Can a computer program really replace therapist delivered cognitive behavioral therapy? According to the latest research, the answer is a qualified yes. Guided CCBT seems to work about as well as in-person CBT. Learn more about computerized CBT and find out if it might be right for you.

Cognitive behavioral therapists teach that the way you think affects the way you feel and act and that the way you act ultimately affects how you feel in life.

Unfortunately, sometimes we get into a habit of unhealthy and inaccurate thought patterns which lead to negative emotions and negative behaviors like avoidance or aggression.

For example: A new co-worker walks by you in the hallway without acknowledging you.

You think...

1. ‘She doesn’t like me…She doesn’t think I am worth saying hello to’
2. You feel snubbed and angry and your self confidence is diminished
3. The next time she walks down the hall you make a show of ignoring her first
4. Your working and social relationship deteriorates

It’s a negative spiral of emotions and behaviors that all began with your interpretation of the situation – it all begins with your thinking habits and patterns.

Using CBT, you might learn how to retrain your mind so that you don’t leap to conclusions which result in negative consequences.

For example: That same co-worker walks by without saying hello...

You accept...

1. that you are friendly and worthy of saying hello to and so you wonder what might be troubling her and causing her distraction – you feel some friendly concern for her
2. You check on her later, mention her earlier distraction and ask her if everything is going OK. You ask her if there is anything you can do to help.
3. She admits that she is lost on a new work assignment and accepts your help gratefully
4. Your professional and person relationship with her is strengthened

Research shows that CBT is one of the most effective therapies for mild to moderate depression and for anxiety and the most effective treatment for moderate to severe depression. People with other conditions may also find CBT helpful. It is frequently used to treat:

• Depression
• Anxiety (panic, phobias, social anxiety and other types)
• Stress
• PTSD
• Bulimia
• OCD
• Bipolar
• Psychosis
• Others ¹
  

What Is CCBT?

Computerized cognitive behavioral therapy (CCBT) is pretty much just what it sounds like – instead of learning with a therapist, an engaging computer program teaches cognitive behavioral techniques and encourages practice exercises of those techniques. The computer program acts as instructor and guide through the process of learning a new way of thinking.

There are two types of CCBT programs

1. Guided, or therapist directed and monitored
2. Unguided, or self help in nature

Guided - When participating in a guided CCBT program, you will still interact with your therapist via live sessions, phone calls or emails. Your therapist will guide your progress, but the computer program will take over the time consuming task of teaching you new CBT techniques and leading practice exercises.

Unguided - Unguided or self help based CCBT programs require no therapist’s participation, but though they can be completed without professional assistance, current evidence suggests that guided CCBT programs are likely more effective than self help based programs. One reason for this may be that people who are prescribed a CCBT program and supported by their therapist during the CCBT course are more likely than unguided CCBT users to complete the program.²

Typical CCBT programs consist of a guided lesson segment which is followed by homework or practice assignments and further informational resources.

How Well Does CCBT Work?

Surprisingly well, actually…

A 2011 meta analysis of 12 studies evaluating the use of CCBT to treat depression (as well as other conditions) found that:

• There is evidence that guided CCBT works as well as therapist provided CBT for the treatment of depression and anxiety
• Self-help CCBT programs help to reduce symptoms of depression and are quite effective in reducing symptoms of anxiety
• Evidence suggests that users of CCBT find it an acceptable alternative to therapist delivered CBT³

Advantages of CCBT

Some key advantages to the use and promotion of CCBT include:

• CCBT is available to people in rural or remote locations who may have difficulty otherwise accessing CBT therapy
• CCBT may be preferable to people who feel uncomfortable receiving services in a clinician’s office
  
• Guided CCBT requires less therapist time and intervention. In areas where there is a shortage of CBT practitioners this may help to improve access to services

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Research suggests that online counseling programs for insomnia can be just as effective as in-person therapy.

Researchers at the University of Virginia and the National Institute of Health are investigating an online cognitive behavioral therapy course to help people with insomnia sleep better.

Early results suggest that the online course works very well.

The research is based on a couple of facts:

1. Cognitive Behavioral Therapy (CBT) has been proven one of the most helpful treatments for people with Insomnia.
2. CBT delivered online has been proven to work well in the treatment of other disorders

Therefore, it is very likely that CBT for the treatment of insomnia should work well when delivered online.

(In fact, at a National Institute of Health Conference on Chronic Insomnia, experts reached a consensus that CBT was the most effective treatment and that it should be more widely used.) ¹

Using CBT Online to Beat Insomnia

While people with insomnia often turn to medications for help, the chronic use of sleep medications has some negative consequences and these medications may not always provide effective sleep. CBT is considered a very effective alternative to medications for people with chronic insomnia.

To test CBT for insomnia delivered online, University of Virginia researchers have developed an online course, which can be delivered via the internet. The course is called SHUTi.

In the University of Virginia program, participants can log on at their leisure for to an online CBT course that takes about 6 weeks of active participation to complete.

During the course, participants are taught/learn:

• More about insomnia and other sleep problems
• How to diagnose their own sleeping problems
• To make treatment goals that fit their situation
• To make lifestyle changes and to integrate these changes into daily life

Initial research results show that between 70% and 80% of people who participate in the online CBT insomnia course show sleeping improvements and that these sleeping improvements endure beyond 6 months post treatment. Specific results include:

• A generally reported reduction in the Insomnia Severity Index
• Improvements (reductions) in waking after sleep
• Better sleep efficiency
• Fewer awakenings ²
  

Talk to Your Doctor

Although the University of Virginia online CBT program for insomnia is not yet open to the general public (research continues) the results indicate that in-person sleep therapy is not necessarily needed and that cheaper and less intrusive computer based CBT programs for insomnia can help a lot.

Ask your doctor if you might be a suitable candidate for an online insomnia program, and for a possible reference into an existing or emerging CBT course.

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The online counseling experience differs depending on the how the therapist chooses to deliver it. There is no singular best method, as all methodologies have some advantages and disadvantages. There may be a best for you method, however.

An Overview of the Different Methods Used to Deliver Online Counseling

• Email counseling – You and a therapist communicate back and forth through email correspondence. This is a very convenient delivery system, as client and counselor need not be online simultaneously. Another advantage of email based counseling is that both the client and the counselor can put some time into their messages, ensuring a thorough and accurate communication. Email correspondence tends to be less time consuming for the therapist, and so is often less expensive than real-time therapy. Email correspondence based therapy, however, is quite far removed from any traditional counseling experience.
• Instant messaging chat – During an instant messaging counseling session, the counselor and client communicate back and forth in real time in through text messages. This type of therapy requires scheduling and commitment, and so is less convenient than email therapy, but more closely replicates a traditional counseling experience.
• Instant messaging chat with video – With instant messaging chat with video, communication still occurs through text messages, but both the therapist and client can view each other through a web-cam based video link. This may provide the therapist with greater information via non verbal communication, but the quality of the video sent can limit this.
• VOIP calls – Online counseling can also occur using Voice Over Internet Protocol Technology (VOIP). A commonly known example of this technology is a Skype call. Using VOIP, a client and therapist communicate verbally with one another. VOIP calls are generally free or very low cost, eliminating long distance phone charges as a factor of consideration.
• VOIP calls with video (web cam) – Some counselors may use VOIP calls with both client and therapist displayed via webcam video.
• Video link – Video link therapy most closely replicates the traditional counseling experience. In a video link session, both the client and the counselor communicate verbally and visually via video. This provides the counselor with the best quality and quantity of information and non verbal cues. Although video-link counseling is likely the preferred mode of delivery, technology and bandwidth limitations still constrain its utility.

• Avatar based therapy – Counselors have begun experimenting with the delivery of counseling services through the use of avatars while “in-game”. Second Life and World of Warcraft are 2 examples of virtual game communities that support avatar therapists.

There is no right or wrong, only what works best within your schedule, comfort level and access to technology.

Sometimes, online counseling meets a valued need:

• If you live in a rural town – online counseling may be the only way you can access mental health services
• If you're very concerned about anonymity, online therapy may assuage your secrecy concerns
• If you're a person that works an erratic and busy schedule, email therapy may offer you a chance to get help, without committing to a scheduled appointment.

Online counseling offers a lot to a lot of people, but although online counseling offers unprecedented access to services, convenience and anonymity, it's still far from a perfect solution, not right for everyone and still entails some risk.

Some of the Disadvantages of Online Counseling Include:

• Typing speed can limit the conveyance of information in chat based sessions. Sometimes people say less when writing than they would when speaking; reducing the amount of information available for the therapist to work from.
• People may find it difficult to put complex thoughts and emotions into written words. People have different skills as expressive writers
• There is a greater chance of miscommunication between client and therapist. Therapists cannot as easily access body language information (even when using video chat). Counselors are therefore at a greater risk of missing important non-verbal cues
• Online counselors are not able (ethically) to work with people in immediate crisis or with serious psychiatric illness. In these situations, counselors must be on-site to observe the client in person and evaluate the degree of risk and the best continuing course of action.
• Although all legitimate therapists must abide by confidentiality and privacy constraints, online therapy may pose a greater security risk than in-person sessions. Someone could breach your computer, your wifi point, your therapist's computer – etc; and since what you reveal may be very sensitive, privacy issues are significant.
• Insurance companies rarely cover the costs of online counseling.
• It may be easier for unscrupulous illegitimate/uncertified counselors to operate online. Some online counseling clients may be putting themselves at risk of, at best, wasted money, and at worst, dangerous mental health advice. Even legitimate therapists operating from other countries (or even from other states) may not require the same standard of certification. Due diligence is necessary, when retaining the services of an online counselor.
• Medication cannot be prescribed after an online counseling session.
• An unreliable internet connection may interrupt the flow and delivery of the therapy.

Facts about insurance plan (or managed care plan) coverage of the costs of online counseling

As of September 2009, most insurance companies do not reimburse the costs of online therapy.

We have heard reports that Tricare does pay for internet based counseling for clients in remote locations who do not have access to a local practitioner. Tricare still demands that these clients attend therapy sessions at a computer in a local health care office.

Insurance companies seem to await research that proves the efficacy of online counseling, or perhaps significant demand for services; or cost savings achieved by covering e-based therapy.

We will update this page as information changes and as we get it. We encourage anyone (client or practitioner) that has had success in achieving insurance funding for online counseling to share some general information of their successes.

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Although you might like to stay anonymous through the use of a pen-name – online counselors, in most cases, will need to know who you are and where you live, before they can ethically provide therapy.

Online counseling sometimes attracts people that have a need or desire extreme for anonymity and who are reluctant to make in-person visits to a counselor or mental health worker, in part at least, out of privacy concerns.

People with an extreme desire for confidentiality might hope for completely anonymous online therapy, accomplished by withholding identity information and by using a pseudonym for correspondence.

Unfortunately, ethical guidelines, in most cases, prohibit licensed counselors, therapists and psychologists from consenting to provide therapeutic services without knowing the identity and location of the client. Online counseling does still provide increased privacy, as no one will see you in a therapist's waiting room, but it cannot provide complete anonymity. Thankfully though, ethics guidelines that demand that you reveal your identity also prohibit therapists and counselors from revealing your information, in all but very extreme situations.

Why Do I Have to Prove My Identity?

1. You need to prove that you are an adult – Ethical guidelines prohibit counseling to minors without parental consent. Your counselor will need to know that you are 18 or older and if you are younger than 18, she will need written consent from a parent or guardian before agreeing to provide counseling.
2. Your therapist needs to know who and where you are in case of crisis situations – Counselors are bound by client confidentiality codes except in extreme cases, such as when a client is in danger of harming himself or others. In emergencies, a therapist must be able to alert relevant authorities and provide contact information. This is required by law.
3. Therapists are, in some cases, bound by the counseling laws and regulations of the client' state, and not the practitioner's. To ensure compliance with the law, a therapist needs to know your jurisdiction.
   

You will likely need to provide a driver's license number or other document as proof of identity as well as a full name, home address and contact phone number.

People in crisis who are unwilling to divulge their identity can still access counseling services via crisis hotlines and crisis chat sessions, which do not demand the same identity verification as formal counseling

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Online counseling can offer a convenient and anonymous solution to the mental health and wellness needs for a lot of people that might not otherwise make contact with a counseling or therapy professional.

Nevertheless, due to the limitations of therapy online, some clients may need to visit an in-person counselor to receive effective help – and your counselor has an ethical obligation to make sure that you understand and accept any possible limitations of online therapy before getting started.

Additionally, some clients who might otherwise be ideal candidates for internet based therapy, have practical or technical limitations that diminish their ability to benefit from online counseling and would be better off getting help in person.

Here are some things to think about, some practical considerations, before getting involved in online therapy.

Practical Considerations of Online Therapy

• Typing speed – Many online therapists use text as a primary form of communication, either through instant messaging or email correspondence. If you cannot type reasonably quickly, you may find it difficult to express yourself meaningfully. If you are engaged in video-link therapy (less common) then typing speed is obviously not a consideration.
• Writing ability – You must be reasonably comfortable expressing yourself through text and feel that you can transmit emotional complex ideas through writing. You don't have to sound good or have perfect spelling or grammar as long as you can get your message across; but if you can’t communicate the problem, you can’t expect to get effective assistance.
• Online experience – People who have some experience in online communication/relationships tend to benefit more from text based online counseling. Communicating emotions effectively in an instant messaging session is a bit of a skill that demands practice. Anyone who uses email and instant messaging should be proficient enough.
• Stable internet connection – technical glitches and connection delays can disrupt a therapy session and limit the effectiveness of the counseling. You should have a stable connection that allows for instant messaging without delays (a very minimal requirement).
• Time Zones – you may want to consider finding a therapist who operates in a time zone similar to yours. Although the internet renders geography less relevant, working with a counselor who wants to sleep while you want to talk can make things needlessly complicated. You also want to make sure that your counselor understands your cultural environment. A counselor from NYC may have difficulty understanding the realities and influences of rural America, for example.

Online counseling is an effective intervention that provides greater access to mental health services; and when provided with an ethical awareness of its limitations and to people with the communication skills and technical abilities to use it well, it opens doors of access that might otherwise stay closed.  

Sometimes, there is no effective substitute for in- person therapy (psychiatric emergencies, severe mental health problems etc.) but in many cases, online counseling works just as well.

Additionally, since the therapist and the client need not meet in the same location, counselors can now access clients who previously had great difficulty getting mental health and wellness services, such as clients in very rural or remote locations or clients with disabilities that make leaving the house problematic.

Online counseling isn’t right in every situation and for every person, but it does serve a valid therapeutic need and can expand access to services to those that otherwise might not seek help.

Some Additional Advantages (Benefits) of Online Therapy Include:

• Easy Entry – subscribing to a session or 2 of online counseling, for a relatively low fee, requires less commitment to the therapeutic process than does in person therapy. It’s easier to get in, and if you don’t like it, it’s easier to get out. A person somewhat ambivalent about seeking help may be more likely to initiate therapy due to this lower perceived barrier to treatment entry, and this is a good thing.

• Anonymity – People seek the assistance of counselors and psychologists for myriad legitimate reasons, mostly so that they may live happier and more fulfilling lives, yet many people still associate seeing a “shrink” with severe mental illness only. Many people feel reluctant to visit a local counselor or psychologist out of a fear of “what other people may think.” Fortunately, online counseling offers apprehensive clients more complete anonymity, and so this can also decrease barriers to effective health services.

• Greater comfort for people who feel anxious in social situations – The greater distance between counselor and client can help people who feel apprehensive about real-world social situations open up and disclose fully. This can help to accelerate the therapeutic process.

• Greater convenience – Imagine the harried executive or busy stay at home parent; a person desiring some therapeutic assistance but with a responsibility schedule that makes committing to appointments difficult. Certain modes of online counseling, such as email based counseling, require almost no commitment to specific appointments and so can be squeezed into available blocks of time.

• Generally lower costs – While the costs of online counseling can vary greatly, in general, the per minute cost of internet mediated counseling is lower than in person therapy, a reflection of reduced practitioner expenses - after all, an online counselor may not need a public office, a fashionable waiting room, a secretary and cleaning staff to administer services over the internet. 

• Allows for counseling Sessions with remotely located loved ones – why suspend needed couples counseling just because one member of the marriage is deployed overseas? With online counseling, multiple participants may join from multiple locations.

• Allows for targeted group therapy sessions with clients suffering from less common conditions. There may not be 6 other people near a client needing help with a particular condition/problem, but when geographical limitations are removed, finding others seeking like assistance becomes much easier.

• It provides you with a written transcript of your therapy session so that you can review and rethink the therapy as necessary.

5 ways to ensure that you are dealing with a legitimate therapist or counselor

You don’t want to waste your money, but more importantly, you want to make sure you take life advice from someone qualified to give it. It is very important that you verify the identity, qualifications and good standing of any online therapist/counselor prior to entering into a therapeutic relationship.

Five ways to ensure that you are communicating with a reputable online therapist or counselor are:

1. Your therapist or counselor should list her office address and phone number on her website. You need to know where she is located so that you can verify her credentials and you may also need to contact her "offline" at some point; and you have a right to do so. Also, professional requirements can vary by jurisdiction and so you have a right to know what rules she operates under

2. Your therapist or counselor should clearly list her qualifications and experience

3. Your therapist or counselor should list his membership with any certification and agency boards and should provide links to these respective websites. You should be able to follow these links to check on the accreditation and or good standing of your therapist

4. According to the American Counseling Association, a reputable online therapist or counselor will not demand a lengthy commitment to services, but will instead allow for a trial period, during which time the client can assess her satisfaction with the services offered

5. Your therapist or counselor will follow established ethical guidelines for providing therapy online, such as: in some cases, informing you that you are not a suitable candidate for online therapy; informing you of other online resources or literature that offer free access to helpful information or counseling/support services and informing you of some of the disadvantages of online counseling (informed consent)

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With online counseling, therapy isn’t just for people with mental illness. The internet expands easy access to counseling services to people who otherwise would unlikely ever seek help. Online counseling delivers effective, convenient and affordable wellness, prevention and life coaching therapies to anyone in need of assistance.

An evening spent browsing the internet, a few clicks of the mouse and a decision to give it a try – the barriers to entry/accessibility for online counseling are refreshingly low.

Online counseling expands access to therapeutic services and allows people that would otherwise never come into contact with mental health professionals get help to enhance health or wellness. Psychologists and counselors spend much of their time working with the mentally ill, but that doesn’t mean that they can’t offer assistance to people without mental illness, but who are experiencing problems or dissatisfaction in some areas of life.

People who think that they have "small" problems often don’t go to the trouble and expense of seeking counseling in a real-world environment; even though that small problem interferes with health/happiness or success.  Online counseling offers increased anonymity and convenience and generally lower cost, and can be a perfect solution for people that wouldn’t otherwise get help.

In addition to mental illness concerns, some examples of the types of situations people often seek online counseling for include:

• Substance use/abuse – People who wonder about their drinking or drug use often find initial sessions with an online counselor beneficial – to help crystallize the situation, the options and the steps to healthier use

• Parenting advice – Parents dealing with a difficult child/situation sometimes just need a bit of advice; a fresh pair of trained eyes – and an online counselor, with expertise in this area, can often offer some helpful insight

• Couples therapy – experts say that although most people enter into couples therapy (marriage therapy) after a severe problem or in an attempt to reconcile, couples counseling is actually more effective when offered as a preventative measure to more serious problems down the road.

• Divorce – Few life changes cause as much disruption as a divorce and it is normal for newly divorced men and women to struggle with one or more aspects of a new life and lifestyle. A counselor can help you sort through the emotions and new relationships of a post divorce life.

• Grief and loss issues – getting past the death of a loved one is difficult for anyone but some people get trapped in complicated grief that never seems to get better. Talking through your grief issues with a grief and loss counselor can help you to understand if what you're feeling is normal, or whether you need more formal therapy on an ongoing basis to break free.

• Life coaching - life coaches help people feeling "stuck" or dissatisfied in some area of life take concrete action toward creating change for the better. Some people work with a life coach on an ongoing basis to continue progress, while others find that brief interaction is enough to kick start change.

• Dealing with illness/pain – Pain and illness counselors help people dealing with pain or illness manage their physical symptoms as well as manage the emotional consequences of illness or chronic pain. Gaining an emotional acceptance of pain can actually lessen the severity of the experience.

These are just a few of the countless issues that online counselors provide assistance with. If you know that you could use assistance in some area of your life, but know that you would never seek more traditional face-to-face counseling services, consider whether online counseling might be a good option for you.

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Is Online Counseling Effective for the Treatment of Bulimia Nervosa?

Two recent randomized control research studies suggest that it is, and that telemedicine or online counseling for bulimia nervosa is also well liked and accepted by those that have tried it, however some critics maintain that in-person CBT is still the better choice.

• A summary of some of the recent research looking to evaluate the effectiveness of online CBT for bulimia nervosa

• Some of the criticisms of online the current research

• A discussion on whether online CBT for bulimia is right for you

• Links to further reading (references)

CBT for Bulimia Nervosa

Cognitive Behavioral Therapy (CBT) helps people change the way they think to change the way they feel and act as well. It is one of the most tested counseling methods and is proven effective in the treatment of a wide array of disorders, from depression, to substance abuse – to eating disorders.

At present, CBT is considered the most effective ‘gold standard’ treatment for bulimia nervosa. ¹

Trained CBT practitioners are not available in many rural and remote areas. CBT delivered online or over the telephone could open access to life saving treatment to people who might otherwise not have contact with such appropriate professionals. Recent and ongoing research has looked to evaluate whether the remote delivery of CBT to people with Bulimia Nervosa is effective and accepted.

Research Results

1. In 2008, researchers at the North Dakota School of Medicine and Health Sciences used a randomized trial to compare how well CBT delivered by telephone compared to CBT delivered in person. Half of the 128 study participants with Bulimia Nervosa were randomly assigned to receive telemedicine CBT, while the other half received in person CBT counseling.

• The researchers found that while those that received counseling in person did marginally better in some areas, both methods were considered basically equally effective. Subjects who received the telephone counseling reported feeling satisfied with their treatment.  ²
  

2. In august 2009, researchers in the UK published the results of a study that aimed to evaluate the effectiveness of online CBT for the treatment of Bulimia Nervosa. They had a subject pool of 101 people between the ages of 13 and 20 with bulimia nervosa or an eating disorder not otherwise specified with bulimic symptoms.

These subjects then participated in a multi month online CBT program that included online interactive sessions, email support from a clinician, a message board and homework/workshop assignments.

• The researchers found that the treatment program caused improvement in number of binge eating episodes, episodes of vomiting, laxative use, BMI and eating disorder symptoms level (overall). They also report that subjects viewed the program favorably and recommend the interventions as a potential first action in the treatment of bulimia for teens. ³
  

Criticisms of Online CBT for Bulimia Nervosa

Although the UK study does show an improvement in symptoms severity, the improvements made were not as great as those typically witnessed after face-to face counseling for bulimia nervosa. Additionally, many teen participants did not complete much of the program. ⁴

Is Online CBT for Bulimia Right for You?

Online or telephone delivered CBT for the treatment of Bulimia Nervosa certainly shows a great deal of promise, and in some studies, shows results that compare to face to face counseling. Because of this, if you live in an area without appropriate in-person counseling, remotely delivered CBT for bulimia might be a good option and you may want to discuss this option with your primary caregiver.

Because the research does not yet conclusively support CBT for bulimia nervosa delivered online, if you do have access to in person CBT counseling, this may still be the better solution, at least until further research can clarify the issue a bit more.

At present, The University of North Carolina, Chapel Hill and the National Institute of Mental Health are running a 5 year comparison trial of online group CBT therapy with face to face group therapy for the treatment of bulimia nervosa.

How to protect your privacy when engaging in online therapy. Easy techniques to ensure confidentiality.

Any reputable online counselor should endeavor to secure correspondence and ensure the confidentiality of a therapeutic relationship – and should very likely outline the steps that she takes to ensure informational privacy on her website.

Practically speaking, with some minimal awareness and commitment to conserving privacy, the confidentiality of online therapy is easily maintained; but since the privacy issues of an internet based therapeutic relationship differ from an offline relationship, they deserve some consideration.

Online therapy affords the potential for great confidentiality, but only when undertaken with some minimal caution, both on your part and the part of your therapist.

Here is a very brief overview of some of the privacy issues associated with online therapy.

Protecting Your Privacy in Online Counseling

• Do not engage in online counseling via an email account that is shared with anyone else.

• Do not leave an email account that is used for therapy open where others may see your messages.

• Be aware that unencrypted emails are sometimes “hacked”, and that if you desire true email confidentiality, you will need to use some form of email encryption software - as will your counselor.

• Be aware that if using a work computer or work email for your therapy, your employer has a legal right to intercept your communications.

• Be aware that some internet chat programs are encrypted while others are not. Does your counselor use an instant messaging service that is encrypted?

• Ask what measures your counselor takes to secure stored data on her hard drive. How long is your information stored for?

• Be aware that files downloaded to your hard drive may be vulnerable to spyware. Make sure to run up-to date anti virus and anti spyware software regularly.

• Be aware that even after you delete files from your hard drive, that in many cases a knowledgeable person can retrieve these files.

• You should understand that online counseling is a relatively new means of therapeutic delivery and so confidentiality laws may not always explicitly protect online counseling communications, especially when client and counselor reside in different jurisdictions.  If you are concerned that the information you reveal could be used against you in a court of law, you may want to ask your therapist about her obligations to reveal information while under legal subpoena.

Don’t be afraid of online counseling, but do be aware of the threats to your privacy and do take easy steps to safeguard your confidentiality.

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