Ethics: will you be properly cared for?
E-therapists are highly ethical. They follow the same ethical standards that apply to their offline practices.
Why should you care about ethics?
"Ethics" means making sure that the therapist acts responsibly in caring for you. Most therapists professional organizations have a "code of ethics" that governs their behavior. Therapists must follow these ethical codes in their online interactions, just as they would offline. For instance: a therapist must protect your confidentiality, and any records of your interaction. A therapist must interact with you in the defined role as a therapist, and not also in a personal relationship (and never a sexual relationship). A therapist must not abandon you, or misrepresent his/her credentials, services or fees, or make false claims about therapy.
As you see, these codes are designed to protect you, and to create an effective healing environment. You should expect ethical behavior from any mental health professional with whom you interact, whether online or offline. Mental health professionals online strive diligently to uphold ethical standards in their sacred duty as healers. It is one reason to seek out a credentialed mental health practitioner -- you know that they have accepted this responsibility, and take it seriously.
The psychotherapists I know who practice on the Internet are among the most ethical people I know. They are skilled professionals who take their sacred duty as healers very seriously. They dont harm people. They help people. They are pioneers who saw a need, took a risk, reached out to help. They are forging this new field because they believe that it is helping people.
Professional associations are often slow to endorse new practices. Thats not a bad thing. They have to be very responsible about reviewing research and carefully examining the new practice, before they will say that it is or isnt ethical, when its effective, and for whom. This research is being done now.
Eventually, ethical codes will catch up. In the meantime, every day, hundreds, maybe thousands of people form relationships via the Internet with professional psychotherapists and these people are being profoundly helped by this process. That is a fact.
Opponents of e-therapy
Some mental health professionals feel very strongly that it is not ethical for psychotherapists to interact with people on the Internet. These opponents speak from the heart. They believe that they represent the best interest of consumers. I truly respect their concern. For the most part, opponents really believe that e-therapy cant help you, and some believe there is a possibility it could harm someone, sometime. "What-if" scenarios have been proposed, that could lead to unwanted results.
You may think I will speak out against these opponents, but you would be wrong. These cautionary voices are essential to the exploration of this new frontier.
It is most certainly true that not all therapists have the aptitude to conduct counseling over the internet, and e-therapy is not appropriate for every patient. There are clearly some "what-if" scenarios that demonstrate certain situations where e-therapy is contraindicated.
On the other hand, there are other situations where it is just as clearly the best alternative available.
Unfortunately, some mental health professionals get sidetracked by irrelevant questions. Is this therapy? Will it replace face-to-face therapy? Is it better than face-to-face therapy? These are all irrelevant questions. Of course this is not ever going to replace traditional face-to-face therapy. And even if e-therapy is not full-fledged psychotherapy -- whether you call it emotional support, psychoeducation, interactive journaling, life coaching, or whatever -- there is no question that it is very helpful. And for some people, it is their only access to emotional support.
The creative tension must continue. We need to be reminded of the risks, and we need to be reminded of the benefits. Both sets of voices must be heard. We must not allow either side to be silenced.
In the near future, research studies will provide concrete evidence to show whether online counseling is safe and effective, or not. Until then, be careful how you evaluate the opinions you hear. Are the speakers comments based on opinion, or fact? Media sensationalism? (Alas, danger sells more papers than hope does.) Professional rivalries?
If online therapy is worthwhile, it will be because it is so, not because someone said so. A speakers eloquence, or professional position, or the number of letters after his/her name, will not change this.
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If the ethical therapist is not online, who is? --Gary Stofle
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Ethics Guidelines for Online Counseling
Recently, a number of health-related organizations (including mental health) have begun to consider what practitioners should do to be certain that their Internet activities are ethical. The links below are examples of some guidelines that have been published by various professional organizations.
- American Counseling Association, 1999: Ethical Standards for Internet Online Counseling
- International Society for Mental Health Online & Psychiatric Society for Informatics, 2000: Suggested Principles for the Online Provision of Mental Health Services
- Internet Health Coalition, 2000: e-Health Code of Ethics (draft)
- National Board of Certified Counselors, 1997: Standards for the Ethical Practice of Web Counseling
- Health on the Net Foundation, 1997: HON Code of Conduct for Medical and Health Websites
- American Medical Informatics Association, 1998: Guidelines for the Clinical Use of Electronic Mail with Patients
- American Psychological Association, 1997: Services by Telephone, Teleconferencing, and Internet
- John Grohol, PsyD: Best Practices in E-Therapy (Definition & Scope, Legal & Licensing Issues, Confidentiality & Privacy), and Potential Risks and Benefits of Online Psychotherapeutic Interventions
Next: Is e-therapy private?>>
General Codes of Ethics for Psychotherapists
For further information: the following links are to the general codes of ethics which govern several disciplines of mental health professionals in the United States, in their day-to-day, offline practices:
Next: Is e-therapy private?>>
