Even when a therapist is seeing someone face to face, it may take several meetings to reach such a diagnosis, Nagy said. Online practitioners agree that e-therapy can't replace traditional methods, so it's not for everyone. Most say they don't take suicidal and seriously mentally ill patients. However, Chechele admitted that no matter how carefully he screens them, his online patients do from time to time become suicidal. Finally, if he feels a case is outside his competence, he refers the patient to another mental health professional.
Confidentiality is another ethical concern.
Skeptics worry that e-mails or chat sessions, which are not usually scrambled, could be intercepted and read, especially at work where such monitoring has become routine. I try to practice by the same mandates as I would in my office. Legal and ethical issues, I try to uphold those as best I can in this new medium. Some cybertherapists say what they are doing isn't therapy. Some also post disclaimers.