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Introduction

About This Site

This site began July, 1999. It has never been an organization. There is no one else affiliated with this website nor has there ever been. My name is Pat Stubbs and in 1999, when I began this site, there were no published guidelines for practicing mental health care online. There are now established guidelines for practicing mental health care online — however, currently there is no way to enforce such guidelines. There is a disparity from state to state on who can practice online and what credentials, if any are needed. For example the following states do not have controlled titles for the term ‘therapist’ or ‘counselor’:

California, Florida, Hawaii, Iowa, Massachusetts, Minnesota, Nevada, New Hampshire, New York, Rhode Island, Vermont, Virgin Islands

Each State Is Different

There are some states that do not have a professional counseling licensure but have a mental health counselor licensure. Some states have controlled titles and do not allow anyone legally to call themselves as a licensed mental health counselor or even as a mental health counselor unless they are licensed. Some states NOT listed above have a clause under their rules and regulations that as long as a counselor does refer or bill themselves as ‘licensed’ they are also not held accountable to the state licensing board. This loophole leaves consumers without recourse should the therapist behave inappropriately or unethically. Do you know what the laws for your state are? Please get involved and you can make a difference.

While a license does not guarantee you will like a therapist or that they are a ‘good’ therapist it does ensure that consumers have recourse should a therapist behave inappropriately or unethically.

Goals

The goals of this website are to:

  1. Educate abuse survivors and more generally consumers about online mental health care.

  2. Encourage survivors and more generally consumers to self advocate within the online mental health care arena.

  3. Ensure that the new Patient Bill of Rights factors in online mental health care.

  4. Ensure uncredentialed practitioners are brought to the attention of the general public.

  5. Inform abuse survivors and more generally consumers about their rights as online mental health care recipients.

Online Mental Health Care

What exactly is mental health care online? Is it therapy, or counseling? What does it include? For the purposes of this web site, online mental health care will be defined as a licensed mental health care professional providing advice and/or counsel via e-mail, video conferencing, virtual reality technology or chat technology or any combination of those. It will not include self-help methods such as public bulletin boards or private listservs (whether they are run by a professional or not).

Background Info

How will online mental health care effect you as an abuse survivor? What do you need to know before looking for an online mental health care provider? As with anything, there is a certain amount of responsibility for you the consumer/client. Some of this responsibility includes taking time to view the prospective providers web site and checking to see that they are credentialed. Look for a license number and the persons name along with a link back to some kind of accrediting agency or a link back to a credential checking service where you can confirm the licensing information. If there are no links back to anything — write down the license number (if provided) and the persons location (if provided), along with their name. If none of that information is provided, look for an email link to the site owner and ask them through email about the credentials. If you are still not satisfied with the results, keep looking for another online provider. Don’t assume just because someone says they are credentialed that they are. Adopt a buyer beware mentality. One doesn’t need to be paranoid to be careful.

Many Names

One of most confusing things about mental health care online is that not everyone refers to it in the same way. Below I have listed some of the various names: (these is not inclusive)

  • e-therapy or e-counseling
  • cyber therapy
  • cyber counseling or advice
  • email counseling or therapy
  • online counseling or therapy
  • distance counseling or therapy
  • life coaching
  • net counseling or therapy
  • psychotherapy online
  • web counseling

Current Research

There have been no completed studies to date to measure the usefulness of this burgeoning field. Until those studies are complete the debate will continue even amongst the professionals as to whether mental health belongs online. Some of the debate within the professional online (and offline) communities centers on the exact definition of “online mental health care.” Is it really therapy? Is it counseling? Some critics argue that it is not therapy or counseling. Other professionals argue that there aren’t more disadvantages to mental health care online than there are for face to face therapy.

Is Online Mental Health Care Therapy?

In order to see this issue clearly we may need to drop our natural inclination to compare it to therapy and look at mental health care online as a unique method of delivery based entirely on its own merits. Only then can guidelines truly be set. In this authors opinion, without an agreement on the language (terminology, what to call it) how can there be true understanding that everyone is indeed talking about the same thing. In the current published standards one can note that there is no agreement on what the guidelines are covering. One published standard refers to it as Web Counseling and another refers to it as Online Counseling. However, if online mental health care is not counseling or therapy than how can guidelines even be proposed? More importantly what good are guidelines without some way of enforcing them? With this unique delivery option, there will continue to be questions. Online mental health care, even with concerns like confidentiality, anonymity, informed consent and liability coverage continues to be a growing practice online.

Not For Everyone

Online mental health care isn’t for everyone. Do you find it easy to express yourself through writing? Online mental health care requires that you be able to express yourself through writing. If you find it difficult to do so, cyber therapy may not be for you. Keep in mind that there are both advantages and disadvantages for getting your mental health care online.

Advantages for Client

  • Accessibility for those located in rural areas
  • Accessibility for those physically disabled and unable to leave their homes
  • Convenience – email at a time that is best for you
  • Affordable (i.e. $100 a month versus $100 per session)
  • Accurate records (copy of email) is kept of correspondence for review later

Disadvantages for Client

  • Absence of non verbal cues (more chances for misunderstandings)
  • No insurance reimbursement (unless you live in California)
  • Confidentiality (may be overcome with encryption programs)
  • Security (hackers)
  • Unreliable technology (email server can go down)
  • No immediate response to crisis
  • New field, not as proven as traditional therapy
  • Not appropriate for serious mental illness such as schizophrenia

Consumer Advocacy

There are advocacy sites online devoted entirely to helping you make choices regarding online mental health care. One is run by Martha Ainsworth, and is entitled The ABC of Internet Therapy. Martha has done a wonderful job of taking some of the guess work out of checking credentials. Please see her site for more information.

Guidelines

Several agencies have adopted guidelines/standards for the mental health industry online, but keep in mind there is really no way to enforce these guidelines. See below for links to those web sites.

Suggested Principles for the Online Provision of Mental Health Services
International Society for Mental Health Online

The Practice of Internet Counseling
National Board of Certified Counselors

Ethical Standards for Internet Online Counseling
American Counseling Association

Services by Telephone, Teleconferencing and the Internet
American Psychological Association

Guidelines for the Clinical Use of Electronic Mail With Patients
American Medical Informatics Association

This is a new and growing field. And while it may open doors for you in the way of a delivering a new way to receive help, there continues to be a certain amount of risk involved. Just a few more things I’d like to mention… 1) unless you live in California any health care or mental health care you received online is not reimbursable by your insurance company; and 2) if you are in crisis, such as feeling suicidal, online mental health care should not be used (see a face to face counselor right away if you are having those feelings).


Disclaimer:   I am not a health care professional. I am an abuse survivor. The resources on this site are for information and education only. Information on this website is meant to support not replace the advice of a licensed health care or mental health care professional. Please consult your own physician for health care advice.

Copyright Policy:   Information included on the MAH Network site is in the public domain; however, you will encounter information that is owned/created by others, including copyrighted materials. Those other parties retain all rights to publish or reproduce those documents or to allow others to do so. Any copyrighted materials included on this site remain the property of their respective owners/creators and should not be reproduced or otherwise used. It is not the intent of the MAH Network to have violated or infringed upon any copyrights. If you believe we have, please let us know and we’ll take care of the matter promptly.



last revised: 9/4/05