Ethical Issues with Distance and Online Counseling

PSYCH5013 Counseling EthicsCharlie Ann Osborn

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What is Online or Distance Counseling?

• Counseling done online via email, chat rooms, instant messaging • Telephone Conversations • Video Conferencing aka ITV • Some online counseling is one on one and some involves a group• Some Cyber-counseling even incorporates art therapy by sending pictures back

and forth (audiographic communication).

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Who would choose online counseling?

• People in rural areas who can not travel to a clinic• Disabled or elderly / unable to drive to and from a clinic• People who are too embarrassed to seek treatment in public• People who are extremely antisocial and spend most of their time online and are

comfortable there• People with Agoraphobia• Military Personal in remote locations

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Primary Ethical Concerns Related to Online Counseling

• Confidentiality, encryption, password protection• Establishing client identity (minors, homicide, suicide)• Ensuring equality of access / Accessibility (individuals may not be able to see

color on screen due to visual disability, some families may not have access to computers at all)

• Informed consent• Laws and statutes or jurisdiction of states of both counselor and client• Providing credentials• Providing referrals in case of emergency• Dealing with technical failure

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Are there ethical codes in place for online counseling?• American Counseling Association (ACA)• National Board for Certified Counselors (NBCC)• American Psychological Association (APA)• American Medical Association • National Association of Social Workers • American Mental Health Counselors Association• Internal Society for Mental Health Online (ISHMO) – a voluntary organization of

mental health professionals who are interested in the ethics of online counseling. ISHMO’s code is the most extensive.

• Compliance to these codes is voluntary.

• An independent web-based guide for consumers known as Metanoia helps consumers choose a counselor with valid credentials. This website was developed by Martha Ainsworth, an active member of ISHMO.

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Studies show WebCounseling Sites compliance to ethical standards are not acceptable

• Some statistical examples of web sites studied …1. Only 46% complied with Informed Consent procedures2. Only 2/3 said NO MINORS!3. Only 27% listed information about encryption, and only 50% said anything about

Confidentiality at all!4. Only 23% warned e-therapy should be experimental and face-to-face therapy

should be sought if e-therapy did not work out.5. Only 40% asked clients to log off and call 911 or the hospital if they felt suicidal

or homicidal!6. Only 3% told clients what to do in case they had a technical difficulty.

There are too many surprisingly low compliance statistics findings to list all of them! These numbers should all be close to 100% even if they are voluntary because we should uphold ethical standards as mental health professionals.

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What is being done to improve ethical standards?

• Continuing education for counselors!!!!!

1. National Board for Certified Counselors (NBCC) has a training program in place for counselors who want to learn more.

2. Local training sessions or seminars

• Books available!!!!!

1. The ACA Ethical Standards Casebook by Barbara Herlihy and Gerald Corey2. Second edition of Cybercounseling & Cyberlearning: Strategies & Resources

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Real Life example: Camarillo funeral home unplugs online grief counseling .

• This is a case where state laws and jurisdiction were not checked and abided by before practiced was put into place.

• In January of 2010, Bob Boetticher Jr., a funeral home director had to put an end to his plan to offer online grief counseling due to the fact that the state of California would not allow his unlicensed counselors, who were also out of state, to practice online via his operation in Camarillo, California.

• He was going to offer the grief services via online chat at $1.99 per minute for his customers who sought counsel after the loss of a loved one.

• Only one of the counselors was licensed, but not in the State of California.• The three “grief experts” were from Boetticher’s Michigan based funeral homes.• In the state of California, unlicensed providers cannot call themselves

counselors, or any other term that implies they are licensed.• Unlicensed people however, are not bound by any ethical code.

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References

Collie, K., Cubranic, D., & Long, B. (2002). Audiographic communication for distance

counselling: A feasibility study. British Journal of Guidance & Counseling,

30(3), 269-284.

Gregory, Kim L. (2010, Jan 10) Camarillo funeral home unplugs online grief

counseling. Ventura County Star: Ventura, California. Kaplan, D. (2005). Ethical use of technology on counseling. Counseling Today.

American Counseling Association: Alexandria, Virginia.

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References

Heinlen, K., Welfel, E., Richmond, E., & O'Donnell, M. (2003). The nature, scope, and

ethics of psychologists' e-therapy Web sites: What consumers find when surfing

the Web. Psychotherapy: Theory, Research, Practice, Training, 40(1), 112-124.

Heinlen, K., Welfel, E., Richmond, E., & Rak, C. (2003). The scope of WebCounseling:

A survey of services and compliance with NBCC Standards for the ethical

practice of WebCounseling. Journal of Counseling & Development, 81(1), 61-69.

Shaw, H., & Shaw, S. (2006). Critical ethical issues in online counseling: Assessing

current practices with an ethical intent checklist. Journal of Counseling &

Development, 84(1), 41-53.

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