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Welcome to CombatCounselor Chronicle, an E-zine dedicated to giving you the most current, pertinent information on cognitive behavioral therapy (CBT) and mindfulness-based CBT available.

Chris Sorrentino, a.k.a CombatCounselor, is a leader and expert in cognitive behavioral therapy. He combines 30 years of experience in psychology with the discipline from having served as a U.S. Air Force officer for 20 years, 4 of those in combat zones, retiring as a lieutenant colonel in 2005.

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Saturday, October 12, 2013

Online Therapy: Boon or Bust?

In a modern world with technology making it easier and easier to communicate across the street or around the planet, we as psychotherapists face uncharted ground and ethically borderline situations when communicating with clients. I see people who call themselves "therapists" on Twitter and other social networking sites offering therapy via email and Skype (to name just two potential platforms) ... AND THAT CONCERNS ME!

Based on my experience, education, and knowledge of clinical ethical standards for our profession, email is "dodgy" to say the least, offering little protection for confidential communications. Skype therapy has been challenged by licensing boards and professional ethical standards (National Board of Certified Counselors, American Counseling Association, American Mental Health Counselors Association) based on state of licensure, with restrictions on whom licensed clinicians can see, particularly concerning domicile of both parties.

In Missouri and Colorado, two states in which I am licensed, licensed professional counselors (LPC) like myself ARE NOT ALLOWED to see clients outside of our state, even if it happens to be over the internet. The reasons for this are numerous, but, most importantly, the well being of our clients should be utmost in our minds. We cannot travel across state lines to see clients and, therefore, cannot travel virtually cross state lines via the internet either.

There are situations where it may be advantageous to see clients remotely, especially when a client is housebound or in geographically remote areas where face-to-face visits would be cost or time prohibitive. Otherwise, it is ALMOST ALWAYS IN THE CLIENTS BEST INTEREST to meet in person. 

Research on language has indicated that a majority of human communication is "non-verbal" with estimates ranging from 70 to 90 percent. Body language is one non-verbal mode of commuication where context is critical in understanding what is being communicated. Electronic commuications do not allow us to experience body language when discussing sensitive and often complex personal experience as is necessary when performing psychotherapy. Intonation is another non-verbal cue we use to determine what exactly is being communicated, a phenomena that is severely restricted, particularly in written communication.

Confidentiality is of utmost concern when working with clients and electronic commuications are not secure, allowing for potential exposure of extremely sensitive experiences, thoughts, and emotions. Would you want the NSA listening in on your therapy season?  I know I do not!

The individuals performing "Skype Therapy" are many times unlicensed, a fact that can easily be manipulated on websites, blogs, and social networking sites. Few understand that WE MUST BE LICSENED in the state in which we practice in order to offer psychotherapy to the public. Licensure involves AT LEAST a masters degree in psychology or counsleng, and in some cases a doctorate (PhD or PsyD) degree from an accredited institution of higher learning. On top of the degree, practicums, supervision, and post-graduate experience totaling in the thousands of hours (3,000 and up in most states) are required in addition to passing a national exam in order to become licensed. People have been "hanging shingles" for many years without proper training, education, and licensure, so why would things be any different today? 

I have preached about unlicensed and other unqualified individuals (can you say "life coach?) elsewhere in this blog, so I will not elaborate here. It will suffice to say that being "certified" is not enough. I, for example, am a National Certfied Counselor (NBCC - since 1991), but I am AND MUST BE licensed in the state in which I practice in order to LEGALLY PERFORM PSYCHOTHERAY. 

As I have also mentioned in other articles, YOU MUST CHECK AN INDIVIDUALS LICENSE BEFORE INITIATNG THERAPY WITH THE STATE REGULATORY AGENCY COVERING PSYCHOTHERAPISTS IN YOUR AREA. Then, and only then, should you consider undergoing treatment, whether it is face-to-face or over the internet. I would recommend face-to-face treatment in all but the most austere or complex situations.