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The Dangers of Online Therapy

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Over the last twenty years we have witnessed the incredible revolution in computer technology and the amazing revolution in cyber space. What this has done is to provide new and fast forms of communication that literally unites the far reaches of the world. When a couple living Georgia, the small nation next to Russia, contacts me via EMail in search of couples counseling and are sitting in my office the very next week, we are indeed living in a new world. By the way, that is a true story.

What this amazing growth in technology and the Internet has done is to provide consumers with new and unique forms of psychotherapy. People living in rural areas or in other distant locations now have psychotherapy available to them. This type of psychotherapy is usually referred to as online therapy, online counseling, cybertherapy, and so on. There are various ways these treatment modalities are made available. For example, there is live or E-therapy chat, video conferencing, text messaging, Email therapy and social networking therapy through Facebook, Twitter and other similar networks.

Advantages to Cyber Therapy:

There are some very real advantages to these electronic forms of therapy. Among them are the fact that it feels safe for some people who: 1. suffer from agoraphobia and will not leave the house, 2. Feel too paranoid to work face to face with a therapist, 3. Are too distant any kind of medical treatment to be able to use it on a medical basis, 4. Have very serious physical disabilities that makes it impossible to travel, 5. Cannot afford traditional psychotherapy. Cyber therapy is usually less expensive than in the office therapy.

Disadvantages to Cyber Therapy

At the very same time, there are disadvantages to Internet therapy and that includes some very real risks.

1. Any type of therapy that is not face to face, such as texting, Emailing, and chat, robs the client of a vitally important means of communication. A large part of what we communicate is from facial expression, tones of voice, body language and gestures. In fact, these do not cover all the ways, both subtle and obvious, that we transmit what we mean when we talk to one another face to face and in the same room. Without these dimensions it is very easy for the client to misunderstand what the therapist is saying and for the therapist misunderstand what the client is saying.

3. Under these circumstance, how well can you know the therapist. Would you trust him if you met him face to face? Maybe yes and maybe no.

3. Unless the online therapy is encrypted there is a danger that private information can quickly become public. The Federal Government has a list of laws whose purpose it is to protect patient privacy. These laws are called HIPPA. It is imperative that every new doctor and therapist a patient visits be given a copy of those laws that must be read and signed by the patient. Without encryption, there is no way anyone can guarantee privacy. It is extremely unpleasant to think of very personal information becoming public information that is available to everyone, including strangers, friends, relatives and employers.

4. Related to item “3” is the danger of identity fraud and that can be as true for the therapist as for the patient.

5. If there is a technological failure, such as the patient’s computer going down or an interruption of service for the therapist, how is that handled. When appointments are face to face at least everyone knows the meeting will take place. If for any reason, a cancellation is necessary, that is directly handled between therapist and patient with time for a new appointment to be made.

6. A new issue had emerged in recent years with regard to licensing. It is always important for a patient looking for a therapist to verify the therapist’s licensing. In doing that is the right of the patient to find out whether the therapist has ever been disciplined by the licensing board or had any law suits made against him, particularly if he lost that suit. This is important whether the therapist is online or face to face. This type of information is available to the public in the state within which the therapist is licensed. However, with regard to online therapy, which state is the therapist licensed in?

Because online therapy can cross state and even international lines, it becomes vitally important to know whether or not the therapist is licensed within the state the patient lives in. There is now a long list of states in which an online therapist cannot practice psychotherapy in any state other than where he is licensed. It is entirely possible for therapists to be licensed in more than one state but it is never safe to assume that he is licensed within the state that you live. This becomes important in order to protect the patient from unethical therapists who may not even be therapists at all.

Video Therapy

One type of cyber therapy that has become popular is uses video technology so that patient and therapist are face to face even though they may be far away. Some believe that it’s the next best thing to being in the office. Maybe or maybe not. One of the dangers that the patient must be aware of has already been mentioned above: Unless the video site is encrypted anything that is communicated can easily become public. In other words, using such methods as Skype or many others, may be fine for family and friend communication but not for professional use.

I guess it comes down to the old saying in business: “Buyer Beware.” In my opinion, it is best to stay away from electronic therapy and that includes telephone therapy. Many of you may disagree with me and that is your right. If you do go this route for therapy, do your homework and be careful. Of course, that goes for face to face therapy as well. It is sad but true that there are charlatans and unscrupulous people who prey upon those who are unsuspecting.

By the way, if you decide to use this type of therapy, verify with your health insurance company whether or not you are covered for this type of treatment.

In case you believe I am being overly cautious, I want everyone to know that there has been a growing number of cases brought by patients against online therapists for ethical and legal violations. In a few cases, a therapist absently mindedly pushed the wrong button and revealed private information about a patient. Intended or not, the Internet gives rise to these types of things.

Your comments and questions are welcome.

Allan N. Schwartz, PhD.

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