫助（Szlamka et al., 2021）、能有效緩解負面情緒（Carbone et al.,
2021）。一個針對 65 篇探究通訊治療效果研究的後設分析指出，通訊治療在改善常見
的憂鬱、焦慮、酒精相關問題方面是可以接受和有效的（Bennett et al., 2020）。而從治
療師的觀點來看，在 0至10 的範圍內，治療師報告通訊治療的有效性是 7.45，算是高
度有效（Sampaio et al, 2021）。但也有研究指出通訊諮商的效果是有限的，一項針對 115
位大學生的研究指出通訊諮商雖有助於減少心理疾病，但對於提升生活滿意度沒有幫助
（Ierardi et al., 2022）。
二、比較通訊諮商與實體諮商效果的研究
比較通訊諮商與實體諮商的研究絕大多數指出兩者在治療成效上並無顯著的差異，
這些研究多是採取嚴謹的隨機控制試驗（randomized controlled trial）之實驗設計，例如
針對馬來西亞的高中生（Zainudin et al., 2021）、針對澳大利亞有初步精神疾病診斷的白
人個案（Stubbings et al., 2013）、針對美國社區有高強度長期疼痛的成人個案（Taguchi
et al., 2021）。也有採取非隨機分派的準實驗設計，例如針對土耳其大學生的研究（Zeren
et al., 2021）。
多個系統性回顧的後設分析研究也同樣指出，通訊諮商與實體諮商都有顯著的治療
成效，而且兩者的療效並無顯著差異。例如 Fernandez 等（2021）就 56 項組內研究（N=1681
名參與者）和 47 項組間研究（N=3564）進行後設分析，發現視訊諮商的前後效果量大
且顯著，但與實體諮商並無差異，同樣都有效改善，這個研究也發現視訊諮商能發揮最
明顯的效果是，兩種條件的同時存在，一是使用認知行為治療（CBT），二是針對焦慮、

5
憂鬱或創傷後壓力疾患（PTSD）的症狀。而 Greenwood 等（2022）針對 12 個比較通訊
與實體諮商的隨機控制試驗之實驗研究（共 931 例患者）進行分析，這 12 個研究是針
對不常見的心理疾病（成癮障礙、飲食障礙、兒童心理健康問題和慢性病）患者，提供
認知行為和家庭療法，後設分析的結果發現不論是立即的效果，或在任何其他時間點（3、
6和12 個月）的追蹤效果都沒有顯著差異，比較的向度包含整體改善、功能、當事人評
工作同盟、治療師評工作同盟，以及當事人滿意度都沒有顯著差異。Lin 等（2022）則
針對 20 個隨機控制試驗之實驗研究，這些研究來自不同的國家（美國 11、加拿大 3、
英國 2、紐西蘭 1、西班牙 1、中國 1、澳大利亞 1），其研究分析結果同樣指出通訊諮
商與實體諮商沒有顯著差異。Giovanetti 等（2022）則聚焦 2000 年到 2021 年之間針對憂
鬱症狀處遇的治療研究進行後設分析，其選取的研究皆是比較通訊與實體諮商的隨機控
制試驗之實驗研究，研究結果也發現視訊及實體諮商在減輕憂鬱症狀方面的療效大致相
當，沒有顯者差異。
上述實徵研究的結果指出了通訊諮商在療效上與實體諮商相似，只是就當事人或治
療師的主觀感受來說，似乎不是那麼正面，例如少數研究指出相較於通訊諮商，當事人
更滿意實體諮商的效果（Zainudin et al., 2021）、治療師也普遍不喜歡通訊諮商，感覺諮
商關係變得更不真實和疏離（Szlamka et al., 2021）、覺得當事人是更不專心、更不易做
情感引導及建立治療同盟（Barker & Barker, 2021）、憂心效果受到網路穩定性與通訊設
備所影響（葉寶玲等，2021；Chen et al., 2023）。
三、探究從實體諮商轉換至通訊諮商的研究
上述有關通訊諮商與實體諮商比較的研究，多是分派兩群不同當事人分別參與實體
與通訊諮商，並且參與通訊諮商的當事人是從一開始就接觸通訊諮商。然而轉換經驗的
研究，則是聚焦在真實場域中因應疫情變化的研究，也就是原本進行實體諮商的當事人
或治療師，因應疫情需求轉換到通訊諮商的經驗探究，筆者認為此類研究最能對照出實
體與通訊兩種形式之差異。
探究轉換經驗的研究目前尚不多，但已發表的研究指出當事人對轉換經驗多傾向不
滿意，即便在轉換後仍對關係感到安全，但其經歷的阻礙多於幫助，例如感覺有多重失
落（Werbart et al., 2022）、虛擬空間感受不到療癒氛圍（洪雅鳳、楊久芳，2022）、別
無選擇只好繼續通訊治療（Lewis et al., 2021）、還是比較喜歡實體治療（Lokai et al.,
2021），主要的原因包含設備干擾與非語言訊息不足影響對晤談的專注與投入。當事人
報告無法情緒投入或開放、失去共融（rapport）關係、失去進入真實治療空間的儀式感、
失去治療性的工作（包含較無法聚焦、治療界線較模糊、治療師失去治療立場），只有
少數當事人有較正向的體驗，例如感覺更便利、更自由（Werbart et al., 2022）。研究也

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初步發現，當事人的特質會影響轉換經驗的知覺，自尊低落、有強烈關係需求和害怕被
遺棄的當事人，其轉換經驗更傾向負向（洪雅鳳、楊久芳，2022；Werbart et al., 2022），
不過研究也發現原本實體關係的基礎有助於轉換過程的適應（洪雅鳳、楊久芳，2022；
Werbart et al., 2022），另一個研究針對 63 名厭食症者的調查也發現當治療時間拉長、
更強的治療聯盟和更高的 COVID–19 焦慮，當事人對轉換經驗的觀點就愈正向（Lewis
et al., 2021）。值得留意的是，Lokai 等（2021）之研究參與者是來自美國紐約一家醫療
中心的 5名治療師和 5名病人，而 Werbart 等（2022）在瑞典進行的研究僅招募到 7位
不同人格取向的當事人，洪雅鳳、楊久芳（2022）則是針對臺灣 9位大學生當事人，這
三個研究雖然能夠深入探究轉換經驗，但因均採用質性訪談的方式、研究人數也相對較
少，在研究結果的解釋力需要未來的量化研究補足。
治療師的觀點部分，也呈現了轉換經驗帶來的負面影響（Emran et al., 2022），一項
探索心理動力取向治療師在疫情下被迫轉換到通訊治療過程中的經歷，五位治療師最初
在通訊技術和安全問題上相當掙扎，尤其失去實體治療空間與非語言細微的訊息，感覺
與當事人的接觸受損、對話也更膚淺，治療師深刻體驗到心理動力心理治療的本質受到
影響 (Ahlström et al., 2022)。Lokai 等（2021）針對 5名治療師進行訪談，即便多數治療
師報告通訊諮商不會影響工作同盟，也認為通訊治療相當有潛力，但治療師認為與當事
人難以在情感上聯繫，以及治療過程相較更貧瘠，過半的治療師也認為通訊治療效果較
差；Mccoyd 等（2022）針對 448 位治療師的質性探究，發現治療師感受到通訊治療缺乏
面對面接觸互動所產生的能量、長時間使用 Zoom 也帶來疲勞。針對 217 位奧地利治療
師的轉換經驗之調查研究也發現，治療師一方面讚賞通訊治療的靈活性，一方面也感受
到通訊治療的挑戰，例如有限的感官知覺、技術問題和疲勞現象（Stadler et al., 2023）。
James 等（2022）針對 161 名心理治療師探究其轉換經驗中對治療界線的體驗以及他們
如何管理這些界線，採取質量混合的研究方法，先進行線上問卷調查，再進一步使用最
大變異抽樣選擇了 12 名參與者進行半結構化訪談，治療師報告說，他們在非工作時間
以外工作的機會增加，也就是在家進行通訊諮商可能導致治療師工作與家庭之間界限的
模糊。
儘管通訊諮商存在許多挑戰和擔憂，但隨著時間的推移，心理治療師似乎逐漸在適
應，也在提高他們在通訊諮商方面的技能，而且不論治療師的取向如何，大多數治療師
原則上都會採用和實施通訊諮商（Stefan et al., 2021）。也有一些治療師報告，因進行通
訊治療的環境是在個人的空間進行，相較於實體諮商，治療師變得更加放鬆、角色也不
那麼僵硬（Lokai et al., 2021）。
從上述三類型研究結果可知，通訊諮商有其一定的效果，在疫情期間也發揮照顧當
事人心理健康的重要功能，但轉換經驗的研究發現當事人與治療師皆不滿意通訊的形式，

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這突顯了通訊形式在治療本質上的問題。以下將聚焦在轉換經驗相關的探究所發現的問
題來進一步論述通訊諮商在實務上的挑戰。
肆、通訊諮商實務上的挑戰
學者指出通訊諮商與實體諮商在情境或本質上是相當不同的（Burgoyne & Cohn,
2020; Lokai et al., 2021; Mccoyd et al., 2022; Werbart et al., 2022），筆者綜合上述研究結
果及學者們的論述，整理出幾個通訊諮商實務上的挑戰。
一、治療設置（setting）的不易掌控
實體諮商是當事人來到專業的治療室，治療室的設置包含動線、裝飾、家具、燈光、
音樂等等，皆是可依治療師的理念來設計，但通訊諮商則是當事人待在自己的住所或其
他空間，非治療師所能掌控。通訊諮商的高自由度，如個案可能不開鏡頭，或未在安全
隱私的環境進行諮商，這會讓心理師難以維持諮商架構（Chen et al., 2023）。相關研究即
指出當事人會因為所處空間的內部環境雜亂或外部環境的干擾（如隔音不佳、隨時被家
人或室友侵入）（洪雅鳳、楊久芳，2022；Werbart et al., 2022），此外，實體諮商原本會
經歷交通過程、進入治療室的過程，但通訊諮商只需要打開電腦或手機，點擊視訊軟體，
這對當事人來說，缺少了進入真實治療室的儀式感（洪雅鳳、楊久芳，2022；Lokai et al.,
2021; Werbart et al., 2022）。當事人描繪進到實體治療室就會去感覺自己的身體狀態、覺
察情緒狀態，但在家就不會（洪雅鳳、楊久芳，2022）。
二、治療架構（frame）與界線的模糊
轉換經驗的研究指出，當事人經歷了模糊的治療框架，因為在轉換前未有明確的協
議轉換後的目標及進行方式（Werbart et al., 2022），此外，因為在家中上線，有些治療師
變得更放鬆、穿著也不那麼正式，這有可能造成治療框架與關係界線上更鬆散，讓治療
師跨越了治療界線或失去治療立場，研究指出有的當事人描述「聽到噴霧和摩擦…感覺
治療師邊在做家務」（Werbart et al., 2022），針對治療師的研究也發現，的確治療師坦誠
在家進行通訊諮商不易管理治療界線（James et al., 2022）。不過，也可留意由於不同國
家的通訊諮商相關規範不同，有些國家的治療師（如美國、瑞典）可以在家工作，所以
當事人會有「感覺治療師在晤談時做家務」的這種情形，然而目前臺灣的法規規範通訊
諮商的執行必須在合格的諮商所或治療所，因此在臺灣比較不會出現這類工作與家庭間
的界線模糊的問題。

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但相對的，在通訊諮商中，治療師的穿著及鏡頭的背景呈現出治療師的真實生活樣
貌，也讓有些當事人感覺治療師的角色更人性化（Lokai et al., 2021）、更能親近（洪雅
鳳、楊久芳，2022）。學者也再指出通訊諮商是讓治療師有更多的權限進到當事人的私人
空間，也讓當事人進到一個異於辦公室的地點來晤談，這些架構和界線上的改變，都可
能改變了當事人與治療師之間的動力（Isaacs Russell, 2021），甚至是彼此權力關係的改
變，研究指出治療師對於非身處同一空間，當事人能在晤談過程中隨時離開，而感到難
掌控晤談的進行，這種掌控感的匱乏或會造成諮商關係中的權力失衡，從而影響整體的
治療成效（Smith & Gillon, 2021）。
三、虛擬空間缺乏真實身體互動
實體諮商與通訊諮商最大的差異即是在兩人的物理距離，前者是近身的接觸，有直
接身體與身體的互動，而後者則有一定距離。依據 Siegel（1999）提出的人際神經生物
學取向（Interpersonal Neuro-Biological approach¸ IPNB）的觀點，在人與人互動中會透過
身體互動來調節彼此（Siegel, 2006; 2019），實體諮商中，治療師溫暖的注視、平靜的語
調、前傾的姿勢等等身體語言，有助於當事人感受到被涵容、進而能調節身體狀態，這
是一種右腦與右腦的交流，也是一種彼此身體間無意識的影響（Weinberg & Rolnick,
2021）。研究指出，當事人感受在實體諮商中，與治療師的眼神交流相當能鼓舞自我表
達，但在視訊的屏幕上，怎麼尋找都找不到眼神的對焦（洪雅鳳、楊久芳，2022）。缺
乏真實互動也讓當事人感覺與治療師的連結受到損害、彼此距離變遠，分享上變得無法
那麼開放、談話也變得平淡（Werbart et al., 2022），甚至當事人感覺治療師的角色變得
「像網友」、「原本是不可取代的支持者掉到像只是聽我說話的人」（洪雅鳳、楊久芳，
2022），治療師無法觀察到當事人的非語言訊息，也就無法貼切地評估當事人（Lokai et
al., 2021），尤對心理動力取向的治療師來說，原本在實體治療中，當事人的沈默是有意
義的，但在通訊治療中就很難判斷（Lichtenstein, 2021）。學者指出情感、關係和調節變
化的機制是心理治療的核心，然而通訊治療消除了多數影響人們感覺親密與依附的氣味、
信息素（pheromones）（Weinberg & Rolnick, 2021），這也讓治療師對當事人的影響力
下降，Bizzari（2022）從訪談 19 位治療師及 9位當事人的研究結果中指出，缺乏身體
的共鳴會導致治療關係中缺少了具身的信任（embodied trust），這種信任是一種對他人
的感覺和身體開放，尤其是如果治療的目標不僅只是在減輕症狀，還涉及要解決潛在的
人格障礙時，身體的存在更為重要。相關研究也指出治療師報告通訊諮商對體驗取向的
治療進行有較多限制，諸如身體工作、空椅等技術不好操作與介入（Chen et al., 2023）。

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四、治療關係深度交流變得困難
學者 Geller 從「治療性的存在（therapeutic presence）」來論述治療師對當事人的影
響力，這是有效治療關係所必需的，是指治療師的整個自我，包含身體、情感、認知、
關係和精神等等多層面地融入當下，接受當事人的語言和非語言的訊息並在當下做出反
應，來展現理解及建構安全的氛圍，也是彼此連結和建立信任的基礎，是一種完全的存
在（Geller, 2020），一位當事人這樣描述「實體實際看到心理師，很自然注意力就放在
他身上……他人就在這裡會有一種氣場」（引自洪雅鳳、楊久芳，2022）。治療性的存
在有一部分是身體與身體之間非語言的提示，包含語調的韻律、面部柔和的特徵、手勢、
開放的身體姿勢等等（Geller, 2020），在通訊的數位世界中，有雙重因素影響治療性存
在，一是設備的干擾，通訊品質不佳導致當事人在轉換初期，最常跟治療師說的就是「哈
囉，哈囉，你在嗎?」（洪雅鳳、楊久芳，2022）；二是非語言交流的受限，當事人無法
完整接收來自治療師的身體訊息，治療性的存在也深受威脅。治療師陳述「通訊諮商這
些（傳遞出來的關懷、感受、溫度）會被打折扣，……甚至敏感度，或是支持都沒辦法
像實體諮商這麼好」（Chen et al., 2023）。
Sayers（2021）進一步論述通訊諮商可能阻礙了同理鏡像（empathic mirroring）及當
事人被涵容的體驗，同理鏡像指的是治療師對當事人的同理，就如同能真的感受到當事
人的感受，這是因為我們神經系統中的鏡像神經元細胞，在看到別人行為時會被觸發，
就好像自己也在經歷一樣，但在通訊諮商中，非語言訊息的匱乏侷限了治療師的同理能
力，不僅如此，學者也指出通訊形式來進行心理分析治療並不利於當事人的移情或退化
（Lichtenstein, 2021; Sayers, 2021），連帶地反移情也很受限（Sayers, 2021），因為移情
與反移情的發展也都與身體的非語言訊息有關。
五、倫理或保密性之疑慮
通訊諮商是透過網路的虛擬空間進行會談，一方面降低了進到實體治療空間身分曝
光的疑慮，但也同時增加了有關空間與設備隱私性不足的問題，洪雅鳳、楊久芳（2022）
指出當事人憂心的隱私及保密問題有三：一是憂慮自身所處環境/空間之隱私性不足；二
是憂慮心理師進行視訊諮商時的空間之隱私性不足；三是憂慮心理師所選用的視訊軟體
之隱私性不足。
同樣的，治療師也會因保密與隱私的挑戰，而降低對通訊諮商使用的熱忱，Sampaio
等（2021）調查 768 位心理健康專業人員，有超過一半（50.9%）憂心安全/保密的問題，
也有將近一半擔心是否符合法規及無法處理緊急情況等倫理問題。臺灣一項衛生福利部
的研究也指出心理師認為目前通訊諮商的執行，在準備上多採且戰且走，從經驗中學習

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的應對方式，通訊諮商的倫理議題，包含適用對象、危機個案評估機制與處置、資訊保
密與處理等等，未來都需納入制度面的規範（Chen et al., 2023）。
伍、通訊諮商實務的建議
承續上述並參酌學者的論述（Chen et al., 2020; Dolev-Amit et al., 2021; Geller, 2020;
Weinberg & Rolnick, 2021），筆者整理出以下實務上的建議。
一、評估是否執行通訊諮商
（一）當事人適切性評估
一是從人格特質的角度來評估：目前研究發現，自尊低落、在關係中害怕被拋棄的
人際特質（洪雅鳳、楊久芳，2022；Werbart et al., 2022）在轉換到通訊諮商的歷程中，
可能會經歷嚴重的失落，美國現階段也正有研究從依附特質角度來探究轉換經驗，未來
將有更清晰的了解；二是從年齡與發展的角度來看：兒童與青少年的專注力與情緒調節
能力有限，最好採取更短、更頻繁的治療方式，例如每週多次、每次 30 分鐘（Burgoyne
& Cohn, 2020），如果其議題與家庭有關，例如受到虐待、忽視或其他創傷，則要留意
社交封鎖令使得孩童可能與施虐者相處時間更多而無法敞開心扉處理他們的創傷
（Racine et al., 2020）；三是從當事人議題的角度來評估：尤其面對有危機問題的當事
人，尤其易引發治療師的焦慮（Tsalavouta, 2013），筆者在實務經驗中，確實發現通訊
諮商在處理自殺危機問題上的困難。
（二）確保當事人有適宜的通訊諮商配備
通訊諮商的基本配備，包含有品質的電子設備（例如電腦或手機，和網路）、進行
通訊的私密實體空間、通訊軟體的資訊安全性，這三者是進行通訊治療最基本的條件，
治療師在通訊諮商前需評估當事人是否能取得這些資源，這三個條件的不足會造成不必
要的情緒損耗。學者指出在實務上，可將責任回歸給成人當事人，直接指導他在通訊治
療期間為自己準備一個安全的環境，不受干擾及確保隱私（Weinberg & Rolnick, 2021），
或在必要時與當事人檢核是否需討論如何與家中成員溝通空間上的需求（Geller, 2020)。
二、通訊諮商前的準備
（一）確切執行通訊諮商的知後同意
前述已提到通訊諮商的治療本質與實體相當不同，因此治療師和當事人有必要共同
討論轉換到通訊治療架構的內容和意義（Werbart et al., 2022），例如通訊諮商的時間、

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為期多長、進行過程、互動方式、彼此的責任與任務、限制等等。轉換經驗的研究也指
出當事人期待在轉換前能有一個治療晤談之外的時段，來討論通訊諮商過程的擔心與問
題，或是最好可以安排一次通訊諮商的演練，以測試各種設備的使用方式及溝通品質（洪
雅鳳、楊久芳，2022）。
（二）治療師的準備—通訊晤談架構的設置
1. 治療師在虛擬治療空間的一致性
一個穩定一致的框架提供了安全的基礎，能協助當事人探索導致其內在不安的因素
（Sayers, 2021)，Geller（2020）提醒治療師需在家中或辦公室設置一個固定的地方，並
儘量能反映此空間的背景，以能提供當事人可預測的環境，研究也指出當事人期待治療
師不是設定虛擬背景，真實的背景能讓當事人感受到治療師同樣有注重談話的私密性
（洪雅鳳、楊久芳，2022）。此外，Geller（2020）建議要使用更大的螢幕，以幫助當事
人能看到完整看到治療師的手勢及身體訊息，才有助於治療性存在的提昇，研究也指出
當事人認為在螢幕中至少要能看到治療師的上半身（洪雅鳳、楊久芳，2022）。
2. 治療師呈現在當事人螢幕上的形象
Geller（2020）提出幾項具體的建議：（1）治療師要試驗一下與屏幕之間的距離，
太近有侵略性、太遠又顯得渺小，可以直接請教當事人的知覺來調整；（2）治療師的螢
幕上當事人的影像要儘量要靠近視訊攝影機，這樣治療師的目光在看著螢幕上的當事人
時，當事人會較能感覺到治療師在看著他；（3）治療師要留意所在地的燈光，最好不要
在身後有明亮的窗戶，以免當事人看到的治療師圖像會眩光；（4）治療師的穿著最好像
在辦公室一樣專業，不要假設當事人看不到自己的下半身而任意穿著。
（三）提醒當事人做準備
1. 空間環境的隱私與不受干擾
除了確保當事人能在獨立的空間進行視訊晤談，最好請當事人戴上耳機來確保隱私
（Geller, 2020），也請當事人能佈置一個乾淨不雜亂的空間或位置來進行通訊。
2. 通訊設備的設置及降低干擾
Geller（2020）指醒治療師要請當事人打開視訊鏡頭，才能看到當事人非語言訊息，
同時確保當事人談話時無其他人在場，也要協助當事人找到照明適切的地方，才能看清
楚當事人的面孔及眼神的注視。研究也發現通訊過程中，當事人可能會受到其他通訊軟
體的干擾（洪雅鳳、楊久芳，2022），例如 LINE、FB、IG、電話、電子郵件等等，所
以需請當事人在進行通訊諮商時關閉或避開這些干擾。
3. 療癒性空間的設置

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為協助當事人能較投入視訊晤談，可請當事人為自己準備布偶或抱枕等有助於放鬆
的物品，Geller（2020）也指出可提醒當事人先準備好面紙，或平日習慣在治療室使用的
情緒調節工具，例如加重毛毯、冰塊或感覺球；而不同治療取向的治療師，也可視治療
工作的需求請當事人先備好需要的材料，例如完形治療取向，可請當事人先備好空椅。
此外，有研究指出通訊晤談結束後，當事人需有時間與空間過渡，才能有更好的反思，
或減少家人碰見其哭泣（洪雅鳳、楊久芳，2022），治療師可與當事人先討論如何應對。
三、治療師在通訊晤談前及晤談過程的應對
（一）每次晤談前的準備
Geller（2020）建議治療師每次在進入視訊晤談前可以散步或做一些身體上的活動
來來往返於虛擬治療室，以模擬平日過渡到實體晤談空間的狀況；或是在進入視訊晤談
前花個 5-10 分鐘專注於自己，不論是正念呼吸或緩和的瑜珈，幫助自己做好進入治療
的準備，也有助於提昇視訊晤談過程的治療性存在。研究指出治療師感覺終日掛在視訊
軟體上相較於實體互動會更容易疲憊（Mccoyd et al., 2022），因此在通訊晤談期間，治
療師需做好自我保健工作，包括移動身體或做一些輕柔的伸展運動，自我照顧的工作亦
有助於培養治療性的存在（Geller, 2020）。
（二）每次晤談過程的應對
在通訊治療中，治療師必須比平時更積極、負責並展現更大的興趣，以協助當事人
感受到治療師的存在（Dolev-Amit et al, 2021）。具體的做法有幾點：（1）治療師需更
觀注自己的面部表情、聲音韻律（節奏、音色、音量、節奏）、目光注視、非語言暗示、
手勢，確保當事人能感受到這些，也可以直接詢問當事人能否感覺到彼此目光的接觸
（Geller, 2020）；（2）治療師需要注意當事人微表情中的細微差別，因為情緒最容易透
過面部表情呈現出來，Weinberg 與 Rolnick（2021）指出其實在視訊中因更近距離看到
身體，對於面部表情的識別比在現場來得好，治療師可以訓練自己對面部表情更敏感，
則能獲得比實體治療更多的面部資訊；（3）透過反映當事人的表情、眼神、語調和節奏，
並隨著他們的呼吸節奏來調節，這種共享的存在可以喚起人際同步並增強安全感和聯繫
感（Geller, 2020）。治療師也可以要求當事人報告其身體感覺，並根據當下需求來邀請
他們遠離或靠近屏幕（Weinberg & Rolnick, 2021），Ahlström 等（2022）研究也發現，
在轉換初期，心理動力取向的治療師相當不適應通訊治療的型式，但在一年後的追蹤訪
談中，治療師表示他們不斷發展新的應對策略，包含更具教學性和實事求是的方式，例
如更主動、更多交流、提供更多訊息，包含更多反映當事人的面部表情，來彌補有限的
非語言交流，同時也發展了新的傾聽方式，關注視訊交流中可獲得的線索（面部表情、

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避開螢幕等），並邀請當事人查看在通訊交流中發生的事情，透過這些應對策略，也漸
漸能回到治療重點；（4）治療師需覺察自己的身體與情緒狀態，來關注可能的反移情反
應，並視需要調整姿勢或語氣，以表達同理（Geller, 2020），然而治療師也得留意身處
在疫情多變的環境中，自己可能也受到影響，要能辨識自己的情緒反應的來源。有時通
訊形式的晤談，治療師也可能因為無法掌握當事人的經驗而產生自我懷疑，此時，可試
著與當事人檢核其經歷，並自我坦誠亦需適應通訊治療的過程（Geller, 2020）；（5）在
通訊諮商中，治療師會感覺到一定程度的自我意識，有些治療師會透過使用「自我」（use
of self），例如向當事人揭露個人的感受、想法和經歷等以增進治療效果，這不僅能令諮
商關係更加穩固，也使治療師對其自我感到更有安全感和更自信（Smith & Gillon, 2021）。
適當的此時此地的自我揭露與透明度，也是有助於提昇治療性的存在（Weinberg &
Rolnick, 2021）。
四、在轉換初期辨識諮商關係的變化並儘早修復
學者指出轉換到通訊諮商，當事人的反應如果變得簡短、沈默，或是更少情緒反應，
或迴避話題，甚至出現做家務、與周圍的其他人交談或在治療期間照顧他們的寵物等等
退出治療的行為，治療師要能辨識這類型治療同盟的破裂（Dolev-Amit et al, 2021），為
了能儘早覺察諮商關係的轉變以即時修復，有幾個作法：（1）在轉換到通訊諮商後立即
公開討論在虛擬環境中的任何感受或疑慮，在第一次晤談結束前也預留 10-15 分鐘詢問
當事人對通訊諮商的感受；（2）治療師也可以透過自我揭露感受到在通訊晤談過程談話
的不流暢或其他談話方式的改變，來邀請當事人來留意轉換帶來對關係的影響；（3）使
用直接處理治療同盟的支持性技術，例如討論治療目標和朝著這些目標的任務活動，或
者表達欽佩當事人進入陌生環境的能力和意願（Dolev-Amit et al, 2021）， 相關研究也
指出治療師對於當事人情緒變化的覺察及即時的情緒安撫與溝通也有助於當事人在轉
換上的調適（洪雅鳳、楊久芳，2022）
五、治療師得關注自己的身心健康與倦怠感
研究指出，在 COVID–19 大流行期間，治療師對職業倦怠感（Burnout）的自我評
估顯著增加 37%，以 0-10 分的評量方式，從 COVID–19 前自評 3.93 分提高到 6.22 分
（Sampaio et al, 2021）。職業倦怠感的提昇，可能與 COVID–19 期間，當事人遇到的困
難比平日高，處在危機狀態的當事人也比平日多有關，也與治療師自身同時也在面對疫
情引發的孤立、恐懼和焦慮等各種困難有關（Prime et al., 2020; Sampaio et al, 2021）。
奧地利有關治療師的研究也指出，遠距心理治療需要花更多時間盯著螢幕，而且在家工

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作的分心，這都使得治療師更疲憊（Stadler et al., 2023）。這些也都會影響治療師執行
通訊諮商的成效。
陸、結語
綜上所述，通訊諮商在實務上的挑戰來自其虛擬空間的治療情境特性所衍生的問題，
包含治療設置的不易掌控、治療架構與界線的模糊、缺乏真實身體互動、治療關係深度
交流變得困難等等，也因此，實務工作者如果能在執行通訊諮商時，不論是一開始就直
接進行通訊諮商，或者一開始是實體諮商後來轉為視訊諮商。實務工作者能在執行通訊
諮商前做好各種評估與準備，也協助當事人做好各種設備與心理的準備，彼此對通訊型
式的諮商可能的挑戰與應對有清楚的認識與共識，有助於減少不必要的干擾、提昇諮商
的品質；更重要的是在通訊諮商的程中，治療師更需要細心關注自身與當事人的各種身
體與情緒的變化，並有更多的溝通與檢核，才能更維繫關係的連結與提昇治療性的存在。
一項追蹤心理動力取向治療師的轉換經驗也指出，治療師對於通訊諮商需有一段適應的
歷程，並從中發展一些創意的方式來應對非語言訊息不足的限制（Ahlström et al., 2022）。
未來通訊諮商的訓練、繼續教育與督導，也應關注提昇治療性存在與維繫關係連結的主
題。尤其可以從長期執行通訊治療或諮商實務的工作者經驗中去整理出，在通訊諮商中
如何促進深度關係交流及如何辨識移情反移情的策略，做為培訓與督導之參考。例如研
究指出在疫情之前 2006年開始，「中美精神分析聯盟」（The China American Psychoanalytic
Alliance, CAPA）就採取互聯網為中國的心理衛生從業人員提供精神分析取向心理治療
培訓、團體及個體督導、個人分析或治療等服務，因此相較於 COVID–19 疫情衝擊才開
始施行通訊治療的美國精神分析從業人員，CAPA 的從業人員在疫情前、疫情期間皆對
通訊治療有較正面積極的態度，並且對通訊治療在處理移情、關係問題和抗拒方面的有
效性有更積極的看法（Wang et al., 2021）。
此外，從目前通訊諮商的相關研究可知，通訊諮商可能並不適合用於所有人，治療
師需謹慎評估其適用性。即便適合使用通訊諮商，學者也指出不宜變成長久的治療方式，
若要長期施行，採取通訊與實體混搭的治療形式可能是一解決方案（Luiggi-Hernandez &
Rivera-Amador, 2020）。目前對於通訊諮商的研究仍在發展中，未來的研究需要更多進
一步的探究以能了解通訊形式如何影響治療過程、對什麼樣的當事人、在什麼情況下、
在何時的影響為何，甚至通訊形式對不同治療取向的影響為何。若能釐清這些議題，或
能發掘出通訊諮商的獨特價值，例如哪些取向是相對不會因通訊的本質而受到負面的影
響、甚至可以發揮正面的影響，如此通訊諮商就不只是做為疫情來襲的短暫替代型式。
最後，值得一提的是通訊諮商與文化的議題。目前有少數學者關注到，由於在通訊
諮商過程可能對案主的各種語言、非語言訊息的感知較無法完整，需特別留意文化差異

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的問題，並提供適切文化的介入。Goldin 等（2021）指出在印度，水平搖頭可能表示「是」
的意涵，專業人員在不確定的情況下，最好能進一步澄清或檢核；又如信奉印度教的婦
女多是依靠配偶來做出與健康相關的決定，也因此在通訊醫療會議中常堅持其配偶要在
場，如果專業人員不了解不同文化的需求，將無法提供適切文化的回應和介入。而華人
文化相較西方文化來說，對於向外求助有更高的羞恥感，所謂「家醜不可外揚」，求助
專業等同揭示了家庭的弱點，代表家庭正在辜負其成員（Yeung & Ng, 2011），也就是
羞恥、面子和隱私等考量是影響華人是否尋求心理健康服務決定的重要因素（Lui, 2017），
因此採取通訊諮商對華人來說，相較於實體諮商能增加某種安全性，降低求助污名，但
由於通訊諮商的執行有可能是在家中的空間，治療師需敏銳到案主的會談空間是否安全
有隱私性。此外，本文指出有些相關研究發現，在由實體轉換到通訊諮商的過程中，當
事人感受治療關係的連結可能會受損（洪雅鳳、楊久芳，2022；Werbart et al., 2022），
而在華人文化中，俗語常說「見面三分情」，意指不論彼此關係如何，一旦面對面，總
會有一些情份，比較好商談、溝通，不致於太絕情。從這個角度分析，通訊諮商的本質
有可能不利於華人文化中治療關係的情感連結之建立，究竟通訊諮商在華人文化中能展
現其降低求助污名的優勢，亦或突顯可能在治療關係情感連結之劣勢，值得未來研究進
一步探究。
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Challenges and Suggestions for Telecounseling Practice:
Based on a Review of Empirical Research
Ya-Feng Hung*
Abstract
Telecounseling has been developed for 50 years, and its development has been accelerated in
recent years due to the COVID–19 epidemic. Originally, clients and therapists were accustomed
to face-to-face counseling, but under the influence of the epidemic blockade order, they had to
transition to Telecounseling. Many studies have pointed out that the working alliance and
effectiveness of Telecounseling are similar to those of face-to-face counseling. However,
empirical research exploring experiences from face-to-face to Telecounseling has pointed out
that both the client and therapist feel many negative effects. The challenges of Telecounseling
are not only the interference caused by communication equipment and space, but also many
practical challenges due to the differences in context and nature from face-to-face counseling,
including the difficulty of controlling the therapeutic setting, ambiguity in treatment structure
and boundaries, lack of real physical interaction in the virtual space, and lack of non-verbal
information resulting in weak therapeutic presence, etc. The purpose of this article is mainly to
review the current situation, effectiveness, practical challenges of Telecounseling, and to
provide suggestions for coping through the results of empirical research and the discussion of
related literature related to Telecounseling in recent years.
Key words: therapeutic presence, face-to-face counseling, videoconference-based
counseling, Telecounseling, COVID–19
Ya-Feng Hung* Department of Counseling and Applied Psychology, National
Taichung University of Education (yfhung@gm.ntcu.edu.tw)
2024 15 2 1-47

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Preface
Since 2019, people worldwide have changed their lifestyles, such as social interaction,
shopping, and medical treatment, due to the spread of COVID-19. Under various countries'
social distance restriction policies, psychotherapy and counseling were once limited. However,
the epidemic has made people generally more anxious and in need of psychological assistance.
Therefore, in a hurry, countries have also relaxed restrictions on Telecounseling and accelerated
the development of Telecounseling. During this period, the author also experienced the service
experience of face-to-face counseling to videoconference-based counseling and
videoconference-based supervision. Faced with the sudden change in service form, I panicked,
so I began exploring this topic. I also found that many scholars paid attention to the transition
experience during the epidemic. This article combines the output of my own practical
experience, relevant literature, and research results and is expected to provide a reference for
Telecounseling practice.
Due to technological advancements, Telecounseling is currently mainly video. Therefore,
in this article, the words tele and video will be used interchangeably to ensure the smoothness
of the discussion. At the same time, considering the citations of literature related to
Telecounseling and Teletherapy, the terms counseling and therapy, psychologist and therapist
are also used interchangeably. In addition, since different countries may have different
regulations on Telecounseling, different empirical studies may also affect the reliability and
validity of the research due to research participants and methods. Therefore, when reporting the
results of the empirical research in this article, the author will try to provide relevant information
about the research to help readers interpret the results and possible cultural differences.
The Definition and Development Status of Telecounseling
Definition of Telecounseling
The "tele" in Telecounseling means "transmission through long distances," so it is also
translated as distance counseling. In recent years, due to the impact of COVID-19, telehealth
or telemental health has become a developing new technology. (Robertson, 2020).
Telecounseling was called e-counseling or online counseling in the early days. Its development
can be traced back to October 1972, when online counseling was first demonstrated between
two universities at an international conference on computer communications (Wardell, 2008 ).

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E-counseling can be defined as a counseling method in which the client and the therapist are in
different locations or remotely, through telecommunication technology media such as telephone,
Internet, and remote conferencing (Sanders & Rosenfield, 1998) because later Internet
technology was often used, also called cyber-counseling. Telecounseling can be divided into
synchronous and asynchronous. Synchronous means the client can communicate with the
therapist remotely in real-time, such as via phone call or video conference. Asynchronous
means that the two parties cannot communicate in real-time, such as the interaction of email
text messages.
Reviewing relevant literature, related names for tele or distance counseling/therapy
include "remote counseling/psychotherapy" (Probst et al., 2021; Stadler et al., 2023), "distance
counseling/psychotherapy" (Robertson, 2020; Sandel, 2021), if particular emphasis is placed
on the media used, there are "audio counseling" (Day & Schneider, 2002), "video-delivered
psychotherapy" (Fernandez et al., 2021), and "videoconference-based counseling" (Stubbings
et al., 2013). The above are all compared to traditional face-to-face counseling, "embodied
encounter," and "in-person psychotherapy" (Probst et al., 2021; Stubbings et al., 2013). This
article uses face-to-face counseling title.
Practical Status and Research of Telecounseling
There were many empirical studies on Telecounseling in Taiwan over ten years ago.
Whether they were about Single Session Counseling Model (Chang et al., 2012), different
theoretical orientations (Hsu et al., 2007; Peng, 2009), or comparative Internet real-time
counseling, email counseling, and face-to-face counseling (Li et al., 2008; Hsu et al., 2010), all
found that Telecounseling has its effectiveness and is similar to face-to-face counseling.
However, due to the communication equipment at the time, it was not as developed as it is now,
and some studies specifically focused on email counseling. Wang et al. (2008) also pointed out
that the development of Telecounseling at that time still had various difficulties and limitations,
such as insufficient workforce and funding, computers, and counseling technical and related
professionals lacking on-the-job training in online counseling, and other issues.
Since the end of 2019, the COVID-19 epidemic has caused people a variety of
psychological distress. The rapid spread of the virus and the rapid increase in the death toll have
triggered emotions of anxiety, helplessness, and sadness, causing people's uneasiness and
promoting the onset or worsening of mental illness (Szlamka et al., 2021). Considering the
needs and safety of the people, many countries have relaxed their original Telecounseling

25
regulations. For example, the United States allows practitioners to provide services online at
home, and some states even allow services with only sound but no images to apply for insurance
premiums (Wehrwein, 2020). Taiwan also passed the "Reference Principles of Approved Work
for Psychologists to Perform Telecounseling." (Ministry of Health and Welfare, 2020) at the
end of 2019, legalizing Telecounseling. Telecounseling has become a meaningful way to
support people's mental health during the pandemic. Therefore, many practitioners are faced
with the need to adjust treatment service forms quickly. A survey of 768 therapists in the United
States pointed out that before COVID-19, 39% of therapists used Teletherapy. Most other
therapists were worried about this and only used face-to-face; however, During the COVID–19
pandemic, almost all therapists (98%) used a wide range of communication technologies to
communicate with quarantined parties, including text messages, phone calls, video
conferencing, and even virtual reality (Sampaio et al, 2021). Even people with severe mental
health problems (such as Schizophrenia, moderate to severe bipolar disorder, major depression,
substance use disorder, borderline personality disorder, suicide, or post-traumatic stress
disorder) have similar transition rates to the general help-seeking population. The attendance
rate of Teletherapy is higher than face-to-face therapy (Miu et al., 2020). Also, because of many
Telecounseling implementations, research and discussion on Telecounseling have sprung up in
the past three years (2020 to 2022). The author can summarize it by comparing Telecounseling
and face-to-face counseling in various issues (Greenwood et al., 2022; Zainudin et al., 2021),
exploring the implementation of Telecounseling (Barker & Barker, 2021; Sampaio et al., 2021;
Szlamka et al., 2021), counseling relationship or working alliance (Chen et al., 2020; Dolev-
Amit et al., 2021; Geller, 2020; Mccoyd et al., 2022; Sayers, 2021), treatment or counseling
effectiveness (Bennett et al., 2020; Carbone et al., 2021; Szlamka et al., 2021; Zeren et al.,
2021), client or therapist experience (Barker & Barker, 2021; Hanley & Wyatt, 2021; Yeh et
al., 2021), etc. Among them, due to the pandemic, some studies used real-time materials to
explore the experiences of clients or therapists switching from face-to-face to Telecounseling
(Ahlström et al., 2022; Emran et al., 2022; Hung & Yang, 2022; James et al., 2022; Lewis et
al., 2021; Lokai et al., 2021; Stadler et al., 2023; Stefan et al., 2021; Werbart et al., 2022).
Research on Telecounseling Effect
The author roughly summarizes the research on the effectiveness of Telecounseling into
three types from the literature I reviewed.

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Research Specifically Exploring Telecounseling
Most current studies show that Telecounseling has good results. A survey on
Telecounseling services provided during the COVID-19 outbreak showed that although the
parties encountered various challenges, they still believed that Telecounseling was helpful
(Szlamka et al., 2021) and could effectively alleviate negative emotions (Carbone et al., 2021).
A meta-analysis of 65 studies exploring the effect of Teletherapy pointed out that Teletherapy
is acceptable and effective in improving common depression, anxiety, and alcohol-related
problems (Bennett et al., 2020). From the therapist's point of view, on a scale of 0 to 10, the
effectiveness of communication therapy reported by therapists is 7.45, considered highly
effective (Sampaio et al., 2021). However, some studies have pointed out that the effect of
Telecounseling is limited. A survey of 115 college students pointed out that although
Telecounseling can help reduce mental illness, it does not help improve life satisfaction (Ierardi
et al., 2022).
Research Comparing the Effects of Telecounseling and Face-to-Face Counseling
Most studies comparing Telecounseling and face-to-face counseling show no significant
difference in treatment effectiveness. Most of these studies adopt rigorous randomized
controlled trial experimental designs, such as High school students in Malaysia (Zainudin et al.,
2021), white individuals with initial psychiatric diagnoses in Australia (Stubbings et al., 2013),
and adults with high-intensity and long-term pain in the American community (Taguchi et al.,
2021). There are also quasi-experimental designs using non-random assignments, such as a
study on Turkish college students (Zeren et al., 2021).
Meta-analysis studies of multiple systematic reviews also pointed out that Telecounseling
and face-to-face counseling have significant therapeutic effects, and there is no significant
difference in the effectiveness of the two. For example, Fernandez et al. (2021) conducted a
meta-analysis on 56 within-group studies (N=1681 participants) and 47 between-group studies
(N=3564) and found that the before-and-after effects of videoconference-based counseling
were large and significant. Still, there is no difference between Telecounseling and face-to-face
counseling, and both can be effectively improved. This study also found that the most apparent
effect of videoconference-based counseling is when two conditions exist simultaneously. One
is the use of Cognitive Behavior Therapy (CBT); The second is for symptoms of anxiety,
depression, or Post-Traumatic Stress Disorder (PTSD). Greenwood et al. (2022) analyzed 12

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experimental studies (931 patients) of randomized controlled trials comparing Telecounseling
and face-to-face counseling. These 12 studies were for uncommon mental illnesses (addiction).
Disorders, eating disorders, childhood mental health issues, and chronic disease), post hoc
analyses of providing cognitive behavioral and family therapy to patients found effects either
immediately or at any other time point (3, 6, and 12 months). There was no significant
difference in the tracking effects or the dimensions of comparison, including overall
improvement, function, client-rated working alliance, therapist-rated working alliance, and
client satisfaction. Lin et al. (2022) analyzed 20 experimental studies of randomized controlled
trials from different countries (United States 11, Canada 3, United Kingdom 2, New Zealand 1,
Spain 1,