Boston Counseling Therapy

eCounseling – Looking Back Seven Years at Internet Therapy

eCounseling – Looking Back Seven Years

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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