Internet-Based Interventions Essay

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Psychotherapeutic, counseling, and supportive services have been available on the Internet for victims of interpersonal violence since the late 1990s. Services include education, information and referral, problem solving, supportive counseling, and psychotherapy. For example, Safe Horizon offers education through an online domestic violence shelter tour as well as a link to email for help. Rape, Abuse and Incest National Network provides chat-based online intervention for rape crisis and support. Services are offered online by professionals and trained volunteers of domestic violence organizations, rape and sexual abuse crisis centers, child abuse agencies, and a variety of private nonprofit agencies as well as by private practice professionals. Service delivery may use asynchronous email, real-time chat-based communication, or Internet-based audio/visual communications. In addition, a large variety of self-help groups for support of victims and others faced with interpersonal violence are also offered on the Internet.

Advantages and Concerns

Scholars and practitioners have debated the advantages and potential harm of online services. The benefits of online therapy over in-person therapy include easier access to therapy, more privacy, and lower cost. Online therapy is convenient, since services may be available at any time from any place. They offer a stable source of support in an increasingly mobile society. Online services may be more likely to be used by those faced with concerns that are often stigmatized, such as domestic violence and rape, since they can be accessed anonymously and without in-person contact. In addition, services are available to those who might not otherwise seek services due to time constraints, geographic distance, caregiving responsibilities, lack of transportation, physical or social isolation, and/or physical or psychological disabilities. Online therapy may be more effective with some people since it uses a medium that promotes more open and disinhibited communication due to the perceived anonymity and safety of online communications. In addition, online services may offer a source of culturally relevant information and services when they are not available in the local community. Finally, although costs vary greatly, online therapy may be less expensive, since more consumers can be served in a shorter time with fewer overhead costs.

A number of ethical and legal concerns are associated with online services. The effectiveness of online therapy has not been established. There is very limited empirically validated evidence related to the outcomes of online service delivery. Therapists trained in face-to-face counseling rely on many visual cues in their assessment and intervention. A therapist’s skills in assessment and providing empathy may not directly transfer to the online world. Since visual and verbal cues are unavailable online, assessment is more difficult online. Misunderstandings are more likely in text-based communications and cannot be immediately addressed in asynchronous modalities. In addition, development of trust may be impaired, since it is difficult to know the true identity of the consumer or the practitioner in a strictly online environment. Another concern is that providing privacy, security, and confidentiality of online communications requires both technological safeguards from practitioners and education of consumers in safeguarding their own computers. Furthermore, a number of ethical requirements, such as duty to warn vulnerable third parties, to make appropriate referrals, to be available and intervene in emergencies, and to consult with previous service providers, may be difficult in online relationships. Finally, practitioners and consumers face unclear legal and liability standards surrounding the jurisdiction and practice of online therapy.

A number of organizations have developed ethical and practice standards related to online therapy. The National Board for Certified Counselors has adopted ethical codes for the practice of e-therapy. The American Psychological Association (APA) has issued the APA Statement on Services by Telephone, Teleconferencing, and Internet. In addition, the International Society for Mental Health Online has adopted Suggested Principles for the Online Provision of Mental Health Services. The National Association of Social Workers (NASW) has not adopted a specific statement on the ethics of online practice. The NASW has adopted a policy statement about technology and social work that emphasizes the importance of using technology in social work directed by the values and ethics that are essential principles of the profession. There is general agreement in these codes of ethics that all ethical standards of face-to-face practice must be met in online therapy.

Research

Increased consumer use of the Internet to meet health and mental health needs is taking place in the context of very limited research about the effectiveness of online therapy. The research literature suggests that online therapy can be an effective treatment modality. Studies are limited in scope, sample size, duration, level of therapist experience, and outcome measures. Studies suggest that a therapeutic relationship can be established through text-based communications. In addition, a relatively small number of empirical studies comparing online treatment with face-to-face therapy or wait-list control groups have examined the effectiveness of online therapy with a variety of populations and social problems. These studies generally find online therapy to be as effective as face-to-face interventions or more effective than wait-list control groups with a variety of diagnostic categories, including anxiety, depression, eating disorders, panic disorder, substance abuse, caregiver stress, pediatric pain, cigarette addiction, grief, posttraumatic stress disorder, and recurrent headache. Studies have not yet evaluated online services for victims of violence. Further research is needed to better determine for whom and under what circumstances online therapy is effective.

As more people use the Internet, human service professionals working in interpersonal violence intervention will need to determine to what extent they will engage in online therapeutic and supportive services. For those who do offer online services, it will require creating secure systems, training workers in online communication, creating policies regarding what services may be offered online by whom, developing policies for handling both expected and unsolicited email, creating record keeping procedures for online communications, developing new forms of supervision, and evaluating the impact of online services. The future will likely see the development of new models of service delivery that include 24-hour access, a geographically distributed workforce, and new ways to link service recipients with information and supportive resources. Finally, services will need to be expanded to accommodate the tremendous increase in those seeking services as a result of online access.

Bibliography:

  1. Barak, A. (2004). Internet counseling. In C. E. Spielberger (Ed.), Encyclopedia of applied psychology (pp. 369–378). San Diego, CA: Academic Press.
  2. Finn, J., & Banach, M. (2002). Risk management in online human services practice. Journal of Technology and Human Services, 20(1/2), 133–154.
  3. Grohol, J. M. (2000). The insider’s guide to mental health resources online. New York: Guilford Press.
  4. Mallen, M. J., Vogel, D. L., Rochlen, A. B., & Day, S. X. (2005). Online counseling: Reviewing the literature from a counseling psychology framework. Counseling Psychologist, 33, 819–871.
  5. Rochlen, A. B., Zack, J. S., & Speyer, C. (2004). Online therapy: Review of relevant definitions, debates, and current empirical support. Journal of Clinical Psychology, 60, 269–283.
  6. Seuler, J. (2000). Psychotherapy in cyberspace: A 5-dimension model of online and computer-mediated psychotherapy. Cyberpsychology and Behavior, 3, 151–160.
  7. Waldron, V., Lavitt, M., & Kelley, D. (2000). The nature and prevention of harm in technology-mediated self-help settings: Three exemplars. Journal of Technology in Human Services, 17(1,2,3), 267–294.
  8. Zack, J. S. (2004). Technology of online counseling. In R. Kraus, J. Zack, & G. Stricker (Eds.), Online counseling: A handbook for mental health professionals (pp. 93–121). San Diego, CA: Elsevier Academic Press.
  9. Rape, Abuse and Incest National Network: https://www.rainn.org/
  10. Safe Horizon: https://www.safehorizon.org/

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