Avoiding the “Medical Model” for Online Counseling, Psychotherapy and Telemental Health
by Marlene M. Maheu, Ph. D. on 19/04/10 at 9:17 am
Over the last few months, I’ve unfortunately had the occasion to hear a number of online practitioners claim that they do not adhere to the “medical model” but rather believe in the ” business model.” Somehow, these practitioners hold strong in the belief that online practice is not related to traditional practice in the brick-and-mortar world. This position could be hazardous.
In the words of one of California malpractice attorney, Brandt Caudill, Jr., Esq.:
“Faced with the complexities of informed consent, standard of care, note taking, etc., some therapists have tried to opt out of these requirements by simply taking the position that they do not believe in, or endorse the medical model, and therefore they should not be held to it. This has the same effectiveness as reporting to the Internal Revenue service that you do not believe that the tax laws are valid, and that you should not have to comply with them. While this may lead to making the acquaintance of interesting criminal defense and bankruptcy lawyers, it will not cause any change in the IRS’s view of the applicability of the tax laws. By the same token, for a psychotherapist to assert that he or she should not be subject to the medical model will be ineffective. The medical model will generally be imposed with or without your agreement.”
For more about traditional face-to-face malpractice issues see Mr. Caudill’s article: Malpractice & Licensing Pitfalls for Therapists: A Defense Attorney’s from which the above was excerpted.
Do you have an opinion? Please leave your comment below.
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Marlene M. Maheu, Ph.D. is the Executive Director of the TeleMental Health Institute, Inc., offering a Certificate training program in TeleMental Health for telepsychiatry, telepsychology, telesocial work, and online counseling. Academic books authored by Dr. Maheu and colleagues include eHealth, Telehealth and Telemedicine and The Mental Health Professional & the New Technologies.
Eric B
May 9th, 2011
what happens when that online service is based overseas, US laws are not applicable to it then. This also keeps the therapy costs to a minimum not having a fleet of lawyers involved in it.
Dr. Maheu
May 9th, 2011
Thanks for your question/comment, Eric. I agree with you that it is a lot easier to practice overseas. I’d suggest you check with your state licensing board to see if that’s legal with your license first, though. Some U.S. states limit practice with the licenses they issue.
The real problem is the reason for our laws in the first place: some practitioners have differing opinions about what’s good for consumers. If we all decided to go overseas to sidestep U.S. law, it is likely that consumers overseas could get hurt and have no recourse. I suppose some U.S. practitioners would welcome that arrangement. But our ego-centrism has been a problem for many consumers, even in the U.S. (i.e., doctors saw fit to have sex with them in the US to “show” patients how to be more “functional.”)
Similarly, our ethnocentrism could be harmful overseas. The truth is that overseas practice is more complex than one would imagine at first blush. How many of us studied multi-cultural mixed-marriage issues related to Croatia? adoption or step families in Sri Lanka? alcoholism in Bolivia? How many of us know about Hindu religious/sexual practices in Pakistan? Or gay issues in Nigeria? Many people live in different cultures and speak English differently than we do. We can’t understand everyone who approaches us online.
What if these people speak English reasonably well, and lie to us about their geographical location, just to get service from an American doctor? What if they aren’t aware of the level of detail we need before rendering ethical services. Just as we are not supposed to do therapy with African American, Hispanic or any other group without multi-cultural training if we aren’t from that same group, we have an ethical duty to know the linguistic, cultural and religious issues before we offer treatment to anyone.
It is daunting to stop and think of the possible ramifications of our actions when we deviate from the standard of care and practice internationally. That’s why we have laws and ethics codes to guide us. But if you are 100% sure you will “do no harm” then you make a good point. Lawyers are quite expensive. Contact your own licensing board first, and let us know what they said, ok?
Camluder
Nov 19th, 2011
I’m impressed! Very useful information specially the closing section