On July 24, 2000, Dr. Julie Keck, a clinical psychologist based in Newport Beach, California, found herself unable to visit her office for six weeks following surgery. Unlike many therapists in a similar position, she did not have to close her practice entirely, as forty percent of it was conducted online.
After nine years of traditional practice, Keck initiated her internet services at the request of a student from Michigan named Joseph, who discovered her through an AOL member profile. Joseph was described as shy, reclusive, and fearful of the stigma associated with seeing a psychologist, particularly concerned that his parents might find out.
Navigating Legal and Professional Boundaries in Web Based Care
Dr. Keck represents a growing number of mental health professionals offering counseling via the internet, despite significant obstacles that deter many practitioners. For instance, the 1996 California Telemedicine Act explicitly prohibits therapists in the state from “treating” patients outside its borders.
Consequently, Keck carefully terms her online work “email consultation” rather than therapy to navigate these legal restrictions. This distinction highlights the emerging and uncertain regulatory landscape that early online therapists had to carefully navigate to provide services across state lines.
The Unique Methodology of Email Consultation and Its Applications
Keck asserts that for individuals who express themselves effectively in writing, email consultation can be an effective method for working through personal problems. She notes that most of her online clients struggle with depression and a lack of clarity about what would make them happy.
Her approach involves having them answer specific questions about their beliefs and how they perceive others perceive them. She clarifies that this method differs significantly from traditional face to face therapy, describing it more as directed advice, comparable to a professional version of a Dear Abby column, whereas in person therapy involves more guiding patients toward their own insights.
Inherent Limitations and Safety Protocols in Remote Counseling
A significant challenge Keck acknowledges is the absence of non verbal cues like body language and tone of voice, which are crucial for therapists to gauge the depth of a client’s emotions. To mitigate risks, she implements strict safety protocols, always collecting clients names and addresses in case they become severely depressed and she fears for their safety.
She recounts one instance where she felt compelled to contact the police for a wellness check, demonstrating the serious ethical responsibilities involved in remote counseling without physical presence.
The Distinct Advantages and Economic Benefits of Online Practice
Despite its limitations, online counseling offers several distinct advantages. Keck points out that clients can write to her at any hour, such as 2 a.m., which can prevent impulsive actions during moments of crisis. The written record of the conversation provides a clear transcript that can help resolve any misunderstandings later.
Furthermore, the practice can be financially attractive. Keck charges a dollar per minute for reading and responding to emails from clients worldwide, which is comparable to her in person rate but involves significantly lower overhead costs, eliminating commutes and the need for formal office attire.
Professional Skepticism and the Future of Digital Therapy
Many of Keck’s contemporaries in the psychology field expressed mixed feelings about online therapy. Dr. Leigh Jerome, who was helping develop online therapy guidelines for the American Psychological Association, voiced caution. She believed that offering referrals and general information online could be helpful but considered counseling a mentally disturbed person via the internet to be risky.
Jerome stated that online therapy was not a good idea at the time due to many unanswered questions, acknowledging that research was just beginning. However, she also conceded that progress necessitated pioneers, noting that someone had to be first to pave the way for future understanding and regulation.
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