Mobile Communication

Ethical Issues in Online Counseling

A New Medium: Know the Potential, Recognize Limits, and Inform Clients

The Internet and mobile communications revolution provides people with new ways to interact with each other. Today, people around the globe can communicate easily, directly, and immediately via text, voice, and even videoconferencing. Within the past several years, visitors to health and mental health websites have been able to locate and even communicate with various professionals online. Yet, when an individual practitioner or organization is tempted to simply go online and offer professional service to the global community, it is crucial that they remember that not all clients and/or situations can or should be dealt with online. Some situations require in-office treatment or assessment. For example, it may be inappropriate to use the online modality with a client who poses a risk of danger to self or others. In times of emergency or when there is real threat to a person’s wellbeing, online communications are an insufficient treatment modality. Following are some situations in which online consults are not recommended:

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  If a client has thoughts of hurting or killing him/herself
  
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  If a client has thoughts of hurting or killing another person
  
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  If a client is in a life-threatening or emergency situation of any kind
  
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  If a client has a recent history of suicidal, violent, or abusive behavior
  
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  If a client holds what others may consider to be unrealistic beliefs (delusions)
  
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  If a client sees or hears things that others do not (hallucinations)
  
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  If a client is actively abusing alcohol or drugs
  

More about the considerations regarding appropriateness of service online can be found at the website of the ISMHO at http://ismho.org/casestudy/ccsgas.htm (Suler et al., 2001). It is important for online clinicians to clearly explain the medium’s limits to visitors and potential clients and to advise how and where f2f evaluation and/or help can be obtained in times of need. A responsible clinician must become acquainted with the extant professional literature about online counseling, giving particular attention to the effectiveness of treatment and outcome studies. Not only should an ethical clinician know about the medium, current research findings, and limits, but this knowledge must also be shared with clients. Clients should understand the potential risks and benefits of online counseling in order to make an informed decision. Clinicians should discuss with the client the effectiveness, limits, and risks, and point out the availability and effectiveness of alternative treatment. More about the suitability of clients for online services can be found at http://ismho.org/casestudy/ccsgas.htm.