ERIC Identifier: ED446326
Publication Date: 2000-03-00
Author: Hughes, Rosemarie S.
Source: ERIC Clearinghouse on
Counseling and Student Services Greensboro NC.
Ethics and Regulations of Cybercounseling. ERIC/CASS Digest.
Cybercounseling, or WebCounseling, as it is called by the National Board of
Certified Counselors (NBCC), is defined by NBCC as "the practice of professional
counseling and information delivery that occurs when client(s) and counselor(s)
are in separate or remote locations and utilize electronic means to communicate
over the Internet." This definition would seem to include Web pages, email, and
chat rooms but not telephones and faxes. The NBCC makes a statement that it does
not advocate for or against WebCounseling (NBCC, 1998). Some therapists who say
that cybercounseling is not counseling have Web sites available to people. Most
of the Web sites have some kind of disclaimer stating that the information found
there is only advice, e-therapy, information and education, or a supplement to
One of the counseling profession's main concerns will be of those who are
unlicensed persons promoting themselves as competent Internet counselors. When a
counselor is unlicensed, a state has no regulatory authority, unless there is a
law in that state that will allow prosecution as a criminal act for practicing
counseling without a license, or gives the board regulatory authority.
Unlicensed cybercounselors are almost legally untouchable, especially when a
disclaimer statement is displayed stating what they are doing is not therapy.
The NBCC Standards for the Ethical Practice of WebCounseling are specific,
and give the impression this is an area that one does not enter lightly, without
careful thought and consideration of implications and possible effects.
WHAT ARE CRITICAL ISSUES IN CYBERCOUNSELING?
1. Truth in
advertising-does the site deliver what it promises?
2. Confidentiality and privileged communication-are your transmissions safe?
Who else in the counselee's home or workplace (use of workplace computers for
cybercounseling is not advised) has access to messages?
3. Duty to warn-is the cybercounselor able to discern when a person is a
threat to self or others, and what is the cybercounselor's obligation?
4. Competence-is the cybercounselor competent and licensed? What protection
exists for the counselee?
5. Dual relationships- a predator-type of cybercounselor could use the
internet to take advantage of counselees, or to arrange subsequent meetings.
6. How does a counselee know that the assigned homework or specific
directions are valid for the type of problem presented?
7. Some cybercounselors may do inadequate pre-screening of potential
8. There may be a lack of cybercounselor knowledge of the circumstances or
culture of the client.
9. The anonymity of the counselee may be problematic for the cybercounselor.
10. Fee structures vary-how does a counselee determine a fair price?
11. Is the counselee actually receiving advice from the person who is on the
web page? In text counseling how does one verify this?
STATE REGULATIONS AND CYBERCOUNSELING
telemedicine, the issues of licensure and jurisdiction arise, except that
counseling boards have not begun to address the problem. A client who obtains
counseling services via the Internet from a counselor licensed in the same state
has recourse to that state's regulatory board for any violations against either
the state code or standards of practice. However, if a client has a complaint
about a counselor licensed in another state, it is unclear in which state to
register the complaint. As indicated earlier, state medical boards have
addressed this issue, but not in a uniform manner.
The Federation of State Medical Boards (FSMB) produced model legislation
regarding telemedicine. This proposal is less than helpful as a guide, as the
main responsibility for who can or cannot practice telemedicine in the state is
left to each state (Orbuch, 1997). The Health On the Net Foundation has a Code
of Conduct for medical and health web sites which might be a guide to those
counselors who have Web pages, but counseling is not specifically mentioned in
any of their eight principles (Health On the Net Foundation Code of Conduct for
medical and health web sites). The International Society for Mental Health
Online was formed in 1997 "to promote the understanding, use and development of
online communication, information and technology for the international mental
health community." The principles are broad and not of the nature of regulation.
The American Telemedical Association has a policy that is a compromise between
having a national medical license and restrictive state regulation. It proposes
that the state should not restrict "virtual travel" of its patients to seek
medical advice outside of the state. It also states that a non-face-to-face
encounter by a patient with a physician in another state is regulated by the
physician's home state.
The next step, then would be making a decision as a state whether or not to
allow cybercounseling to be part of the definition of counseling within that
state. On the other hand, not saying anything about cybercounseling may already
allow it. States could follow the example of the Telemedicine Development Act
(Orbuch, 1997) and spell out, in detail, how reimbursement, confidentiality,
informed consent, and licensure specifically apply to electronic communications.
As opposed to individual Internet therapists, some of the more credible
counseling services are received through established intra-state networks,
formed from telemedicine grants, when mental health centers network with
referrals from primary physicians. In these cases, there are no questions of
credentials or licensure, or client protection from ethics violations, because
everyone is under the same state's regulation and often use VTC. These networks,
in some cases, are also eligible for Medicaid reimbursement (Health Care
Some states are requiring that doctors must be licensed in that particular
state, even if holding license in the state of residence, to practice
telemedicine. Credentials, length and type of post graduate experience, exams
and fees vary substantially by state. If counseling were to follow this model,
holding licenses in several states could mean multiple exams, extra courses, and
expensive fees that would all serve as deterrents and drive the counselor out of
cybercounseling. The counselor could be liable to differing standards of
practice if licensed in two or more states, and would possibly have differing
procedures regarding the reporting of abuse, billing issues, keeping records,
and other standards of conduct (Whelan & Wood).
OTHER SALIENT ISSUES
1. Many colleges and universities are
now offering distance courses and degrees via Internet. Will a counseling degree
obtained via Internet be considered valid for a state license?
2. When using the Web for information purposes, how does one discern the
validity of the information gathered, particularly that information which is
3. As technology becomes more sophisticated and more accessible, will video
conferencing become a standard, just as phone calls are now, not just in regular
communications, but in cybercounseling as well?
4. Will the poor and underserved be part of the technological advances, or
will they be increasingly left behind?
5. Data on counselors who have been sanctioned should become easier to access
via states' Web sites, and therefore, the public protection factor should
6. Telemedicine has not yet solved the issue of being licensed in one state
and operating via Internet in others; cybercounseling will find itself in the
same vague positions.
7. NBCC, CACREP, the Ethics Committee of ACA and the AASCB should work
together to develop a draft of standards for acceptable cybercounseling
standards and practices and address Internet-based distance education courses
for counselor licensure. National standards, endorsed by these organizations,
might prevent disparity among state boards regarding cybercounseling
Regulation is a complex issue. In telemedicine,
some have advocated an international worldwide license. The hurdles are many,
such as variety of educational standards and legal codes, not to mention
determining who would administer this license. It would seem that a start might
be a national counselor certificate in cybercounseling, with states accepting
that certificate and thus allowing its already licensed counselors to
participate in cybercounseling, with the counselor subject to the jurisdiction
of the state of license.
Cybercounseling in one form or another is upon us (Lee, 1998). To dismiss it
is unrealistic. We cannot ignore it, for to do so is to allow it to progress
unregulated and open to charlatans, with the result of diminishing the
profession of counseling. To change the quagmire into a quest will require
risk-takers who are willing to be forward thinkers, embracing technology as
having the possibility of a positive effect on the profession, and bringing
wellbeing to a greater number of people.
Health Care Financing Administration. (1998).
States where Medicaid reimbursement of services utilizing telemedicine is
available (Report). Federal Register, 63(119), 33882-33890 [On-line]. Available:
Health On the Net Foundation. (n. d.). Code of conduct for medical and health
web sites. HONcode principles [On-line]. Available:
Lee, C. (1998). Counseling and the challenges of cyberspace. Counseling Today
[On-line]. Available: http://www.counseling.org/cton-line/sr598/lee498.htm.%20
National Board for Certified Counselors. (1998). Standards for the ethical
practice of web counseling [On-line]. Available:
Orbuch, P. M. (1997). A Western state's effort to address telemedicine policy
barriers. North Dakota Law Review, 73(1) [On-line]. Available:
Whelan, L. J., & Wood, M. B. (1996). Unresolved issues snarl licensure
laws. Telehealth Magazine, 2(8), 33 [On-line]. Available: