ETHICAL ISSUES IN ONLINE COUNSELING

 Discuss about the key ethical issues in the use of online counseling and the many forms
of service delivery via the Internet. This field involves both potential benefits and risks
and practitioners have a priamry duty to consider the best interest of the client while
making sure that no harm comes to the client and legal requirements are being complied.
(Koocher and Morray, 2000).
 Mental health professionals are responsible for evaluating ethical, legal, and clinical
issues when providing counseling and behavioral services from a distance. (Mallen,
Vogel, and Rochlen, 2005)
 Mental health professionals should consider incorporating delivery of services via
Internet but must assert that associations should develop standards for this kind of
practice. (VandeBos and Williams, 2000)
A. Ethics Codes and Technology
 The Code of Ethics of the American Mental Health Counselors Association (AMHCA,
2000) includes guidelines for Internet online counseling that address issues pertaining to
confidentiality, client and counselor identification, client waiver, establishing the
online counseling relationship, competence, and legal considerations.
 APA (2002) – psychologists who offer services via electronic transmission should inform
clients/patients of the risks to privacy and limits of confidentiality.
 ACA (2005) – counselors should inform clients of the benefits and limitations of using
technology in the counseling process.
 Ethics Codes box titled “Technology Applications: American Counseling Association
(2005)” – sets guidelines for using this new technology.
B. Emerging Issues in Online Counseling
 The ethics of online therapy is currently the center of debate in our profession as there are
major cautions valuing clients experiencing significant psychological distress, recurrent
psychopathology, and suicidal or homicidal intent. (Welfel, 2009)
 Some of the Current ethical practices of 88 online counselors in their “Ethical Intent
Checklist” (Shaw and Shaw 2006)
a. Only one third of the online counselors required an intake procedure and an
electronically signed waiver explaining the limits of confidentiality on the Internet.
b. Less than half of the online counselors required the client to give his or her full name
and address.
c. Less than half of the websites provided a statement concerning circumstances when
confidentiality must be breached.
d. Only one third of the websites provided a statement that the Internet is not completely
secure and that confidentiality could not be guaranteed.
e. Only half of the websites provided a statement that online counseling is not the same
as face-to-face counseling.
  Online counselors lack knowledge about ethics codes and ethical practices. If counseling
professionals will not address the ethical issues of online counseling then online
counselors will do counseling without considering the professional boundaries of the
field.
C. Ethics Codes
 Technology Applications: American Counseling Association (2005)
a. Benefits and Limitations
Counselors should inform clients of the benefits and limitations of using information
technology applications in the counseling process and in business/billing procedures.
b. Technology-assisted Services
When providing technology-assisted services, counselors should verify if the client is
capable of using the application intellectually, emotionally and physically and that the
application is appropriate for the needs of the client.
c. Inappropriate Services
If technology-assisted services are deemed inappopriate by one or both parties, then
face-to-face counseling session should be considered.
d. Access
Access to computer applications should be taken into consideration.
e. Laws and Statutes
Counselor should ensure that the use of technology does not violate any law and
observe all relevant statutes.
f. Assistance
Counselors seek business, legal, and technical assistance when using technology
applications especially when the use of such crosses state or national boundaries.
D. Advantages and Disadvantages of Online Counseling
 Internet counseling is not considered as traditional psychotherapy but can benefit
clients who are reluctant to undergo traditional counseling sessions (Rabasca, 2000a).
 Asian American underutilize mental health services because of masculine
stereotyping so they resort to online counseling sessions so that they can express their
emotions and personal concerns anonymously (Chang and Yeh, 2003).
 Health care over the internet is rapidly evolving and may be considered beneficial for
those who can’t easily access health care. Another benefit of internet intervention is
that a greater number of people will be able to receive the service. Ethical and legal
issues about privacy, confidentiality, data validity, credentials of professionals,
potential misuse of Internet interventions, and equality of Internet access must be
addressed when using Internet Interventions. Also, Internet Interventions should
undergo scientific testing to prove feasibility and efficacy. (Ritterband and
colleagues, 2003)

 Advantages (Riemersma and Leslie, 1999)

1. Some consumers want brief, convenient, and anonymous therapy service.
 2. Some clients who are unwilling to participate in traditional therapy may
be willing to accept help online.
3. For persons with physical disabilities, online services are more accessible.
4. This form of counseling is suited to a problem-solving approach, which
appeals to many consumers.
5. Clients who experience anxiety when talking face-to-face with a therapist, or clients
who are extremely shy, may feel more comfortable dealing with their problems by
means of a computer.

 Benefits to Therapists (Sampson, Kolodinsky, and Greeno, 1997)

1. Access to clients in rural areas.
2. Facilitates assigning, completing, and assessing client homework.
3. Enhances record keeping.
4. Expands the pool of referral services.
5. Increases flexibility in scheduling.
6. Increases options for supervision and case conferencing.
7. Enhances collection of research data.

 Suggestions for Counselors considering Online Counseling (Ravis, 2007)

1. Before offering distance counseling, acquire the appropriate competencies related to
this evolving specialty.
2. Learn how to adapt traditional methods for effective application to distance
counseling.
3. Screen clients for suitability with respect to the specifi c distance services you are
considering using.
4. As a part of informed consent, educate your clients about the diffi cult
situations that may occur during distance counseling.
5. Familiarize yourself with the ethical guidelines that have been developed to inform
your specifi c scope of practice.
6. Be aware of the legal issues and state licensure board regulatory policies
that govern your specifi c practices when delivering online counseling.

 There are ethical problems involved in using online counseling to deal with a serious
crisis, a psychotic individual, or even someone who needs more than a behavioral
intervention.

 Disadvantages (Freeny, 2001)

Inaccurate diagnosis or ineffective treatment may be provided due to
lack of behavioral clues and the lack of nonverbal information.
1. Confidentiality and privacy cannot be guaranteed.
2. Therapists’ duty to warn or protect others is restricted.
3. Clients who are suicidal, suffering extreme anxiety or depression, or
who are in crisis may not receive adequate immediate attention.
 4. Anonymity enables minors to masquerade as adults seeking treatment.
5. Transference and countertransference issues are diffi cult to address.
6. Difficult to develop an effective therapeutic alliance with an individual
who has never been seen in the traditional face-to-face counseling
context.
7. Complex long-term psychological problems are not likely to be successfully
treated.
 Informed consent documents should state that online counseling is not a replacement to
face-to-face counseling (Shaw and Shaw, 2006).
E. Legal Issues and Regulation of Online Counseling
 A host of legal questions will not be addressed until lawsuits are filed pertaining to its
use, misuse, in counseling practice.
 “Is it legal for a mental health practitioner who is licensed in one state to treat a client in
another state by telephone or over the internet?” In some states, mental health
professionals cannot practice in states which they are not licensed.
F. Competent Counseling Online
 Practitioners need to consider their level of competence and determine what kinds of
services they can and cannot appropriately offer, and assess the benefits and risks of this
form of service delivery. Therapists should undergo training regarding counsleing via
internet.
 Issues that need to be addressed (Riemersma and Leslie, 1999):
1. Evaluate and diagnose a client at the beginning of treatment, ideally through an initial
face-to-face session, to determine whether the client is a good candidate for online
counseling.
2. Require the client to be evaluated by a physician to rule out a physical cause for the
client’s psychological problem prior to initiating Internet counseling.
3. Fully inform the client of the limits and expectations of the online relationship.
4. Develop a plan for how emergencies will be dealt with.
5. Address with the client, in advance, the limitations involved in confi dentiality over
the Internet and discuss what actions might be taken in the event that confi dentiality
is compromised.
6. Discuss with the client, in advance, how situations involving technological failure
will be handled.

 It is unlikely that Internet Interventions will replace face-to-face counseling but may be a
way to treat some psychological problems that could have been untreated.
G. Perspective on Online Counseling
  Therapists need not to choose between Internet Interventions and ad Traditional
Counseling sessions. Technology can address unique needs and therapists can combine
both.

In Relation to ASCA:
A. Technical and Digital Citizenship
1. Appropriate selection and use of technology and software applications. Ethical and
legal concerns of technological applications is given attention.
2. Appropriate and reasonable measures for maintaining confidentiality.
3. Promotion of safe and responsible use of technology.
4. Promote the benefits and clarify the limitations.
5. Use established and approved means of communications.
6. Equal access to technology.

B. Virtual/Distance School Counseling

1. Adhere to ethical guidelines of face-to-face counseling.
2. Recognize and acknowledge the limitations.
3. Implement procedures in both emergency and non-emergency cases.
4. Recognize and mitigate the limitation of confidentiality.
5. Inform the benefits and limitations.
6. Educate clients how to participate in online counseling sessions to avoid
misunderstandings.