Especially fascinating is that group services can be held in real time using chat rooms, or in some cases, utilizing virtual reality technology. With chat technology, users log on to different chat rooms and view written dialog on their monitors. Powell cites Quimby's investigation of dynamic online communication and supervision and training for cybertherapists. Compressed audio software allows users to “speak from the avatar and also allows for programming of a few facial expressions” (Powell, 1998).
Arguably, communication and convenience serve as two significant assets to online mental health resources. “Communication with other professionals- not just across the nation, but across the world- is quick, easy, and cheap online” (Grohol, 2000, p. 4). Databases such as MEDLINE or PsycLIT and references such as the Diagnostic and Statistical manual of Mental Disorders (DSM-IV TR) are easily accessible online as in-depth “clinical and research articles and references, which summarize the major treatment approaches and latest research developments for any given disorder, can be browsed online” (Grohol, 2000, p. 4).
While clear advantages and opportunities arise, such as the ability to time shift through the use of asynchronous communication or to location shift by use of synchronous chat, obvious difficulties can manifest at the outset with such basic issues as knowing the identity of who one is speaking with, and their age, emotional state, and gender (Suler and Feniche, 2000).
Ethical Implications of Cybertherapy
What is the clinician's responsibility raises a myriad of questions with respect to interapy, primarily due to the issue of where services emanate from. The national affiliates regulating ethical and professional practices for mental health care workers are unprepared for the onslaught of online implications. In a legal sense, therapeutic relationships are based on a contractual agreement between clinician and patient. However, most malpractice insurance policies will not cover treatment by a clinician provided outside of his or her principal state of practice, unless pre- approved by the insurance company. A clinician is only subject to disciplinary authority in the state in which he or she is licensed (Lloyd, 1996).
The American Psychological Association, APA, Ethics Committee recommends that psychologists follow Standard 1.04c, Boundaries of Competence, which indicates that 'in those emerging areas in which generally recognized standards for pre-paratory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect patients, clients, students, research participants, and others from harm (APA Online, 2003).
Although the NASW Code of Ethics (is largely silent on the issue of online social work, the standards dealing with informed consent (1.03), professional competence (1.04 and 4.01), and client records (3.04) certainly apply to online services as well as face to face services. Paragraph 1.07(m) does, however, specifically require the practitioner to insure confidentiality and privacy of information transmitted through electronic or computer technology.
Several associations of online professionals and health care organizations have developed codes of conduct for online services. Most relevant are those of the International Society for Mental Health Online and the Health on the Net Foundation (eTherapy, 2003). The International Society for Mental Health Online, ISMHO, whose members are online counselors, to date, is the sole mental health organization endorsing online counseling (Snow, 2001). The American Counseling Association notes “to mitigate the risk of potential breaches of confidentiality, professional counselors provide one-on-one counseling only through ‘secure' web sites or e-mail communication applications which use appropriate encryption technology” (Snow, 2001). However, it should also be noted that preserving anonymity poses a special problem as counselors would not be able to intervene if a client expresses a desire to harm himself or herself or others.
The lack of interstate licensure and inadequate policing of online counseling makes the ethical and legal use of this medium somewhat murky (Snow, 2001). As the popularity of telemedicine grows, state licensure agencies will have to deal with cross- state licensure (Lloyd, 1996).
Discussion
As the debate pertaining to cyberpsychology's efficacy ensues, it is important that a forthright dialog continue. This ongoing dialogue in turn should be succeeded by research into this emerging medium of mental health care. Technology can pose upheavals as it introduces constraints to the client's well- being not foreseen in traditional face-to-face therapy. The flow of communication, technical hindrances, sense of remoteness or isolation, ethical and legal liability, and identity or intent falsification on the part of the consumer or the therapist make etherapy as convoluted as it is fascinating. It is suggested more in-depth research continues and examines the effectiveness as well as discern if new models of theoretical application are warranted at the forefront of an exciting new mental health subspecialty.
References
APA Online. (2003). APA statement on services by telephone, teleconferencing, and internet. Retrieved Saturday, November 29, 2003 from, http://www.apa.org/ethics/stmnt01.html
CWRU. (2003). Etherapy. Retrieved Monday, December 8, 2003 from,
http://www.gingerich.net/etherapy.htm
Allen, J.L. (2003).
What is etherapy . Retrieved Tuesday, December 02, 2003 from, http://members.tripod.com/eTherapyWeb/page11.html
Find-a-therapist, Inc. (2002). E therapists online . Retrieved Monday, December 8, 2003 from, http://www.find-a-therapist.com/onlinecounseling/etherapy.htm
Finn, J., Banach, M. (2000). Victimization online: The downside of seeking human services for women on the internet. [Electronic Version]. CyberPsychology & Behavior, 3, 785-796.
Gladding, S.T. (1994). Effective group counseling. [Electronic version]. ERIC/CASS Digest.
Grimble,S.S. (2003). Etherapy Online. Retrieved Monday, December 8, 2003 from, http://www.etherapy-online.com/
Grohol, J.M. (2000). The insider's guide to mental health resources online. 2000/2001 Edition. New York , NY : The Guilford Press.
Lloyd, M.G. (2000). Have you had a long-distance therapeutic relationship: You will. [Electronic version]. Ethics and Behavior, 6(2), 169-172.
Maheu, M.M. (2003). The online clinical practice management model. [Electronic Version]. Psychotherapy: Theory, Research, Practice, Training, 40 (1-2), 20-32.
Mallen, M. J., Day, S.X., Green, M.A. (2003). Online versus face-to-face conversations: An examination of relational and discourse variables. [Electronic version]. Psychotherapy: Theory, Research, Practice, Training, 40 (1-2), 155-163.
Oravec, J.A. (2000). Online counseling and the internet: Perspectives for mental health care supervision and education. [Electronic version]. Journal of mental health 9 (2).
Powell, T. (1998). Online counseling: A profile and descriptive analysis. Retrieved Tuesday, December 02, 2003 from, http://netpsych.com/Powell.htm
Snow, S. (2001). Is online counseling ethical . Retrieved Tuesday, December 02, 2003 from, http://www.commcure.com/ethicsonline.html
Suler, J., Fenichel, M. (2000). The Online Clinical Case Study Group of the International Society for Mental Health Online: A Report from the Millennium Group. Retrieved Tuesday, December 16, 2003 from, http://www.fenichel.com/CaseStudy.htm
Wallace, P. M. (1999). The Psychology of the Internet. New York Cambridge : University Press.
