Counseling

Counseling over the Internet:
Benefits and Challenges in the Use of New Technologies

R. J. Sussman

Counseling on the Internet is alive and, in the opinion of some, well. The question is, as counselors, do counselors and other behavioral health professionals want to take an active role in shaping this new avenue of our discipline, or can we afford to adopt a wait and see attitude? After all, professional counselors do have a duty to protect the public from the chicanery of unqualified Internet “therapists” while still allowing the consumer to exercise choice.

This paper examines three areas of current concern: the tension between the advantages and disadvantages of counseling online, the modalities currently utilized to deliver counseling online, and some of the issues surrounding the need for regulation of on-line counseling.

Advantages and Disadvantages: The Balance
There appear to be advantages to offering counseling services on the Internet, one being the ability to bring mental health services to persons in under-served or geographically isolated areas. A game warden or pipeline worker in a remote part of the Alaskan wilderness is prone to experience personal growth issues and crises as much as persons in well served metropolitan areas. Those who may be better served by gerontological, rehabilitation or career specialists might have access to more qualified counselors. Those who are physically challenged or seriously ill would have the option of getting support without having to leave their homes. Those with child care or elder care responsibilities would be free to seek help without making other arrangements. Finally, those apprehensive about being seen walking into the office of a counselor, or individuals who have thought about counseling, but are not sure what it’s about, may be more likely to seek services if they can do so from the safe and comfortable confines of their homes. An additional advantage for the practitioner is that entire sessions can be automatically recorded and preserved, thus eliminating the need for additional case notes, or any other form of session recording which may be required for supervision.

Because e-mail may be read by those other than for whom it was intended, concerns about protecting confidentiality is a major disadvantage. Possible solutions include digitally encrypting transmissions, and password protecting access to sensitive information on both the counselor and client’s computer. In reality however, phone conversations are more likely to be eavesdropped upon than are e-mail transmissions likely to be monitored. Another problem is the handling of emergency situations that arise with clients who may be halfway across the globe. Local authorities may be able to assist the online counselor by contacting emergency services within the client’s local area. A proactive way to deal with this quandary may be to get a prospective client’s local emergency numbers as well as their physical address and phone number before initiating work.

What if the client is dishonest? Actually the same possibility exists in face to face counseling. Rarely is a client asked to produce proof of identification and address when they come into the office for an initial visit. Once a relationship is established, emergency contact with an online counselor may be handled in the same way that it is handled in face to face counseling. The client may be given a home, cellular phone, pager or voicemail number, or they may be given information on local community resources (Hopefully, for most locations, this information will soon be posted on the world wide web. However the majority of crisis hotlines will take calls from anywhere). Or, in keeping with the online theme, the client may be asked to contact the counselor via e-mail.

Another concern is that a client may more easily terminate a session or a counseling relationship if the counselor touches upon sensitive issues. This is a good argument for getting a client’s phone number, physical and e-mail addresses before beginning work. The premature closing of a session or termination may at times be an issue with online counseling, however with this information the practitioner will have several avenues for reestablishing contact. A final concern centers on malpractice litigation. If a client is in some way harmed, under what jurisdiction will they be entitled to bring suit against the counselor? As our technology evolves, our legal systems struggle to keep pace.