Can distance counseling occur across international boundaries?
My sister has battled depression in her late teens and early twenties. She made a lot of progress and she has been overseas for the last 3 years working as a teacher. From what I can tell she is sliding back into depression. When I suggested that she talk to someone she said that there was really no one where she was working (Vietnam) that did counseling, especially for westerners. I suggested online counseling but she said that there were ethical issues that prohibited counselors from giving therapy to people in other countries. Is this true? It would seem to me that she is the kind of person that would benefit most from online therapy. Is there any way around the rules?
Art Matthews Says...
Interstate and international distance counseling has not been clearly defined; therefore, there is a huge gray area related to what can and cannot occur. In the US, counselors and therapists are licensed state-to-state with some rather large variations in the licensure requirements existing across the country. Most states have not paid much attention to counseling over the internet or phone, but some have taken notice in a big way, such as New York where it is considered a felony for a therapist to provide services to someone in the State of New York without having a New York State License to practice counseling or psychotherapy. Notice in that situation, the client in is New York and the counselor is not. This seems to suggest that the legal definition of where counseling occurs will eventually relates to where the CLIENT is, not where the counselor is. The main requirement at this point is that the counselor must be licensed in the state or jurisdiction where the client is at the time of service.
Some states have allowed counselors with a previous relationship with a client to continue to provide services for a time period when a client moves out of the state where the counselor was licensed. Other states have exemptions for religious-based counselors (pastoral counselors) and for counseling that occurs through an institution of higher education.
International distance counseling is a whole other ball of wax. In situations like this, it's important that the counselor be familiar with the laws of the country where the client is residing at the time of counseling and abide by those laws, as well as understand the culture and belief system of the client. The client would not in any likelihood be held liable if they reached out to a distance counselor outside their country and find that the counselor was not allowed to provide services to them. The counselor would face possible fines or jail time but the likelihood of this happening is very low even in a worst case scenario.
This brings up the importance of the principle of "Caveat emptor": let the buyer beware. Use good judgment and vet the counselor you are going to work with carefully so that you know that they are qualified (at least in the jurisdiction where they are licensed) and have training and experience in cross cultural counseling and distance counseling services.
Your sister should check with to see if there are laws regulating counseling in the country and jurisdiction where she lives. If a reasonable research does not prevent her from seeking services outside of Viet Nam, she can look to some professional associations that might help her locate a trained and experienced professional:
- The International Society for Mental Health Online
- American Distance Counseling Association
- The Center for Credentialing and Education-Distance Credentialed Counselor Directory
Your sister may want to start with her old therapist, who may be willing to work with her over the internet or phone or may have a referral for her of someone that does.
It will be a while I am afraid before policy and practice catch up with what technology ghas made possible. In the meantime, it's important to wise and cautious about entering into a professional, therapeutic relationship with a mental health worker over the internet.
Stay in close contact with your sister, be supportive and let her know you are there for her. An international helping site that may or may not have specific resources for her is befrienders.org
Best to you both.
Page last updated Jun 04, 2012