Legal and ethical questions about online clinical practice were raised when this forum began over five years ago, and they remain unanswered. Neither professional associations nor state licensing boards are in a hurry to address these issues in a clear and definitive manner, and as a result, the 'legitimacy' (in every sense of that word) of these practices remain questionable. The hesitancy of these organizations is quite understandable given the current lack of empirical evidence concerning it's effectiveness. Giving an official go-ahead to this kind of thing may be interpreted by some potential client/patients as evidence of its parity with face-to-face therapy -- and this misapprehension may very well be encouraged by unscrupulous practitioners. On the other hand, forbidding this work may stunt research efforts, and would most likely create a negative overall image of the practice in the public mind, regardless of the vindicating research that may be forthcoming. To my mind, proponents of online clinical work damage their case by basing their arguments and research on the question: Is online therapy as good as face-to-face therapy? This is a poor starting point for a number of reasons. First of all, face-to-face therapy has been evolving for about a century, while online formats are still in their infancy. Comparing the two at this point is like throwing a challenger into the ring with the Champion before he has a chance to train and condition. Secondly, a failure to 'win' at this phase will likely set the movement back tremendously. It seems obvious that online 'therapy' is still in a rather crude state...one that attempts to simply reproduce face-to-face interaction through the use of email and chat rooms. Eventually, if given a chance, new forms of therapy will evolve that exploit the unique advantages offered by available technology -- only then should face-to-face therapy and online therapy be compared and contrasted. In the meantime, proponents of online clinical work should begin their task by asking a more modest question: Is online clinical work better than nothing at all? In this way, researchers can focus on rural and isolated client populations whose choice isn't "online or face-to-face" but rather "online or nothing". Proving that online clinical work, even in its current infantile state, is better than nothing is a realistic, practical, and attainable goal. It should prove persuasive in convincing the "powers that be" to officially sanction online clinical work for a specific population. This will: (1) give online pioneers the scope necessary to develop 'real' online therapy, (2) finally set a precedent of 'official' legitimacy for online work, (3) generate goodwill toward online practice in the mind of the public, and (4) create research opportunities that will serve as the foundation for future work. Thoughts, problems, questions, or issues?
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