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##  Ethics and Regulations of Cybercounseling. ERIC/CASS Digest.                 

Cybercounseling, or WebCounseling, as it is called by the National              Board of Certified Counselors (NBCC), is defined by NBCC as "the                practice of professional counseling and information delivery that               occurs when client(s) and counselor(s) are in separate or remote                locations and utilize electronic means to communicate over the                  Internet." This definition would seem to include Web pages, email,              and chat rooms but not telephones and faxes. The NBCC makes a                   statement that it does not advocate for or against                              WebCounseling (NBCC, 1998). Some therapists who say that                        cybercounseling is not counseling have Web sites available to                   people. Most of the Web sites have some kind of disclaimer stating              that the information found there is only advice, e-therapy,                     information and education, or a supplement to therapy. 
One of the             counseling profession's main concerns will be of those who are                  unlicensed persons promoting themselves as competent Internet                   counselors. When a counselor is unlicensed, a state has no                      regulatory authority, unless there is a law in that state that will             allow prosecution as a criminal act for practicing counseling                   without a license, or gives the board regulatory authority.                     Unlicensed cybercounselors are almost legally untouchable,                      especially when a disclaimer statement is displayed stating what                they are doing is not therapy. 
The NBCC Standards for the Ethical             Practice of WebCounseling are specific, and give the impression this            is an area that one does not enter lightly, without careful thought             and consideration of implications and possible effects. WHAT ARE              CRITICAL ISSUES IN CYBERCOUNSELING?1. Truth in advertising-does             the site deliver what it promises? 
2. Confidentiality and                     privileged communication-are your transmissions safe? Who else in               the counselee's home or workplace (use of workplace computers for               cybercounseling is not advised) has access to messages? 
3. Duty to            warn-is the cybercounselor able to discern when a person is a threat            to self or others, and what is the cybercounselor's obligation? 
4.            Competence-is the cybercounselor competent and licensed? What                   protection exists for the counselee? 
5. Dual relationships- a                 predator-type of cybercounselor could use the internet to take                  advantage of counselees, or to arrange subsequent meetings. 
6. How            does a counselee know that the assigned homework or specific                    directions are valid for the type of problem presented? 
7. Some               cybercounselors may do inadequate pre-screening of potential                    counselees. 
8. There may be a lack of cybercounselor knowledge of             the circumstances or culture of the client. 
9. The anonymity of               the counselee may be problematic for the cybercounselor. 
10. Fee              structures vary-how does a counselee determine a fair price? 
11.              Is the counselee actually receiving advice from the person who is on            the web page?  In text counseling how does one verify this? STATE             REGULATIONS AND CYBERCOUNSELINGSimilar to telemedicine, the                 issues of licensure and jurisdiction arise, except that counseling              boards have not begun to address the problem. A client who obtains              counseling services via the Internet from a counselor licensed in               the same state has recourse to that state's regulatory board for any            violations against either the state code or standards of practice.              However, if a client has a complaint about a counselor licensed in              another state, it is unclear in which state to register the                     complaint. As indicated earlier, state medical boards have addressed            this issue, but not in a uniform manner. 
The Federation of State              Medical Boards (FSMB) produced model legislation regarding                      telemedicine. This proposal is less than helpful as a guide, as the             main responsibility for who can or cannot practice telemedicine in              the state is left to each state (Orbuch, 1997). The Health On the               Net Foundation has a Code of Conduct for medical and health web                 sites which might be a guide to those counselors who have Web pages,            but counseling is not specifically mentioned in any of their eight              principles (Health On the Net Foundation Code of Conduct for medical            and health web sites). The International Society for Mental Health              Online was formed in 1997 "to promote the understanding, use and                development of online communication, information and technology for             the international mental health community." The principles are broad            and not of the nature of regulation. The American Telemedical                   Association has a policy that is a compromise between having a                  national medical license and restrictive state regulation. It                   proposes that the state should not restrict "virtual travel" of its             patients to seek medical advice outside of the state. It also states            that a non-face-to-face encounter by a patient with a physician in              another state is regulated by the physician's home state. 
The next            step, then would be making a decision as a state whether or not to              allow cybercounseling to be part of the definition of counseling                within that state. On the other hand, not saying anything about                 cybercounseling may already allow it. States could follow the                   example of the Telemedicine Development Act (Orbuch, 1997) and spell            out, in detail, how reimbursement, confidentiality, informed                    consent, and licensure specifically apply to electronic                         communications. As opposed to individual Internet therapists, some              of the more credible counseling services are received through                   established intra-state networks, formed from telemedicine grants,              when mental health centers network with referrals from primary                  physicians. In these cases, there are no questions of credentials or            licensure, or client protection from ethics violations, because                 everyone is under the same state's regulation and often use VTC.                These networks, in some cases, are also eligible for Medicaid                   reimbursement (Health Care Financing, 1998). 
Some states are                  requiring that doctors must be licensed in that particular state,               even if holding license in the state of residence, to practice                  telemedicine. Credentials, length and type of post graduate                     experience, exams and fees vary substantially by state. If                      counseling were to follow this model, holding licenses in several               states could mean multiple exams, extra courses, and expensive fees             that would all serve as deterrents and drive the counselor out of               cybercounseling. The counselor could be liable to differing                     standards of practice if licensed in two or more states, and would              possibly have differing procedures regarding the reporting of abuse,            billing issues, keeping records, and other standards of                         conduct (Whelan & Wood). OTHER SALIENT ISSUES1. Many colleges             and universities are now offering distance courses and degrees via              Internet. Will a counseling degree obtained via Internet be                     considered valid for a state license? 
2. When using the Web for               information purposes, how does one discern the validity of the                  information gathered, particularly that information which is                    health-related? 
3. As technology becomes more sophisticated and               more accessible, will video conferencing become a standard, just as             phone calls are now, not just in regular communications, but in                 cybercounseling as well? 
4. Will the poor and underserved be part             of the technological advances, or will they be increasingly left                behind? 
5. Data on counselors who have been sanctioned should                 become easier to access via states' Web sites, and therefore, the               public protection factor should increase. 
6. Telemedicine has not             yet solved the issue of being licensed in one state and operating               via Internet in others; cybercounseling will find itself in the same            vague positions. 
7. NBCC, CACREP, the Ethics Committee of ACA and             the AASCB should work together to develop a draft of standards for              acceptable cybercounseling standards and practices and address                  Internet-based distance education courses for counselor licensure.              National standards, endorsed by these organizations, might prevent              disparity among state boards regarding                                          cybercounseling CONCLUSIONRegulation is a complex issue. In               telemedicine, some have advocated an international worldwide                    license. The hurdles are many, such as variety of educational                   standards and legal codes, not to mention determining who would                 administer this license. It would seem that a start might be a                  national counselor certificate in cybercounseling, with states                  accepting that certificate and thus allowing its already licensed               counselors to participate in cybercounseling, with the counselor                subject to the jurisdiction of the state of                                     license. 
Cybercounseling in one form or another is upon us (Lee,              1998). To dismiss it is unrealistic. We cannot ignore it, for to do             so is to allow it to progress unregulated and open to charlatans,               with the result of diminishing the profession of counseling. To                 change the quagmire into a quest will require risk-takers who are               willing to be forward thinkers, embracing technology as having the              possibility of a positive effect on the profession, and bringing                wellbeing to a greater number of people. REFERENCESHealth Care            Financing Administration. (1998). States where Medicaid                         reimbursement of services utilizing telemedicine is                             available (Report). Federal Register, 63(119),                                  33882-33890 [On-line]. Available:                                               Http://www.hcfa.gov/medicaid/telelist.htm. 
Health On the Net                  Foundation. (n. d.). Code of conduct for medical and health web                 sites. HONcode principles [On-line]. Available:                                 http://www.courses.has.vcu.edu/students/cbryce/651/honcode.htm.                 
Lee, C. (1998). Counseling and the challenges of cyberspace.                  Counseling Today [On-line]. Available:                                          http://www.counseling.org/cton-line/sr598/lee498.htm. 
National                Board for Certified Counselors. (1998). Standards for the ethical               practice of web counseling [On-line]. Available:                                http://www.ncbb.org/ethics/wcstandards.htm. 
Orbuch, P. M. (1997).             A Western state's effort to address telemedicine policy barriers.               North Dakota Law Review, 73(1) [On-line]. Available:                            http://wga-internet.westgov.org/wga/publicat/NDLRART.HTM. 
Whelan,             L. J., & Wood, M. B. (1996). Unresolved issues snarl licensure laws.            Telehealth Magazine, 2(8), 33 [On-line]. Available:                             http://www.telemedmag.com/topics.licen5.htm. 
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ERIC Digests             are in the public domain and may be freely reproduced and                       disseminated.  This publication was funded by the U.S. Department of            Education, Office of Educational Research and Improvement, Contract             No. ED-99-CO-0014. Opinions expressed in this report do not                     necessarily reflect the positions of the U.S. Department of                     Education, OERI, or ERIC/CASS.                                               **Title:** Ethics and Regulations of Cybercounseling. ERIC/CASS Digest.                 **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Counseling and Student Services Clearinghouse, University of               North Carolina at Greensboro, 201 Ferguson Building, P.O. Box 26171,            Greensboro, NC 27402-6171. Tel: 336-334-4114; Tel:                              800-414-9769 (Toll Free); Fax: 336-3344116; e-mail:                             [email protected]; Web site: http://ericcass.uncg.edu.                       **Descriptors:**  Counseling,  Counselor Certification,  Ethics, Internet,  State                Regulation                                                                   **Identifiers:**  Cyberspace                                                                  
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