- ETHICAL ISSUES:
- OPTIONS IN COMMUNICATION
- ABSENCE OF VERBAL OR NON-VERBAL CUES
- CONFIDENTIALITY AND SECURITY
- TECHNOLOGICAL GLITCH
- THERAPIST CREDIBILITY
How counselling practice might be influenced by online delivery of service?
1. Have to address ethics in this essay
2. The advantages and disadvantage
3. All end sentence have to have citation, cannot have long paragraph without several citation
4. The ability to collate and assimilate information effetively
5. Reference ( 15 minimum)
6 Must demonstrate background research into your topic, through references and appropriate bibliograhpy.
This essay dwells on a very pertinent topic in the field of medical science and healthcare service especially with the rise of social media and the wave of web 3.0. It deals from various aspects the practice of online counselling that have emerged nowadays. This work has tried to critically analyse and evaluate the factors that influence the online counselling practices. Ethical considerations is one of the points that needs to be thought of while looking at the influence of online counselling on mental healthcare service. The aspects of information and confidentiality which cannot be compromised in counselling practice has been elaborated. This article also throws light on the numerous benefit and disadvantages with respect to influence on online counselling practice that can be derived from the evolution of such innovative means of mental healthcare delivery. This article should be viewed as a guiding work in order to identify the pros and cons involved in online delivery of counselling service which can reach millions of victims who are in real need of this service but are not able to access mental healthcare due to lack of infrastructural facilities.
As more than 100 million people are looking for online healthcare information and the number is increasing day by day with more looking for actual healthcare services there is a genuine requirement to analyse the regulatory and ethical aspect of online counselling service. The data from American Psychological Association (APA) indicates that around 2% of the individual psychotherapy offered by practitioners are through internet and there is surge in the use of e-mails and faxes in order to conduct assessments or family therapy which ranges in between 13-15%. There is an increasing intent among the practitioners that they might revert to professional services offered on the internet with those service becoming a routine practice. This article throws light on the ethical considerations for such practices and also evaluates the advantages and disadvantages in detail (Dunway, 2004).
Online Counselling has gained traction in the recent years with more people opting for this service which has led to the requirement of strong legal and ethical codes. This is all the more pertinent because internet goes beyond boundaries and nations to touch the lives of people all around the world. Different geographies have varied requiremnts as far as the legal and regulatory issues are concerned. For instance a pertinent ethical issue in this regard would be that whether it is legal for a practitioner to offer chat room facility to clients in geographies that is beyond their licensed or accredited jurisdiction of practice boundary (R.K. Elleven and J. Allen, 2004).
If there is no assurance about who is being treated by whom and what is his/her credibility or expertise in that domain it is very difficult to bring this service to the mainstream healthcare service. To resolve the issue APA had formulated a new Ethics Code on 1st June, 2003 which had brought under its ambit the internet and electronic transmission of information. It had covered topics like informed consent, discussing the limits of confidentiality, avoidance of false or deceptive statements, etc. However it did not provide clear standards or benchmarks for overcoming the unique hindrances involved in delivering mental and behavioural healthcare services through online service delivery (Foxhall, 2005).
These are some of the pertinent issues related to ethical considerations which practitioners need to think about before starting to deliver online services.
There are numerous researches that have been conducted which provide ample evidence that online counselling coupled with cognitive behaviour therapies can be successfully employed on a wide range of clinical diseases. Counselling over internet can be done through numerous channels like e-mails, chat rooms, web cams, etc. The popular names given to such therapy include e-therapy, e-counselling, cyberspace counselling or tele-counselling. It comes with certain benefits which can be classified as follows (Griffiths, 2006):
Web counselling has the capability to breach all boundaries and reach those who seek to use the therapy but are not able to because of locational constraints. For example, people who are located in the interior or rural areas may need counselling facilities but are not able to access them because of the locational restrictions. Moreover, people who are physically handicapped or disabled without being able to leave their home will be highly benefitted from such online deliver of counselling services. People with hearing or vision impairment may also benefit from such services. It has also become quite popular among the younger generation since they are more comfortable in using the internet facilities (Haberstroth, S., Duffey, T., Evans, M., Gee, R., and Trepal, H, 2007).
As a result of the flexibility that is rendered by online counselling service enables both the patient and the practitioner to come together and engage in productive counselling as per their suitable time. It has eradicated the hassle of scheduling and fixing an appointment as is done in case of traditional therapy. This also has the advantage of practitioners catering to more patients over the online medium where appointments can be done 24 hours throughout the day and also span over a wider geographical area. Apart from this, there are few patients who may not be comfortable with face to face counselling and sometimes do not have faith in its efficacy. These people can access online counselling from the comfort of their home (Pelling, 2009).
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Web counselling is far more economical than traditional modes since there is less fixed costs involved like renting a space or setting up an office. On the other hand, patients can save considerable amount of bucks by saving on the transportation costs (Oravec, 2007).
Social Stigma – There is social stigma associated with receiving counselling in public which makes a lot of people uncomfortable. They generally feel embarrassed about their condition while waiting in the counselling centre or in front of the administrative officers. Online counselling service can plug these gaps in the medical counselling therapy by reaching those customers at the comfort of their home without having them feel embarrassed in public space at the counselling centre. The anonymity offered by online delivery of counselling service has an added value proposition in this field (Recupero, P.R. & Rainey, S.E, 2005).
As patients are not communicating face to face and there is anonymity involved in the process, this may lead to increased response from the participants. They are more independent to talk about diverse issues ranging from gender, race, religion, caste, size or physical appearance. It results in more honesty in the answers given by patients and which in turn drives a better therapeutic care process for the healing of the individual (Richards, D., & Vigano, N, 2011).
OPTIONS IN COMMUNICATION
Communication mode in case of online delivery of counselling is primarily written which has an added advantage of everything on being record. It enables the practitioner to take note of the important points mentioned by the patient and reflect at a later stage. There is a better expression of thoughts and feelings among the participants in case of written communication. In fact this is specifically helpful for people who find it difficult in assimilating diverse thoughts and express themselves coherently while speaking. They are also insulated from the non-verbal cues given by the practitioner if at all there is any (Shaw, H.E., & Shaw, S.F, 2006).
Research has proven certain facts like while a person is in a depressed condition it is better to write things down since it provides a medium for him to ventilate his emotions which eventually lead to his/her healing. Online counselling being primarily a mode of therapeutic writing it enables the patients to be more thoughtful, self-reflective and insightful in numerous ways (Trepal, H. Haberstroth, S. Duffey, T., & Evans, M., 2007).
As we discussed at length about the advantages of online counselling we should also pay heed to the criticism of online counselling referring to the confidentiality issues, non-availability of verbal or non-verbal cues, etc. The disadvantages are listed as follows (Michael J. Mallen, David L. Vogel and Aaron B. Rochlen, 2005):
ABSENCE OF VERBAL OR NON-VERBAL CUES
Verbal and non-verbal interactions are essential for the imperative to understand the present state of the patient or sometimes serve as the medium to investigate the discrepancies between the stated fact and the actual behavioural patterns. Online counselling has faced severe criticism for the eradication of such micro skills involved in counselling process. Traditionally verbal interactions act as a guide to gauge the thought process, feelings as well as the behaviours among the clients. Online therapy does not have the reach to understand voice tone, facial expression, body language and eye contact. This has the consequence of negatively influencing the result of a counselling service (Kraus, R., & Zack, J. S, 2004).
CONFIDENTIALITY AND SECURITY
Mental health practitioners are entrusted with sensitive information while counselling and it is their duty to protect them. It comes under their ethical responsibility to protect and maintain the confidentiality of their clients. With the emergence of online counselling service there is an increasing threat of confidentiality of clients being hurt and the mode of communication being written sensitive data can be accessed leading to the divulgence of sensitive data. Although most of the sites try to instil encrypted security systems within their websites and try to gain the trust of clients but still there is doubt among the participants regarding the ethical and moral integrity of the practitioners servicing online (Norcross, J. C., Hedges, M., & Prochaska, J. O, 2006).
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Everyone starting from researchers to common people have posed serious questions regarding the efficacy of online counselling service. There is lack of evidence regarding the effectiveness of online counselling which can act independently to affect the healing process in a patient. The lack of physical presence increases the risk of misguidance or inappropriate diagnosis by the practitioner in case of online delivery. As a result online counselling is still considered to be ineffective or inappropriate in cases of clinical diseases like chronic depression or psychotic nature (Palmiter,D., Jr.,& Renjilian,D, 2004).
There is an increased dependency on technology to service the online mode of counselling mental healthcare. In this process there is always the possibility that there will be technological failure like computer being crashed or internet connectivity disruption. People in the remote areas often face these technical glitches and sometimes it may create a barrier in the delivery of counselling service. On another note, the success of a practitioner’s success in healing the client is partially tied with his/her efficiency with computers or other technology related knowledge especially the communication section wherein there is requirement for installing new software or hardware. If there is disruption in the middle of a session, it may create severe emotional imbalance for the client (Pomerantz, 2009).
The patient receiving the healthcare service is unknown about the person on the other side of the phone. There is serious concern regarding the credibility or qualification of the practitioner who is completely unknown for the patient. There is a possibility that the patient might get exploited by an amateur who poses as an expert in an online counselling service. Therefore it is justified to refer young people who are in need of counselling to renowned and established sources like Lifeline, Kids Helpline and Headspace (Ragusea, A. S.,& Van de Creek, L, 2010).
This paper has discussed in detail the different aspects online delivery of counselling service. It started off making a critical evaluation of the diverse ethical and legal issues that arises while delivering therapeutic healthcare service online. Then it looked into the pros and cons of such service and evaluated every element of online counselling service. It was found that as there are some advantages, some the disadvantages were also quite severe and hindering the credibility as well as delivery of such service. With all these factors acting together there have been a surge of online counselling service like Kids helpline, Lifeline, Headspace and Suicide Call Back which have created a new and innovative way of dealing with mental depression. This work should be viewed in the light of emerging trends and the advantages associated with it the online delivery of counselling service (Rochlen,A. B.,& Hoyer,W.D, 2005).
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