Assessing a Person's Suitability for Online Therapy: The ISMHO Clinical Case Study Group

675 I N THE MONTHS before the turn of the millennium , the International Society for Mental Health Online (ISMHO) established its Clinical Case Study Group (http://ismho.org/case study/). Created and facilitated by John Suler and Michael Fenichel, this online research and training group is devoted to the discussion of psychotherapy cases and professional clinical encounters that involve the internet. The creation of the group evolved out of the need for more in-depth explorations of clinical cases in which online life and interventions play an important role. The group's philosophy is that clinical work involving cyberspace sometimes will resemble traditional in-person psychotherapy , but also that the Internet has resulted in some very new clinical issues and a fascinating variety of unique intervention formats. In its second year, the group discussed the various factors that might determine a person's suitability for online therapy. Because the group was not aware of any comprehensive set of guidelines for determining such suitability, it decided to create them. Although these guidelines are designed mostly with text-based therapy in mind (e-mail, chat), many of them apply also to other online methods of communication (e.g., internet telephoning, video conferenc-ing). 1,2 " Suitability " refers to a variety of factors, including the person's preferences regarding online therapy, how suggestible the person is within a particular communication modality, his or her skills in communicating within that modality , and the potentially therapeutic aspects of that modality for the person. Because there are many possible formats for online clinical work, as well as many different theories of psychotherapy , these guidelines are not intended to be exhaustive or definitive. Hopefully, clinicians will adapt these ideas to the unique aspects of each of their online psychotherapy cases. While conducting the assessment, the clini-cian needs to keep in mind the ethical issues regarding online therapy, such as those described in the suggested principles of the International Society for Mental Health Online (http://ismho.org/suggestions.html). As these suggested principles indicate, it's important to inform clients about issues regarding privacy, the potential benefits and risks of online therapy , and possible safeguards. The client's ability to understand this information and his or her attitudes regarding these issues could be important determinants of the client's ability to benefit from online therapy. The clinician has a variety of communication methods for conducting the initial assessment of the client: in-person, video-conferencing, phone, e-mail, and instant messaging or chat. Clients …