Analysis of the Objectivity and ompetence of Online Therapy Sites - Essay Example

?The Legitimacy of Online Therapy Sites The idea of doing therapy online is controversial but there are many studies that have been done to show thatsome types of online therapy work. Although in the past it may have been a difficult situation to execute, today, with people as busy as they are, the time for online therapy has come of age. Many people would rather check online for something that they can do for self-help than to go into an office. Also, therapy still carries a stigma that says there is something wrong with the individual who goes for help. When an individual can find a therapy on the Internet that meets their needs they are assured that their friends and family will not know unless they decide to tell them. The challenge is that there are some sites that are better than others and consumers can find it difficult to find a site where legitimate therapists can help. Central to the controversy has been the idea that confidentiality cannot be assured with online therapy. Hanley and Reynolds (2009) reviewed quantitative research to see how counselors handled this situation. They found that online work was “moderately effective” (p.7 ) for some clients. In their study, counselors used a variety of online methods including chat rooms, webcam, email, forums and audio. They found that online therapy was a “promising field” and should be studied further. In order to understand how these programs worked, it was important to understand how these therapy sites worked and whether they are a viable solution in helping mental health professionals and their clients. Online Therapy and Regulatory Boards Generally speaking, online therapy is still an evolving field and many organizations have not regulated how it will be used. However, they have offered guidelines as to how counselors should conduct themselves in the use of the Internet. According to the American Counseling Association’s Code of Ethics (2005) counselors must make a determination about their clients before they begin this type of service. They must determine whether the client is “intellectually, emotionally and physically capable of using the application and that the application is appropriate for the client needs” (p. 6 A12-b). If counselors or their clients feel that this is not an appropriate method to use, the counselor must see the client in a face to face relationship. Also, counselors must provide “reasonable access” to computer applications when they are using them with a client (p. 6 A12 c-d). The American Psychological Association (2010) did not address the issue of online psychotherapy in their Code of Ethics. However, several psychologists have addressed this situation via articles that the APA has printed. As an example, Novotney (2011) addressed the issue of online psychotherapy and states that those psychologists who use it are able to reach people in remote areas who would not otherwise be able to receive counseling services. In Novotney’s article, the term telehealth is used to mean any alternative form of therapy whether it is over the phone, through email, video conferencing and through the Internet. Novotney states that psychologists must be licensed to perform this type of counseling and may have restrictions on how they do this on a state by state basis; in other words, they should check the laws in the state where their clients reside to make sure that they can practice in those areas. A challenge is that in most states, the laws are antiquated around counseling and psychotherapy and have not instituted specific guidelines on telehealth. The American Psychiatric Association (2010) uses a more medical model and specially created some areas that are specific to psychiatry. They do not address the issue of online psychiatric assistance in their code of ethics. Regulatory Boards Each state has a regulatory board that decides what should and should not be done by a licensed practitioner. Therefore, there are no specific guidelines that act as a blanket approach to this issue. Online Therapy Sites Visited This section of the paper will report on the sites that were researched and this researcher will discuss the security and ethical issues found as well and the confidentiality and informed consent information. Online Counseling E-therapists Online This website seemed to be a portal for a variety of therapists. The individual looking for therapy begins by deciding which therapist they want to work with through reading their individual files. There were currently 15 therapists of different ages, backgrounds and mostly white individuals. Each person had a bio on the site with their picture and information about their credentials and specialties, and how they used online counseling. Pricing was the same for everyone. Payment ranged from $39.95 for one email session to a one hour session via chat or phone for $95. They also provided a package of sessions that could be done from two to ten sessions and this ranged in price from $349 (10 email sessions) to $888 for 10 chat/phone sessions. There were no statements about confidentiality or how the counseling sessions would be handled. It seemed that this would be discussed by the individual therapist once a decision was made. The therapist were all trained and were either licensed professional counselors , most had PhDs with some having Masters degrees and one MD was listed on the roster. A client would come to this website, decide on a therapist, pay a fee, and then start sessions. Online Therapy.com This website seemed more commercial than the e-therapists site but it did not have the degree of sophistication that the e-therapists site had. There were several different types so counseling listed on the sidebar and an individual again could pick a therapist. Their listing of therapists did not have pictures and the people put bar minimum information about what they did, their credentials and how they used online counseling. The website was colorful and all the therapists specialized in Cognitive Behavior Therapy (CBT). A client could go to this site and gain information about CBT, how it works, and how their sessions would work. They provided eight weeks for $199 and provided gimmicks like a “test your progress monitor” along with a forum and one on one counseling in the area that the client chose. They listed ten therapists on this site although they have been in business since 2009. They did provide articles about online therapy and how it works. Marriage Matters, LLC This site is the business of a private marriage and family counselor, Jacqueline Gay. The site may be old because there was a note that said she would not be taking clients until after September 1, 2005. However, there was a wealth of information on the site. Ms. Gay presented information about online counseling and why it is successful. She states that she uses email or the phone to do her counseling sessions. Clients can receive a single session for $60 or a joint session with a spouse/significant other for $120; the single session is one hour while the joint session is two hours. Monthly charges for “unlimited emails back and forth” were $250 for individuals and $500 for couples. Gay has an MSW along with other credentials and is a licenses social worker. Security and Ethical Issues Ross (2011) suggests that there are several ethical considerations when doing counseling online. One ethical issue that stands out is the availability of an individual’s credentials. When someone walks into an office, they can see these credentials on the wall, but online, they will need to be shown. Counselors should make their credentials available on their websites with their “website—name, state and country, telephone number, discipline, and the certifications and licenses they hold” (p. 55) so that clients can verify their credentials easily. Also, many clients felt they could be more open with a counselor that they could meet online because the stigma of counseling was no longer a barrier to their interaction with mental health programs. Abbott, Klein and Ciechomski (2008) state that one best practice for using e-therapy is to make sure that emails and other online methods are secure. They give the example that it is important to make sure that emails are always sent to the correct client, making sure that the email address is a private address for the client and making sure that if other people have access to the therapist’s computer that the email for their clients cannot be seen by others. Some therapists use encryption programs to make sure that human error does not enter in. Abbott, Klein and Ciechomski also suggest that to make sure that informed consent if given by the client, a telephone or video interview can be a part of the initial interview. Also, requiring a birth certificate as proof of age is used if the age of the client is in question. One other area that is important is the area of training. Although many therapists enjoy the convenience of online, they must also continue their education in their area of expertise. Therapists should also continue training in the use of technology and online therapy. Many therapy programs have therapists use technology in their supervision sessions to make sure they understand how to use this information effectively (Abbott, Klein and Ciechomski, 2008). Advantages and Disadvantages of Using Online Therapy Certainly an advantage of using online therapy is that a therapist can reach many people in rural areas who may not otherwise have access to therapy. The anonymity of the Internet can allow clients to keep their therapy sessions away from their family and friends. Many assessment instruments are also available online which can make taking these assessments more available for clients. In this situation, they would not be limited by a specific time that they would need to take the assessment. The therapist has a larger field of techniques they can use. As an example, a virtual reality situation could be helpful in creating an immersion task for the client suffering from PTSD or some other issue such as overcoming fear. Disadvantages may include the fact that in some situations, the client would not be seen face to face and the therapist could not see body language that may be essential in their work together. Some individuals may become addicted to the use of the Internet because of their work in therapy, or they may trade one addiction for another. Another disadvantage for the counselor may be that the cost of some of the different software or other equipment may be prohibitive. Also, if the client is not used to using the Internet, there may be some resistance to using techniques or interventions that use the Internet. A challenge for the client may be that they would not have the equipment or the computer capacity to use some of the techniques that the counselor wants to use. Conclusion In this researcher’s opinion, online therapy is just another alternative that can be used for some clients. There are some areas such as play therapy or art therapy that may not do as well on the Internet unless there could be some type of virtual simulation for the client. The therapist may actually reach more people online because the stigma of using a therapist is taken away online. Some therapists may have some resistance to this because they are unable to use their intuition with clients because they are not face to face, but a way to deal with this may be to use video instead of phone. Online counseling is an important aspect of moving the counseling profession forward because it has the capacity to reach more people than face to face counseling. Although it is still a very young field, it is a field that will grow as time passes and people are more harried in their lives. References Abbott, J. M., Klein, B., & Ciechomski, L. (2008). Best practices in online therapy. Journal of Technology in Human Services, 26(2/4), 360-375. doi:10.1080/15228830802097257 American Counseling Association. (2005). Code of ethics. Retrieved from http://www.counseling.org/Resources/CodeOfEthics/TP/Home/CT2.aspx American Psychiatric Association. (2010). The principals of medical ethics with annotations especially applicable to psychiatry. Retrieved from http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards.aspx American Psychological Association. (2010). Ethical principals of psychologists and code of conduct. 2010 Amendments. Retrieved from http://www.apa.org/ethics/code/index.aspx Gay, J. (n.d.). Marriage Matters, LLC. Retrieved from http://www.marriagematters.com/index.htm Hanley, T., & Reynolds Jr., D. J. (2009). Counselling Psychology and the internet: A review of the quantitative research into online outcomes and alliances within text-based therapy. Counselling Psychology Review, 24 (2), 4-13. Retrieved from EBSCOhost. Novotney, A. (2011). A new emphasis on telehealth: How can psychologists stay ahead of the curve — and keep patients safe? American Psychological Association 42 (6). Retrieved from http://www.apa.org/monitor/2011/06/telehealth.aspx Online Counseling E-therapists Online. (2010). Online therapy site. Retrieved from http://www.etherapistsonline.com/ Online Therapy.com. (2011). Online therapy site. Retrieved from http://www.online- therapy.com/ Ross, W. (2011). Ethical issues involved in online counseling. Journal of Psychological Issues in Organizational Culture, 2, (1), 54-66. doi: 10.1002/jpoc.20047 Read More