What is counseling online?

What's The Difference Between Coaching and Therapy?

Psychotherapy generally deals with people with emotional/behavioral problems and disruptive situations - and seeks to bring the client to normal function by focusing on dysfunction. The primary focus is on healing.

Coaching, on the other hand, deals with functional people who want to move toward higher function - and achieve excellence while creating an extraordinary life. The primary focus is on evolving and manifestation of potential. And, healing is often a side affect.

Additionally, the expectations and focus the client brings to the professional relationship sets the context as coaching or as therapy.

Counseling online is a new modality of helping people resolve life and relationship issues. It utilizes the power and convenience of the Internet to allow simultaneous and time-delayed communication between a the client and the counselor. As I work with only women, the focus of counseling on line varies from client to client. Some women will want to discuss interpersonal relationships, or learn new ways of dealing with stress. Others may use this modality to help clarify issues they are currently working on. Still other women will use counseling on line to "check-in" from time to time with an objective third-party professional to take stock in their life and work on more philosophical life issues.

What counseling on line is not?

Counseling online does not presume to diagnose or treat mental or medical disorders, and because it does not limit who may be appropriate to provide counseling on line services, it would be inappropriate to compare it to traditional face-to-face psychotherapy or assessment. Counseling on line helps a woman address issues of concern to her in her life under the guidance of a professional counselor. I do not diagnose disorders, nor do I treat diagnosed mental or medical disorders. Counseling on line is similar to the idea of "coaching," helping a person address specific concerns with specific skills.

What makes counseling on line better than other modalities of help available?

When counseling on line is conducted via its preferred modality (e-mail, chat rooms, journals) it allows both the client and the counselor to fully reflect on issues discussed in a previous correspondence. Unlike other helping methods, such as traditional psychotherapy, counseling on line's strength is in the ability to explore and flesh-out a person's concerns without awkwardness or the need to "think on one's feet."

In fact, because there are no social and nonverbal cues in counseling on line, the participants can get to the point of issues quickly and easily. Embarrassment and other impediments (e.g., confidentiality fears) do not have to be issues in counseling on line. And because counseling on line is text-based, it is more likely to access the skills most associated with reading and comprehension. This means the cloud of emotion can be, perhaps, more readily lifted via e-counseling's methods.

What makes counseling on line worse than other modalities of help available?

Counseling on line's strength is also its weakness; without nonverbal cues, communications between the participants have a greater potential for being misunderstood. It also requires that a person be adept and relatively comfortable with reading and writing, and that the participants be able to communicate at similar levels of comprehension.

Principles and Guidelines:

The following suggestions are meant to address only those practice issues relating directly to the online provision of mental health services. The terms "services", "client", and "counselor" are used for the sake of inclusiveness and simplicity. No disrespect for the traditions or the unique aspects of any therapeutic discipline is intended.

• Informed consent: The client should be informed before he or she consents to receive online mental health services. In particular, the client should be informed about the process, the counselor, the potential risks and benefits of those services, safeguards against those risks, and alternatives to those services.
• Possible misunderstandings: The client should be aware that misunderstandings are possible with text-based modalities such as email and phone sessions (since nonverbal cues are relatively lacking).
• Turnaround time: One issue specific to the provision of mental health services using asynchronous (not in "real time") communication is that of turnaround time. The client should be informed of how soon after sending an email, for example, he or she may expect a response.
• Privacy of the counselor: Privacy is more of an issue online than in person. The counselor has a right to his or her privacy and may wish to restrict the use of any copies or recordings the client makes of their communication.
• Assessing the Counselor: When the client and the counselor do not meet in person, the client may be less able to assess the counselor and to decide whether or not to enter into a treatment relationship with him or her.
• Counselor's Name: The client should be informed of the name of the counselor. The use of pseudonyms is common online, but the client should know the name of his or her counselor.
• Counselor's Qualifications: The client should be informed of the qualifications of the counselor. Examples of basic qualifications are degrees and certifications. The counselor may also wish to provide supplemental information such as areas of special training or experience. So that the client can confirm the counselor's qualifications, the counselor should provide the telephone numbers or web page URLs of the relevant institutions and associations.
• Potential benefits: The client should be informed of the potential benefits of receiving mental health services online. This includes both the circumstances in which the counselor considers online mental health services appropriate and the possible advantages of providing those services online.
  For example, the potential benefits of email may include:
  1. being able to send and receive messages at any time of day or night;
  2. never having to leave messages with intermediaries;
  3. avoiding not only intermediaries, but also voice mail and "telephone tag";
  4. being able to take as long as one wants to compose, and having the opportunity to reflect upon, one's messages;
  5. automatically having a record of communications to refer to later;
  6. feeling less inhibited than in person.
• Potential risks: The client should be informed of the potential risks of receiving mental health services online.
  For example, the potential risks of email may include
  1. messages not being received and
  2. confidentiality being breached.
  Emails could fail to be received if they are sent to the wrong address (which might also breach of confidentiality) or if they just are not noticed by the counselor.
• Safeguards: The client should be informed of safeguards that are taken by the counselor and could be taken by himself or herself against the potential risks.
  For example,
  1. a "return receipt" can be requested whenever an email is sent and
  2. a password can be required for access to an Instant Message or Chat Room.
• Alternatives: The client should be informed of the alternatives to receiving mental health services online.
  For example, other options might include
  1. receiving mental health services in person,
  2. talking to a friend or family member,
  3. exercising or meditating, or
  4. not doing anything at all.
• Standard operating procedure: In general, the counselor should follow the same procedures when providing mental health services online as he or she would when providing them in person. In particular: The counselor should remain within his or her boundaries of competence and not attempt to address a problem online if he or she would not attempt to address the same problem in person.
• Structure of the online services: The counselor and the client should agree on the frequency and mode of communication, the method for determining the fee, the estimated cost to the client, the method of payment, etc.
• Evaluation: The counselor should adequately evaluate the client before providing any mental health services online. The client should understand that that evaluation could potentially be helped or hindered by communicating online.
• Confidentiality of the client: The confidentiality of the client will be protected at all times. Information about the client should be released only with his or her permission. The client should be informed of any exceptions to this general rule.
• Records: The counselor should maintain records of the online mental heatlh services. If those records include copies or recordings of communications with the client, the client should be informed.
• Established guidelines: The counselor should of course follow the laws and other established guidelines (such as those of www.ISMHO.com that apply to him or her.
• Emergency Procedures: The procedures to follow in an emergency should be discussed. These procedures should address the possibility that the counselor might not immediately receive an online communication and might involve a local backup.
• Emergency Local backup: Another issue specific to online mental health services is that the counselor can be a great distance from the client. This may limit the counselor's ability to respond to an emergency. The counselor should therefore in these cases obtain the name and telephone number of a qualified local (mental) health care provider (who preferably already knows the client, such as his or her primary care physician).

Advantages and disadvantages

To reiterate: Online Mental Health Counseling contains many advantages including:

• Mental Health Counseling can be conducted without ever leaving your home or office.
• Some of us simply feel more comfortable talking to someone online, rather than face to face.
• There is no stigma of driving and entering a therapist's office.
• When sending emails, one can take as much time as they like to compose them, and this can be accomplished at the person's convenience (communication via email is an option, but Cora recommends that at least a portion of the treatment be through a live chat or phone)

To reiterate: Online Mental Health Counseling is not a good choice if you:

• Feel like hurting yourself or others (please contact your local crisis emergency center immediately)
• Prefer a face-to-face form of Mental Health Counseling.
• Are in need of serious and intense treatment.
• Are in need of someone to prescribe psychiatric medication for you.

With the growth of the internet, services are being provided in ways never thought possible. Mental Health Counseling, something traditionally done in a professional's office, has now become something that can be achieved "online". Online Mental Health Counseling shares many similarities to traditional Mental Health Counseling, but is also different in some ways. It does not offer the physical face to face encounter, but this is not necessarily a hindrance.