So you decide if the following assumptions and view points from over 7 years ago are relevant or outdated:
We live in a fast-paced society where virtually everything is just a click away. With the click of a button, you can pay your bills or even have merchandise shipped to your front door without ever leaving the comforts of home. The Internet has made this and much more a reality. The number of Internet users today is reported at 972,828,001, which is 15.2% of the world’s population and the percentage of population usage growth during 2000-2005 was reported at 169.5% (Internet World Stats, 2005). As the number of Internet users across the globe continues to soar, more and more resources are becoming accessible online. The possibilities of services that can be offered on the Internet are endless. Today, one can even receive online professional services such as counseling.
Online counseling is a relatively new service. Therefore, there currently exists limited research to support or disconfirm its effectiveness. The long-term ramifications of such an experience are yet unknown. There are many concerned with the ethical dilemmas associated with online counseling. Below I will briefly explore the ethical issues centered around online counseling, beginning with a definition of a traditional counseling relationship:
A traditional counseling relationship is an interpersonal relationship between a client and counselor in which the counselor provides the client a reflection of the client’s self in a safe atmosphere in which the client feels comfortable enough to completely relay information to the counselor in order to gain order over personal conflicts.
Confidentiality:
The first and most obvious ethical dilemma with rendering mental health services over the Internet is one of confidentiality and privacy. The Internet is an open network and therefore is not secure. Consequently, when communicating through an insecure source one cannot be completely guaranteed that what is being revealed in a counseling relationship remains only in that relationship.
Because the Internet is not secure, there are numerous opportunities for an invasion of privacy. Such could occur if one were receiving counseling while at the work place where his or her email is subject to being read because it is considered company property. Other possibilities include, but are not limited to, that another could access confidential emails intentionally by eavesdropping or unintentionally if information was misdirected and intercepted.
Identification:
Another ethical issue associated with online counseling involves client and counselor identification. Without being able to confirm the identity of a client during each interaction, one cannot be certain of who is being counseled. The danger in this circumstance is that one could easily misrepresent him or herself and the counselor could be mislead to believe that he or she is counseling a particular individual when in fact this may not be the case. If this were to happen, confidential information could be unintentionally divulged to a third party.
Additionally, if the client were to misrepresent his or her own identity, for instance their sex or ethnicity, this could be just as damaging and could hinder the counseling process. If a counselor does not fully know with whom he or she is working, then the story which is being revealed by the client cannot appropriately be put into context, thus resulting in misinterpretation of what the client is communicating.
Virtual Relationship:
One of the most common negative results of interacting online is the phenomenon of being in a virtual relationship. Both the counselor as well as the client are in a sense unreal, they are simply “cyber-beings” as the author likes to describe them. Being in a virtual relationship causes an individual to have no sense of commitment to the counseling process. The client is simply writing another email via a keyboard and has minimum personal connection to the counselor.
Due to the lack of a personal relationship with the counselor, a client may be more easily offended by the advice that is given in an online counseling session. A client may feel that a cyber-being has no right to become so personal. If this is the case, then a client may also be more apt to end the relationship either temporarily or permanently by simply clicking a button.
The first and foremost responsibility of a counselor is to protect the welfare of his or her client. Yet, if one is counseling a virtual person then it is nearly impossible to be able to ensure the client’s safety. A counselor does not even truly know whom they are counseling or the location of the client’s residence. With this being the case, a counselor cannot intervene if a client is a danger to him or herself or others. A counselor’s hands are tied when it comes to his or her “Duty to Warn.”
Dishonesty:
As a result of communicating over an insecure source to a cyber-being, a client receiving online services may not be willing to be straightforward about all information. Additionally, when information is shared with a lack of commitment to the counseling process this could lead the client to actually falsify information. Not only is there a danger that a client might be misleading or may even lie, but there is also the risk that a client could intentionally leave out parts of his or her story. A client may feel the need to be deceitful due to the fact that he or she may fear a breach of confidentiality or simply feel no responsibility to be honest because no personal relationship exists between counselor and client. If this is the case, then the counselor cannot work at full capacity because of a lack of all the pieces of the client’s history.
Dishonesty leads to confusion which makes the counseling process difficult if not impossible. If a client were able to be assured that what is said would stay only between counselor and client, then there would be more freedom to be completely honest. Also, if a client were in a face-to-face relationship, they may perhaps feel more of an obligation to be upfront.
Lack of Nonverbals:
Nearly 94 percent of all communication is nonverbal. We communicate with our facial expressions, posture, eye contact and so forth. Needless to say, reading nonverbals is an essential element of counseling. If one is being counseled online, these nonverbals are unobservable and such is detrimental to the counseling process. Nonverbals which cannot be observed during an online session are nervous behaviors, whether eye contact is maintained, angle and distance of body in relationship to the counselor, etc. Also, a client may be typing content which appears to be uplifting, but at the same time may be crying. Conversely, a client may be typing distraught messages but may be laughing while doing so. Such is evident of inappropriate affect and is a good indicator of possible mental diagnoses.
Abandonment Issues:
Another responsibility of the counselor is to not abandon a client. Yet, abandonment may be impossible to avoid when counseling occurs online due to the instability of the Internet. Communication could be hindered because of technology failures or glitches or as a result of a poor Internet connection.
If a relationship is suddenly ended for any reason, it would be almost, if not, impossible for a counselor to get back in touch with his or her client due to the fact that in an online counseling relationship the client is anonymous in most of the cases; thus making abandonment impossible to avoid. Furthermore, if a client were to abruptly leave a counseling session after threatening to harm him or herself or others, then not having the ability to protect your client would be the ultimate case of abandonment.
Conclusion:
There appears to be many “ifs” in the ethical dilemma of online counseling and not enough certainty. “If” we as counselors could guarantee the privacy of our clients, “if” we could make certain of who we are counseling, “if” our client is completely truthful and “if” we were guaranteed they would not terminate before a session is over, then there would be little debate over whether online counseling should be attempted. Nevertheless, as of now, the “ifs” do exist.
Counseling, whether online or in person, involves much responsibility. When counseling an individual, you are placed in a position where you are a major influence in that person’s life. A counselor holds much control over the mental health of another. If Internet counseling is attempted, it should only be done by a competent professional who is well-educated in the field and should only be done via secure websites or with an encryption technological e-mail communication application.
Counseling online is a great responsibility as is counseling an individual face to face. As well, such a relationship should be treated with the highest ethical professionalism. Regardless of that an online client is communicating in a virtual world, his or her problems are still very much real.
Reference
Internet World Stats (2005). Usage and Population Statistics, downloaded from http://www.Internetworldstats.com/stats.htm on 12/2/05. 10 a.m.
DATE WRITTEN: January 17, 2006