Web Secret #45: The Ethics of Online Counseling - part 2

Since my last post, I presented "Web Secrets for Social Workers – Boost Your Organization & Your Professional Practice" at the 2009 Power of Social Work Conference. Once again, participants asked multiple questions about the ethics of online counseling and other social networking media. I essentially provided answers culled from my last blog post.

That said, I am pleased to add a few more resources to the online ethics fund of information.

The clever people at the Online Therapy Institute Blog posted a useful summary of the answer to a question included in the February 2009 edition of Psychotherapy Finances (not available online).

The question asked whether an online therapist has to be licensed in every state to offer online therapy. Here are some highlights from the response:

• Web-cam therapy is not as popular as had been expected due to the need for high speed connection and the fact that some people prefer the perceived anonymity offered through text-based therapy.
  
• In theory, some officials suggest that a clinician could be liable for ethics charges of even loss of license if they see a client who resides in another state.
  
• The state of Ohio is looking at a new rule saying that therapy takes place wherever the client is.
  
• There are no legal cases yet.
  
• Insurers are generally not happy with the concept of Internet services but coverage remains in place.
  
• The first person who gets hit (with a lawsuit) will get hit big.
  
• Even so, many individuals are seeking therapy online.
  
• Various associations offer ethical guidelines but retain attitudes ranging from indifference to hostility.
  
• Informed consent may need to be modified for online work.
  
• It is suggested that if your license is listed on your website, you come under the jurisdiction of the license regardless of what service you state you are providing (consulting, coaching or advice).

The fabulous folks at the Online Therapy Institute have posted a really interesting Ethical Framework for the Use of Technology in Mental Health. Sample bullet points from the comprehensive framework include:

• Dual Relationships: Practitioners discuss with clients the expected boundaries and expectations about forming relationships online. Practitioners inform clients that any requests for "friendship," business contacts, direct or @replies, blog responses or requests for a blog response within social media sites will be ignored to preserve the integrity of the therapeutic relationship and protect confidentiality. If the client has not been formally informed of these boundaries prior to the practitioner receiving the request, the practitioner will ignore the request via the social media site and explain why in subsequent interaction with the client.
  
  
• Insurance, Subsidy or Reimbursement Information: If the client resides in a geographic area that generally accepts insurance or other forms of reimbursement for therapy services, the practitioner informs the client of this information. Conversely, services delivered via technologies that are not covered at all or at the same rate, the practitioner informs the client of this information also.
  

A framework! I feel much better now. READ IT!

Web Secret #44: The Ethics of Online Counseling and Everything Else

Anytime I present to a group of eager professionals wanting to promote their private practices and businesses using Web 2.0 platforms, they ask me about the ethics of using Facebook, YouTube, Skype, and other social media. Anytime I listen to a speaker talk about online counseling, guaranteed - someone in the audience asks about the ethics of providing online counseling.

Now I would love nothing more than to include information about the ethics of the Internet in my presentations. But here's the rub - go find it. Every couple of months I do a search for any articles/conferences/presentations touching upon the ethics of online professional practice, and I usually come up empty handed.

The truth of the matter is that the Internet, social media, and a broad range of web based applications are developing at warp speed, and the ethics folks are just beginning to come to grips with the implications of these technologies. A major association recently revamped their code of ethics and they didn't even touch upon online counseling.

Another confession: until recently, I had a bias that online counseling was somehow less than face-to-face counseling. Then, at last year's 2008 World EAP (Employee Assistance Program) Conference, the head of India's largest EAP revealed in a presentation to conference attendees that in India, 70% of all EAP counseling is delivered online, via e-mail. Turns out that over there, counseling is still a major taboo. If you have problems, your family is supposed to help you solve them, NOT a therapist. I would venture to guess that counseling services of all stripes in India are delivered primarily via the Internet. So wrangling with the ethics of all of this would seem to be important and timely.

Finally, just a couple of weeks ago, I came across some resources, at least about the ethics of online counseling.

• The International Society for Mental Health Online
  
  
• Suggested Principles for the Online Provision of Mental Health Services - these date from 2000 but are a good starting point)
  
  
• The Online Therapy Institute Blog
  
  
• A new book, Therapy Online - A Practical Guide by Kate Anthony and DeeAnna Nagel, is slated for publication in fall 2009. If you subscribe to the Online Therapy Blog, you will get an announcement about the book.

If any of you come across articles/books/blogs/webcasts about the ethics of social networking platforms and Web 2.0 - please give me a holler!

Web Secret #43: 5 Tips for Controlling the e-mail Monster

In a recent New York Times article with the catchy title An Empty In-Box, or With Just a Few E-Mail Messages?, author Farhad Manjoo suggests various techniques for maintaining control over your e-mail in-box. Prominently, he recommends archiving e-mails.

Farhad, I am with you, an overflowing in-box drives me nuts. But archiving? No, no, no - DELETE, DELETE, DELETE. Ruthless deletion is the key to mastering your in-box.

Still, not all of Farhad's suggestions are bad, so with a nod to him, here are my tips for taming the e-mail monster:

Tip 1 - DELETE. I basically agree with Farhad's suggestion to only check your e-mail in a focused manner, no more than once every 20 minutes. But after that, we part company. My first tip is to delete any e-mails that fall into any of the following categories - and whenever possible without opening them:

• spam that somehow didn't make it into your spam folder - sample subject line: "I can make you bigger"
  
• chain letters
  
• jokes
  
• cartoons
  
• FYI's
  
• thank yous
  
• Anything remotely related to Twitter
  
• requests to join LinkedIn, become someone's friend on Facebook/My Space/etc., unless you are desperate for friendship or currently/soon to be job hunting
  
• info about conferences/events/parties you have no intention of attending
  
• work related stuff you have no intention of doing, reading, or responding to
  
• etcetera, etcetera, etcetera.
  

If you deleted too aggressively, you can always hunt down the e-mail in your deleted folder. "The Johnson Report? I just skimmed it." Then you dig up the Johnson Report.

Tip 2 - Delete your deleted e-mails. You know those e-mails you deleted? After a couple of months, there will be hundreds of them accumulating in your "Deleted Items" box. So now, every three months or so, you delete everything in the "Deleted Items" box, EXCEPT for the last couple of weeks of most recently deleted e-mails. Whew! That feels GREAT!

Tip 3 - Manage the stuff you didn't delete PRONTO. Here I agree with Farhad - if you can respond to it in less than two minutes, do so immediately. If you can forward it to another person to deal with - that's a slam dunk - forward it RIGHT NOW!

Tip 4 - Manage the leftovers. If you have been as merciless as Attila the Hun, there should be very little leftover e-mails to deal with. There may be a handful of informational missives that you want to keep for future reference. DO NOT ARCHIVE THEM - keep them in your in-box! My experience - sorry Farhad - is that if you archive that stuff - you will never reread it/deal with it/look at it again. NEVER. As for the rest, there may be a few messages that require a more complex response on your part. Don't procrastinate more than 24-48 hours on those.

Tip 5 - Back to Tip 1. Every month or so, comb through your in-box. That informational stuff you hung on to? If you haven't needed it to date - DELETE. Those e-mails requiring a more elaborate response? If you didn't deal with them yet, they can't be that important - DELETE. Remember, if you overdo the deleting, you have three months to excavate that critical e-mail from your deleted items file.

If you think my approach is too brutal, consider the recommendation given at the 2008 Web 2.0 Expo presentation, "Surviving and Thriving Amid Information Overload." Speaker Paul Christen suggested the opposite tactic. WARNING - not for the faint of heart. Paul suggested deleting NOTHING, ever. Any e-mails he doesn't immediately respond to, he just marks as read, and never touches again. He figures that if it's important, the sender will resend it to him at some point, or maybe even give him a call (how retro).

So it's your choice - delete almost everything, or delete almost nothing - either way, you will save time to tackle what really matters, whatever that is...

Web Secret #42 - Online Meetings for Free

With the economy in the proverbial crapper, most of us are trying to cut down on our business travel and figure out novel ways to make extra bucks.

Enter Web conferencing (aka "online meetings"). Web conferencing allows you to:

Meet and collaborate across the globe
Deliver online training and even counseling
Provide consulting services

There are a number of companies that offer online meetings, but GoToMeeting.com is one of the simplest to use, and you can try it out for FREE.

GoToMeeting's technology enables your colleagues, clients and others to view any application running on your PC in real time.

If you've never tried web conferencing, take the plunge (the set up takes 2 minutes) with their FREE TRIAL and enjoy unlimited online meetings with up to 15 attendees each for 30 days.

If you decide to buy the service, it costs only $49 a month (no long term commitments).

Web Secret #41: Avoiding e-mail Viruses

If your computer has ever been invaded by a virus - I feel your pain. I remember clearly...the hours on line with technical support, the loss of data, the time spent hunting down the original install discs for all my operating software (where is that stuff anyway?), the days spent reinstalling said software...The horror...

If it's been a while since your last virus invasion, or if you are lucky enough never to have been infected, this post is for you. This is not the time for complacency.

Aside from the obvious, (ie make sure you have an active and updated anti-virus software installed on your machine), here are 5 tips to avoiding e-mail viruses.

1. When you receive e-mail advertisements or other unsolicited e-mail, no matter have bland or seemingly harmless, do not open their attachments or follow web links contained in them.

2. If you receive an e-mail from a friend that seems rather out of character - you never knew that Pamela spoke urdu, or Fred was selling viagra, or Nancy was into condo conversions - call your friend BEFORE opening any e-mails with odd subject matters or out of character attachments. They may have been infected and are unwittingly passing the virus on to you.

3. This one seems obvious, but sometimes I go through my e-mail very early in the morning, when my double espresso has yet to kick in. Do not open e-mails or attachments with sexual filenames. E-mail worms often use attachments with names like PORNO.EXE or ROXANNE_NUDE.

4. Never open e-mail attachments with the file extensions VBS, SHS or PIF. These extensions are almost never used in normal attachments but are frequently used by viruses and worms.

5. Never open attachments with double file extensions such as NAME.BMP.EXE or NAME.TXT.VBS.

Amen.