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From January 2001 NASW NEWS Caution Urged Before Web Counseling
At least 300 to 400 mental health professionals already offer online services. More research and groundwork need to be done before social workers rush headlong into practicing Internet therapy, Goutham Menon said at his Social Work 2000 conference workshop in Baltimore, "Online Counseling? Should We Do It?" Professional ethics require that whatever interventions social workers use be based on evidence that they work. Internet counseling is very different from in-person therapy, where trust builds slowly in face-to-face sessions and nonverbal cues are often as important as what's said. Yet many social workers seem eager to practice online therapy before they know whether it is therapeutic, said Menon, who teaches social work at the University of South Carolina. Before online counseling becomes widespread, there are also legal, technical, licensing and professional issues that need to be worked through for the good of the profession and the protection of practitioners, said Menon. There are potential positive aspects to online therapy, he said. It may be useful to the homebound and those in rural areas who can't easily get to a mental health professional. In topic areas where there is stigma attached, the anonymity of the Internet might help people open up. It is available round-the-clock, and the overhead costs are negligible. Many are already practicing before the ticklish problems of online therapy are solved. An Internet search showed at least 300 to 400 mental health professionals already offering online services, said Menon. Many students are interested in the medium, and more and more companies are signing up practitioners for networks of online therapists. Just because social workers are good at face-to-face therapy doesn't mean they are qualified to successfully use the Internet for counseling, Menon said. Most practitioners are untrained in therapeutic techniques that don't rely on voice and visual cues. He suggested using communications theory developed by others and training in such techniques as use of "emoticons," small cartoon-like figures, to convey emotion. Broadband will mean that Internet voice and video technology will soon be widespread, but it will be a long time before most clients can afford it, he said. Menon seemed especially concerned about a lack of empirical evidence that Internet counseling is effective. He said he has tried to survey online therapists, but the response rate is extremely poor. "In my opinion, they don't know if it's working or not, so they don't respond," he said. "It is unethical not to participate in outcomes research. We need to know if these interventions work. If they don't work, they don't work." There should be social work input into any Web-based counseling system in which social workers take part, said Menon. If social workers aren't in on designing the system, other professions will set the standards. For instance, some fledging Internet-based therapy companies want to have access to and keep a record of any therapist-client interactions. When they learn the importance social workers place on confidentiality, they may say they understand the social work Code of Ethics and will comply with therapists' needs for confidentiality. Technical issues Menon said need addressing include the use of nonsecured sites — those without encryption, which could compromise confidentiality — by most online practitioners he surveyed. Computers also leave a text residue that can be read by others. Software has been developed that can read the contents of computers without the knowledge of the owners, allowing spouses or others to read the contents of sessions. Clients need to be warned and software loaded as an antidote to this, he said. Legal issues include text residue that can be subpoenaed by courts, and which area would have jurisdiction in liability cases — where the therapist works or where the client lives. Licensing laws seem to have come full-circle, said Menon. Once NASW's ACSW certification was required for practice in many states, but most states now have their own licensing procedures, and most licenses are restricted to a single state. A national license to practice on the Internet is needed, and NASW ought to investigate that possibility, suggested Menon. National licensing for online therapy might be a problem because state licensing boards could lose money if there is a separate license, he said. Menon listed six broad issues he said social workers need to consider:
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