2. As a single therapist can reach more clients, especially in underserved populations, long waiting lists for face-to-face treatment can be reduced, offering a possible solution to the workforce shortage in mental health provision. Anonymity and Privacy 1. Because online psychotherapy can be provided anonymously and one is not seen entering the therapist’s office, it can enhance the client’s sense of anonymity and privacy. 2. Perceived or actual anonymity may lead in turn to reduced inhibition and greater openness in discussing emotional topics. Eliminating Barriers to Engagement 1. By reducing or eliminating barriers, such as fear of social stigma, online psychotherapy can reach patients who might never have sought traditional in-person therapy. Online Teaching and Supervision 1. Technology-mediated communication can contribute positively to teaching and supervision and facilitates inter- professional and inter-collegial exchange worldwide. 2. Online psychotherapy conducted by email or other text- based communication automatically generates a record of the sessions, and a videoconferencing approach enables sessions to be videotaped for later supervision. Informed Consent 1. The informed consent process can be enhanced by online communication. Web pages can be revisited with links to additional information resources or technical material and for translation into different languages. Diminishing Intimacy 1. As the distance provided by technology inhibits physical proximity, online psychotherapy can help to reduce the risk of clients-therapist (sexual) intimacy. Protection of the Therapist 1. Security issues raised by risky environments, or when communicating with potentially dangerous clients, can be reduced by online service provision. Ethical Arguments Against Online Psychotherapy Privacy, Confidentiality, and Security Issues 1. Among concerns about privacy, confidentiality, security, and safety in online psychotherapy, is the use of unsecured websites or unencrypted communication tools, and commercially available software that is easily hacked. 2. Data security may be compromised when technology fails, with potential breaches of confidentiality that might extend beyond the therapist’s control. Therapist Competence and Training 1. To provide online psychotherapy, training is needed to ensure appropriate technology-related competences, clinical and therapeutic competences specific to the online setting. The therapist would require knowledge of ethical approaches and guidelines, as well as specific legal requirements and policies. 2. In general, therapeutic skills for in-person contact do not automatically translate into online therapeutic skills. Communication Issues 1. Among negative issues, one of the most widely discussed is the absence of non-verbal cues in the therapeutic interaction, Discussion Ten brief descriptions of arguments for and against were presented here, but the study included many more that should be reviewed in the complete study results. Some concepts were argued as both benefits and risks depending upon the provider’s perspective on the issue.
especially when using text-based media but also when using telephone or videoconferencing, which may lead to misunderstandings and miscommunication. 2. If a therapist were to miss some important item of clinical information, the whole diagnostic process and psychological assessment could be impaired. 3. The use of e-mail in this context can undermine the conversation in terms of time lag and lack of spontaneity, and it may prove difficult to express empathy, warmth, and feelings. Research Gaps Some authors claim there is insufficient research to support online psychotherapy or that there are too many knowledge gaps, especially regarding effectiveness, efficacy, and long-term outcomes compared to in-person treatment. Emergency Issues 1. Questions arise as to whether an emergency or crisis involving threat or harm to self or others can be detected and addressed where patient and therapist are at different locations. Ethical issues regarding emergency or crisis situations include verification of patient identity and location, technological difficulties, and cross border practice jurisdiction. Technological Competence 1. A therapist’s lack of technological competence, patient/ client and therapist awareness of their respective skills are important issues in this context, as discomfort or fear of using technology is common. Legal Issues 1. Unresolved jurisdiction and few or no specific laws governing licensing, certification, training, education, informed consent, and cross-border practice are problematic issues for online psychotherapy. Practicing Across Borders 1. Many issues arise in relation to online psychotherapy conducted across state or national borders, including legislative, licensing, and cultural differences. 2. It may be unclear whether the therapy take place at the client’s or the therapist’s location, raising such questions on which jurisdiction is responsible when a problem arises, or which regulates professional practice in the event of a violation. Therapeutic Relationship Issues 1. Many authors have questioned whether an effective therapeutic alliance can be developed solely through technology and whether the benefits of the therapeutic relationship might disappear or diminish in online psychotherapy. 2. Other issues raised in this include absence of non-verbal cues and lack of intimacy. Patient Characteristics 1. Online psychotherapy may not be suitable for all clients, clinical conditions, psychiatric disorders, and problems; it may sometimes be contraindicated, especially in the case of severe mental disorder, or for clients who are highly dysfunctional and/or pose a threat to themselves or others. 2. A patient’s inability, diminished competence, or discomfort when using technology might be a barrier. There are extensive standards and guidelines included for reference in this course, and numerous research exists for further study. The counselor will need to weigh the risks and benefits based on their competency to use technology, facility preparedness, organizational support, compatibility with counseling style, effectiveness, and reliability in addition to client
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Book Code: PCTX1324
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