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JustBen September 14th, 2004 09:58 AM

ISHMO's Myths & Realities of Online Clinical Work
John Suler, the moderator of the "Psychology of Cyberspace" forum, was kind enough to stop by and contribute to our discussion of online clinical work. He linked to two excellent works, and I'd like to specifically address ISHMO's "Myths and Realities of Online Clinical Work" (

Under the "Myth #1" section, the authors assert that: "It is important to note that personal computers are relatively easy to break into and obtain information saved in them, including sensitive reports on clients. On the other hand, however, this possibility is not greater than breaking into a therapist's office or a locked file cabinet."

Frankly, this is absurd. The average Internet-connected PC is "pinged" by hackers two or three times an hour. These aren't specific attacks, just people prowling around looking for weaknesses that they can exploit to get at whatever information you might have stored. Can anyone honestly say that they've noticed two or three people an hour hanging around their office door looking for security vulnerabilities?

The "Myth #2: Text-only is inadequate to convey a richness of human experience" section opens with these lines: "Why do people continue to argue that words alone cannot convey the breadth of human experience? The whole body of human literature from Homer to hip-hop renders this frequently stated myth absurd. It is widely believed that Shakespeare saw as deeply into the human heart as Freud."

Words alone can convey the breadth of human experience, but they often don't. It's easy enough to cite Shakespeare or Homer, but most clients don't have that kind of talent or skillcraft. I'm not an opponent of online clinical work, but the assertion that the average client can convey the same information in plain text that they convey in-person is the kind of claim that makes people dismiss the online argument. Text cannot convey non-verbal messages, and it almost never conveys unintentional messages, which I think most therapists would agree can be quite useful.

jo ames October 14th, 2004 11:48 AM

Re: ISHMO's Myths & Realities of Online Clinical Work
Hi JustBen,
In response to the comments you made regarding John Sulers input, I would like to add the following:

These aren't specific attacks, just people prowling around looking for weaknesses that they can exploit to get at whatever information you might have stored

So, then you are agreeing with John that the online security threat is no greater. (I guess there is very little evidence to support this either way)!

Text cannot convey non-verbal messages, and it almost never conveys unintentional messages,

On what was this assertion based? (See smilies) ;) :(

(these images are based on the keyboard/keypad and are commonly used in text).
There is a widely known ettiquette or nettiquette regarding the use of text, which most people use automatically, LIKE SHOUTING! (ask any young person)

Practitioners who have undertaken quality and adequate training, (or indeed, like John Suler who are pioneers in online mental health) will know this and can pick up messages from a clients text in the way you might from a facial expression, say.

I see the words that you write indicate you are not an opponent of online clinical work, however, it would appear you do not see this form of therapy as being 'proper' in someway as it deviates from all the training and experience you have in the field and at this time maybe you are not willing to accept that 'real' counselling can occur online, in 'real time' and even with a visual connection.
(OK so the visual connection is still not as sharp and precise as it might be - but technology improves daily)!

Have a good day.

JustBen October 14th, 2004 03:26 PM

Re: ISHMO's Myths & Realities of Online Clinical Work
Thanks for the response, Jo. You may be surprised to learn that I have very little therapuetic training thus far, and no field experience to speak of. I do have a Bachelor of Science in Business Information Systems, however, and think of myself as an enthusiastic proponent of technology in almost all human endeavors. (In fact, it would be fair to characterize me as one of the "young people" you suggest I speak to in regard to netiquette.)

I think that online counseling/therapy has terrific potential, but I don't think we do the "movement" any favors when we dismiss legitimate criticism and push forward with irrational optimism. To propose that netiquette, for example, conveys anything even close to the range of expression evident in a face-to-face meeting is just plain bizzare. As for highly-trained professionals and pioneers in the field reading hidden messages in text in the same way that the rest of us read facial expressions, I'll just have to take your word for it for the sake of this discussion -- I would very much like to see any research that may back this claim up, however.

As for security, I must admit that I don't understand your response to my concern. There are reams and reams chock-full of evidence that support my claim that PC's are constantly probed for security flaws and attacked by hackers. They're called firewall logs. I'd be happy to compare these to the reports generated by the security alarms that protect the physical offices of face-to-face therapists. There's absolutely no doubt in my mind how that comparison would look. To say that breaking into a computer is approximately the same level of difficulty as breaking into an office or file cabinet is debatable, but the likelihood of having your computer broken into is far greater than having your office broken into. That makes the threat more serious.

Using video connections is very promising, but we do have some serious infrastructure challenges to deal with. The fact that many online therapists are so enthusiastic about video-conferencing - which, after all, is more like face-to-face therapy - only underscores my apprehension about text-only therapy. Think about that for a minute. On one hand, we're saying that text-only therapy is just as good as face-to-face; on the other, we're embracing video-conferencing as in improvement. It's that kind of inconsistency that gives people the impression that we're just plain enthusiastic about the medium, and we'll worry about the justification later.

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