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» What about Online Therapy?
Crisis Management
Once a professional relationship has been established, the licensed clinical psychologist or mental-health professional has a responsibility to the welfare of the client. Not having immediate in-person availability presents real difficulties for a therapist to effectively respond to online clients who are suffering a crisis. Problems can arise as a result of any one--or a combination--of the following factors:
Accurately Assessing the Situation
In March 2000, the Los Angeles Times featured an extensive critique of online therapy in which one of the major concerns was a therapist’s limited ability to accurately assess the severity of an online client’s situation: “When you’re online, you can’t see someone getting tense, getting upset, getting guarded.” When meeting face-to-face, “the therapist can assess the situation, help calm the client, and assist them in getting to a safe place. While online, the therapist may not even be able to know that they are freaking out…they may even be on the verge of suicide and the therapist can’t do a thing about it.”
Client Anonymity
When discussing intimate or deeply troubling issues, many people are extremely reluctant to provide personal, identifying information (such as address, telephone number, employer, nearest relative—or even their real name) along with their online therapy communications. For situations in which a person is suffering a serious or potentially life-threatening crisis--for example, an “anonymous” online client tells the therapist that they are the victim of domestic violence, that the abuse is escalating, and then abruptly stops sending or receiving e-mail messages--the therapist has absolutely no way of knowing whether or not their client is safe, or ensuring they receive necessary emergency help.
Message Delays
E-mail communication can involve significant delays between the time a message is sent and when it is finally received and read. The real and present possibility exists, notes Russ Newman, executive director of the American Psychological Association, that a person who is suicidal could send an urgent e-mail message of desperation and plea for help to an online therapist that is received too late.
Difficulty in Securing Local Emergency Resources
Because it is highly likely that the online therapist will be unfamiliar with their at-a-distance client’s local community and its emergency resources, in the event of a crisis, they will be at a significant—and maybe catastrophic—disadvantage in ensuring their client receives the assistance they need.
Conflicting Laws
Laws mandating when and how mental health professionals breech confidentiality and report a client’s danger to self (suicidal ideation) or others, or how they are required to respond to suspected incidents of child, spousal, or elder abuse can vary from one geographical jurisdiction to another. When the client lives in a different legal jurisdiction from the therapist, it is currently unclear which laws--those that cover the client’s geographical region or those that cover the therapist’s geographical region--are applicable.
For instance, if a therapist in Los Angeles is counseling a client in Houston via the Internet, where is the therapy actually taking place and what laws should apply? The issue of properly and legally responding to crisis situations becomes even more complex when addressing situations that involve online therapists and clients who reside in different countries.
Link: Find a Therapist
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