Text-based Counseling Debate and Controversy

One of the few (and most severely) negative statements to date against text-based Online Counseling was delivered by the Clinical Social Work Federation (CSWF), in 2001.

They stated in reference to text-based counseling:

The general coverage of online counseling, both in professional and general print and other media, has exploded within the past couple of years and the debate about such issues as liability, efficacy and jurisdiction is raging. Clinicians across all disciplines are bombarded with information and solicitation by online counseling companies and recent reports indicate that there are several hundred therapists across the country providing such e-therapy services. The belief of the Clinical Social Work Federation is that psychotherapy services cannot be delivered online because of the inherent nature of the service and, therefore, the Federation is opposed to the practice of Internet-based treatment. By the term Internet-based treatment, the Federation is referring specifically to, and this paper asserts a position about, psychotherapy services that are limited to text-based exchanges between therapist and client.

This position paper does not address telephone counseling or email when used as an adjunct to in-person sessions, or two-way video conferencing either as a primary means or adjunct to in-person sessions, or any other technological medium that is used as primary or adjunctive to a basically in-person treatment  process. While this paper does not express a position with respect to those formsof communication when used as an adjunct to the therapeutic process, the Federation recommends that the principles detailed later in this paper be used as a means of evaluating whether those adjunctive techniques meet well-accepted professional standards. 62

However, others involved in the research and practice of online counseling disagree. Michael Fenichel, in 2001, while president of the International Society for Mental Health Online, responded by letter to the CSWF, stating:

Dear CSWF Committee Members:

I commend you for your careful and deliberate consideration of ethical and practical issues in conducting “psychotherapy” online. However, as somebody who has studied psychotherapy outcome research for over 20 years, I am well aware of the difficulties in ascribing “effectiveness” to psychotherapy in general, however it is defined, much less on the basis of the venue in which it takes place. Therefore, like many others who have written publicly and privately to me and my organization, it seems rather biased to single out one particular treatment modality–the ill-defined “online psychotherapy”– as being particularly problematic in terms of ethical or technical limitations.

Yes, even well past 1995-96, when your commission first began to discuss this looming possibility, there remains particular concern about confidentiality, privacy, and authenticity, as well as the legal and regulatory issues insofar as professional licensing. But it is precisely these issues which have been increasingly explored and addressed by both mental health professionals and consumers. There is growing recognition, among members of professional organizations, that while there are definitely grave risks inherent in “online treatment” there is also an incredible potential benefit in providing services to those who are geographically isolated, socially anxious, physically disabled, or fearful of stigma for seeking help, information, and support. To name a few. The Internet exists, and it can facilitate the work of professionals, with the potential for a myriad of benefits to consumers, far beyond telephone hotlines or “therapy.”

Fenichel contends that, contrary to the claims of the CSWF, there is outcome-research supporting the efficacy of text-based counseling.63 In addition to efficiancy studies, practitioners propose that there are numerous intrinsic advantages to ext-based counseling, in addition to the advantages of Online Counseling in general. These advantages pertaining solely to text-based Online Counseling are presented below.

62 Lonner, R. B., Trimm, S., Phillips, D. G., Amey, B., & Jean Synar, B. (2001). CSWF position paper on Internet text-based therapy. Clinical Social Work Federation. Retrieved  February 22, 2005, from ttp://, para 1; Bold emphasis mine.

63 Fenichel, M. (2001, July 24). A Response to the Clinical Social Work Federation Position Paper on Internet Text-Based Therapy: A response from the president of ISMHO. Retrieved December 12, 2004, from ttp://, para 3; these studies are presented  in detail in a later chapter.

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