What’s the Deal with Online Therapy?

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Marlene M. Maheu, a therapist, uses video conferencing to communicate remotely with patients. She has served on task forces to address issues of online therapy. Credit Sandy Huffaker for The New York Times

Online counseling or “web therapy” is an emerging practice in the world of social services.  Although online counseling is not a substitute for traditional psychotherapy, it has many benefits, including flexibility, anonymity, comfort, and convenience.  Perhaps you are nervous about going to therapy—with online counseling you can test it out for as little or as long as you’d like in many different modalities.

Many services are offering “Skype” or video counseling using secure software, or voice phone calls directly with a therapist, or even text message/email therapy that is not offered in “real time”—giving you and the therapist both a chance to respond when most convenient for you.  Whichever modality you choose, the world of online counseling can introduce you to therapy in a non-invasive, comfortable manner at your own pace.

However, online counseling is not appropriate for everyone.  Online counseling likely does not include prescribing medications, which can be essential to the recovery of severe mental illnesses.  It is also not appropriate for anyone who is currently suicidal or homicidal, or anyone who is currently experiencing psychotic symptoms. If this is the case, you should immediately call 911 or your local emergency authority.

Another draw and danger of online therapy: anonymity. Many people avoid treatment for reasons of shame or privacy. Some online therapists do not require patients to fully identify themselves. What if those patients have breakdowns? How can the therapist get emergency help to an anonymous patient? Read More

Most importantly, anyone who needs intensive support or hospitalization is not a good fit for online counseling. Online counseling should be used as additional support and not a replacement for those needing intensive treatment.  Another limitation of online counseling is the difficulty in interpreting voice tone, body language, and other forms of non-verbal communication in traditional therapy methods.

Although online counseling is not appropriate for everyone and some professionals are still skeptical about it, there are studies showing online counseling can be just as effective as face-to-face in person therapy with a better attendance rate.

The Journal of Affective Disorders reported a University of Zurich study divided a group of 62 patients in half and found that depression was eased in 53 percent of those given online therapy, compared to 50 percent who had in-person counseling. Three months after completing the study, 57 percent of online patients showed no signs of depression compared to 42 percent with conventional therapy.

In an April 2012 edition of Psychiatric Services, it was reported that in a four-year Johns Hopkins study that included close to 100,000 veterans, the number of days that patients were hospitalized dropped by 25 percent if they chose online counseling. This is slightly higher than the number of hospital visits experienced by patients who used face-to-face counseling.

Lastly, according to the American Psychiatric Association in 2007, patients in Ontario, Canada were assigned to face-to-face or live video counseling and experienced statistically the same clinical outcome and level of patient satisfaction. The only difference was that the cost of providing the online service was 10% less per patient.

Overall, online counseling permits the client to access therapy when it’s convenient for them and without having to leave the comfort of their home.  It could be a type of counseling that can reach more people in need which is necessary and important.  What do you think?

NASW Technology Standards: How Do You Measure Up?

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One thing that students and current working social workers are familiar with is the NASW, which has a huge influence over most of the standards set for social work practice and education.  They also have some clearly defined standards for technology as outlined in the NASW’s Code of Ethics.

The standards cover a wide variety of topics, and I know that my education as a social worker did not address more than a minimum number of the standards. As discussed in an earlier article by Deona Hooper, Social Work and Technology: Fails in Teaching Students Technology, even though in 2005 it was directly laid out that we should by the NASW!

Lets take a look at what the NASW’s standards are and we can see how we measure up:
I will be scoring myself on a 1-5 scale you should too!

Ethics: 4/5

“Social workers providing services via the telephone or other electronic means shall act ethically, ensure professional competence, protect clients, and uphold the values of the profession.”

Technology adds an entirely new dimension to the ethical standards social worker’s have to abide by. Not only do you have to know what can  and cannot be shared via communication on telephone and email. Technology has a way of blurring lines that are otherwise clear. If someone texts you something are  you still mandated to report that or is that something you keep private? What about if you hear something in the background of a Skype conversation?

Privacy: 4/5

“Social workers shall protect client privacy when using technology in their practice and document all services,taking special safeguards to protect client information in the electronic record.”

Do you know about HIPAA regulations? Do know about the many ways client confidentiality can be compromised in electronic means? More importantly do you know what you might be held liable for? To compound  the issue  most social workers need to know about how to maintain client privacy when using nonstandard means of communication. This is particularly relevant when looking at the recent development of teletherapy (therapy via video conferencing). Worse, what happens if you store your clients information on a personal computer and it gets lost?

Let me know in the comments section if you have ever had questions about client confidentiality and privacy related to technology!

Access: 3/5

 “Social workers shall have access to technology and appropriate support systems to ensure competent practice, and shall take action to ensure client access to technology.”

The NASW acknowledges that we work in organizations that often have obsolete software and equipment and they clearly state we should advocate for both ourselves and our clients when it comes to access to technology, something I agree with. Good job NASW! Do you have access to “appropriate technology”? Do you know what the technology you might need is? Let alone the technology that your clients might need. This is a gap in education for social workers that needs to addressed by schools across the country.

If you know of any schools that have classes that address technology and social work let me know in  the comment below!

Proficiency: 3/5

“Social workers shall be responsible for becoming proficient in the technological skills and tools required for competent and ethical practice and for seeking appropriate training and consultation to stay current with emerging technologies.”

This is where you can check where you measure up, do you know how to use the technology in your workplace? Does your workplace offer training in that technology so that you can better help your clients? What should social work programs offer in the way of technology?

Let me know in the comments below what you wish your social work program had taught you about using technology to help your clients!

Final Score: 14/20

Ouch  70%!  It is pretty obvious that this is an issue that still needs to be address, for right now you can keep visiting Social Work Helper to educate yourself about technology until social work education gets its act together!

And don’t forget to let me know your final score in the comments below!

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