Distance Therapy

I've been working with a former client of mine online for the past two weeks.  Instead of seeing this person at my office (which is exceptionally far for them), I'm seeing this person online, via email, or cell phone.  Like Distance Learning, the computer has come to therapy.  So this person and I have to figure out how this treatment will work.  Here is what we've decided.  First, this is going to be formal therapy.  There are arranged times, homework assignments, readings, and substantial information being provided, including daily assessments.  We've agreed on a specific type of treatment.  There are a lot of security issues.  The internet isn't secure.  We use minimally identifying information back and forth online.  The phone isn't secure.  The information can be overheard. 

So in two weeks what's been accomplished?  The client has a new job, an improved relationship, and (I can document with the questionnaires that have been completed) a 50% reduction in depression and anxiety.  Not bad for two weeks.  Not bad for online and no face-to-face interactions.

So what are the clinical and ethical issues in this new world of computers?  Security is certainly an issue.  I don't know about how confidential anything is.  I assume everything on the internet is pretty much public information, but I don't think everyone else thinks that way.  I have to remind the client about this.  I certainly get more detailed records this way since everything is written out.  The client gets access to data that is tracked and trended, color coded and on an excel spreadsheet.  Daily.  I'm interacting on a daily basis instead of once a week or once every two weeks.  But the interactions are extremely brief.  High touch and high tech certainly.  The client has a workbook they are using in conjunction with treatment.  The type of treatment uses homework assignments and is readily available in workbook format by a number of authors.  I can explain concepts in general in email.  The rating scales can be readily downloaded from the internet and the results sent back over email.  Could I do more formal assessments remotely with say a web cam or remote server?  Maybe.  And the results are fast.  Same day, or next day.  But this is traditional treatment it's just the format that's different.  What about seeing someone online I don't know?  Is it ethical to provide online only treatment?  What if I'm seeing someone in another State?  I'm licensed in California and Nevada.  If my client were to move to say Idaho or Arizona would I need to be licensed in the State they are in to provide services online from California or Nevada or do my current licenses cover that treatment?  I don't know off hand.  I would have to check with the State licensing agency involved if that were to happen.  What about less traditional treatment?  What about assessments that are only normally done face-to-face?  Does a computer based assessment system change the results?  Does insurance cover this type of treatment?  How does it get priced out?  Lots of new questions to be determined. 

So far so good with this person.  As I add people in this format I'll keep updating.