Updated: Sep 11
Teletherapy is a hot topic, so this is not your oridinary blog post. Occasionally, you will find research I have conducted as a part my continued education in the field of mental health. These postings will contain empirically supported documentation on mental health, holistic living, wellness coaching and any other topic I find suitable for Ahava Wellness. I will always include a reference section for researched based posts. I try to use the most current research, however, on a topic such as online therapy that has been an ongoing discussion for almost the last two decades, the research will reflect this timeframe.
As the field of mental health services moves forward, so does technological interactions between therapist and client. Online therapy has been around for some time with research indicating this has been a subject for discussion since early 2000, but it has become a more prominent topic in the last five years as online therapy has become a widespread alternative to traditional face-to-face therapy.
Research supports the perception that online sessions can be profound, with clients feeling more positive and confident about the therapeutic process (Suler, 2014). Other studies have shown that client’s bond well with their online therapist and the experience is more beneficial, but there are also ethical considerations that need to be assessed. Here, we will discuss the two that seem to be reoccurring concerns for the counseling community:
Definition of Online Therapy|Therapist|Coach
The term online therapy or online coaching does not guarantee a level of education or professional licensure. That’s scary. Online therapy, as defined by the National Board for Certified Counselors, is the modality used for clinician and client to meet via through secure video-conferencing, text exchange, email, and secure web-based messaging systems by licensed professional mental health providers and clients. According to Nelson & Valasquez (2011) video-conferencing is the ideal mode for meeting clients in the virtual realm, because it is it similar in face-to-face therapy where there are visual and verbal cues.
Counselor is not a protected term. Mental Health Counselor|Therapist is protected terminology that may be used interchangeably by a licensed, qualified mental health provider as long as credentials are clearly stated and the board issuing the license is indicated in printed format, such as a website, business card, or advertisement. The title of coach gets even more messy when determining level of education or expertise.
However, a good rule of thumb is for the client to ask the questions that are important to them and do their due diligence in verifying the therapist’s identity and credentials (Barnett & Scheetz, 2003; Frame, 1997;).
While online therapy is restricted to the state(s) in which the therapist holds a license, online coaching is available worldwide, which brings up the question on the therapist’s ability to relate to the cultural diversity that would be experienced by servicing clients from such geographically different locations, (Mallen et al., 2005;). Cultural competence is already a difficult topic to discuss within the walls of the therapy room; so there are considerations to be made to appropriately assess cultural differences in an online environment where subtle cultural cues could be missed.
Remaining true to the ethical boundaries for cultural competency is a priority for the online therapist. The therapist evaluates the appropriateness for an online therapeutic relationship and remains attentive of the impact culture has on therapy.
Why it Works
There is plenty of empirically validated support for the effectiveness of teletherapy with many benefits that make it an attractive option for both therapist and client;
Ease of access
Those who travel for work
No transportation involved
Online therapy has been regarded as an excellent modality for the treatment of anxiety, depression, PTSD, and eating disorders (Rochen, et. al, 2005). As clinicians are able to reach a larger population with ethical and effective treatment, clients will no doubt benefit from the effectiveness, convenience and ease of access of the online therapeutic environment.
Barnett, J. E., & Scheetz, K. (2003). Technological advances and telehealth: Ethics, law, and the practice of psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 40(1-2), 86-93. doi:10.1037/0033-3204.40.1-2.86
Frame, M. W. (1997). The ethics of counseling via the Internet. The Family Journal: Counseling and Therapy for Couples and Families, 5(4), 328-330. doi:10.1177/1066480797054009
Mallen, M. J., Vogel, D. L., & Rochlen, A. B. (2005). The practical aspects of online counseling: Ethics, training, technology, and competency. The Counseling Psychologist, 33(6), 776- 781, doi:10.1177/0011000005278625
National Board for Certified Counselors. (1998). Standards for the ethical practice of web counseling [Online]
Nelson, E., & Velasquez, S. E. (2011). Implementing psychological services over televideo. Professional Psychology: Research and Practice, 42(6), 535-542. doi:10.1037/a0026178
Rochlen, A.B., Beretvas, S.N., & Zack, J.S. (2005). The on-line and face-to-face counsel- ing attitude scales: A validation study. Measurement and Evaluation in Counseling and Development.
Suler, J. (2004). The online disinhibition effect. Cyberpsychology & Behavior, 7(3), 321-326.