Many practitioners deliver services online without adequate professional training. It also appears that many are making a number of similar cognitive fallacies when justifying rogue practice decisions with their online practices. They might believe they have had a client in a special circumstance. Maybe they read something someone wrote on a website, joined a band of other rogue practitioners who have come up with their own “ethics code,” or even read an article that was published in some book or journal.

Ken Pope and Melba Vasquez (current American Psychological Association President) are two respected ethics researchers and authors. Their article “21 Ethical Fallacies: Cognitive Strategies To Justify Unethical Behavior” might be worth a careful reading so we can check some of our own cognitive distortions at the door.*

Here are a few cognitive maneuvers they describe that I suspect are alive and well in the online counseling, online therapy and telementalhealth worlds. I encourage you to consider these, perhaps add your own, and discuss in our comment section below.

2) It’s not unethical if the professional association you belong to allows it.

3) It’s not unethical if an ethics code never mentions the concept, term, or act.

4) It’s not unethical as long as no law was broken.

6) It’s not unethical as long as we can name others who do the same thing.

7) It’s not unethical as long as we didn’t mean to hurt anyone.

9) It’s not unethical as long as there is no body of universally accepted, methodologically perfect (i.e., without any flaws, weaknesses, or limitations) studies showing — without any doubt whatsoever — that exactly what we did was the necessary and sufficient proximate cause of harm to the client and that the client would otherwise be free of all physical and psychological problems, difficulties, or challenges. This view was succinctly stated by a member of the Texas pesticide regulatory board charged with protecting Texas citizens against undue risks from pesticides. In discussing Chlordane, a chemical used to kill termites, one member said, “Sure, it’s going to kill a lot of people, but they may be dying of something else anyway” (“Perspectives,” Newsweek, April 23, 1990, p. 17).

11) It’s not unethical if we acknowledge the importance of judgment, consistency, and context. For example, it may seem as if a therapist who has submitted hundreds of thousands of dollars worth of bogus insurance claims for patients he never saw might have behaved “unethically.” However, as attorneys and others representing such professionals often point out: It was simply an error in judgment, completely inconsistent with the high ethics manifest in every other part of the persons’ life, and insignificant in the context of the unbelievable good that this person does.

12) It’s not unethical if we can say any of the following about it (feel free to extend the list):

“It came from the heart.”

“I listened to my soul.”

“I went with my gut.”

“It was the smart thing to do.”

“It was just common sense.”

“I just knew that’s what the client needed.”

“Look, I was just stuck between a rock and a hard place.”

“I’d do the same thing again if I had it to do over.”

“What’s the big deal?

15) It’s not unethical as long as no one ever complained about it.

16) It’s not unethical as long as we know that the people involved in enforcing standards (e.g., licensing boards or administrative law judges) are dishonest, stupid, destructive, and extremist; are unlike us in some significant way; or are conspiring against us.

19) It’s not unethical as long as it would be almost impossible to do things another way.

20) It’s not unethical as long as there are books, articles, or papers claiming that it is the right thing to do.

21) It’s not unethical as long as we can find a consultant who says its OK.

* The above excerpt is adapted from the chapter “Ethics & Critical Thinking” in the book Ethics in Psychotherapy and Counseling: A Practical Guide, Third Edition, by Kenneth S. Pope, Ph.D., ABPP, and Melba J. T Vasquez, Ph.D., ABPP (San Francisco: Jossey-Bass/John Wiley & Sons, 2007), and is used with permission of the holder of the copyright.

~

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.

Does their licensure signify that they are indeed competent and operating legally/ethically as many consumers would believe? Or does it simply mean that they are simply running ahead of the law, taking advantage of an overburdened legal system that cannot keep up with the rapid pace of technological advancement? Are they taking their chances because they know that licensing boards are severely overworked, sometimes employed by states that are financially strapped, and that consumers often need to file a significant number of complaints before even an informed licensing board can take action? Are they just trying to make a fast and much easier buck than in their face-to-face practices? Or is this just all one big misunderstanding? If it is a misunderstanding, whose job is it to know and disseminate the facts?

Before I offend too many of my loyal readers, let me say that ask the questions I am asked by my readers at SelfhelpMagazine, and I hope to assist rather than point to any specific professional or business online. I also will speak only to mental health websites in particular, because this is  my area of specialty.

In reviewing a large number of websites for mental health practitioners offering “online counseling” or “online therapy,” it’s obvious that there’s a fair amount of confusion or misinformation (or what else?) about licensure,  and even among licensed professionals.

This is an interesting phenomenon, especially because licensure means that some point in time, those licensed professionals understood the law clearly enough that they passed the test designed to document their understanding of state law, particularly state law related to where it is legal to practice.

As we detailed in our last text book, The Mental Health Professional and the New Technologies: A Handbook for Practice Today, licensed mental health professionals need to be licensed in the state of residence of the client or patient.

In other words, professionals selling their services to Internet sites by claiming they are “licensed” may very well be misleading consumers, who may trust that they are more protected when seeing  a licensed practitioner.

While indeed, licensure signifies that the professional has demonstrated to an objective third party that they have at least a minimal level of competence, the fact that these particular professionals are announcing to the world (and their local licensing boards) that they are open for business to treat anyone who calls them from their Internet site, lets us all know that they are not as competent (or perhaps just not as informed?) as most consumers would like to believe.

After all, just how informed are they if they don’t realize that they’re in effect advertising that they are either licensed in all 50 states (and anywhere else in the world where local licensure is required), or that they are practicing over state lines without a license?

Now there might be some online counselors or online therapists who only make themselves available online to consumers from the particular state(s) from where the professional is licensed, but they are the vast minority. Never have I met a mental health practitioner who is licensed in all 50 states.

That’s not to say that no single practitioner is licensed in all 50 states, but after training literally thousands of therapists who want to learn about online practice, I can honestly tell you, I’ve never met any. Most of the time, what I see on these websites is a practitioner whose license in 1-3 states in making themselves available to anyone who’d like to call, chat or email.

Making this sort of public mistake about one’s licensure is noteworthy. Caution is in order. It literally is a crime to practice without a license in all 50 states. If any of you have different information, please let me know below.

If any of you are offering services online without having fully considered the boundaries of your licensure, you may want to simply go to your website now,  and make it clear to your readers as well as clients and patients that you can only legally serve them online if they currently reside in a state where you are licensed. If you have any doubt as to the veracity of my statements above or my suggestion herein, call your licensing board and ask them. I would be interested in hearing your feedback.

Those are my views. Might you provide additional information that could help me see it differently? Please comment below.

ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT (2002)

“2. Competence

2.01 Boundaries of Competence
(a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

(b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies.

(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

(f) When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles.

2.02 Providing Services in Emergencies
In emergencies, when psychologists provide services to individuals for whom other mental health services are not available and for which psychologists have not obtained the necessary training, psychologists may provide such services in order to ensure that services are not denied. The services are discontinued as soon as the emergency has ended or appropriate services are available.

2.03 Maintaining Competence
Psychologists undertake ongoing efforts to develop and maintain their competence.”

I stepped to the side of the room, as I turned and asked the other people waiting to speak with me just give me five minutes. This is what the man said:

” I started working for a counseling company who wanted licensed practitioners for their online counseling service. I gave about 15 hours a week for six months. It was easy to fill the hours because whenever I had an opening, I could call the company and they would always find somebody for me to connect with from somewhere in the world.

The agreement was they were supposed to pay me quarterly, because they were a startup didn’t have much cash flow at the beginning. At the end of the first quarter they didn’t pay me in full, but rather, they paid me a substantial portion of what I was owed, and promised to pay the balance with 15% interest at the end of the next quarter.

I was happy with the influx of cash earned in what otherwise would be empty hours, and I had no reason to believe they weren’t doing well. At the end of the next quarter they had nothing to give me. I was told that one of the partners had barely taken off with cash and left the country. When I threaten to sue them, the remaining partner offered to give me a part of the company in exchange for what was owed. I accepted.

And this is the part I need you to know and tell others: because I was now an owner in the company they gave me the passwords to the back of the website. I’ve been a part owner for over a year now, and it’s only recently that I bothered to use the passwords I was given a look at some of the documents on the backend of the website, on the server. It was only after a weekend of looking at records from the beginning that I finally began to understand….

They had taken my name and my license number and assigned it to a number of cases that were seen during hours that I was not available. From what I understand now, they had forged my name and fraudulently been billing people’s credit cards who thought they were speaking with me, but the truth is, the person they were speaking to was not me. There were hundreds of hours billed this way. I’m serious. There were hundreds of fraudulent charges.

I have no idea who was using my name, and I’m not going to press charges, because  the guilty party is probably the guy who left the country. No one knows where he went, so it seems futile to try and track down.

The other reason I’m not going to say anything is that I  am now an owner of this company and need to make it succeed. There are a lot of things that can go on with these websites, and nobody is behind-the-scenes verifying who consumers speak with when they think they’re talking with someone who’s credentialed.

When people come to the website and pay their money, they really don’t have a clue who they’re really speaking to. All they know is that somebody is using a name of someone who has a license.  If they checked by state licensing board, they would see that indeed my license is valid. But the reality is, they could be speaking to the janitor, who might just happen to be a good schmoozer. The the point is, a consumer and professionals like me can easily get bamboozled by ruthless business people who take advantage of us both.

I didn’t wear my name badge this weekend, and I’m leaving right now. Just don’t forget my story. Let other people know that the Internet is a wild West right now, and that assumptions can be dangerous.

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How can you tell who’s who online? Your ideas are welcomed!