You’ve raised quite a few points that all seem to me pretty important — both from the standpoint of an individual evaluating the services that are available, and from the standpoint of the positive development of the field as a whole. Let me see whether I can offer a few brief thoughts on some of the issues you raise. (Did I say brief? Uh-huh, right…I could certainly go on at length about some of these things!)

First, with regard to the general question of online practice and ethics, I think the territory can be be chopped up into at least two big swathes. On the one hand are the ethical principles espoused by various organisations with regard to online therapeutic work: there is no shortage of groups (and individuals) trying to position themselves as the authoritative voice of what is or is not ethical practice online. Some, such as the ISMHO, may well simply point to their ’suggested principles’, published around 2000, and say there you go, that’s ethical online practice.

However, this misses the other swathe of territory, and that’s the territory best summed up by the old adage “the devil is in the details”. It’s in this area that we ask questions about what specifically practitioners are doing to ensure that their practice (not to mention their marketing) is ethical. It’s in this area that we wind up asking questions not just general questions like “is online practice ethical?”, or “do you have a list of suggested principles for ethical practice?”, but rather more specific ones. It’s in this area that I personally believe the field is in a bit of a muddle, and it’s in this area that it sounds like you’ve found it hard to get straight answers.

If you’re interested, one section of a paper called 9 Observations About the Practice and Process of Online Therapy addresses very briefly some of these kinds of questions about ethical online practice.

Moving on to your question about studies of online practice and ethics, one (unfortunately quite old) study which comes to mind is:

Heinlen, K.T.; E. Reynolds Welfel, E.N. Richmond and C.F. Rak (2003) ‘The Scope of WebCounseling: A Survey of Services and Compliance With NBCC Standards for the Ethical Practice of WebCounseling‘, Journal of Counseling & Development 81(1): 61-9.

This paper evaluates sites for compliance with an early version of the ethical standards of the National Board for Certified Counselors. (By the way, the NBCC ethical standards are vastly more widely cited and more influential than the ’suggested principles’ of the ISMHO.) You can read my comments on this paper in the online therapy section of the research library.

With regard to your question about the availability of a forum to address ethical concerns a client has with an online therapist they are using, am I right in understanding you to mean a body to which you could bring a concern about the behaviour of an online therapist? If so, your main recourse would be to the practitioner’s professional body or licensing body. To my knowledge, there are no actual online counselling/online therapy bodies which have any type of complaints procedure or ethics procedure. As you will have read, the ISMHO very definitely does not.

With regard to therapists’ sites pointing to one another without letting you know that the sites may all be owned by the same person, I’m not sure I agree with you that this is necessarily unethical — although it certainly might be, depending on context. For me, the red light would probably go on if I realized that one site were promoting another in a way that suggested the recommendation was impartial and disinterested. In other words, one important question for me would be “is this person deliberately trying to mislead me, or are they just keen to mention their other sites/projects/etc.?”.

Last but not least, it seems to me there’s an important underlying issue that remains untouched by all this, and that’s the issue highlighted right at the end of your comment: you would still like to pursue online therapy but are concerned about what you may be getting into. You’re clearly doing some background research and following things up and forming a general impression of the state of the field. But even with the effort you’re putting in, how can you be sure? I suppose in the end, it would be pretty darned difficult to really be sure, but I hope that your background research is able to answer some of the questions well enough that you’ll feel confident deciding one way or the other. And I hope some of the above will be of some use in that.

All the best,
Greg

Are there unbiased (by non online therapists) studies on how ethical online therapy really is (even when they do not term it as such but as coaching, etc.)?

Is there a forum to address ethical concerns a client has with an online therapist they are using?

I recently realized that almost all of the online therapist sites seem to “point to each other” to give validation to their own site (unethical?) even to the point of pointing from one of their sites to another without mentioning that all of the sites referenced are those they set up themselves (unethical).

I would still like to pursue online therapy but are concerned about what I may be getting into.

Your reply would be greatly appreciated. Regards