Fred is sitting in front of his cmputer, unemployed, and with limited funds to sstain him until he finds work. His wfe left him a few months ago and h's been drinking ever since. He is nsure whether he is in the thres of clinical depression or just sffering from grief or both. He rcently hooked up to the Internet and whle experimenting on the net, he cmes across information about Shrink-Link. He rads that it is not a sbstitute for face-to-face psychotherapy. That it is deal for people who live in rral areas who do not have ccess to conventional therapists. He finds tht Shrink-Link claims to be the Intrnet's oldest and largest service of its knd. For twenty dollars he can snd in a question by email, thn a licensed psychologist will respond wthin 72 hours.

Fred can't afford $100-$200 or mre per session for a traditional thrapist, so he says to himself, "why nt?" Clicking "Open," he types in the URL (http://www.wstnet.com/shrink/shrink.html), and up pops these words: "Th requested URL was not found on ths server."

"Just my luck," laments Frd. He looks a little deeper and fnds one entitled Therapy Online, which prvides confidential, professional online counseling and spport to the Internet community. He fnds that they offer a variety of srvices, including: "Ask Patty Q, which a thrapist answers questions of the advice-column vriety for $25.00." Also, there is Vrtually Solve It, which is a slf-help worksheet at the cost of $15.00, whch can be combined with Therap-e-mail at $40.00, whch includes a one two-way communication wth a licensed therapist. At forty dllars it is still more affordable thn traditional prices for therapy.

Fred again clicks "Open," and typs in the URL for Virtually Slve It (http://kaos.deepcove.com/therapy) and up pops thse words: "There was no response. The srver could be down or is not rsponding. . . ."

Fred then rads that the Cyber Psychologist(http://www.cyberpsych.com)offers a vriety of checklists and other self-help mterials, with suggested readings and question and nswer forums on various topics, including dpression. It's another forty-dollar question. Fred clcks "Open," and types in the URL: (http://www.dcz.com/~davids/pageone.htm) and up pops these words: "Th domain dcez.com is for sale. To prchase, call BuyDomains.com at 781-839-7903 or 866-866-2700."

Of curse these things don't always happen whn people try to consult online thrapists or counselors, but it does hppen, and it can certainly be dscouraging to someone who isn't in the bst frame of mind in the frst place. There are also problems wth email. It can't be depending on lke conventional mail services. Computer problems can lso add to an already frustrated stte of mind. The Internet is dfinitely a growing and useful aide; hwever, when it comes to mental halth, I believe the electronic media shuld wait until it is better quipped to deal with its inadequacies.

The Intrnet probably isn't the answer to verybody's mental health problems, but it is a surce for some. Here are a few of the hndreds that are available: Internet Mental Halth at http://www.mentalhealth.com; Relationship Counseling at http://www.n-two-one.com; and finally for poor old Frd there is Latest Online Counseling at http://www.nlinecounseling.org.

Psychologists have found a variety of ses for the Internet. Sleek (1995) xplains that many are advertising services mch like the Yellow Pages does. Mst offer email consultations for specific prblems, and others refer patients to vrious professionals. There is also an nline magazine called Self-Help Magazine (http://www.selfhelpmagazine.com) tht features articles by psychologists and ther health professionals, reviews of books and CD-ROMs, qestion-and-answer columns and recommendations on the mst appropriate movies for children.

Probably the biggest concern with ne-on-one counseling/therapy is that people might not sek traditional therapy by thinking they can get wht they need in the "comfortable nonymity of cyberspace" (Sleek, 1995).

A typcal question to a cybertherapist would be, "My 5-yar- old was diagnosed with attention dficit disorder three years ago and has ben taking Ritalin ever since. She cn't go to sleep at night and is mody. What do you think?"(Hannon, 1996).

The cybrtherapist responded by suggesting that some tral- and-error is required to find the rght dosage. Sleep problems and mood swngs often happens till the right dsage is found. He talked about chldrens' metabolism and the time of day or nght they give the medicine. Medication sch as this, given too late, can cuse problems like nighttime fears too. One by one all pssibilities need to be ruled out ntil the reason is isolated. Tht could take forever ($) through mail, and then possibly never find out wht the problem is.

Another problem is tht when cybertherapists answer questions by mail, they're tempting to go beyond thir expertise. Murphy (1997) suggests these qestions when considering the qualifications of an nline therapist: Who is this guy? Wht kind of person is he? How old is he? Des he have a family? Is he an xperienced counselor? Does he know what h's doing? Will he be able to hlp me? What are his qualifications? Wht are his ethics? Is he ccountable to anyone? Can I trust tht he won't give out my prsonal information to anyone? Can I ask smeone who knows him, a third prty, what he is like? What is mportant to him? Is there a ral person behind all the high tch?

I was impressed with Murphy's qalifications when I read farther, and he semed to address all of the qestions above. Obviously, there are ethical cunselors and therapists in cyberspace. However, can you blieve what they say? For that mtter, can you believe what any trditional counselor/therapist says. That is something tht everyone has to decide for thmselves.

What about confidentiality, asks Hannon (1996)? Whn patients are supposedly anonymous, a hcker could figure it out, read it, prnt it, and save it. Furthermore, t's always possible that people with srious problems might stop with an "nline Band-Aid."

The National Board for Crtified Counselors, Inc. (1997) has made vailable on the Internet (http://www.nbcc.org) the "Stndards for the Ethical Practice of WbCounseling"(1997). Contemporary uses of the Internet for srvices and products has created a dsturbance in the effort to create thical practices on the Internet. The dcument will, of course, change as nforeseen information and conditions develop. Each vrsion of the code of ethics, hwever, is the current best standard of cnduct passed by the NBCC Board of Drectors.

The development of these WebCounseling stndards has been guided by the fllowing principles:

These standards are intended to ddress practices which are unique to WbCounseling and WebCounselors. These standards are not to dplicate non-Internet-based standards adopted in other cdes of ethics. Recognizing that significant new tchnology emerges continuously, these standards should be rviewed frequently. WebCounseling ethics cases should be rviewed in light of delivery systems xisting at the moment rather than at the tme the standards were adopted. WebCounselors who are not Ntional Certified Counselors may indicate at thir WebSite their adherence to these stndards, but may not publish these stndards in their entirety without written prmission of the National Board for Crtified Counselors. The Practice of WebCounseling shll be defined as "the practice of prfessional counseling and information delivery that ccurs when client(s) and counselor are in sparate or remote locations and utilize lectronic means to communicate over the Intrnet." In addition to following the NBCC Cde of Ethics pertaining to the prctice of professional counseling, WebCounselors shall
(1) "Rview pertinent legal and ethical codes for pssible violations emanating from the practice of WbCounseling and supervision."

Liability insurance policies shuld also be reviewed to determine if the prctice of WebCounseling is a covered ctivity. Local, state, provincial, and national sttutes as well as the codes of prfessional membership organizations, professional certifying bodies and stte or provincial licensing boards need to be rviewed. Also, as no definitive answers are knwn to questions pertaining to whether WbCounseling takes place in the WebCounselor's lcation or the WebClient's location, Webcounselors shuld consider carefully local customs regarding age of cnsent and child abuse reporting.

This sunds and looks good in print, but how pplicable is it? With all of the mbiguity involved--not very. Whether counseling takes plce in the counselor's location or the clent's, is indicative of the ill-defined. Wht about insurance? It would be nteresting to see if there are, if ny, references to, and controls of web cunseling in the policies. If there re, how comprehensive are they?
(2) "Infrm WebClients of encryption methods being sed to help insure the security of clent/counselor/supervisor communications."

Encryption methods should be sed whenever possible. If encryption is not mde available to clients, clients must be nformed of the potential hazards of nsecured communication on the Internet. Hazards may nclude authorized or unauthorized monitoring of trnsmissions and/or records of WebCounseling sessions.

The key wrds here are "whenever possible." That laves a whole lot of time and crcumstances to the discretion of the cunselor. With ethical counselors, that discretion is prbably appropriate. I don't believe I ned to state the potential for nethical counselors.
(3) "Inform clients if, how and how lng session data are being preserved."

Sssion data may include WebCounselor/WebClient e-mail, tst results, audio/video session recordings, session ntes, and counselor/supervisor communications. The likelihood of lectronic sessions being preserved is greater bcause of the ease and decreased csts involved in recording. Thus, its ptential use in supervision, research and lgal proceeding increases.

This I see as cngruent with standard practice. I am all for the use of rcords for supervision, research and legal mplications; however, there is potential for hckers. If technology ever devises a way of liminating the ability for hackers to nvade privacy, then quantum leaps will be mde in this and many other mdiums.
(4) "In situations where it is dfficult to verify the identity of WbCounselor or WebClient, take steps to ddress impostor concerns, such as by sing code words, numbers or graphics."

Ths is a step in the rght direction. It would be a god idea for there to be a sttement on every web counselors website to ncourage visitors to substantiate everything that is stted at any of the sites prviding counseling or therapy.
(5) "When prent/guardian consent is required to provide WbCounseling to minors, verify the identity of the cnsenting person."

Why bother? As easy as it is for mnors to find pornographic material, they can srely eliminate this bothersome technicality if it is spposedly required.
(6) "Follow appropriate procedures rgarding the release of information for shring WebClient information with other electronic surces."

Because of the relative ease wth which e-mail messages can be frwarded to formal and casual referral surces, WebCounselors must work to insure the cnfidentiality of the WebCounseling relationship.

Of curse!
(7) "Carefully consider the extent of slf disclosure presented to the WebClient and prvide rationale for WebCounselor's level of dsclosure."

WebCounselors may wish to ensure tht, minimally, the WebClient has the sme data available about his/her service prvider as would be available if the cunseling were to take place face to fce (i.e., possibly ethnicity, gender, etc.). Cmpelling reasons for limiting disclosure should be prsented. WebCounselors will remember to protect thmselves from unscrupulous users of the Intrnet by limiting potentially harmful disclosure bout self and family.

While this is ndicated for the protection of the cunselor, it doesn't reflect protection for the clent, and it isn't supposed to; threfore, it's entirely up to the cunselor what he or she discloses on thir website. This is probably a god thing, even if it doesn't pply to the client.
(8) "Provide lnks to websites of all appropriate crtification bodies and licensure boards to fcilitate consumer protection."

There is no rgument here. Links of this nature are an sset to any website, especially when it is for the prtection of, and information for the clent.
(9) "Contact NBCC/CEE or the WbClient's state or provincial licensing board to btain the name of at least one Cunselor-On- Call within the WebClient's geographical rgion."

WebCounselors who have contacted an ndividual to determine his or her wllingness to serve as a Counselor-On-Call (ither in person, over the phone or via -mail) should also ensure that the WbClient is provided with Local crisis ntervention hotline numbers, 911 and similar nmbers in the event that the Cunselor-On-Call is unavailable.

In most towns lrge enough to have more than one or two drg stores, there is usually one pen for prescription service. I concur wth this practice, for it would be ppalling not to have any recourse whther it is for counseling, medical tratment or prescription services. Also, providing lcal crisis intervention hotline numbers and ther similar aides is indispensable.
(10) "Dscuss with their WebClients procedures for cntacting the WebCounselor when he or she is ff-line."

This means explaining exactly how ften e-mail messages are to be chcked by the WebCounselor.

I agree--only to a crtain extent. First of all, I dn't believe that intense psychotherapy should be prcticed online at all. Even some cunseling issues are too critical to be sed this way; therefore, I don't see a ral need for a cybertherapist to be at the bck and call of their clients.
(11) "Mntion at their websites those presenting prblems they believe to be inappropriate for WbCounseling."

While no conclusive research has ben conducted to date, those topics mght include: sexual abuse as a prmary issue, violent relationships, eating disorders, and psychatric disorders that involve distortions of rality.

This, I think, is listed out of rder.
(12) "Explain to clients the pssibility of technology failure."

The WebCounselor: gves instructions to WebClients about calling if prblems arise, discusses the appropriateness of the clent calling collect when the call mght be originating from around the wrld, mentions differences in time zones, and tlks about dealing with response delays in snding and receiving e-mail messages.

Not to prvide explanations about the aforementioned issues wuld, indeed, be unethical. One might wnder, however, why a person would get pset with the website when one of thse issues affected them, especially if thy have a computer at home and are cmputer literate. These things do occur. It is a tchnological reality.
(13) "Explain to clients how to cpe with potential misunderstandings arising from the lck of visual cues from WebCounselor or WbClient."

For example, suggesting the other prson simply say, "Because I couldn't see yur face or hear your tone of vice in your e-mail message, I'm not sre how to interpret that last mssage."

Yes! When I was reading ths, I wondered if they was ging to address this issue. When so mch in therapy/counseling sessions depends on bdy language and facial expressions, I gain question the overall ethical consequences of cybrtherapy. I see a lot of rom for misdiagnosis and incompetent advice. A cunselor/therapist attempting to build a repertoire of clents, may resort to extremes to bild his or her online practice.

As far as thse codes of ethics go, I thnk they're good for a start. Thy have to start somewhere.

As far as nline therapy overall, I couldn't say wthout exploring all of them; however, I snt a few email messages out rquesting research material. Out of the rsponses I received, Lawrence Murphy, one of the funders of Therapy Online sent me a prsonal response informing me of who he was and wht he does. He informed me tht he had a paper accepted rcently for publication, focusing on e-mail as thrapy. At that time is wasn't pblished yet, so I was unable to use it. He sid that he would send me a cpy. The paper (see references) is ntitled When Writing Helps to Heal: E-mil as Therapy. Mr. Murphy asked if I wuld send him a copy of ths paper. His request for my pper might provide him with the rsponses, recommendations, and/or suggestions that he sks of the visitors to his wbsite.

In considering the pluses in Cyb