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January 01, 2011

"E-Therapy" Raises Questions, Possibilities


Therapy in cyberspace? It sounds like something out of Aldous Huxley's futuristic novel, Brave New World. Yet both service providers and recipients are already using the Internet as a tool in the delivery of treatment services for mental and addictive disorders.

How does "e-therapy" work? What are its limitations? And is it useful? Continuing Education for MFT
SAMHSA's Center for Substance Abuse Treatment (CSAT) sponsored a meeting last year to explore some of these questions and to launch a dialogue on this recent innovation.

In his opening remarks, CSAT Director H. Westley Clark, M.D., J.D., M.P.H., identified the most fundamental issue: What is e-therapy? He noted, "We currently have no solid definition for this new mode of treatment."

David Nickelson, Psy.D., J.D., Director of the Office of Technology Policy and Projects for the American Psychological Association, suggested that in order to define e-therapy, several questions would need to be answered: Is it traditional psychotherapy using a new medium? Or is it actually a new type of therapy? Should it be considered something other than therapy, such as counseling?

He identified some questions pertaining to health service as well, such as:

How do ethical and legal guidelines apply to e-therapy?

Should e-therapy be regulated?

Can e-therapy sessions be kept private and confidential?

Is it clinically appropriate to use the Internet in this way?

Advantages/Disadvantages
Gary Walz, Executive Director of the ERIC Counseling and Student Services Clearinghouse at the University of North Carolina-Greensboro, said that people who are in the midst of a serious crisis are not good candidates for e-therapy. This includes people who are suicidal or are experiencing a serious drug addiction.

Mr. Walz further noted that some clients might feel uncomfortable discussing important subjects online, and that the lack of immediacy and nonverbal cues could be a disadvantage. He also observed that no state licensor codes deal with e-therapy, no legislation guides its use, and many professional liability insurance policies will not cover it.

Dr. Nickelson added that some pathologies might present problems to treatment online. For example, when individuals are online, they can alter their identities and claim to be a different age or gender. This could be particularly problematic in the treatment of people with certain personality disorders, he said.

Several participants expressed concern about establishing rapport between client and therapist-often considered vital to successful therapy-over the Internet.

But participants also discussed the potential advantages that e-therapy offers. Mr. Walz noted that therapy online could help reach underserved populations, including those in remote geographical regions. Also, counselors could continue to treat clients who relocate to other areas. Clients with time constraints or difficult schedules might find e-therapy more convenient, he said. All of these factors could enable many more people to receive treatment then receive it currently.

Guidelines and Standards
Professional organizations are developing professional guidelines and standards for addressing practices that are unique to Internet counseling. Doug Gilbert, Ph.D., NCC, ethics officer for the National Board of Certified Counselors, discussed his organization's process for developing standards. These standards address such issues as verifying the identity of the Internet client, determining if a client is a minor and therefore in need of parental or guardian consent, and explaining to clients the procedures for contacting an Internet counselor offline.

Donna Ford, NCC, LPC, Past President of the American Counseling Association, recommended that counselors provide individual online counseling only through a secure Web site or e-mail application that uses appropriate security measures including encryption. Even so, she said, clients should be informed that some information transmitted may not be secure. Client waivers should acknowledge the understanding of the limitations in ensuring confidentiality of information. She added that counselors should identify potential situations to clients in which confidentiality would have to be breached.

Volunteer: Popular New Year's Resolutions



Have an idea for a service project – like getting a group together to volunteer each week at a homeless shelter, or reading to kids at your local library? Learn how to turn your volunteer idea into a successful service project using our do-it-yourself toolkits below.

Education
Help close the achievement gap and reduce “summer learning loss” by reading with kids or organizing a book drive.

•Toolkit: Read with Children
Read with Children: The Facts
Children who are not engaged in learning between school years suffer from “summer learning loss.” Many of the achievement gaps that continue to exist for disadvantaged students today result not from students falling behind during the school year but rather losing out on chances to learn over the summer.

Did you know that if a young person reads only five books over the summer, the effect “is potentially large enough to prevent a decline in reading achievement scores from the spring to the fall?” footnote 1

Did you know that if a young person is read to at least three times a week, that person is twice as likely to score in the top 25% of reading? footnote 2

Commit yourself and a team of your friends, family, and neighbors to help young people close the summer learning gap by joining United We Serve. This tool kit will give you the basics to start a reading program from scratch, recruit a team, organize your group, and make an impact.

•Toolkit: Organize a Book Drive | en Español
Starting a Book Distribution Team: The Facts
80% of preschool and after-school programs serving low-income populations have no age-appropriate books for their children. footnote 1

A recent study shows that while in middle-income neighborhoods the ratio of age-appropriate books per child is 13 to 1, in low-income neighborhoods the ratio is 1 for every 300 children. footnote 2

The most successful way to improve the reading achievement of low-income children is to increase their access to print. Communities ranking high in achievement tests have several factors in common: an abundance of books in public libraries, easy access to books in the community at large and a large number of textbooks per student. footnote 3

Commit yourself and a team of your friends and neighbors to help increase reading achievement and literacy by joining United We Serve. This tool kit will give you the basics to run a book drive, organize your group, and make an impact.

What will you do to help increase reading and literacy?


Health
Promoting healthy lifestyles in your community is key to preventing costly disease and improving our nation's health.

•Toolkit: Support Community Gardens | en Español
•Toolkit: Starting a Walking Team | en Español
•Toolkit: Promote Back to School Health | en Español
Community Renewal
At a time when many Americans are struggling with the loss of their job or their home, you can help meet some of their most basic needs by working to reduce hunger, secure donated clothing and strengthen community resources.

•Toolkit: Support Local Food Banks | en Español
•Toolkit: Organize a Clothing Drive | en Español
Energy and Environment
Join your friends and neighbors to reduce energy by auditing your home and helping maintain public lands.

•Toolkit: Audit Your Home | en Español
•Toolkit: Maintain Public Lands | en Español
•Toolkit: Let's Glean! (USDA)
Veterans and Military Families
Support military families and veterans who have served our country.

•Toolkit: Connecting Veterans to Community Services
Disaster Preparedness
Help your community prepare for disasters.

•Toolkit: Preparing Your Community for Disasters
Create Your Own Project
Work with your neighbors to identify local needs and find solutions that work. MFT Continuing Education
•Toolkit: Create Your Own Project
Disclaimer of Endorsement
Toolkit references to any specific non-profit organization, commercial product, process, or service by trade name, trademark, manufacturer, or otherwise do not necessarily constitute or imply its endorsement, recommendation, or favoring by the U.S. Government or any agency thereof.
Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 Unported License.