Ethical Issues in the Provision of Online Mental Health Services (Etherapy)

ABSTRACT

A number of ethical issues involved in face-to-face therapy are examined in relation to online therapy (etherapy). Etherapy is defined and its strengths and weaknesses discussed. Specific ethical issues addressed include boundaries of competence, basis in science, avoidance of harm, confidentiality, avoidance of false or deceptive statements, forums, testimonials, solicitation of clients, fees, and informed consent. A concluding section briefly addresses legal issues, particularly interstate etherapy. It is recommended that federal licensing legislation be enacted, informed by the NASW, the APA, and similar groups.     

The LivePerson Model for Delivery of Etherapy Services: A Case Study

ABSTRACT

There are several models for the delivery of etherapy on the Internet. This article presents a case study of one model, the LivePerson website. The model is based on a privately owned infrastructure through which etherapy is practiced by licensed counselors using chat or e-mail for service delivery. A content analysis of the website is presented, including policies, number of consumers, consumer ratings, and therapists’ degrees, licensure, age, sex, race, fees, and languages offered. In addition, the experiences of one LivePerson practitioner are presented to highlight methods, processes, and ethical concerns. This case study of the LivePerson model for service delivery highlights many of the benefits and concerns previously discussed in the literature related to etherapy. In addition, concerns are raised that there may be some conflict of interest when ethical standards of practice are delivered within the context of a profit-making company.     

A Comprehensive Review and a Meta-Analysis of the Effectiveness of Internet-Based Psychotherapeutic Interventions

ABSTRACT

Internet-based psychotherapeutic interventions have been used for more than a decade, but no comprehensive review and no extensive meta-analysis of their effectiveness have been conducted. We have collected all of the empirical articles published up to March 2006 (n = 64) that examine the effectiveness of online therapy of different forms and performed a meta-analysis of all the studies reported in them (n = 92). These studies involved a total of 9,764 clients who were treated through various Internet-based psychological interventions for a variety of problems, whose effectiveness was assessed by different types of measures. The overall mean weighted effect size was found to be 0.53 (medium effect), which is quite similar to the average effect size of traditional, face-to-face therapy. Next, we examined interacting effects of various possible relevant moderators of the effects of online therapy, including type of therapy (self-help web-based therapy versus online communication-based etherapy), type of outcome measure, time of measurement of outcome (post-therapy or follow-up), type of problem treated, therapeutic approach, and communication modality, among others. A comparison between face-to-face and Internet intervention as reported on in 14 of the studies revealed no differences in effectiveness. The findings of this meta-analysis, and review of additional Internet therapy studies not included in the meta-analysis, provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity and suggest several insights in regard to its application. Limitations of the findings and recommendations concerning Internet-based therapy and future research are discussed.     

Development of a New Approach to Guided Self-Help via the Internet: The Swedish Experience

ABSTRACT

This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations.     

Transmissive Reminiscence Therapy with College Students and Institutionalized Senior Adults

Abstract

The aims of this study were to determine the effectiveness of five sessions of one-on-one, transmissive reminiscence therapy (TRT) and to assess the effects of serving as a facilitator for TRT. Fifty-one undergraduate college students from the University of Toledo were trained to conduct five 45-minute sessions of TRT with institutionalized senior adults. A pretest/posttest control group design was employed in order to detect differential effects of the therapy. The impact of the therapy was measured using a survey instrument, the Short Form General Health Survey (SF-36). The impact of serving as a TRT facilitator was measured qualitatively via weekly journals and a final reflection paper.     

Evaluating College Student Interest in Pet Therapy

The first year of college can be extremely stressful, especially for students residing on campus. Objective: The authors obtained information from college freshmen about their relationships with pets and investigated interest in a pet therapy program as social support for transient stressful periods. Participants: As part of a university orientation program, 246 college freshman attended 1 of 5 health issues sessions offered during the 2006-2007 academic year. Approximately 50 freshmen attended each session. Method: Participants completed a questionnaire at the beginning of the session, followed by a 20-minute presentation about pet therapy that ended with pet therapy visitation. Results: Students identified that visits with certified pet therapy dogs could be beneficial to college freshman during their first year away from home. Conclusions: These students indicated that a pet therapy program could temporarily fill the absence of previous support systems and be a catalyst for establishing new social relationships.     

Cognitive Variables

Abstract

The literature indicates systematic attempts have been made to combine the approach of cognitive therapy with behavior therapy. The following paper reflects that much research has been done in this area showing great promise. Certainly the cognitive variable is significant in the treatment of human behavior, yet it can not be considered in isolation of other dimensions of behavior. Significant contributions have been made in the treatment of depression, phobias, anxiety, and panic attacks. Treatment elements have been applied to a diverse range of conditions, yet practice research has not documented statistical evidence of the effectiveness of the results. Further study needs to isolate the aspect of treatment that is producing the outcome. Greater attention needs to be given to the generalization and maintenance of treatment. Certainly the inclusion of cognitive variables in the assessment of human behavior enables comprehensive treatment of the individual. The authors indicate that further clinical research is needed to isolate specific predictors for using cognitive therapy alone or in a combined regimen.     

Structuring Home-Based Therapy: Four Phases to Effective Treatment

ABSTRACT

Home-based services are gaining more popularity than in years past. Therapists going into the home are exposed to various treatment issues that differ from those in a clinic or office setting. One of these issues is that of structuring the therapeutic process. Much has been written about the structure and stages of clinic-based therapy; however, little is known about the process of home-based therapy. This paper will delineate four phases of home-based therapy which the in-home therapist can use as a guide to provide faster and more effective services.     

Integrating Art Therapy Methodology in Brief Inpatient Substance Abuse Treatment for Adults

ABSTRACT

Decades of drug addiction research and clinical work have underscored the need for multifaceted and comprehensive treatment responses in order to sufficiently address the varied needs of individuals struggling with addiction. One valuable treatment component that can be incorporated into traditional treatment protocols to expand the comprehensive nature of treatment response is art therapy. A conceptual framework is presented, detailing the integrative opportunities and benefits of including an art therapy component to short-term hospital-based inpatient substance abuse treatment programs. A creative arts component can be particularly beneficial for brief inpatient programs, where the client population is diverse, in crisis, and at high-risk for relapse; and where clinicians need to obtain comprehensive client information from multiple sources in a short amount of time. Art therapy methodology can provide a mechanism for collecting such collateral information for assessment purposes, can be employed to facilitate therapeutic change, and is used to track and document client progress and clinical change over time. Practice guidelines and specific treatment techniques are presented through short case examples.     

Etherapy: A Training Program for Development of Clinical Skills in Distance Psychotherapy

ABSTRACT

This article describes a project by the Virtual Teaching and Cyberpsychology Laboratory of the National Autonomous University of Mexico developed to (1) implement a teaching program for clinical psychology students to learn therapeutic skills in providing online psychological services; (2) evaluate the students' acquisition of knowledge and skills in diagnosis via the Internet, case formulation of treatment, and adherence to treatment protocols; and (3) incorporate technologies for creating training settings and online professional services in order to develop the students' clinical competency in this treatment modality. A pilot study was conducted with 17 clinical psychology students in the first phase of the teaching program and 6 students during the second phase. Preliminary results indicate that students increased knowledge of Internet-based clinical interventions and improved in clinical skills. It is necessary to continue the evaluation of the teaching program with larger samples, and further research is suggested.     

Borderline Personality Disorder and Adolescence

SUMMARY

This chapter addresses many of the potential challenges clinicians face when working with adolescents with BPD. First, we present the diagnostic issues related to an adolescent population. Second, we review issues related to the families, peers, and larger systems (e.g., schools) that reciprocally influence the adolescent and the treatment. Third, we discuss specific treatment concerns and propose solutions, including how to effectively manage therapists' own reactions to working with this population. Many of the clinical vignettes and suggested interventions in this chapter derive from our experience working in an outpatient adolescent Dialectical Behavior Therapy (DBT) program. As described later in this book, DBT is an evidence-based treatment effective for suicidal multi-problem individuals with promising data published with suicidal adolescents diagnosed with borderline features (Rathus & Miller, 2002).     

Medical decision-making: Whose values?

Abstract

Bioethical debates contribute to discussions about the direction of healthcare funding as we enter the twenty - first century. The funding of healthcare is debated by economists, bioethicists and clinicians. Because of their practice experience and knowledge base social workers are also well-placed to contribute to such issues. The debate has taken place at the ‘macro’ rather than the ‘micro’ level. Yet many ethical decisions about healthcare are made at the patient's bedside. Are they procedural or clinical decisions? Are decisions made for a group or class of patient or on an individual basis? Answers for these questions are sought in a study of medical decision-making for head-injured patients admitted to the Intensive Care Unit of a major teaching hospital.

This paper attempts to draw out ethical principles which are part of medical decision-making. The notion of contextual ethics is likened to the ecological approach of Carel Germain which provides a useful framework for ethnomethodological research.     

Lesbians and Gay Men Embrace Their Sexual Orientation After Conversion Therapy and Ex-Gay Ministries

Abstract

This article examines narratives of gay men and lesbians who participated in conversion therapies and/or ex-gay ministries in order to change their sexual orientation to that of heterosexual. Data for this study were gathered through an analysis of the stories of 14 people, published in a document titled Finally Free, who describe their negative experiences with conversion therapy through ex-gay ministries. Analysis of the data revealed seven common psychosocial issues faced by gay men and lesbians who turned to conversion therapy in an attempt to become heterosexual. These issues provide knowledge for social workers' intervention with gay men and lesbians seeking healing and personal growth after participating in conversion therapy and ex-gay ministries.     

Radical prostatectomy for clinically localized prostate cancer in patients aged 75 years or older: comparison with primary androgen deprivation therapy

Objective: To determine whether radical prostatetomy (RP) is suitable for prostate cancer patients with age ≥75 years in comparison to primary androgen deprivation therapy (PADT).

Patients and methods: A cohort study was conducted in clinically localized prostate cancer patients with ≥75 years of age who underwent RP or PADT at six institutions from 2005 to 2013. Patients who had less than 12 months of follow-up, or received neoadjuvant or adjuvant therapy were excluded. We compared clinical characteristics, cancer-specific and overall survivals, and post-treatment complication rates between two groups.

Results: We included 92 and 99 patients in the RP and PADT groups, respectively. In survival analyses, there were no significant differences in cancer-specific and overall survivals (p?=?.302 and .995, respectively). The incidence of serious adverse events (cardio- or cerebrovascular event, or bone fracture) was higher in the PADT group (p?=?.001). Multivariable analysis showed that PADT had a worse effect on the serious adverse events (OR 10.12, p?=?.038).

Conclusions: In selected elderly patients, RP was safe and effective for treatment of localized prostate cancer, as compared to PADT. Surgical treatment options should be considered in elderly patients with respect to life expectancy, rather than chronological age.     

Systemic Therapeutic Approaches with Sexual Minorities and Their Families

Abstract

GLBTQ families encompass very diverse forms, all of which are interwoven with other differences such as class, race, ethnicity, religious and spiritual beliefs. This article will familiarize the reader with some challenges faced by families of sexual minorities and how different family therapy approaches might be applied. Training issues for therapists are identified and future areas for development are discussed.     

Adoptees' and Birth Parents' Therapeutic Experiences Related to Adoption

ABSTRACT

This study examined adoptees' and birth parents' experiences in therapy, including the perceived level of helpfulness and preparation by therapists relating to adoption issues as a function of the year these experiences occurred. Participants consisted of 152 adoptees and 66 birth parents, with the majority (78%) of the respondents being female. Overall, adoption inquiry, addressing adoption issues, helpfulness, and preparedness by therapists increased from 1965 though the 1990s. Therapists who inquired about adoption (54%) or addressed adoption (72%) were perceived as being significantly more prepared and helpful compared to those therapists who did not inquire about or address adoption issues.     

How Sturdy is that Digital Couch? Legal Considerations for Mental Health Professionals Who Deliver Clinical Services via the Internet

ABSTRACT

This article reviews legal issues related to providing mental health services via the Internet. It provides a general overview of the field and discusses jurisdiction, licensure, legal duties (competence, consent, confidentiality), and other legal concerns related to the business of online counseling. It surveys potential criminal and civil liability issues, noting procedural and substantive aspects of the relevant law. The author concludes that, although providers face a variety of challenges, their efforts in providing a service needed and desired by an important segment of the help-seeking population are worthwhile.     

Woman Abuse and Conjoint Therapy: Therapists' Experiences of Engagement

ABSTRACT

Treatment approaches with couples in which woman abuse is a factor have been the subject of much attention and concern in the therapeutic community. We used focus groups to examine therapists' experiences of what they see as impeding or facilitating their ability to engage therapeutically with heterosexual couples when a man has used violence. Results were coded along four categories: contextual issues, the person of the therapist, client characteristics, and strategies for enhancing engagement. Results point to the difficulties therapist participants experienced engaging with males who have been violent with their partner. Strategies which therapists used to enhance engagement are illuminated. We discuss differences between the experiences of male and female therapists, and implications for clinical work and future research.     

College Counselors’ Perceptions and Practices Regarding Anticipatory Guidance on Firearms

Abstract

Objectives: This study assessed college counselors’ anticipatory guidance on firearms for student clients. Participants: The membership of the Association for University and College Counseling Center Directors was used to identify a national random sample of counseling centers (n = 361). One counselor from each center was selected to survey. Methods: In the winter of 2008, a 3-wave mailing procedure was used to maximize the response rate. Completed surveys served as consent (as approved by the University Human Subjects Committee). Results: A total of 213 counselors (59%) responded. They were unlikely to provide anticipatory guidance (6%), chart/keep records on client ownership/access to firearms (17%), or to counsel the majority of clients from various diagnostic categories on firearms. Conclusions: University personnel are likely to refer students with suspected mental health problems to university counseling centers. The findings indicate that few counseling centers will address firearm issues with students.     

Three-dimensional virtual reality: Applications to the 12 grand challenges of social work

Abstract

The American Academy of Social Work and Social Welfare (AASWSW) identified 12 Grand Challenges of Social Work to unify the profession with focused research, practice and policy applications for the most pressing social issues. Virtual Reality (VR), specifically three-dimensional immersive computer-generated environments, has a history of research and applications to address social and behavioral problems. VR is becoming more readily available, as the technology is becoming more common in mainstream platforms such as mobile technology. While social work interventions are often tailored for vulnerable populations that may not have access to VR computing, it appears that virtual reality is gaining accessibility with these advances. Within the framework of the 12 Grand Challenges of Social Work, researchers from three social work virtual reality laboratories in the United States, Texas State University, the University of Houston, and the University of Alabama, review applications previously tested and currently in development to focus future research and intervention in social work practice.