IEEE Technology and Society Magazine - December 2019 - 30

(BACP) or the U.K. Council for Psychotherapy (UKCP).

are always "on grid," 24 hours a day,
7 days a week.

Ethics

Technological Challenges

As online counseling services develop, therapists will need to pay attention to the legalities and the ethics
of this form of practice. It is particularly essential when working with clients overseas as the Internet transcends some international borders
and, in the U.S., states. Many legal
and regulatory issues need to be
considered. For example, is it legal
for a therapist to provide online
therapy to clients in a jurisdiction
outside the boundaries of their own
particular practice?
And how is quality service to
be ensured if no one knows who is
treating whom. Also, if a therapist
does not know where their client
is geographically located, how can
they access help in the case of an
emergency, for example if the client is talking about taking their life.
It is much easier to respond to the
immediacy of such risky situations
with a client in the same room.

Unfortunately, from time to time,
Internet connections become fragile
and computer hardware fails. Certain popular VoIP offerings are notorious for their once excellent, but
now poor quality of sound and
video, and the degradation in quality of service during connection.
Some of those living in remote
areas may experience sub-ideal
transmission that drops out regularly, or there is always the possibility
of servers crashing and network
connections faltering. Any disruption of the session can cause the client distress. Also, benefiting from
online therapy is in part dependent
on a client's IT skills and knowledge,
especially if it involves installing and
familiarizing themselves with new
pieces of software.

Boundaries
The vast majority of clients in faceto-face therapy don't make a habit
of barging into their therapist's practice in between their sessions if they
are in crisis - a key component of
therapy is to foster resilience so that
the therapist alone is not solely
depended upon. When a client and
therapist are in an online therapeutic relationship, a client who
becomes distressed in between sessions may decide that therapist is
their first port of call in the crisis
rather than use some of their own
inner resources/coping mechanisms/strategies. Inter-session contact needs to be carefully negotiated
in advance and appropriate boundaries put in place, especially when
there is a growing social expectation
that everybody, including therapists,

in any of its various forms, can
be very helpful in certain circumstance, for example serving as a
container while a client is waiting for
appointments, especially in the face
of long and lengthening waiting lists
for appropriate treatment. Therefore
self-help is not necessarily a bad
thing - some intervention is surely
better than none - and it can work
well in conjunction with other good
support, for example an empathic
person who understand the situation, who is aware of when the distress is likely to turn into a crisis,
and who knows what to do in such
circumstances.
However, there are (at least)
three potentially serious downsides.
First, again, there are perhaps inadequate boundaries, as it requires
considerable self-discipline to stay
focused (and SmartPhones have
been accused of impairing attention
spans [3]). In traditional F2F treatment a client can't wander off halfway through a session - although,
in fact, if a client mentally "checked
out" in a F2F consultation, the therapist should identify a signal and
investigate what is happening, if the
person is dissociating for example
(disassociating being a mental process that separates a person from,
say, a traumatic event which needs
to be worked through in therapy).
Secondly, self-help should not
replace F2F contact, for all the reasons already discussed. Finally, the
availability of such relatively lowcost resources should specifically
not be used as an excuse for cutting
costs through cutting corners.
A second extrapolation of these
developments might also converge
with recent developments in Artificial Intelligence and machine
learning, as it is possible to envisage a mental health chatbot or
"TherapyBot" [6]. While this particular vision may yet be some way
off (notwithstanding that one of

The "Aesthetically
Challenged"
It is evident that online psychotherapeutic services are undergoing rapid
growth. Moreover, the Internet has
proved to be a useful resource for
those who have poor mental health.
This includes finding information on
a myriad disorders and understanding the different approaches to
counseling (e.g., person-centered
versus cognitive-behavioral), as well
as providing guidance on the most
up-to-date treatment possibilities.
One question then arises: could an
extrapolation of these two trends
converge with the provision of mental-health services through online
self-help therapies delivered, for
example by video (it could be
argued that this is simply transforming the shelves of bookshops into
an alternative form fit for consumption by the video generation)?
Anecdotal evidence suggests
that taking part in guided self-help,
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DECEMBER 2019

IEEE Technology and Society Magazine - December 2019

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