Since my last post, I presented "Web Secrets for Social Workers – Boost Your Organization & Your Professional Practice" at the 2009 Power of Social Work Conference. Once again, participants asked multiple questions about the ethics of online counseling and other social networking media. I essentially provided answers culled from my last blog post.
That said, I am pleased to add a few more resources to the online ethics fund of information.
The clever people at the Online Therapy Institute Blog posted a useful summary of the answer to a question included in the February 2009 edition of Psychotherapy Finances (not available online).
The question asked whether an online therapist has to be licensed in every state to offer online therapy. Here are some highlights from the response:
- Web-cam therapy is not as popular as had been expected due to the need for high speed connection and the fact that some people prefer the perceived anonymity offered through text-based therapy.
- In theory, some officials suggest that a clinician could be liable for ethics charges of even loss of license if they see a client who resides in another state.
- The state of Ohio is looking at a new rule saying that therapy takes place wherever the client is.
- There are no legal cases yet.
- Insurers are generally not happy with the concept of Internet services but coverage remains in place.
- The first person who gets hit (with a lawsuit) will get hit big.
- Even so, many individuals are seeking therapy online.
- Various associations offer ethical guidelines but retain attitudes ranging from indifference to hostility.
- Informed consent may need to be modified for online work.
- It is suggested that if your license is listed on your website, you come under the jurisdiction of the license regardless of what service you state you are providing (consulting, coaching or advice).
The fabulous folks at the Online Therapy Institute have posted a really interesting Ethical Framework for the Use of Technology in Mental Health. Sample bullet points from the comprehensive framework include:
- Dual Relationships: Practitioners discuss with clients the expected boundaries and expectations about forming relationships online. Practitioners inform clients that any requests for "friendship," business contacts, direct or @replies, blog responses or requests for a blog response within social media sites will be ignored to preserve the integrity of the therapeutic relationship and protect confidentiality. If the client has not been formally informed of these boundaries prior to the practitioner receiving the request, the practitioner will ignore the request via the social media site and explain why in subsequent interaction with the client.
- Insurance, Subsidy or Reimbursement Information: If the client resides in a geographic area that generally accepts insurance or other forms of reimbursement for therapy services, the practitioner informs the client of this information. Conversely, services delivered via technologies that are not covered at all or at the same rate, the practitioner informs the client of this information also.
I feel abit like I am falling off a cliff by posting here. I am a Psychiatric Nurse with traditional Mental Health Training and have been in practice and research for about 35 years.
The Old adage was Face to face was better than telephone counseling and now I am learning that the rest of the world is doing "therapy" online. Clearly it raises a great deal of ethical issues for me as well as everyone...... but it also opens the door to many more people getting help in a 21st century modality.
Thus I am trying to educate myself about this new emerging trend. In the process when I talk to Canadians then know exactly what I am talking about. When I speak with US folks, the usual response is that is NOT being done in the States due to liscensing issues. But here you are.....
Can anyone answer for me or point me in the right direction to understand the extent online Therapy is being conducted in the US, and why main stream folks are denying its existence here....
Patricia A. Herlihy
Rocky Mountain Research