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eTherapy

eTherapy refers to the delivery of mental health services online. Online services are typically delivered in the form of email communications, discussion lists, live chat rooms, or live audio or audiovisual conferencing. For an introduction to eTherapy, and some of the legal and ethical issues involved offering it, you can view my presentation on Legal and Ethical Issues in Online Counseling to the Northern Ohio Chapter of the Employee Assistance Professionals Association.

Potential Benefits: Online services are proliferating rapidly, due in part to the potential benefits they have for clients and practitioners:

  • Make it possible for clients to access services at any time, any day of the week
  • Take services to clients in remote and under-served regions
  • Reach out to clients who are physically unable to leave their homes
  • Provide confidentiality for clients in small communities
  • Increase honesty and candor – experience shows clients may be more forthcoming on the Internet than in person
  • Reach clients who are unwilling for a variety of reasons to seek face-to-face services
  • Give clients access to highly specialized practitioners, since geographical proximity is not an issue
  • Make services available to clients who are highly mobile, since they can access services from any internet portal anywhere in the world
  • When conducted asynchronically (email), they allow the client and the worker to fully reflect on the issues being discussed
  • Reduces the time needed for the client and practitioner to develop rapport
  • Make help available to the client at the time of greatest need
  • Give the practitioner access to a larger pool of potential clients
  • Make it feasible for practitioners to develop more specialized practices
  • Allow practitioners more flexibility in their work schedules


Limitations: The online delivery of mental health services carries with it a number of limitations and unknowns:

  • The potential for miscommunication may be greater online due to lack of non-verbal and paralinguistic cues
  • Lack of access to client’s non-verbal behavior may make it difficult to correctly assess and diagnose disorders
  • Online services may turn out to be ineffective – little research exists on the efficacy of online services
  • Differential effectiveness – online services may be completely inappropriate for people experiencing psychotic symptoms whereas they may be very particularly appropriate for children with attention deficit disorder
  • Is difficult to insure the confidentiality of online communications
  • The ability to intervene in emergency situations (e.g., suicidal client) may be severely limited
  • Clients may misrepresent themselves, undermining the integrity of the services provided
  • Fewer safeguards for clients increases the burden on them to be intelligent consumers
  • Online services are available only to clients who have access to the internet and the skills to use it


Legal and Ethical Issues: The online delivery of services raises a number of important legal and ethical issues, most of which are as yet unresolved: determining the identity of the recipient of services, maintaining confidentiality, legal jurisdiction, and technical competence of the therapist. 

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.


A highly informative book, just out, that discusses theoretical and practical issues, as well as the history of online counseling - highly recommended:
Kraus, R., Zack, J., & Stricker, G. (Eds.). (2004). Online counseling: A handbook for mental health professionals. San Diego: Elsevier Academic Press.


The following links provide a range of useful information on eTherapy:

Social workers on the web

 

 

 

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Last  updated:  06/15/10
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