Online counseling: effectiveness, implementation, and current practices

Online Therapy

Given the prevalence and permeation of digital discourse, it is not surprising that psychological counseling can now be conducted online. Online counseling provides similar sets of services to clients as in-person counseling, albeit the scope of services will be limited to the restrictions of the technology. One of the benefits of online counseling is that it permits individuals to transcend both geography and time with regards to scheduling services with professionals. Individuals in rural areas, and those with difficult schedules, stand to benefit most from online counseling. Preliminary research shows that online counseling can be effective for many disorders (Bell, 2007). However, not all psychological issues or disorders are conducive to an online counseling intervention. Online sessions have a "disinhibiting" effect that can be especially effective for cohorts with issues like social anxiety (Cook & Doyle, 2004, p. 95).

Four of the top Google hits for a search on online therapy include Blah Therapy (http://blahtherapy.com/), 7 Cups of Tea (http://www.7cupsoftea.com/), Breakthrough (https://www.breakthrough.com/), and Online-Therapy.com (http://www.online-therapy.com/). Each of these websites shares in common similar features. For instance, they offer both professional and amateur talk therapy in the form of both community forums and one-on-one. Services are rendered primarily via live online chats. Of these four online therapy websites, Blah Therapy and 7 Cups of Tea focus more on creating a supportive online community and offering amateur and free services to users. On the other hand, Breakthrough and Online Therapy are designed more for individuals seeking professional counselors.

On Blah Therapy, the user interface is attractive and based on the language and tone of the site content, target audience is a young demographic. There is an option to seek professional services from a therapist online, and the subjects covered range from eating disorders to addiction. The client can ask questions to discover which therapist might be best suited to their needs, or the client can choose from a number of associated counselors based on their areas of specialization or gender. The counseling is charged by the minute, and users can use PayPal. There are also free services on Blah Therapy including forums and a question room.

On 7 Cups of Tea, the emphasis is almost exclusively on amateur and free services. Users can become "listeners," who create public profiles. Clients can choose a listener to have a virtual conversation with, and engage in talk therapy. Clients can also select listeners based on their geographic location, language, and keywords in the listener profile. In addition to these services, 7 Cups of Tea also offers a series of digital self-help guides.

Breakthrough is almost the opposite of 7 Cups of Tea because the website features mainly professional services. Users can browse available therapists and take intake assessments for optimal placement. Moreover, therapists can use the site to refer clients. Clients can use their insurance to pay for Breakthrough counseling sessions. Information about the effectiveness of Breakthrough counseling services is provided on the website as well.

Online-Therapy is similar to Breakthrough in that the emphasis is squarely on linking professional counselors to paying clients. There is the opportunity to chat live with questions related to appropriate services and professional matches, clients can take assessment or personality tests online, and receive targeted interventions such as cognitive-behavioral therapy. In fact, Online-Therapy is the only one of the four online counseling services mentioned that focuses on one particular treatment modality. Like Breakthrough, Online-Therapy offers research to substantiate the efficacy of its interventions.

The American Psychological Association and the National Association of Social Workers accept online therapy as a reality. There are a few professional organizations for online counselors like the Online Therapy Institute. As with traditional forms of therapy, the consumer need mainly be aware of issues like licensing and insurance coverage. States will have different rules and regulations regarding online therapy, and those rules are bound to change as rapidly as the technology. Three states (California, Kentucky, and Vermont) have already devised specific requirements for online therapists, regarding issues like informed consent and mandating evaluations that ensure the client is knowledgeable about what online therapy entails (DeAngelis, 2012). All the standards of professional ethical practice will need to be fulfilled in the online setting, and technically there are no special provisions for the online environment. Online therapy does not necessarily present unique legal or ethical constraints. Just as a person cannot claim to be a licensed therapist working from an office, a person also cannot claim to be a licensed therapist online (Zack, 2011).

Professional psychologists, counselors, and social workers may choose to refer clients to an online therapist, and likewise, an online therapist might opt to recommend that a client use traditional services when his or her needs cannot be met online. The websites that specialize in amateur counseling such as 7 Cups of Tea are not covered under the professional provisions of websites like Breakthrough and Online-Therapy. However, a therapist may suggest a client use these sites for the free services they provide. Even the amateur services can lead to a reduced level of stigma regarding mental health issues, lead to a familiarity with counseling and specific treatment modalities, and can promote the use of therapy in a broader sense.

Unfortunately, none of the online therapy websites consulted offer information about how client data will be stored or protected. The professional websites like Breakthrough and Online-Therapy will likely conform to professional ethical standards that strictly maintain client confidentiality. However, clients should be aware that their personal information is not protected when using amateur services. Amateur "listeners" and members of online forums are under no professional obligation to protect the user or his or her shared information. This is why informed consent does remain a critical issue for clients using online therapy.