One difference is that national borders are more permeable online:
Reviewed by John Grohol Corresponding author. Originally published in the Journal of Medical Internet Research http: Except where otherwise noted, articles published in the Journal of Medical Internet Research are distributed under the terms of the Creative Commons Attribution License http: This article has been cited by other articles in PMC.
Abstract The Internet offers psychotherapists a new communication medium through which they can deliver psychotherapeutic interventions that are appropriate to the medium.
Yet online psychotherapy also offers new ethical challenges for therapists interested in providing online psychotherapeutic services. The differences between interactive text-based communication and in-person verbal communication create new ethical challenges not previously encountered in face-to-face therapy.
This article will examine the Internet's potential for providing online psychotherapeutic interventions and will review the ethical issues involved with providing interactive text-based psychotherapy. Internet, Psychotherapy, Psychiatry, Ethics, Quality of Health Care, Remote Consultation, Physician-Patient Relations, Professional-Patient Relations, Teleadvice, Electronic Mail Introduction The Internet provides a new medium for interpersonal communication that holds the potential for delivering forms of psychotherapeutic interventions that are appropriate to the medium.
The challenges facing psychotherapists lie in discovering what types of interventions are appropriate to this new medium and in delineating the potential advantages and limitations inherent to this new communication format.
Mental heath professionals are already exploring the usefulness of the Internet medium in delivering online psychotherapeutic interventions [ ], and several professional associations have developed general guidelines for the online delivery of therapeutic services [ ].
Simply practicing within recommended guidelines, however, does not release each individual therapist from the personal responsibility to be aware of, and to independently evaluate, the variety of ethical issues involved in the practice of online therapy.
The obligation to act ethically cannot be transferred to an organization, but remains the personal responsibility of each therapist seeking to practice online. The Internet provides several different communication systems, some of which are similar to in-person communication e.
The ethical and pragmatic challenges facing psychotherapists seeking to use the Internet to deliver online psychotherapeutic interventions will vary depending upon which communication medium is being used. This article will focus primarily on the use of email to deliver online psychotherapeutic interventions.
While two-way video technology may someday become widely available, it is unclear whether it will ever gain acceptance as a common means of personal communication on the Internet. Two-way video technology has long been available for telephones, but people have not rushed out to buy video telephones.
It is also questionable whether people will feel comfortable having video cameras in their homes. Cameras attached to personal computers may be viewed as an unwelcome intrusion into personal privacy.
While interactive real-time video communication holds potential in a variety of health related interventions, the technology may remain limited to large organizational and hospital uses, without widespread dissemination into personal use. Should two-way interactive video become widely accepted and available, then it can be incorporated into delivering therapeutic interventions; and since video is a form of "-to-face" interaction, the ethical issues will, to a large extent, be similar to those encountered with in-person, face-to-face therapy.
Currently, however, email provides the backbone of interactive online communication, and it may hold the greatest potential for delivering psychotherapeutic interventions using the Internet [ 7 ].
The most significant feature of email is that it is text-based communication, and this is the source of its greatest strengths and its greatest limitations. Issues Specific to Email Psychotherapeutic Interventions As text-based communication, email is asynchronous not in real-timewhich allows the participants to communicate at their own convenience.
The asynchronous nature of email can facilitate the client's perception of the therapist's availability, and may provide the client with a more intense psychological holding environment [ 8 ] than is available through a traditional in-person relationship.
The perceived availability of the therapist may also enhance the client's ability to incorporate the therapist's presence into daily life. Rather than waiting for the weekly in-person session to discuss an issue, the client can instead write the therapist an email while the issue is still active, thereby evoking the therapist's psychological presence in the moment.
Asynchronous text-based communication also allows the parties involved to carefully consider and edit their communication, which is an advantage over real-time text or in-person communication. Even asynchronous video and audio communication do not offer the advantages of editing afforded by interactive text-communication.
Asynchronous text communication actually involves writing small-scale essays, similar to traditional letter writing.The Praxis ® tests measure the academic skills and subject-specific content knowledge needed for teaching. The Praxis tests are taken by individuals entering the teaching profession as part of the certification process required by many states and professional licensing organizations.
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