Smriti Sawhney Joshi is one of the first certified telemental health professionals in Asia and a clinical psychologist with a rich experience of 15 years in the field of mental health. She has played a key role in setting up of one of the first online therapy platforms in India and has been on the advisory board of some others. Joshi is also a life member of International Society of Mental Health Online (ISMHO) and Tememedicine Society of India (TSI). Here she discusses what it takes to set up an online psychotherapy and counselling practice.
In the times where we can get help at the click of a button, online psychotherapy and counselling is gaining popularity as a cost effective means to bridge the gap between service providers and service users. Plus it’s now akin to owning a designer label – “oh! You don’t have an online presence?” And yes, there is a difference in having an online presence versus seeing your clients online for delivering therapy or conducting assessments.
It makes a lot of sense to have an online presence to let people know about yourself, your areas of practice, your location of practice, fees, even get some basic information forms or informed consent forms filled (how many of us are actually doing this? even in our face to face settings?). But to set up an online practice, there is much more that is needed in addition to being a licensed professional for the service area you want to set up your practice-say counselling or coaching or clinical psychology. The moment you go online, you go global and the first questions that you need to answer for yourself and also for the clients in the FAQs sections is: Are you allowed to provide services to people residing outside your geographical location?
Then, you also need to let the clients know who you are — your credentials, certifications and licenses obtained, etc — so that they can make an informed choice. Anonymity may be allowed for the client (and there are ways to do this too and absolutely doesn’t mean no information about the client who s approaching you for help-refer to duty to inform in case of self harm or suicide or harm to another) but is surely not allowed for the you or people providing services on your portal.
The most easiest way to communicate online is using texts 🙂 isnt it? Client doesn’t need to see us and we do need to be formally dressed to see the client and the best part is more than one client can be attended to..but hey!! there s a need for self check there-IS THIS ETHICAL?
Ethical provision of therapy is our hippocratic oath. However easy and convenient as it may seem, I can tell you from my experience that this is the most difficult thing way to conduct a therapeutic session. One has to make sure of the right choice of words to right way of typing them (no K or okay or keeping the client waiting while you think of what you are going to type) to making sure that there are no linguistic differences in the way you express and the user understands the the text. Training oneself in doing this is the key to becoming effective in providing therapy using text.
One of the articles I recently read about text therapy on Forbes mentions four hidden risks of the ‘Unlimited Messaging Therapy’ model which are very real and they include:
1. delaying effective treatment
2. making things worse not better
3. minimal protections for crises and emergencies
4. strengthening the stigma against seeking psychotherapeutic help
I leave you with this question- Are you prepared to handle these risks as an online provider, especially with anonymity in text therapy as the main “attraction” for people to use these services.
Telemental health delivery is the best way to reach those for whom face to face therapy or counselling may not be a possibility yet for it to be effective, lets make sure we r ready before we offer our help via this mode.