My Therapist .com

Real Therapy, Online

Historical Practice Archive for Dr Greg Mulhauser

Ethics, Security and Real Therapy, Online

Photo by creating in the dark - //flic.kr/p/59m8LT
Photo by creating in the dark - http://flic.kr/p/59m8LT

At MyTherapist.com, we have never offered ‘virtual therapy’. We only do real therapy, but we do it online. The difference is more than mere semantics: every practitioner at MyTherapist.com is prepared to engage in a real relationship, providing real counselling, real therapy or real psychology services online

For some folks, online therapy and online counselling are just pale imitations of the real thing. You can use them just for fun, or when you don’t have real problems. Practitioners offer them as part of being au fait with ‘the latest thing’. I mean, all that internet stuff is here to stay, isn’t it? But they don’t necessarily believe in online mental health services as a viable alternative for real people with real problems, and they don’t necessarily have much (if any) first hand experience with actually doing online therapy or online counselling. They get a serious look and say “what about security?”; or mumble something ending with “aren’t there ethical questions about doing therapy online?”. Sometimes, the unspoken message seems to be that if you just ask the question, without doing any work to answer it, then you’ve satisfied your duty to be ethical yourself, and you can move on to another topic that you feel more comfortable with.

Well at MyTherapist.com, we say Yes, actually, now that you mention it: there are ethical questions about doing therapy online and security questions about doing therapy online — and they’re exactly the same as the questions about doing therapy in Portuguese…or in American Sign Language…or in a war zone. Nobody asks “is it ethical to do therapy in Portuguese?” or “is it ethical to do therapy in American Sign Language?” or “what about security when you’re doing therapy in a war zone?”. Why? Because in these cases, most people recognize that while there may be special contextual considerations of which both therapists and clients should be aware, the underlying ethical principles governing our work — what philosophers call “normative principles” — do not change in the slightest.

Consider the normative principle of non-maleficence, for example: it does not suddenly become right to harm clients merely as a result of someone’s inventing a new way of communicating called email, or as a result of adopting Portuguese as a language, or as a result of working in a war zone. The underlying normative principle of non-maleficence says we do not seek to harm clients, regardless of context, end of story.

So is it all free-sailing, then, and online therapy or online psychology services are just like their face-to-face counterparts? No, clearly that isn’t true either. In order to practice ethically, a would-be online therapist must have at least acquired the technical competence necessary to apply the underlying ethical prinicples to the relevant technological context. It’s no good saying “I’m a psychotherapist, I don’t worry about the technology stuff” — which is a little like an underwater welder saying “I’m just going to focus on my welding, and not worry about the swimming”. Similarly, a practitioner working in Portuguese or American Sign Language must have acquired at least a minimum working knowledge of the language sufficient to grasp what a client is articulating and sufficient to communicate what they need to say to the client.

The upshot is that online therapy is real therapy — ethical, secure, and suitable for real problems — but only when offered by practitioners who are sufficiently competent to discharge their ethical duties surrounding the therapeutic relationship in that context. This is exactly analogous to the example of practitioners working in sign language, in Portuguese, or in war zones.

In my personal experience, it is only the practitioners who have never done much real online counselling work who question whether it is for real problems, or who insist on calling it ‘virtual therapy’. And it is only the practitioners who do not themselves grasp the application of agreed ethical principles to the technological context of online therapy who get those serious looks and mumble questions like “is it ethical?” without actually going on to address those questions — as if just asking the question is enough to end the discussion. Such questions are real and legitimate and need to be answered — but to presuppose negative answers says much more about the practitioner doing the presupposing than about the actual ethics and practice of secure online counselling or secure online therapy.