E-Therapy: The New Frontier
Marsha B. Sauls, Ph.D.
An article written for the January 2001 Georgia Psychologist
Everyone is talking about it, but what is it? Who is doing it? How does it happen? Is it helpful? Is it ethical? Is it legal? E-therapy is a new frontier. It is not traditional psychotherapy in which the established research has documented that the relationship is the essential ingredient in the healing process. The researched relationship being, of course, a face-to-face relationship. At his point we do not know how introducing a machine into the process will affect the therapy process.
Adventurers, however, are eager and motivated to experiment with this new modality of delivering services. There seem to be two directions from which exploration in this area emerges. Those in the e-business world, see this as another service to offer to a worldwide market with of course the possibility of huge financial reward. The IT (Information Technology) moguls have the expertise and financial backing to put together the technical requirements for online services but don’t have the therapy expertise. This means they have to come to professionals who are licensed as psychologists, clinical social workers, professional counselors or marriage and family therapists, to provide the services they want to offer. On the other hand, some therapists, including psychologists, would like to offer services over the Internet but most often are not adept at the technical expertise necessary nor have the funding available to turn their therapy practices into an e-business. These therapists need the IT people to help provide the technology. There is a chasm across which both sides are working to bridge. Eventually the task will be done.
Where are we now? Presently there are at least 200 sites offering on-line therapy. This is a constantly changing number. On the horizon is the technology to allow Tele-therapy. This will more closely approximate “real” therapy because the client and therapist will actually be able to see each other as they e-mail or actually talk to each other. The technology for Tele-therapy, however, is not yet readily available in a cost-effective way. Therefore e-therapy, at this time, consists of a client and therapist communicating to each other through e-mail. Some label their service as therapy, but new labels are being created to deal with the issue of licensure limited within state lines and the legalities and ethics of possibly not ever meeting in person with your client. Personal Coaching, e-therapy, on-line therapy, and coaching are some of the unlicensed titles for services provided through the Internet.
For people who travel, who are infirmed or live great distances from centers where mental health services are available, e-therapy can be helpful. For people who feel uncomfortable facing someone face to face, e-therapy can be a warm up to “real” therapy. But for the majority of those who use it, the reason is time and familiarity with being online to access other life necessities such as banking, shopping, gathering research data, participating in “chat” rooms, and e-mail.
One of the IT professionals that has created a web site with links to therapists able to provide e-therapy is Martha Ainsworth. She is one of the technology experts that have the technical ability and an organization to create the forum from which one could participate in online therapy. Her web address is www.metanoia.com. There you can find her own personal story about her extremely positive experience with e-therapy and therefore her desire to make the service available to others. It has exhaustive, accurate, and ethical information about the entire field of on-line therapy and well worth the look. From her site one can link to other informational sites and a list of therapists she has actually rated to provide online services. But again, her side of the chasm works well. The information posted is excellent, timely and easily accessed. Her links work well. When you try to access some of the therapists, however, the system breaks down. Some of their web sites work and some do not.
For someone interested in pursuing this new frontier there are some ethical considerations. Some are congruent with face to face therapy and some are particular only to e-therapy.
One must be concerned about:
limits of confidentiality.
statements about who you are as the professional.
ways to allow a potential client to check your credentials.
methods you will use to determine if your online client is legitimate.
disclaimers about what can and cannot be expected from you as an online therapist.
organized methods to deal with suicidal clients.
clear and accurate descriptions of the cost of services and how payment will be made.
The American Psychological Association is addressing ethical issues for services delivered via “electronic media” by having in their revisions of the Ethical Code for Psychologists a statement that psychologists offering services products or information via electronic media inform users of the risks to privacy and limitations of confidentiality.
The American Psychological Association’s new site www.dotcomsense.com/index describes issues related to making decisions about privacy when using the Internet.
An important legal issue with online therapy is the fact that licensure is a state by state process at this point. Because of this, licensure boards are beginning to dialog and explore strategies for reciprocity. Because of this legal issue, some who offer on line services do so only for people in the state in which they are licensed. Others require a face to face meeting, or use e-mail to communicate with existing face to face clients as one would use a telephone consult.
The International Society for Mental Health Online is a nonprofit organization that has as its purpose “to promote the understanding, use and development of online communication, information and technology for the international mental health community." (www.ismho.org) Began in 1997, it has a web site to provide research data and information to therapists about this emerging field. One can access this site at www.ismho.org. This site has information about the organization, links to papers and resources about online mental health services, and a list of presentations made by the organization at the American Psychological Association’s Annual Convention in Washington this year.
Other sites one might look at to begin to develop an understanding of the state of the art of e-therapy at this time are the following. I am not recommending or endorsing any of these sites. They are listed only to give the reader a place to start one’s own search in this area. I am listing these mainly because they were there when accessed and did not have a “site in progress” or “site not available” message as many others did. John Grohol, Psy.D. has a site www.psycentral.com. Dr. Grohol is one of the founders of the ISMHO. On his site are articles he as written about legal, licensing, confidentiality, and privacy issues. Another, www.helphorizons.com has information and is one of the many sites on which one can register to be listed on the site. Www.here2listen seems to be one of the online clinics Martha Ainsworth discusses are forming as is www.onlineclinics.com. One discovers quickly as one “surfs the net” that sites have different presentations and varying levels of professionalism.
This is a very brief overview of this emerging frontier. It is constantly changing, as is the technology involved. In time it will develop as a safe and accessible form of help and support for the Internet literate people of the world. It will be a different form of the experience now known as face to face individual psychotherapy. It may even have different names, but it will have a purpose and a place in the kinds of mental health services available from which clients will be able to choose.