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The nuts and bolts of online therapy contd ...

How do you suggest online therapists deal with the threats to the confidentiality of the information they exchange with clients, especially when they are using asynchronous (e-mail) based approaches?

There is no effective way to deal with these threats, outside of both the client and the therapist using complicated encryption for their e-mails. Anything less is simply not sufficient.

How much growth has online therapy seen in the past five years and what do you think the growth of online therapy will be like in the coming decade?

We went from a handful of practitioners in 1996 to over 300 today. In the next decade, I'd expect that number to jump exponentially. By 2005, I predict there will be over 5,000 online practitioners.

What are the legal implications of providing online therapy to somebody who lives in another country or state, which may be governed by different laws from the country in which one practices?

The legal ramifications are unknown at this stage, so it is in a therapist's best interests to check with their counsel as to the best course of action in how to proceed. Typically, if the practitioner is attempting to practice in an effective, ethical, and legal manner, that will be weighed accordingly in a court versus the therapist looking to make a quick buck.

As one data point, the firm Concerned Counseling based in San Antonio, TX has been offering online therapy for over 2 years without a single legal complaint brought against it. They offer online therapy to anyone in any state or country.

Are there any other potential legal pitfalls of which therapists need to be aware when conducting online therapy?

Therapists need to keep in mind all the laws and ethics they practice under, as they are still in effect online. Pay special attention to issues of confidentiality and boundary setting up-front, especially in terms of future availability and payment.

How do you suggest therapists considering going online draw up a billing structure. Should they bill by time, by electronic contact, on a monthly basis or by some other method? Which, in your experience are the most common and most appropriate methods?

It's up to the individual therapist to setup whatever payment structure they feel most comfortable with. For some, that's billing as they do in real-life, per time spent. For others, it's billing per interaction with the client. By far, the latter is more common, but I'm not sure that will continue to hold true as more mainstream therapists start doing e-therapy.

If there was one question I should have asked about online therapy, but didn't, what might that have been? How would you respond to it?

None I can think of.


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