Further Adventures Pt. 3

[Art Matthews, MA LPC DCC]

Well, I officially have asked for my LivePerson and LiveCounseling accounts to be removed. After several months of trying to persuade folks at LivePerson to address ethical concerns for their counseling clients and seeing no response, I've come to the conclusion that I don't want this fight. They are both too big for me to influence any sort of grand change.

Along with my LivePerson.com (AKA Live-Counselor.com) and LiveCounseling.com (AKA LiveCounselors.com)account, I have also deleted my account from MyTherapyNet.com Although these services or "online landlords" have slick, attractive websites, only MyTherapyNet.com had any real system of screening counselors that suggested any due diligence. LivePerson.com advertises they are a "World of Experts" but use that term loosely. With listings of experts from psychics/spiritualists to creative arts to business and health and medicine, the criteria for being an Expert in any particular field is elusive. LiveCounseling.com advertises that they are in a state of Beta testing so perhaps judgment should be reserved for them... but... their entire site seems to be a copy of LivePerson with fewer bells and whistles as far as site development. LiveCounseling does advertise as "video chat" (which LP doesn't have) but I haven't seen it work yet.

Also only MyTherapyNet.com required proof of malpractice insurance, documents like a Consent for Treatment or discussed ways of addressing legal and ethical concerns. Too bad they had problems of functionality like the other two (couldn't upload documents through the site, had to email to customer service and CS never posted my documents so I couldn't get started seeing clients). They were approachable when I asked them to add resources for counseling and supporting GLBTQ clients (but didn't know what GLBTQ stood for when I first requested the change).

If you are considering heading into eTherapy as a counselor, make sure you have a lot of patience. If a site doesn't "feel" right, don't go. My suggestion is to log in as a client on a site and see what type of experts are already working there. If you wouldn't be comfortable being seen by a counselor on a "multidisciplinary" site, then why would you want to be associated with them? If you wince every time you see a psychic advertised next to your profile on your site... what message do you think clients are getting about counseling? (Oh, and to you psychics reading this review... I already know you read this and are angry with me for "judging" your services, so there's no need to email me about your anger.) Think hard about sites that use the term "counseling" broadly and allow "expert advising" from all manner of self-appointed "authorities."

If you are considering going to a multidisciplinary "counseling" or "advising" site for your own personal counseling, remember the old saying "Let the buyer beware!" As a counseling client, you are a consumer of an online service that presents significant risk to you. If the client is afforded anonymity in the counseling relationship, how can you trust that the counselor is who they say they are? Neither LP or LC asked me for a photo ID. LC didn't even ask for a copy of my counseling license! LP was happy to set up my account after I faxed them copies of my degree and counseling license (they told me I had to pay a fee of $20 for a "background check" but that was never deducted and I never knew if it happened or not). Neither LP nor LC showed any knowledge of or consideration of the ACA Code of Ethics or the Ethical Framework for the Use of Technology in Mental Health from ISMHO (I provided access to both LP and LC Customer Service).

If you are communicating with a "counselor" after having done nothing more than giving a credit card number and checking that you read some terms and conditions, you should seriously consider if you have paid enough attention to the process of selecting a qualified professional. Do not trust that the site has actually verified anything about the "expert" serving you. You need to do more than read a legal disclaimer that was created to protect a web site from your litigation. Spend the time, do some investigating and don't settle on the first site you cross.

I am expanding my eTherapy to my "day job" as a counselor for a graduate university of health sciences for out of town students on clinical rotations and internships. I've created my intake, consent for treatment and releases and am working on the content of our new website for counseling at my campus. Although I've been counseling using Skype with some of these students since last year in July, I am now publicly making the service available. The timing seems to be excellent.

Until next time... be safe and support ethical practice, y'all!

[Mark Goldenson]

Hi Art, this is a helpful and thoughtful post. I think you have accurately described a lot of the concerns about online counseling sites.

If I can say this without being spammy, this is part of the reason we started Breakthrough (www.breakthrough.com). I hope we address many of the concerns you mention:

1. We only accept licensed mental health professionals. Psychics, sex workers, and life coaches are not allowed.

2. We verify both identity of providers and that they are currently licensed. We plan to continually re-check credentials. We do not currently charge for this and unless the costs for us to verify increase, I do not think we ever will.

3. We are working with DeeAnna Nagel to meet the Online Therapy Institute ethical framework. I can not promise that we can meet every tenet, but we do want to meet a higher standard.

4. We try to dissuade use of our site among people who are not suited to telecounseling, such as people in crisis. We believe this is not only ethical but helps protect providers and ourselves.

5. In the coming months, we will be offering liability insurance for online work through an insurance partner.

I would be interested in hearing your thoughts on our approach. We try to be responsive to questions and feedback. Feel free to reach me at [e-mail].

Best,

Mark

[Catherine Drennan]

Great dialog on a really important topic. You have done a ton of work, and I, for one appreciate the research you did. Now that I know how to obtain the list you mentioned, that's a big step; I only called the Maryland Board of Social Work Examiners and the NASW, and that was enough. Your tolerance for that sort of thing must be pretty high. I registered for the 2 day training in Maryland June 18 and 19 and I am really excited about it. I am not a big fan of "big brother", but the consumer needs protection from unscrupulous predators. Thanks again for your persistence and your reply. And, I apologize to anyone who might have taken offense at my oldest profession remark. Just being facetious. Enjoy the weekend.

[Art Matthews, MA LPC DCC]

Catherine: I believe that online counseling (etherapy) not only can be, but is ethical and effective when the professional is properly prepared, trained and experienced. Setting up your own individual site seems to provide the most security for you and the client but can be costly and requires technical knowledge not all of us have naturally. Using some of the more professional and ethical sites out there allows counselors to trade off some of the cost of start-up for less control. There are a number of reputable sites that have paid attention to legal and ethical concerns as they were developing and allow a counselor to provide a consent for treatment and release documents, verify the client's identity, etc. They require a monthly fee as well as an application/verification fee. Initially I wanted to have as little out of pocket as possible but that lead me to an association with a site I was less than comfortable admitting I belonged to (for the reasons you mentioned).

After doing some research with the help of multiple states' departments of health/mental health, I was able to come up with a pretty comprehensive list of states that already regulate online counseling. I forwarded that document to DeeAnna Merz Nagel, one of the founding members of the Online Therapy Institute. Go to: http://onlinetherapyinstitute.ning.com/profile/DeeAnnaMerzNagel and you can message a request for more information on those restrictions.

The problem of states boards monitoring sites such as the ones I listed; many of the contact people in these offices didn't respond to me at all and some didn't think that there was much to monitor. The clients on these "advising mega-sites" may have access to information regarding in which states the "Experts" are licensed/certified; however, they (like many of us) may not understand which set of laws applies to the counseling relationship, the client's state or the counselor's state. Then to find the proper state's site that handles the complaints for the particular licensee and locating the process and policy for filing a complaint... Overwhelming to many clients who already have difficulty coping. I'm sure there are horror stories that will not be registered because the client contacted the site's customer service and received a refund, not realizing that the "expert" quite probably should have been reprimanded by their state board.

IMHO: ALL counselors need to have an open mind and honest debate on etherapy. We need to push for states to develop etherapy specific wording, standardization of laws across state boundaries, and/or national legislation that addresses the regulation of etherapy. Right now in etherapy, the "www" seems to refer to the "Wild West Web." (Remember, it really is world wide so how do we regulate sites and practices in other countries?)

I'm not out of the online game entirely. I intend to use etherapy in my practice but I will use it more wisely, thanks to the Distance Credentialed Counselor training. The quality of etherapy varies (just as it does in face to face) with the therapist. Consumer education, professional education and minimal but necessary regulation must be considered.

I do not want to disparage all the therapists on LP/LC as many that I had the privilege to chat with shared my concerns and were actively trying to promote change from within. Many of them are also frustrated over the lack of response from the site developers and admin. I just wasn't willing to take the risk any more.

[Art Matthews, MA LPC DCC]

I'm hopeful that sites will see the importance of creating a structure that balances the therapeutic needs of the client, the legal, ethical and business needs of the counselor as well as the profit expectations of the site.

[Trinka Polite]

Thank you Art for sharing your reviews and experience with both sites. I was actually looking at both. You covered points that I had not considered.

[Art Matthews, MA LPC DCC]

"I accidentally referred to LiveCounseling in my original post in the first paragraph (now edited) where I stated I had spent several months addressing ethical concerns. A LiveCounseling person contacted me pointing out that they have been in Beta testing for only 5 weeks, so I could not have spent several months convincing them. I lumped the two services together, and they should be addressed separately. In their defense, an LC customer service person had responded positively to my initial comments to them in their first week in service saying they would like to work with me on development (evan asked for permission to contact me) after I asked if they had anyone licensed in mental health on their development team; however, they did not contact me further."

[Kate Anthony]

Fascinating stuff, Art - thanks for sharing :o)

Kate

[DeeAnna Merz Nagel]

Hi Art, Thank you for your thoughtful and thorough assessment of these e-clinics. One that remains for you to try (would love to hear your review of it!) is HelpHorizons. Years ago I used this service and was quite pleased. They have been bought out by an EAP company and seem rather quiet but the site remains functional.

The other option is for folks to add online services directly to their own website using encrypted forms of delivery. I offer consult and build websites that allow for ease of use for the client and at a low cost of the therapist.

Best,
DeeAnna