Counseling On Line 1
Counseling On Line
Silva Redigonda
Professional Ethics RGP 3564HS
Professor Buhagar
May 26, 2011
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Counseling On Line
With the introduction of computers, society has evolved to another level. That level is one, that is wireless. Technology is on a continuous path of progression, instantly connected to the entire world through the lens of a computer, as compact as a cell phone or as large, as a screen is available. Each home now is equipped with some sort of social media technology and a generation is being born into this new wave of banking, buying, selling and studying all on line. It is only a matter of time that counseling on line will become routine, as all else is becoming. Is on line counseling practical? Is it safe? Is anything safe on line? The benefits and risks of counseling on line, to the therapist and to the client, need to be investigated and solutions found by addressing the following questions:
1. What are the on line counseling opportunities, complaints, and reviews?
2. What zones from a respective Code of Ethics are there to determine if there is
provision for counseling on line and which codes would be inclusive for the
protection of both the client and therapist?
3. What difficulties and dilemmas may be encountered in theory and in practice
and what is positive?
This paper regarding the ethics of counseling on line will focus on these three questions.
What on line counseling is available?
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The internet provides an international source of information for on line counseling. Type on line counseling, on a key board and 17,600,000 sites are available (Google). Type it again, a few hours later and about 40,400,000 sites are available (Google). This is the world of the web, where information is constantly changing, altering, increasing and decreasing. This is the web where people have instant information world-wide. On line counseling is email, skype video conferencing, blog and any other counseling possible on line. For the purposes of this paper, on line counseling will be restricted to email, mindful of associated problems.
While searching for on line counseling on the internet, there are on line counselors who provide and list their credentials, while others do not. A counseling site named Cozy Therapy, promises, not to sell the information received from the client, and an informed consent is available to preview on line. The advertisement for this particular site reveals that the counseling is not recommended for one who is suicidal, and a potential client must indicate as such, on the informed consent site (Burris). One of the questions posed to potential clients, stipulate that “the use of therapy for sexual gratification will not be tolerated. Your session will end immediately and no refund will be given” (Burris, Getting Started). In the questions and answers portion of the same site, one of confidentiality is cited. “Is on-line counseling confidential?” The response is “Yes. We use the most trusted software in the industry to enure confidentiality. Our therapy sessions are encrypted. Also, you have a transcript of our session...you can review it and process the information for as long as needed” (Burris). The spelling mistake of “enure” rather than ensure is that of the web site and not this writer. The “most trusted software in the industry” is not identified. There are Christian counseling sites, and one in particular claims to be free. Scrolling on this site is lengthy, with biblical quotes. No qualifications of the counselors are
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listed. The site also suggests that any client taking medication should not stop. Also, advertised is the option of sharing of one’s journal, with others in a forum (Christianity Oasis). The “program was created to help lost souls and troubled Christians find truth….”(Christianity Oasis).
There is extensive counseling on line opportunities, providing different arenas of counseling. Some who do not list qualifications, may lure clients with attractive advertising. Who is the counselor? Is the counselor qualified? Endless sites contradict what others offer. The opportunity for on line counseling is available at a large scale. How would a client identify who is a legitimate on line counselor?
What are the online Complaints and Reviews?
There are complaints about therapists in general. None seem connected to the internet counseling. One site depicted 13,193 visitors, indicating that there is an interest regarding complaints against therapists. This service was shut down due to spam and malicious users (Therapist Ratings).
On line counseling is not altogether a recent discovery. One article provided a 1997 review, questioning on line psychotherapy and listing a definite availability of 50 counselors but a possibility of 100 counselors. This review lists one advantage of on line counseling, as people believing they are anonymous and therefore behaving differently. This behavior will have Clients introduce, more serious issues quicker, than face to face. A disadvantage is that the client may not know who the counselor really is. There can be a question of lack of credentials.
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A disadvantage for the counselor is that geographical boundaries are being crossed, and therefore the counselor may be breaking the laws, of another country (Psych Central).
What zones from respective Code of Ethics codes, pertain to on line counseling and would be inclusive for the protection of both the client and therapist?
The Canadian Association for Spiritual Care (CASC), Code of Ethics, Ethical Principals in Relationships with Colleagues, 5.3, indicates to “Exercise due caution when communicating through the internet or other electronic means.” This is nothing specific to on line counseling but this section could be used as a guideline. Defining “exercise due caution” is left to the opinion of the counselor. This is open to interpretation and therefore ambiguous.
The Canadian Counselling and Psychotherapy Association (CCPA), Counseling Relationships, B16, Computer Use, is more in depth. Clients and Counselors identity need to be verified. The client should be capable of using the computer and application, and follow-up. This section also refers to D5 Evaluation and Assessment, Use of Technology which indicates:
“that counselors recognize that their ethical responsibilities are not altered… or
diminished” by using technology “for the administration of evaluation and assessment
instruments” and maintaining ethical principles of “privacy, confidentiality and
responsibility for decisions regardless of the technology used.”
Though the section D5 pertains specifically to Evaluation and Assessment, the same principles could be updated to pertain to on line counseling. B17 is specific to the Delivery of
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services, by telephone, teleconferencing and internet. This section informs counselors to follow additional, ethical guidelines as those pertaining to telephones. Again, these additional guidelines are left to the discretion of the counselor.
The American Association of Pastoral Counselors, (AAPC) Principle 111 – Client Relationships, I, is specific to Interactive long-distance counseling delivery when the pastoral counselor and client live in two different locations. There is also a restriction that this mode, cannot completely replace face-to-face therapy. The section also indicates that all “reasonable steps” be taken to ensure the client understands the limits of “long-distance” therapy but does not specify what these limits are. The client is also to understand the “computer application, what it is used for, and its possible effects.” Principle 1V, regarding Confidentiality A, requires all records kept on a client be stored under lock and key. There is no provision for on line records.
The Canadian Psychological Association (CPA), Code of Ethics has no zones connected to on line counseling but the Ethical Standards, Respect for Society, 1V.17, indicates that psychologists are “to familiarize themselves with the laws and regulations of the societies in which they work.” This would be applicable to on line counseling, that the counselor be aware of the laws, from where the client is being counseled from. Does the counselor really know who the client is on the internet and where the client is actually from?
The American Association for Marriage and Family Therapy (AAMFT) Code of Ethics has no code specific to the internet. But Principle 11, Confidentiality, 2.5, does indicate that a “therapist arranges for the storage, transfer, or disposal of client records in ways that maintain
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Confidentiality, and safeguard the welfare of clients.” How confidential is counseling on line? How are files contained?
What difficulties and dilemmas may be encountered in theory and in practice and what is positive?
In 2006, the internet was regularly being used by almost one billion people (Spinello, ix). Over 90% of undergraduate students use the Internet daily, and 67% are on line from 0.5 to 4 hours daily (Scott and Thompson, 33). Personal information on the internet can be collected and exchanged. Spyware and cookies allow for internet surveillance (Spinello, 141). Spyware is a program, which is usually installed on a person’s computer, without consent, to track a user’s habits and transmits the information to a third party. Some spyware steal passwords and credit card numbers. Cookies can monitor a user’s behavior to web sites (Spinello, 149). Computers can also remember everything indefinitely (Spinello, 147).
What can be used on the personal computer to increase security is a firewall. It is not always effective, but in cases where a breech has occurred, there is a detection system. This software monitors the network to look for signs of an intrusion, takes steps to stop it, and highlights the security hole for repairs (Spinello, 197).
There is a public apprehension about the Net’s security flaws. New problems are exposed “underscoring the internet’s fragile infrastructure. Despite the use of firewalls, security scanners, intrusion prevention products, and other security devices, Web sites have been a major target for hackers.” (Spinello, 182-184). One form of “malware” is the “Trojan horse” used to corrupt information into a program, and providing the opportunity to steal passwords and destroy files.
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The Net’s architecture is radically open, designed to share information and not conceal it. It is possible to develop adequate security, with acceptable risk, but this requires time and money that many government agencies and corporations have been reluctant to undertake (Spinelli, 184-185). The key words here are “acceptable risk,” which even with intensive security measures in place confidentiality cannot be guaranteed. What kind of security is in place for emails? One way is encrypting one’s communication. This makes the information “undecipherable” to anyone not having a “key” to encrypt the data (Spinelli, 185). Private key encryption has been in widespread use since the 1960’s (Spinelli, 198). The best way to verify identity, which would be imperative in counseling, is through the use of digital signatures, which is possible by the use of public key encryption. In this situation a private key is used to verify a signature, after it has been sent (Spinelli, 199).
Data protection legislation was formulated in the early 1970’s in Europe. Countries such as Germany and Sweden believe “that privacy is rooted in basic human rights.”(Spinello, 160). This was contrary to the States at that time, where Americans were occupied with debates about the justification of privacy (Spinello, 160). There are laws in place to protect credit and financial information. There are also rules (HIPPA) to safeguard sensitive medical information (Spinello, 165). In 1986 the Computer Fraud and Abuse Act (CFAA) amended in 1996 (U.S. legal system) made it a crime to access “virtually” any protected computer connected to the internet. According to the CFAA, trespass is a federal crime when one pilfers “classified information to perpetrate fraud or to cause damage (eg. to destroy files or disable an operating system). It is also a federal crime to cause the transmission of a program or piece of cod (such as a virus) that intentionally causes damage to a protected computer.” The CFAA also prohibits unauthorized
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access that causes damage, regardless if it was caused recklessly or not (Spinello, 190-191). A 1998, copy of the Criminal Code of Canada (CC of C), section 310.2, reveals that the user of the unauthorized use of computer, if found guilty of an indictable offence, is liable to imprisonment for a term not exceeding ten years.
AAMFT’s magazine for therapists offers a more positive outlook for online therapy. One of the first demonstrations of the Internet at U.C. Berkley was a simulated chat therapy session. Renowned founder of Rational Emotive Behavioral Therapy, Dr Albert Ellis, used online therapy from the early period of the internet, to meet with clients from all over the world (Derrig-Palumbo, 24). Online therapy is beneficial and not restricted to, people who suffer from shame or feel stigmatized going to a face to face visits, people who are homebound, people who live in rural areas, and people who travel extensively. Online therapy is an additional option to enhance accessibility, but not replace face to face therapy. Dr Derrig-Palumbo founded MyTherapyNet.com, which is a global online therapy service with over 2,100 licensed mental health providers. Studies demonstrate that online counseling may be as effective as face to face therapy (Derrig-Palumbo, 24-25). Derrig-Palumbo argues that though client identity becomes important in emergency situations during therapy, face to face clients are rarely asked for identification. They compile an intake form with whatever information they wish to fill. If the client pays cash as well, a therapist may not have an accurate location for the client. However, the client online will need a credit card with a valid billing address which can be used to locate the client in an emergency. An IP address can also be tracked by the Internet Service Provider and an exact location may be provided (Derrig-Palumbo, 26). Derrig-Palumbo recommends that online therapists check with their state boards regarding counseling outside one’s area. A benefit
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that therapists have, is the ability to offer services, outside of their locality. It also provides their clients greater flexibility such as when they are sick. This permits more regularity for clients and the minimization of revenue loss for the therapist (Derrig-Palumbo).
Are online clients satisfied? A 2006 study by Leibert, Archer Jr., Munson and York concluded that online clients were satisfied but not as satisfied as face to face therapy (Haug, 29).
A 2006 study by Shaw and Shaw concluded that from 88 counseling web sites they followed, fewer than half, of the online therapists followed accepted ethical practices, and a number provided no licensing information (Haug, 29).
Haug reports that most mental health organizations, including AAMFT do not take official positions regarding the practice of online counseling. Exceptions to this rule, are the ethical codes of the America Mental Health Counselors Association and the American Counseling Association (Haug, 29). Haug reports that “informed consent requires the therapist to inform clients of potential risks and benefits of treatments for which generally recognized standards do online counseling may “hamper assessment and effective treatment” since there is an absence of visual or auditory clues (Haug, 30). There is a concern about text-based online counseling. To have every word typed, there is concern that what is being said may be taken out of text. A disgruntled client may have multiplied avenues for discrediting and harming family members or the therapist (Haug, 31). A breach of confidentiality on line has the same consequences as any other breach (Family Therapy, Ethical and legal, p 44). Mills however, has another perspective. She finds written records beneficial. Mills reports that the client can reread the conversations so that something not understood initially can be given further thought. She further indicates that
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supervision would also be easier since the entire written record can be provided (Mills, 107). The benefits of the client writing emotional events that has happened can be therapeutic in its own right (Mills, 110) and email permits an in-depth relationship between the therapist and client to be “psychologically useful” (Mills, 107). Email may be used to convey positive regard and empathy. A client in the early stages of stress can also be helped, for better well being, through email (Mills, 115).
One of the main differences between online counseling and on line pastoral care is the religious element (Mills, 108). There are no known evaluations of pastoral care from the religious aspect since it is presumed to be present in the relationship (Mills, 114). Studies do exist that some clients, value spiritual support alongside clinical therapy (Mills, 115).
There is an entire generation being raised without a preconceived notion of living without the internet. Though there is no guarantee of a breach of confidentiality on the internet, there is no guarantee of such a breach, when counseling clients face to face. Society evolves and those that refuse to do so are left behind. There is a concept of balance in life. On line therapy is becoming an option for the public. It is presumed that therapists use the guidelines of the existing Code of Ethics pertaining to their discipline. But the Code of Ethics needs to be brought up to date and training upgraded to include on line counseling.
The internet has a different language and offers more challenges. Confidentiality cannot be guaranteed and there is a “reasonable risk” that would need to be included in a consent form. But there is also a positive aspect to the openness of the internet. Breaches of ethics are more
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visible and as the laws in Canada begin to regulate therapists, breaches on the internet can be corrected and therapists who are not qualified identified.
The internet is not fully integrated by all in society and among those are therapists who may not have been integrated into the system. New technology can become a frightening aspect when it is unknown or not part of one’s culture. There was a time when there were no airplanes. There was a time when there were no vehicles and there was a time when there was no internet. Though internet counseling can still be delayed, there is a new generation who will demand it. Internet counseling will be no different than anything else which has been discovered. It is part of evolution. Theology will need to grow along side it and it is. Jesus walked among the people and was always in conflict with the leaders of that time. Jesus was progressive as a man of his time. Pastoral Counseling needs to be as progressive. On line counseling does have potential problems and face to face counseling in this transition will not necessarily become obsolete. We still go to the bank and not all feel comfortable with internet banking. What is important is reaching out to people in areas where there are no counselors. There is an opportunity presented to be leaders and develop and refine the Code of Ethics as it pertains to on line counseling. There is an opportunity and duty, to educate the public of what is ethical, when it pertains to on line counseling. Concerns regarding on line counseling may disturb one counselor but may be found to be an asset to others. When counseling is recorded indefinitely, that may be a concern for some therapists. Counselors are not immune to mistakes and are not perfect and that is why there is always a notation of the word “reasonable” in ethics. It is not that counselors will never make mistakes. When those mistakes are recorded, there can be a concern of liability. Since the internet is now part of the world, pioneers in this technology will make mistakes. Until case
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laws begin appearing in relations to online counseling, counselors can only ensure that they counsel on line, remembering that they are bounded and responsible to abide in their respective code of ethics and that all listed in the Code of Ethics and more pertains to on line counseling.
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References
American Association for Marriage and Family Therapy. Code of Ethics. 1-9. Internet.
Alexandria, VA, 2001. Available: www.aamft.org.
American Association of Pastoral Counselors. Code of Ethics. 1-8. 2010. Internet. 2010.
Canadian Association For Spiritual Care. Code of Ethics. 1-8. Internet. Counselling and
Psychotherapy Research. Routledge, 2009.
Canadian Counselling and Psychotherapy Association. Code of Ethics, 1-23.
Canadian Psychological Association. Code of Ethics. Third Edition. 1-32. Internet. Ottawa,
Ontario, 2000.
Christianity Oasis. Internet. 21 May 2011. Available: www.chrisitanityoasis.com.
“Considerations for MFTs Working with Clients Online”. Family Therapy Magazine May/Jun.
2009: 24-27.
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Haug, Ingleborg E. “Is Online out of Line” A View From the Sidelines. Family Therapy
Magazine May/Jun. 2009: 28-31.
Martin’s Annual Criminal Code. Criminal Code of Canada. Greenspan, Canada Law Book Ltd: Aurora, 1998.
Mills, Stella. Caring Through Technology Using e-mail for Christian pastoral care. On line.
Psych Central. “Why On Line Psychotherapy? Because There is a Need.” 24 October 1997,
Editorial. On Line. Last reviewed by: John. M Grohol. Psy.D., 27 Jan 2007. Available:
Scott, William., and Thompson, Charles. Digital Immigrants, In A World of Digital Natives.
Family Therapy Magazine May/Jun. 2009: 32-35.
Spinello, A., Richard. Cyberethics. Third Edition. Sudbury: Jones and Bartlett, 2006.
“Traversing the World of Distance Therapy” Ethical and legal Matters. Family Therapy
Magazine May/Jun. 2009: 44-45.
Therapist Ratings. Internet. 21 May 2011. Available: www.therapistratings.com
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