How quickly things change, or do they? Issues of ethics, privacy, and client demand have been forefront topics since the inception of online therapy. In this column, I look at where eCounseling was over half a decade ago, and note major changes to the present day. Then, with the risk of sounding like Ken Olson (Founder of Digital Equipment Corporation), who in 1977 said “There is no reason anyone would want a computer in their home.” I’ll make a few predictions about where eCounseling might be going.

Ethics

Seven years ago, if I would give a lecture about online therapy, I would spend the first half of the speech describing the debate over whether online and telephone therapy were legitimate clinical practice: “Is it within the bounds of a therapy license?” was the dominant question from the audience. The Clinical Social Work Federation, in 2001, had issued a statement denouncing text-based therapy, and around the same time the APA issued an, at best, neutral statement that “The Ethics Code…has no rules prohibiting such services.”

Today, many persons at my lectures already provide some form of online care. Also, over the past seven years the ACA, NBCC, and other associations have added online counseling into their ethical codes (the AACC is planning the same as they revamp their ethics code this year). Therefore, I don’t even address whether or not online therapy is legitimate practice; I focus on how to provide it ethically.

Privacy

Seven years ago, people were really, really, concerned about Internet security. Many seemed paranoid, certain that electronic data would jeopardize their privacy and increase their susceptibility to identify theft. They were right to be concerned.

Over the last several years, government agencies have lost personal information of U.S. citizens, including the Office of Inspector General at the U.S. Department of Transportation which, in 2006, lost a laptop containing data on 133,000 Florida residents. In March of 2008, 2,500 patients’ personal health information (PHI) was lost by the National Institutes of Health (NIH). Not to be outdone, that same month, Hannaford and Sweetbay supermarkets lost 4.2 million customer credit card numbers to hackers—oops! There are hundreds, if not thousands, of stories like this; and some estimate that 1 in 5 persons in the U.S. has been a victim of identity theft.

Microsoft CEO Steve Ballmer, this month (July, 2009), described a huge need for cyber security, stating, “The president needs to use his ‘bully pulpit’ to make sure businesses and local governments are protecting their data.” He explained “information technology departments’ vigilance has trended down over the past few years.”

A good sentiment, but it is unclear whether vigilance is enough. Today, a clinician can be vigilant 99 percent of the time, but one small error—connecting to the wrong wireless network, losing a USB flash drive, failing to log out of a program, or even forgetting to beta carbon copy an email can mean the PHI of hundreds, or hundreds of thousands, is compromised.

Expect to see more privacy disasters in the years to come.

Client Demand

Over the past seven years we have learned a lot about client demand. In a recent column titled The eCounseling Myth, I described the misconceptions that new eTherapists often have about building an online practice.

Online care is a tiny fraction of the counseling market. In June, there were 60,500 searches on Google for the word “Counselor” and 480 searches for “Online Counselor.” Also, in the current recession, private pay practices are hurting (eCounseling practices are, in nearly 100 percent of cases, private pay). Hence, unless one is a fantastic marketer, has a huge fan base, or some really lucrative niche, a thriving online-only practice is not likely (Side note: Life coaches are similar. They usually work by telephone or online, but the most successful life coaches I know are the ones teaching life coaching, not providing it.)

eCounseling has a place, as a minority prefers it to in-office care, and some clients opt for online care in addition to their in-office sessions. Successful therapists are using telephone and online care as a way to add value for their current clients. This, I predict, will continue to grow.

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There is an article about this very issue at: http://en.wikipedia.org/wiki/Psychological_testing

Also, you can read below…

Psychological testing is a field characterized by the use of samples of behavior in order to assess psychological construct(s), such as cognitive and emotional functioning, about a given individual. The technical term for the science behind psychological testing is psychometrics. By samples of behavior, one means observations over time of an individual performing tasks that have usually been prescribed beforehand, which often means scores on a test. These responses are often compiled into statistical tables that allow the evaluator to compare the behavior of the individual being tested to the responses of a norm group.

Psychological assessment is similar to psychological testing but usually involves a more comprehensive assessment of the individual. Psychological assessment is a process that involves the integration of information from multiple sources, such as tests of normal and abnormal personality, tests of ability or intelligence, tests of interests or attitudes, as well as information from personal interviews. Collateral information is also collected about personal, occupational, or medical history, such as from records or from interviews with parents, spouses, teachers, or previous therapists or physicians. A psychological test is one of the sources of data used within the process of assessment; usually more than one test is used. Many psychologists do some level of assessment when providing services to clients or patients, and may use for example, simple checklists to assess some traits or symptoms, but psychological assessment is a more complex, detailed, in-depth process.

Typical types of focus for psychological assessment are to provide a diagnosis for treatment settings; to assess a particular area of functioning or disability often for school settings; to help select type of treatment or to assess treatment outcomes; to help courts decide issues such as child custody or competency to stand trial; or to help assess job applicants or employees and provide career development counseling or training.[1]
A useful psychological measure must be both valid (i.e., there is evidence to support the specified interpretation of the test results[2]) and reliable (i.e., internally consistent or give consistent results over time, across raters, etc.).

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Five Love Languages Video: Couples Communication

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From the couples examined, older couples and happier couples were the ones using more “we” language, indicating that long, healthy marriages are ones that exist in a cohesive conjugal environment.

Improve Your Marriage

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Here is a link to the article on Death, Dying, and Grief:
Good Grief
Is there a better way to be bereaved?

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A: I’m sorry to hear you’re having such troubles.
I think there is free counseling, but you’ll need to do some work to track it down.

Here are a few places to look:
Samaritans International — here is there NYC website (the phone number if on their homepage) number http://www.samaritansnyc.org/
Also, 1-800-SUICIDE is a crisis line– they might have volunteers who will talk with you, and they might know of more sources themselves.
Also, often churches provide free pastoral counseling, which many people find helpful. You might want to look into churches near you, to see if there is a counselor you can talk with at no charge.
There is also a lot of good information out there about depression and anxiety that you might find helpful. Dr. David Burns “Feeling Good Handbook” is a very good book on overcoming depression and anxiety. WebMD.com is a highly respected sours of information. You can find some information on our www.thriveboston.com website about depression and anxiety:
Boston Depression Counseling Tips
Overcoming Trauma
Relationship Stress and Advice
Overcoming Anxiety
Finally, if you are thinking you might hurt yourself, please go to your nearest E.R. (or call 911 now) and the professionals there will help you to find good emergency care.

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