Online Therapy, Online Counseling and Web Therapy 5 Ways to Make Sure They Are Safe
by Dr. Maheu, Self-Help Magazine
January 19, 2012

Good News
Help comes in all shapes and sizes, as do people and their challenges. Similarly, online therapy, online counseling and web therapy are being practiced in many research-based and viable forms by responsible practitioners. The scientific literature supporting "telemental health" and "behavioral telehealth" is over 50 years old, and shows that benefits often parallel in-person therapy.

Bad News
However, online therapy, online counseling, web therapy, Internet therapy and even Skype therapy are also being offered in random, unmeasured and undisciplined ways, from anonymous chat room sessions for $3.99 a minute to Skype sessions. (Anybody online can claim to be a therapist without actually being one even your next-door neighbor using a false name.)

Worst yet, many therapists have jumped online without any training whatsoever, and now are offering "professional" services through email, chat rooms, text messaging and videoconferencing without so much as an undergraduate course in what can go wrong, or how to make sure you are safe. That's like allowing them to drive without a driver's ed course or exam, and just hoping they won't hit anything.They might do just fine, until there's a problem with the road, or traffic, or in an emergency.

The professional mental health associations are working hard to help develop guidelines for therapists wanting to use technology, but they move slowly and simply are not there yet in many ways. Their second step will be professional training.

Questions to Ask
1. Make sure anyone you see online is a real therapist. Look for their state license number and verify it on YOUR state licensing website. If they aren't licensed in your state, you often have no recourse if they harm you. Be careful. Even if they are licensed in their state of residence, their state won't offer you much assistance if they mis-treat you. State licensing is about consumer protection. Know your rights and make sure your online therapist does, too.

2. Ask questions about their specialized training, not only in your problem area (depression, pregnancy, anxiety, relationships, etc.) but also in the technology they use. If our banks occasionally get hacked online, how can your private therapist make sure your very private, personal exchanges are protected? Here are a few questions to consider:

  • Have they demonstrated competence with the technology they are offering you? How many courses did they take in email-based therapy? Video conferencing? Chat rooms? Text messaging?
  • Do they understand their own professional association's ethics as they related to the Internet?


Learn of your therapist's other security practices.

  • Did they study how to keep your private records away from prying eyes online?
  • How do they get supervision for treating you?
  • Do they lock up the laptop computer where notes from your session are kept? (They should.)
  • Will they inform you if they lose their cell phone with all your test messages to them? (They should.)
  • Is their cell phone encrypted and will they download those text messages to the paper or electronic files they keep for you? (They should.)
  • Did they explain all these issues in the "informed consent" they gave you when you started working with them? (They should.)
  • Have they reviewed other ethical statements & guidelines related to telemental health? (The American Telemedicine Association's Telemental Health Special Interest Group (SIG) published 2 sets of guidelines in 2009 to guide professionals using technology to offer services. If your therapist doesn't know about them, encourage your therapist to read these documents.)


If your trusted therapist offers services without understanding the technology they choose, they might be well-intentioned but just uninformed. Many are just beginning to seek this education now. If they haven't yet, and already are offering services online, you may want to speak to them about getting training. Ask them to look for training at their professional associations (we offer training at many association meetings); at ask them to drop into our TeleMental Health Institute or carefully consider why the associations are going out of their way to train professionals now. It's not as easy as many professionals would like to believe. Lots of things can and do go wrong online.

3. If in the United States, verify that they are using a "HIPAA-compliant" or "HIPAA-compatible" platform for email, chat or video. The website hosting your connection should specifically say those phrases (Skype does not.) Can they explain the privacy policies in terms you understand of the web platforms they use to connect to you? Ask to see the security level protections of any platform suggested by your therapist. They ought to be able to direct you to a webpage that publicly states the platform's HIPAA standards.

Free platforms such as Gmail, Google docs, Hotmail, Skype etc. don't offer health grade security protections for you. NOTE: encryption is not enough. The platform's website should say, "HIPAA-compliant" as you will see for email on Hushmail, and for video, on CaliforniaLiveVisit, COPEToday, or VIA3.

4. Don't let anyone record chat, audio or video sessions with you. There's no more need for chat, audio or video recording than in an in-person session, unless you are convinced it is useful. If you do, then make sure it is stored by a company that publicly announces their health-grade, "HIPAA-compliant" security protections for you, such as Behavior Imaging Solutions.

5. Find out where notes from your session will go. If therapists say you need not worry because they don't take notes, be leery. Most states have laws that require a therapist to keep notes as a condition of licensure. After all, in 5-10 years, you may need to be reminded of the interventions that were beneficial to you. Or they may need to communicate their treatment plan to other treating professionals, or you may be involved in a court case that hinges on your proving you are sane. Just make sure they follow YOUR state law. It was put in place to protect you.

If you want your problems taken seriously online, make sure your therapist takes their work online seriously, too. Otherwise, find a local practitioner who will at least give you the service you rightfully deserve as a consumer. If they do not have the expertise you desire, ask your local practitioner to pay for their own consultation with a specialist online. Obtaining supervision is commonplace in all health care, and many leading trainers can be reached online for supervision now, too.