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Health Practices to Integrate Online Care


The literature concerning counseling acknowledges the importance of building rapport as a basis for enhancing a working alliance with the aim of offering excellent services. This is the foundation of working agreements, group counseling sessions, and joint conferences, mainly constructed through common face-to-face communications. Today the technology has a different impact upon means of interaction.

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It has become apparent that people are able to connect to each other electronically by use of techniques such as emails, instant messaging, and live chats without the need for a physical meeting. This paper explores the importance of these technological strategies or techniques that build effective online alliances, especially in the health sector. The paper also presents the challenges and related ethical issues of online therapy. Lastly is the outline of some successful stories, strategies, and guidance from operational websites and professional experiences.

The common scenario involves counselors offering online therapy to their clients without ever meeting them physically or even hearing their voices. Online therapy also facilitates collaboration to achieve a common goal. For instance, group work projects enable colleagues to connect from diverse or remote locations to build a healthy working alliance.


The online therapy has many references, including cyber-counseling, e-counseling, or teletherapy. The therapy is a development in the mental health departments with psychological support or advice provided through the Internet. Real-time therapy involves phone conversations or online chartrooms. Today there is a wide range of patients suffering from minor illnesses and thus the rapid dynamism of service delivery measures like e-therapy. Most physicians argue out that e-therapy cannot replace traditional therapy considering some of the severe cases it cannot administer, such as incorporating the mental treatments. The electronic counseling is for guidance and advice in work, relationships, and life-related problems.

History of Online Therapy

The concept of distant communication between the counselor and patient begun in the early 1980s, and according to Kanini and Regehr (2003), Dr. Sigmund Freud used letters to communicate extensively with his clients back then. The growth of this form of health care service catalyzed the formation of the International Society for Mental Health Online, which provides a dramatic control over the rise of online care. The guidelines protect the customer’s interests and privacy issues as he/she receive care via the Internet.

How the E-Therapy works

The common tools are e-mail, real-time charts, videoconferencing, phone conversations, and instant messaging (IM). Today the therapy sites have many similarities regarding the agreements, but the main and important contents include a “legal duty to warn.” These documents indicate that the therapist has a responsibility to inform or involve third parties or authorities in cases of threats. Adherence to the law and ethical guidelines is inevitable in licensed states or countries. Enforcement of the rules is, however, difficult to implement because of the transparency requirements and differences regarding laws covering various geographical locations.

Some of the salient variables involve ethical issues. A common issue involves racism and cultural differences recognizable through interactions. For instance, people in a coastal region practice fishing as an economic activity, whereas their counterparts from other regions would find it to be a recreational activity. Cultural differences mean similarity in location but wide differences in meanings (Rubinstein, 2010).

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Common e-therapy site

Numerous websites offering the services today exist, and good examples include and (2010). Today the common focus of these electronic psychiatric services falls upon the recovering addicts, especially those who feel uncomfortable accessing the traditional face-to-face support. The therapy is not appropriate for everyone, and therefore one must consider all the legal issues involved, the confidentiality of information, and viability to the counselor (Ehrenfeld, 2006).

Informed consent is an online therapy website that offers private guidelines or support in real-time on topics varying from anxiety, addictions, depressions, anger, physical illnesses, fear, guilt, or relationships related conflicts. The professionals have experience regarding specific subjects, the requirements being empathy, patience, and, ability to facilitate learning/growth. The psycho-educational and personal cantered approaches ensure transparency.

The services offered by the site entails the instant sessions in which a patient can have a live chat with a professional. The second reason is that one is in a position of using an automated system designed to assist one in finding a counselor who is the right match. Last is the availability of a list of all professionals in which the client makes a choice. The specializations of professionals focus on common events but specialize in specific fields in relation to the topic. They use message boards, quizzes, surveys, articles, and schedules to support the live chats. They function as a team based on availed topics (help-horizons, 2010).


To ensure support for confidential requirements, the site provides a list of qualified professionals in which the client has a right to question credentials. The contact management occurs between the client and therapist without outside interference, but the patient is free to choose any other professionals, especially when counseling sessions seem not to work out. A decision regarding the fee is equally an aspect between the patient and the counselor but under some guidelines. With all the exchanges strictly falling between the therapist and patient, compromising the assurance of confidentiality is not possible. The site does not monitor or track the messages in the system.

Security issues

Assurance of security at occurs by the protection of transactions on the site. The assurance occurs by the use of overlapping and sophisticated mechanisms/technologies such as firewalls, secure sockets layers (SSL), and logins. Full-time monitoring and maintenance of the computer web servers ensure a secure work and hosting facility.

Informed consent

The system focuses on the general and current issues affecting people. This mainly entails relationship concerns, career advice, parenting and, child nurturing issues, among others. This form of counseling is best for people who have experience of online sessions. The therapist/psychologists are a person who has a wide range of qualified credentials and licenses, such as “Board certification by the American Board of Forensic Psychology (ABFP)” for specialty board certification. “The American Board of Professional Psychology (ABPP), Academy of Certified Social Workers license (ACSW), Advanced Practice Registered Nurses (APRN), Registered Art Therapist (ATR-BC), Board Certified Diplomats (BCD)” among others (Find-a-therapy, 2010). The clients are equally free to choose a therapist in his/her choice.

Confidentiality and security issues

This online therapy system has a health insurance kitty with varying policies with a health plan indicating the number of visits covered. The coverage also focuses on the network, in which case it may cater to the basic drugs. Employees’ assistant programs help one in identifying and coming-up with resolutions regarding emotional struggles, family difficulties, and other legal problems.

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Matters of discussion re kept confidentially between the patient and therapist. Various legal expectations exist, such as the release of information if the therapist notes some possibilities of harm. Nevertheless, insurance has legal proceedings regarding diagnosis and appointments.

The procedure begins with the therapist obtaining informed consent from the e-clients. This legal procedure ensures consideration of all professional boundaries all through the program. The patient should have information that pertains to any potential risks or benefits involving the nature of treatment and alternatives. Other procedures requiring coverage before administration include the fees, modes and, time of payment, insurance covers, and ability to determine the anticipated outcome before making the final decision.


Informed consent

According to Rubinstein (2010), “people are equipped to transform the obstacles to optimum health and happiness.” This means that a good professional can create a visual perspective of clients. Some salient details are common, and thus the picture remains tentative to adjustments as the program matures. The initial creation of such a picture occurs through curiosity. Questions enhance the required revelations such as those regarding location, culture, daily activities, preferences, and, culture of the organization, which may be a good starting point for the therapist into the inquiry process. Therapists also need to be observant of clues regarding revelations throughout the therapy process. Some of the clues are a direct link or insight into the context of the problems. Sympathy and empathy are important for consultation as well as a measure of catalyzing more revelations.


Some aspects are never obvious during online interactions. This has a significant impact on lifestyle choices, career, educational achievements, or background and the ability to accept and use the current technology.

Practitioners face difficulties involving personality identification and protection through online communication with patients. The online posts cannot indicate if one is introvert or extravert. The amount of reflection provided in the text is, however, more visible among other online procedures, such as chatting. The context of the discussion programs mainly depends on the challenges the patient faces with respect to the geographical location. The counselor has to consider the fluency of language from various perspectives to accommodate diversity.

Some patients are not able to use online services because of their ability to communicate. Accents are not an obvious factor during online written communication as it is in oral. This means that the client has to watch closely for any inconsistencies regarding grammar and accommodate any struggles associated with language to deliver the medical procedures. These include patient’s short replies to emails or long-intervals for replies during chatting procedures, which are confidentially in archives.

Security issues

The security of the patient and the quality of medical care have to defend support from the policies implemented by the government or other medical bodies. To improve the quality of care and enhance the standardized measure, the professionals ought to practice accuracy, reliability, and relevance in discussions by centering all the focus on the patient. These measures assist in evaluating performance and comparing the efficiency of the care. Quality measures ensure the clients are safe, and handling of their personal aspects occurs professionally. They safeguard the health results of the patient, the procedures for transferring patients from one-location or practitioner to another, and the resources used during the therapy program.

Advantages of online therapy

The Internet provides a consolidation of all types of media with a detailed register of collected events, indefinitely stored and are subject to retrieval, distribution, analysis and, modification without location or time limitations. According to Orange of “the futurist” (2009), networking provides the mobile social systems with the ability to share information based on their needs. Therapists have greater social networks and instant messaging services with the capability to point out interactive maps indicating the location of client and server, thus enhancing communication. With the steady growth of mobile technology, online therapy expectations are to overthrow the majority of other common therapy systems with an estimated 75% representation by 2011. Mobility of the hardware makes them the ideal tools of communication because of time and location flexibility.

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Considering that mental illness may cause or emanate from physical illness, online services can cater to disabled or housebound patients. E-Therapy is equally affordable and convenient considering the current offers of the required hardware, such as home computers and modems.

The disadvantages of Online Therapy

Today most insurance policies do not cover online therapy because of concerns regarding confidentiality, privacy and, reliability of the technology. The system is not applicable to complicated psychiatric illnesses, thus catering for a limited scope of cases. The therapists are equally not in a position to respond to urgent or crises. This makes the enforcement of ethical or legal code to be difficult because of differences of requirements depending on the physical location, considering that the interaction is global.

The counselors heavily rely on a variety of oral and equally nonverbal communication to offer the required services fully and effectively. Online therapy mostly relies on the nonverbal system, with only approximately 10% of the communication done verbally. Currently, most of these nonverbal clues, such as facial expressions, body postures or appearance, tone of the voice, or circumstances of the communication, enhance interpersonal communication and chances to establish the required rapport.

Most of the online environments are text communications involving electronic mails, chatrooms, and discussion forums. Verbal communication still offers the advantages of written communication, such as recording conversations and thoughts for future references. Some current technological features such as videoconferencing, allow voice and visual communication, but the hardware requirement remains incomprehensible, unaffordable, or inaccessible to most clients, especially those in the local settings.

The online verbal communication, however, loses access to rich clues provided by the body language, reaction to visual contacts, vocal annotations, and gestures. Depending on the equipments used, some of the important aspects the counselors need to know are inaccessible in online conversations such as the geographical setting of the patient, community and, street identification, which may be influential to the problems.

Other hindrances entail the language differences such as regional pronunciations and details, many people find to be less obvious and difficult to determine; for instance, the age of the patient or ethnical background. Many professionals question the viability of online therapy without the inclusion of some additional aspects of face-to-face interaction. Nevertheless, the programs work effectively because the professionals are willing to work in an online alliance toward achievement.

Personal opinion

Comparing online psychotherapy to face-to-face counseling, building an efficient online therapy program is achievable through teamwork or counselors’ alliances. The key to the success of the programs includes solid coalition, competency and, facilitated discussion forums. Projects require active participation between the client and the counselor. It also facilitates professional collaboration across various time zones and geographical backgrounds.

The online therapy is not only a healing practice but also equally an excellent opportunity for the parties involved, especially counselors, to gain skills and knowledge of the entire practice. They have the opportunity to meet other global professionals. The technology has facilitated the elimination of the need for a particular physical workplace. People are currently able to deliver from any location and any time of the day.

This helps therapists to work around their families in collaboration with the outside world. It gives them a wider perspective and chances for transition. The clients who live in rural settings are equally able to benefit from the counseling services without extra travel expenses. Physical challenges are the main source or irregular work schedules, thus the difficulties that concern scheduling. With electronic conversations, clients believe valued and appreciated and are more enthusiastic about the procedures.

Views of professional associations and state regulatory boards

The states are concern with issues relating to the patient’s safety, experience, and health disparities. The online therapy is a field requiring quality measures supporting quality improvements of the traditional system and use measures that support out-come and substantiation-founded care. The issue of transparency regarding the patient’s information is vital, and therefore these quality measures ensure the proper use of health information programs and technology. This ensures availability, and user-friendly counselors provide services for patients with respect to financial incentives.


Today the regulatory bodies are working in conjunction with health practitioners to integrate online care beyond the single interface setting. The focus of technology advancement today is upon the distribution of intelligent systems. High requirements regarding cost and volume for such deliveries, but the authorities are looking at such issues in the transitional care projects with the aim of improving quality. The focus of care seems to shift continuum to coordinated and widely integrated service delivery system that enhances transparency and decreases the errors. The therapy sites aim at providing a system that caters to the contextual view of patients’ records, which boosts further developments toward better services delivery.


Ehrenfeld, T. (2006) Virtual Therapy. Newsweek.

Helphorizons. (2010). Guide to E-Therapy. Web.

Kanani, K, & Regehr, C. (2003). Clinical, ethical, and legal issues in e-therapy. Families in Society, 84, 155-162

Orange, E. (2009). Mining Information from the Data Clouds.The Futurist. New York, NY. Fururist publishers.

Psychology today. (2010). Guide to E-Therapy. Web.

Rubinstein, N. (2010) Team & Frequent Contributors’ views.Web.

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