In this video I talk about the challenge between the freedom of the individual to access therapeutic services online from whomever they wish to, and the issue of jurisdictional restrictions and the laws that are in place.
With the technology available today and the World Wide Web, everything is changing. New guidelines need to be developed in relation to online counseling therapy. There are a few professional organizations such as the International Society for Mental Health Online, working on developing these guidelines. You may be interested in getting involved in helping to make the changes happen.
We have our work cut out for us as professionals, but I believe this service option for online therapeutic services will be driven by the general public and the clients who wish to access therapy from whomever they choose. We need to start thinking globally.
I welcome comments and opinions on this topic. Take a look at the video.
A much more comprehensive set of guidelines are developed by the American Telemedicine Association, Telemental Health Special Interest Group (SIG). Their information is based on peer-reviewed research spanning 3 decades and not a lot of opinions and anecdotal “research” from people who aren’t in the mainstream.
If you want to change US government regulations, you need to be in the mainstream system, not refusing to acknowledge what the US government has been doing to develop remote service delivery systems in the United States through NIH and NIMH for decades.
If you want to see something by an insider talking about licensure issues, go to Center for Online Counseling, here, http://centerforonlinecounseling.com and look for the video clip on the right side of the page, with Dr. Dena Puskin, Director of the Office for the Advancement of Telehealth (OAT).
She is one of the leading people in “licensure portablity” (licensure across state lines) because she heads OAT, the US office which has been funded by the US government to research inter-state licensure issues.
Watch the 4 minute video, then decide if you want to follow ISMHO or ATA to get information upon which to decide your future.
Also, look to my hand book to get accurate information about the future of mental health online: “The Mental Health Professional and the New Technologies.”
You’ll find it at Amazon and Barnes & Nobel online.
I think we need a whole new way of thinking that reflects a mixed reality experience that more and more of us are around.
Personally I am happy to be accountable to my local jurisdiction and respect the jurisdiction of where the client physically lives, and look forward to a time when the law will reflect the fact that we are meeting in a non-physical space.
Thank you Marlene for your timely information. I will definitely check this out. I will also pass this on to others I communicate with.
John, you are so right. I also recommend professionals operate within their jurisdictional parameters and work to expand them to the global reality. I believe, ultimately, it will be the public that will put pressure on policy makers to expand their horizons. It will take much work from many sides, but it is something we must do. Issues of credibility are ultimately not about the method of service delivery, but of the quality of the professional who will make sure their methods of delivery match their quality standards that they use in their services.
I welcome other comments from those who know what is happening on this matter in other countries as well, whether private, public or government initiatives. I want this to equip me with a breadth of knowledge to offer this to others interested in the delivery of global health services.
Hi everyone. This is a lively conversation and I think what would be great is if all such organizations- Marlene’s, ISMHO, Norm’s- could pull together to help spread the word, the concerns and our common ground. I think John is right. This is a global community and that cannot be ignored. On the other hand, the Online Therapy Institute’e Ethical Framework states clearly that we should all respect the laws of our own and our client’s jurisdiction. Our framework offers a point of reference for state and national boards and organizations seeking clarity on the most basic issues involving online therapy. And for those working in nations with no regulatory oversight, professionals can obtain a basic knowledge base from which to practice.
I think that while there is some overlap between the medical profession and the counseling profession, there are also distinct differences and I am not sure that the American Telehealth Association speaks fully to the needs and concerns of counselors and psychotherapists in the United States. We are not represented largely, if at all in that organization either.
The Online Therapy Institute has formed a legal and ethical wiki that is available to everyone and information can be added by people who are in the know and wish to share their knowledge about jurisdiction and ethics around the globe. Just go to the OTI website and click the wiki menu tab.
The British Association for Counselling and Psychotherapy (BACP) has had published, peer-reviewed Guidelines for Online Counselling and Psychotherapy available for 10 years. They are now in their third edition and include Guidelines for Online Supervision in the last two editions (2005/2009). Along with ACA, NBCC, EthicsCode and ISMHO, they form the basis for the Online Therapy Institute’s Ethical Framework, as DeeAnna mentions. They are based on empirical research and expert opinion from around the globe. I’m not sure why organisations keep inventing the wheel. In the UK, we no longer need “special interest groups”, because Online Therapy is considered mainstream – as acceptable for accreditation as face-to-face work, for example.
I agree, Norm, that the future will be led by the client in demanding service provision using technology and telling us professionals how this should be done. That is Web 2.0 in action and I have been lecturing on that for two or three years now.
Of course I am based in the UK, with very different jurisdictional codes to the US, but I still feel that I don’t need to decide who to “follow”. BACP just happens to be my chosen professional organisation, not my god. Web 2.0 demands a melting pot of the globe, for countries and US states to work together in finding the best ethical way forward for the good of our clients. I welcome ATA’s input into the mix to further educate ourselves as professionals, as I do ISMHO, ACTO, and all the other organisations.
Fascinating discussion, and I really want to thank you, Norm, for taking the time to Vlog about the importance of addressing jurisdictional issues in the provision of mental health services online. Although I am sure that none of my colleagues would encourage anyone in the cyber-realm to intentionally break the laws of their locale, your core point – that of the right of the individual to choose the practitioner, remains unresolved in today’s legislative bodies.
The Suggested Principles for Online Provision of Mental Health Services were endorsed by the International Society for Mental Health Online in January, 2000, and were designed to be guidelines for practitioners in the larger, global market – not only those who remain rooted within the United States. Since its inception in 1997, members of ISMHO have created training programs for practitioners, researched both process and perception of online mental health services, toured the globe to encourage leading clinical groups to prompt more research in the field, and funded awards for related scientific projects. Our organization continues to gather resources as they become available across the planet, many of which can be found in the White Papers and Research Bibliography located on our site. While many members hail from the United States of America, many others physically reside in countries like the United Kingdom, Australia, Canada and Austria – many of which have been extremely encouraging of its practitioners to adopt distance counseling services.
Kate, I too would like to see more joint collaboration across global organizations and less competition amidst them. I believe that this is an achievable goal for the next decade, and one that will benefit residents of less technologically present countries as well. The National Board for Certified Counselors was approached by the World Health Organization in 2002 to find a way to reach across its American boundaries and out toward the African Continent to assist in training counselors to provide services to the meet the growing mental health needs in that locale. ISMHO remains well suited to facilitate and promote similar discussions amongst its global peers.
Let me jump in for a moment (while this Canadian is on holidays and family matters in South Carolina, USA).
I’d like to highlight and recommend all comments above that reflect inclusive discussions on this matter. There is a point to be said that those who hold too tightly to their own creation tend to diminish the natural desire in others to help that person succeed which only results in the withholding of knowledge and wisdom necessary to benefit the whole. Let’s encourage input into each group’s efforts (and valuable they are) and even recommend some to other organizations where their interests may be better utilized. Keep priorities focused on what we are each best at…and the rising tide will raise all ships. Thankyou each one for being part of the rising tide.
As we all sort these issues out, people will continue reaching out for our services, in growing numbers, and from all parts of the global community.
How do you explain to a client who is reaching out to you for help that you can’t accept them because they are in a restricted zone?
What do you do with an existing client who moves into a restricted area but outside your area yet wants to continue services with you?
In addition to those mentioned above, what other organisations, individual efforts, and government initiatives are being made towards defining jurisdictional (and add insurance) issues related to providing health services nationally, internationally, and globally?
