The topic of online therapy has been the subject of debate since the widespread use of the Internet has become a matter of routine for vast numbers of people who find it convenient and easy to utilize just about any service via their computers or smartphones. When it comes to psychotherapy and counseling, however, the role of the Internet becomes much more complicated since having counseling sessions online automatically creates many ethical and practical issues involving standards of care, such as confidentiality and the formation of a therapeutic relationship. This paper will critique an article on the subject, “The Practical Aspects of Online Therapy: Ethics, Training, Technology, and Competence” which discusses many of the problematic issues pertaining to the provision of online counseling.
The article immediately raises the point that despite the increasing use of the Internet to provide and receive counseling services, there have been few regulations or standards established to govern the professionalism and ethics of the therapeutic process in that situation. The researchers focus on issues that are extremely relevant to the practice of online counseling, such as multicultural competencies, the education and training of future professional counselors, and the tremendous need for research into the efficacy of various treatment approaches in the provision of online therapy.
Included among the most significant issues that psychologists should be addressing when it comes to providing online therapy, are: the duty to warn, or a counselor’s obligation to prevent a client from harming him or herself or anyone else, which would be very difficult to assess over distance and from a computer because of the inability to directly observe the person’s mood and behavior; the need for licensure standards, which vary from state to state, so that online therapists who are counseling someone online in different states have no uniform guidelines to follow regarding mandated reporting, duty to warn, and other legal issues; the issue of confidentiality, which is a tremendous risk when it comes to online counseling because of the chance of security breaches caused by computer hackers; and record-keeping, which also runs the risk of violating a client’s confidentiality if the information entered into a computer becomes available to other people. The risk of keeping such records on a computer also presents an easy opportunity for records to be subpoenaed, revealing the contents of full client sessions which could be extremely damaging to the person’s life outside and inside the therapeutic context.
This article was extremely useful in thinking about making decisions regarding my own clinical practice and future applications of my work, because it was so comprehensive, covering issues such as the importance of being closely supervised when providing online sessions, the inaccessibility of online therapy sessions to a certain segment of the population that does not have access to computers or is not computer literate, and the importance of the counselor providing feedback to the clients in various forms, such as describing his/her physical or emotional reaction to what the client is expressing.While Internet counseling sessions would be convenient as well as cost-effective for myself as a clinician as well is for clients who can avoid paying transportation costs, there are significant obstacles that I would anticipate. One of the most important issues for me would be the establishment and development of an ongoing
therapeutic relationship, and the limitations to that process if it is conducted online. There are certain nonverbal and behavioral cues that are very revealing when meeting with someone face-to-face that are simply not possible to observe in online therapy, even if both parties have web cameras. Body language, the way a person is sitting and other observational cues simply cannot be perceived through a computer screen. Therefore, my sense is that any assessment of a client from online sessions would not be as thorough as one in which I can gather information from the person’s verbal presentation as well as his or her appearance, posture, eye contact, or lack thereof, affect when discussing sensitive topics–these are only a few aspects of what I believe cannot be replicated in online sessions.
Still, in my opinion, face-to-face sessions cannot be replaced by online therapy sessions, but they could conceivably provide a service to people who would otherwise not be able to engage in a therapeutic relationship, such as prisoners were people with illnesses that prevent them from leaving their homes. that option is certainly preferable to the person simply not receiving help. If I am working with a client, face-to-face and have a therapeutic relationship with him or her, but the situation changes in that one of us is unable to come to my office (illness, lack of transportation, family obligations),then certainly online counseling sessions would be appropriate since we have already established a (hopefully) good therapeutic alliance.
Online counseling may be a viable practice method for the area in which I plan to study, solution-based therapy in the field of criminal justice. Since solution-focused therapy centers
around the here and now rather than the past, and aims to find concrete, short term solutions rather than dwelling on the past, communicating through the computer might provide assistance to a population who a) are either incarcerated or not in a position to come to an outpatient setting or b)might actually be more tolerable for people who have significant problems with object relations or have extreme anxiety in expressing themselves on a face-to-face basis. Online counseling would be less threatening for such people, and not having to look a counselor in the eyes while discussing sensitive issues might eventually allow such a person to open up more easily. Working with offenders is likely to bring me into contact with people who have difficulty with interpersonal relationships, so that communicating through the Internet could be an excellent experience for them in which they may feel safe in the relationship, which would not run the risk of having another person see them wrestle with emotional issues.
The reasons for utilizing online counseling sessions are, for me, also the very reasons why I believe that there are inherent problems in providing such a service, i.e., the lack of face-to-face contact would allow a person to avoid the intimacy of a genuine therapeutic alliance taking place within an office. In addition, conducting sessions online would also allow the therapist to avoid confronting his or her own countertransferential issues; sometimes, it can be extremely beneficial to clients to see their therapist have an emotional or strong reaction to what they are saying, as a demonstration that the therapist is really engaged with them and is also a human being who experiences emotions. Essentially, in my opinion online counseling sessions
risk minimizing the ability of the counselor to serve as a real-time role model since by the time people type their messages on the computer, their reactions are not necessarily spontaneous.
If online sessions are conducted via a WebCam, there is a greater opportunity for the clients and counselors to witness each other’s reactions to each other by facial expressions, shifts in seating positions, and other nonverbal cues. However, it seems that there is also a greater chance for both the counselor and the client to be distracted by their surroundings, then there would be if they were seated together in an office with the door closed. On a Showtime program called “Web Therapy” the premise is exactly involving this issue: a therapist whose clients “meet” with her online; however, a large part of the hilarity of the show is the fact that not only is the therapist completely unqualified (I believe that she has an MBA, rather than any counseling degree), the sessions are only three minutes long because this counselor believes that the shortest term therapy is the most effective. It is a comical show, but it does underscore some of the points discussed in this paper: the counselor is frequently distracted by things that are going on in her household, and it is all-too-easy for her clients to simply avoid talking about anything much, although in three minutes, that would be likely be an issue!
To summarize, this article detailed both the benefits of online counseling, as well as the many potential complications, and concluded that there is a great need for valid research to be done regarding methods and outcomes. Given that since the technology is here to stay, online counseling will likely become more commonplace as computers become more affordable and
people are more pressed for time and unable/unwilling to commit to a regular counseling appointment. Certainly,psychologists need to be able to draw on a body of sound scientific inquiry so that they can learn/supervise about the potential problems as well as benefits in conducting an online therapy practice.
For me, conducting counseling sessions face-to-face will always be the ideal; however, in the event that it is not a practical remedy for certain populations, such as those in the criminal justice system or people who are ill or lack transportation, the next best option would be conducting counseling sessions using a WebCam so that at least there could be some eye contact and visual connection. I believe that the last resort for clients would be to engage in counseling sessions that simply involves typing messages between therapist and client with no opportunity to see each other; if there is no other option for a person to receive professional help, then certainly that option should be considered. This fascinating article addressed so many levels of complicating issues involved in online counseling sessions that it should be read by anyone who is considering taking their mental health practice in this direction.
Michael Mallen, D. V. (2005, November). The Practical Aspects of Online Counseling: Ethics, Training, Technology and Competency. The Counseling Psychologist, pp. 776-818.