E-therapy splits U.S. social workers, OASW studies technology issues.

ARLINGTON, VA -- E-therapy, or online text-based therapy, is fraught with risks and hazards for both clients and Social workers, says a position paper from the Clinical Social Work Federation. The Ontario Association of Social Workers is looking at the issue.

The CSWF paper has drawn strong criticism, according to a report in the NASW News, the organ of the National Association of Social Workers. Many practitioners say the practice can be beneficial for people who are geographically isolated, socially anxious, physically disabled or fearful of stigma for seeking help, information and support. In contrast, the federation calls text-based therapy another form of the disconnection that leads to much human suffering.

In Toronto OASW Executive Director Joan MacKenzie Davies told Community Action that "we are in the process of developing `Guidelines for Technology-Mediated Social Work Practice' to assist in guiding the development of new methods of service delivery, as well as clarifying the circumstances and reasons for involvement with, and the limitations of technologies in social work practice."

The U.S. federation does not take a position on telehealth services that are used as an adjunct to the therapeutic relationship. However, it is opposed to internet-based treatments that are limited to text-based exchanges between therapist and client.

The paper outlines a set of principles for telehealth in general and e-therapy in particular, stating that:

* basic standards of professional conduct are not altered by technology;

* client confidentiality and integrity of information is essential;

* all clients directly involved in a telehealth encounter must be advised of risks and benefits and must give informed consent;

* services provided must adhere to basic standards of quality and professional health care;

* each health care discipline must examine how its patterns of care delivery are affected by telehealth;

* documentation requirements for telehealth must be developed;

* clinical guidelines should be based on empirical evidence;

* the integrity and therapeutic value of the relationship should be maintained;

* health care professionals do not need additional licencing to provide services via telehealth;

* the safety of client and practitioners must be ensured.

In setting forward these principles, the paper states that it is impossible to ensure confidentiality when information is transferred over the internet. The practitioner has no way of knowing if the person using telehealth services is the same person they see in their office.

The federation's position is an overly rigid and simplistic, one-dimensional view of online mental health services, according to Michael Fenichel, president of the International Society for Mental Health Online told the NASW News. He said there is a growing body of evidence that some positive outcomes have resulted from online therapy. His organization supports additional training, competencies and skills for online practitioners.