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Telehealth: Practicing psychotherapy on the Internet. Risk Management and great opportunity
Abstract
Imagine a dot.com referral service that allows consumers to select a psychotherapist in their state of residence. You register, and eagerly await referrals. Within a month, you receive an email referral from someone at the far end of your state. The email describes the details of how a prospective patient "had to punish" her elderly grandmother for not eating and not bathing last night. The consumer is requesting your professional services for managing her anger toward her grandmother. The note describes the punishment in enough detail that you have reason to report her for elder abuse. You have her name, street address and telephone number, as well as that of her grandmother. The consumer awaits your response. You look at the website documentation, and they suggest you "follow your state protocols" or "dial 911" for all emergencies. What do you do?
... Hence, fulfilling counselling training and owning a professional licensure indicates good ethical practices among e-counsellors. However, past studies show that most counsellors do not possess a high level of technological understanding of computers [48] nor specific training in psychotherapeutic contact in text-based setting [49], which are both important when conducting e-counselling services. The e-counsellor"s competency and credibility may be questioned, hence, they need considerable skills to communicate and convey emotions and the main contexts of their messages accurately through the written words [50]. ...
Despite the increasing number of e-counsellors, there is a lack of studies especially in the Malaysian context that highlight the skills and practices among e-counsellors and how these are linked to their perceptions when providing e-counselling. This study identifies the relationship between e-counselling skills, e-counselling ethics and e-counselling limitations with counselling self-efficacy among e-counsellors in Malaysia. A total of 159 e-counsellors from various institutions in Malaysia participated in this online survey study. The respondents were selected using the simple random sampling method. The Counselling Self-Estimate Inventory was adopted, and three self-constructed scales were employed for data collection purposes. Correlation analysis found that e-counselling skills (r = 0.597, p < 0.001), e-counselling ethics (r = 0.201, p < 0.001) and e-counselling limitations (r = -0.511, p < 0.001) were significantly correlated to counselling self-efficacy. The structural equation model analysis confirmed the model of relationship between e-counselling skills, e-counselling ethics, e-counselling limitations and counselling self-efficacy. From the three dimensions, e-counselling limitations predicted counselling self-efficacy the best (β value = -0.60), followed by e-counselling ethics (β value= 0.56) and e-counselling skills (β value= 0.18). The findings imply that the extent of e-counsellors’ perceptions on the limitations present in e-counselling play an important role to predict the variance in counselling self-efficacy among e-counsellors. Professional counselling bodies, supervisors and counsellor educators are urged to design a more comprehensive educational and training programme for counsellors. Both counsellor candidates and professional counsellors will benefit from this study as it provides insights for more effective implementation of e-counselling.
... i California (Maheu & Gordon, 1997). Det finnes råd og retningslinjer i forhold til etablering og drift av tilbud, og forslag til avklaring av juridiske og etiske spørsmål (Maheu, 1999; Maheu et al., 2001; Tantum, 2001). En undersøkelse blant norske leger i 1999 viser at 90% har Internett-tilgang, en av tre på kontoret. ...
... Approximately 58% of American adults were reported to first consult online resources when seeking solutions to health problems rather than seeking offline information sources (Lovejoy et al., 2009). Alarmingly, mental health topics are among the most commonly searched terms, with depression being the fourth of ten top accessed health topics (Maheu, 2001). Coupled with this, around 25% of young people used the Internet as a source of mental health information (Gould et al., 2002). ...
One of the most controversial topics in the field of clinical psychology, online tele-health, or the integration of computers and the internet with therapeutic techniques, remains at the forefront of many debates. Despite potential interest, there are numerous factors that a psychologist must consider before integrating an online tele-health intervention into their own practice. This article outlines literature pertinent to the debate. The article begins with a brief history of the use of non-face-to-face interventions as well as the earliest recorded use of "tele-health" before discussing the modern benefits and risks associated with usage. Considerations for the psychologist as well as the client are detailed; incorporating ethical implications. The authors conclude that the utilization of tele-health interventions is an exponentially expanding field that should continue to be explored. Despite many well-conceived studies, a psychologist should educate themselves in all aspects of the new modes of intervention (e.g., ethical, legal, evidence-based treatments) before attempting to implement them into everyday practice. The article ends with a discussion on the acceptance among psychologists, as well as the outlook for the future.
... In response to criticism from e-therapy skeptics, some clinicians and patients have documented success stories of e-therapy (Murphy et al 1998;Wylie, 2000;Ainsworth, 2002). While positive patient outcome reports are available, little if any scientific research has assessed the effectiveness of Internet counseling (Maheu, 2001). Studies have found positive results for related technologies, such as telephone-based assessments (Aziz et al 2004;Paulsen et al 1988;Rohde et al 1997;Wells et al 1988) and treatment (Simon et al 2004), Internet support groups (Houston et al 2002), computer-based self-assessments (Chinman et al 2004), and videoconferencing telepsychiatry treatment (Ruskin et al 2004). ...
E-therapy, the provision of mental health treatment through the Internet, poses many risks as well as benefits. This article addresses some relevant risks and benefits of e-therapy and discusses the practicality of using computers in the informed consent process. Although e-therapy has numerous proponents, no clinical trials have assessed its long-term effectiveness. To limit liability and to protect patients, e-therapy providers should disclose material risks as well as possible benefits and engage patients in an active dialogue. A thorough informed consent procedure enables patients to make an educated decision about whether e-therapy is right for them. In the future, e-therapy and informed consent online may become more common; in the mean time, clinicians must be prepared for e-therapy's uncertain legal status and allow patients to decide for themselves whether or not to seek counseling on the Internet.
A number of ethical issues involved in face-to-face therapy are examined in relation to online therapy (etherapy). Etherapy is defined and its strengths and weaknesses discussed. Specific ethical issues addressed include boundaries of competence, basis in science, avoidance of harm, confidentiality, avoidance of false or deceptive statements, forums, testimonials, solicitation of clients, fees, and informed consent. A concluding section briefly addresses legal issues, particularly interstate etherapy. It is recommended that federal licensing legislation be enacted, informed by the NASW, the APA, and similar groups.
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