Kathleen Bazile M.a. NCC, LPC Mercer University Moving Towards Standardization in Online Counseling: New Ethical Considerations Kathleen Bazile M.a. NCC, LPC Mercer University
Online counseling, Telemental health, Cyberpsychology, e-counseling, web counseling Within the past 15yrs, online counseling has grown along side the growth technology and internet. Online counseling: Delivery of therapeutic interventions in cyberspace where communication between a trained professional counselor and client(s) is facilitated using computer-mediated communication(CMC)technologies, provided as a stand-alone service or as an adjunct to other therapeutic interventions (Richards & Viganó, 2012). Internet is a ubiquitous medium of communication
Computer Mediated Communication (CMC) Online Counseling Delivery methods Computer Mediated Communication (CMC) Email Instant messaging Chat rooms Videoconferencing Computer voice message system. Synchronous: Interacting in real time. Instantaneous messaging, chatting in real time. Asynchronous: Time-lapse between interaction. E-mail communication. 2 distinctions in how online counseling is delivered: Synchronous/asynchronous. Carries special ethical issues. Mallen, M.J., & Vogel, D.L. (2005). Counseling psychology and online counseling. The Counseling psychologist, 33, 761-775.
Ethical and Legal implications
Considerations and concerns Competence Technological Skills Proficient typing skills, speed, and accuracy Data security and clinical record confidentiality Internet-based language (ex. LOL) and use of emoticons (ex ), other common internet related forms of expressions. Helping Skills-version online Communicate empathy, warmth, openness, genuineness Non-verbals of client Multicultural Competence Increased exposure to various cultures Relatively new phenomenon. One has never conducted video-based psychotherapy using the internet before. Being familiar with various computer and internet technologies. Ensure sensitivity to clients’ beliefs and practices, so these are not misinterpreted or violated.
Considerations and Concerns Jurisdiction Standard face to face (F2F) therapy requires clinicians to practice in the state they are licensed. Online counseling blurs this line Online counseling provides access to potential clients w/o geographical boundaries. Which state is the clinician practicing in? Theirs or the clients, or both? Malpractice insurance Only covers services that are within the clinicians scope of license which is usually bound by state regulations Are they practicing where they are being virtually received? Currently, there is minimal state laws provisions.
Considerations and Concerns Limits to Confidentiality Online counselor cannot completely guarantee confidentiality to clients over internet Provisions include password protection, data encryption, use of secure socket layer encryption, and firewall. Cannot protect against accidental interception, e-mail snooping, unauthorized e-mail access and other forms of counseling applications.
Considerations and Concerns Informed Consent Mandated reporting Clinician obligated to be aware of laws and duties in clients’ residential state as well as clinicians’ state. What if laws conflict? Imminent danger What online behaviors indicate risk of self-harm Abrupt termination of chat session, allusions to suicide, direct threat How will clinician respond? Clients responsibility Educating client on how to protect sensitive information online
Considerations and Concerns Ethical and legal implications that have and continue to arise concerning online counseling lead us to question: Should there be formal training for appropriately conducting online counseling and facilitating an effective online therapeutic relationship?
Current Standards & Rules
NBCC National Board of Certified Counselors Standards for the Ethical Practice of WebCounseling 1997 The Practice of Internet Counseling Distance Professional Services Use of electronic or other means (e.g., telephone or computers) 20 Set Standards NBCC Policy Regarding the Provision of Distance Professional Services: Approved February 6, 2016
ACA American Counseling Association 2014 ACA Code of Ethics Section H Distance Counseling, Technology, and Social Media Protocols for: H.1 Knowledge and Legal Considerations H.2 Informed Consent and Security H.3 Client Verification H.4 Distance Counseling Relationship H.5 Records and Web Maintenance H.6 Social Media American Counseling Association (2014).
ISMHO International Society for Mental Health Online Nonprofit formed 1997 “to promote understanding, use and development of online communication, information and technology for the international mental health community.” International Society for Mental Health Online. (2016, March). Retrieved from http://www.ismho.org/ismho/about-ismho.
Georgia GA State Board Rules: CH. 135.11 Telemental Health Provisions Implemented October 2015 Includes but not limited to telephone, video, internet, smartphone, tablet, desktop computer, or any other electronic means. Provisions Informed Consent Client Assessment Code of Ethics Scope of Practice Out of state Clients ‘Advised to check w/ the state board in which client resides for information about telemental health regulations outside of GA’
Georgia 6 Continuing education hours that include: Internet use dependency and psychological problems Research in Telemental Health Intake & Assessment Delivery Methods Theory Integration Termination Risk Management Business of Telemental Health Ga Comp.R. Regs. R. 135-11-.01
Louisiana Louisiana Professional Counselors Board of Examiners Louisiana's Position Statement on Internet Counseling “Mental health services delivered over the internet are rendered where the patient is situated.” “This position is based on assertions that all counselors serving Louisiana residents will be licensed in Louisiana and will otherwise adhere to all applicable state laws relative to the practice of mental health counseling” LA LPC board of Examiners 2012
Therapy? There’s an App for that
Therapy Apps: TalkSpace and Betterhelp Talkspace. Groop Internet Platform inc. [Mobile application software]. 2016. Retrieved from http://itunes.apple.com Betterhelp. Compile, inc. [Mobile application software]. 2016. Retrieved from http://itunes.apple.com
Why Standardization is needed
Need for standardization Several studies conducting surveys of online counseling website (2006) Practitioners’ credentials varied widely 32% of practitioners requested clients sign informed consent 42% of practitioners did not use any encryption to protect confidentiality Very low compliance with established ethical standards for online counseling were found. High number of practitioners provided information about the limitations of online counseling As cited in Richards, D. & Vigano, N. (2013). Online counseling: a narrative and critical review of the literature. Journal of Clinical Psychology, 69(9), 994-1011.
Need for standardization Increasing number of apps for mental health offering ‘trained’ and ‘expert’ help
Standardization Development of ethical frameworks has been significant in contributing to regulate and standardize the practice of online counseling As online counseling becomes more incorporated and accepted as a legitimate form of delivery of therapeutic interventions, it will be looked at not as an insurgent but as a trustworthy and viable option that would benefit from regulation and standardization. In conclusion, online counseling continues to grow and is becoming a more acceptable delivery method of counseling. Great that NBCC and ACA have set an ethical framework regarding this new and ever growing popular method; however it will be imperative for ethical guidelines to be developed at the state level, training to be provided, and ideally a nationwide standard to accommodate the uniqueness of this form of delivery.
References American Counseling Association. (2014). American Counseling Association code of ethics. Retrieved from http://www.counseling.org/resources/aca-code-of-ethics.pdf Barnett, J.E., & Kolmes, K. (2016). The practice of tele-mental health: ethical, legal, and clinical issues for practitioners. Practice innovations, 1(1), 53-66. Betterhelp. Compile, inc. [Mobile application software]. 2016. Retrieved from http://itunes.apple.com Georgia Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists. (2015, October). Rules and regulations of the state of Georgia, March 2016 (Rule 135-11-.01Telemental Health). Retrieved from http://www.rules.sos.ga.gov/gac/135-11
References Haberstroh, S., Barney, L., Foster, N., & Duffey, T. (2014). The ethical and legal practice of online counseling and psychotherapy: a review of mental health professions. Journal of technology and Human Services, 32 49-157. doi:10.1080/15228835.2013.872074 International Society for Mental Health Online. (2016, March). Retrieved from http://www.ismho.org/ismho/about-ismho Louisiana Licensed Professional Counselors Board of Examiners. (2012, September). Louisiana’s position on internet counseling. March 2016. Retrieved from http://www.lpcboard.org/position_statements_internet_Counseling.htm Mallen, M.J., & Vogel, D.L. (2005). Counseling psychology and online counseling. The Counseling psychologist, 33, 761-775.
References National Board for Certified Counselors.(2016) National Board for Certified Counselors policy regarding the provision of distance professional services. Retrieved from http://www.nbcc.org/assets/ethics/nbccpolicyregardingpracticeofdistancecounselingboard.pdf Richards, D., & Viganó, N. (2012). Online Counseling. In Y. Zheng (Ed.), Encyclopedia of cyber behavior (Vol.1, pp. 669-713). New York, NY:IGI Global Richards, D., & Vigano, N. (2013). Online counseling: a narrative and critical review of the literature. Journal of Clinical Psychology, 69(9), 994-1011. Rummell, C.M., & Joyce, N.R. (2010). “So what do you want to wrk on 2day?”: the ethical implications of online counseling. Ethics & Behavior, 20(6), 482-496. Talkspace. Groop Internet Platform inc. [Mobile application software]. 2016. Retrieved from http://itunes.apple.com
Discussion/Questions