By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
Update – 2020.
This post was originally written in 2014. My how things have changed. The COVID pandemic has forced counselors, therapists, and educators to rethink the way we do things. In the beginning, there was a lot of resistance to working online. But when forced to do so each of these professions has developed new methods for working in a different way. Below is the post as originally written in 2014. In the near future, I will be publishing some new posts about the changes that have come about as a result of working online.
Can you get counseling or therapy while sitting at home?
There are still some big ifs, and’s, and but’s about internet or remote distance counseling. I can see some good points in favor of this approach. There is also some serious buyer beware issues.
The Internet is a new technology and so far most mental health professionals have been reluctant to adopt this one. There are some serious concerns on the part of licensing boards and professional associations about the ethics and the safety of this method.
The mental health profession has come a long way from the days when the client lay on the couch and the therapist sat behind them. In the old model, the client talked and the therapist listened. Sometimes the professional said a lot of “Um-hu’s” and “I see’s” and spent the rest of the time doodling on a pad and daydreaming. The belief was that the client if they talked long enough, might figure out the solution to why they were having this difficulty and what they should do.
This approach also presupposes that most of your problems are left over unfinished business from childhood.
Nowadays most counseling is a lot more active and focused than the old psychoanalytic model. We do more direct interventions and we have more responsibilities to keep the client and the public safe than ever before.
The preferred way to do internet counseling is via a program that lets both people see each other and talk in real-time. Emailing questions or comments is more like advice-giving. I try to answer readers’ questions on this blog in general ways but this is not therapy and is no substitute for actually sitting down and doing therapy.
Professionals who communicate with clients via emails and texts primarily use this to set appointments and confirm or change times not for doing therapy.
So is remote or internet counseling safe and is it good for the client, the professional, and the public?
Let’s look at some of the pros and cons.
Pros of distance counseling.
Internet counseling can bring help to those who live in remote areas, can’t get out of the house for physical or mental health reasons, and who just find it more convenient to seek therapy from home.
Studies suggest that distance counseling can be as effective as in-person therapy and it can be available at all sorts of times and places when a counselor might otherwise not be available.
Cons of distance counseling.
Much of what is communicated is non-verbal. From a distance, a counselor can miss those other body language messages. Some of what we do is point out the discrepancies between what the client is saying and what their body language tells us. Can’t do that if you can’t see them. Also, the tone of voice can be distorted or unrealistic over the distance.
In-person counselors work in the area you live in. That means that if they do something wrong you know who to complain to. Here in California, we are licensed by the California Board of Behavioral Sciences. That means we should be working with clients from California and only those from California unless we have a license from another state.
Where exactly does that person who is doing your internet counseling located? Do they have a license in your state, in another state, or anywhere for that matter?
What if you are feeling suicidal or if the client we are talking to is thinking about killing someone? If you are in an office we can make some calls and get you into a hospital or get you to a place that keeps you or the person that this client intends to kill safe?
What happens to the suicidal client if your therapist is on the internet from another country? What if they have little or no training and just decided online therapy was a way to make a lot of money?
Some state codes and some ethical guidelines require the professional who does over the internet counseling to meet with you at least once in a face to face session to make sure that they really know who you are and you can see and sign all the required forms.
If this internet counseling is arranged by a third-party, doctor, nurse, or rural government agency, that first visit may need to be conducted at one of their offices.
Information sent over the internet can be a lot less secure than the confidential setting in a therapist’s office. Make sure you understand the steps that the professional is taking to make sure your sessions stay confidential.
Right now there is a problem with those calling themselves “coaches.” In most places, there are no licenses required to become a coach. Some “life coaches” have taken a couple of hour class on the internet on how to make money being a coach. Others may have taken much longer trainings in how to be a good coach.
What very few coaches have done is taken the training needed to work with people who have a mental, emotional, or behavioral disorder.
Here are some rules for picking a professional if you decide to work with them over the internet.
1. Make sure the person you are working with is a mental health professional who is licensed in your state.
2. Try to find someone who lives in the same part of the state you live in so that if you need to go see them at some point you can.
3. Plan to visit the counselor’s office at least once to get to know this person and to be sure this is the one you want to work with.
4. Discuss privacy concerns, confidentiality, prices, and so on.
This field is new and like any new technology, the specifics seem to be constantly changing. I expect there will be plenty of changes to this practice as well. Hope that sheds some light on the use of the internet to conduct remote or distance therapy.
Have any of you used the internet in this way? How did this work out for you? I would especially be interested in hearing from any professionals that are doing distance counseling.
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As a Licensed Professional Counselor, Licensed Clinical Addictions Specialist, & National Certified Counselor, I am considering getting my Distance Certified Counselor certificate (DCC) to offer flexibility for myself with 3 kids. The DCC requires one adhere to the code of ethics & practice responsibilities set forth by NBCC. That allows for an avenue to file therapist complaints if needed, as well as, verify credentials. That being said, I agree there are limits or “cons” to distance counseling as you pointed out. I would think & hope a responsible therapist would make clear to potential clients the inherent concerns with distance counseling, including the recommendation that some circumstances are best treated in one-on-one sessions, group therapy, IOP, or in a specialized treatment setting. In other words, a distance therapist would have a heck of a disclosure statement & consent form that is discussed thoroughly and signed. Enjoyed the post. Thanks.
From the Therapist perspective I think you are right on the money. From the clients perspective the problem becomes how do they know who should and who should not be doing this. As a profession we have a ways to go to make this process safe for the clients. Best wishes on your plans and let me know how that progresses.
If internet therapy is more abundant and reaches across states, it may be easier for patients to find the right therapist. I took a few tries before finding someone suiting. If you’re in my country, I would have gone and seen you. 🙂