BMJ 2001;322:1509 ( 23 June )

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Beware online therapy, counselling association warns

Zosia Kmietowicz

London

People using the internet to access a therapist are being warned to take precautions to protect themselves against fraudulent practitioners.

Guidelines from the British Association for Counselling and Psychotherapy this month recommend that anyone considering internet counselling should ensure that the therapist is suitably trained and supervised and that they understand the contract they are agreeing to and the limitations of the service they are receiving.

"Online therapy has enormous potential, and this is an exciting new area," said one of the report's authors, Dr Stephen Goss, research development officer at the association and honorary research fellow at Strathclyde University, Glasgow.

He continued: "However, it is important that we don稚 rush headlong into doing something just because we can. People should always ask whether their therapist is properly qualified and recognised as such by a reputable professional body, like the British Association for Counselling and Psychotherapy."

Research on the value of internet therapy is still in its infancy, according to the guidelines, and to date there is no quantifiable evidence that it works. The internet could, however, be a valuable tool to help physically disabled people and those who are very shy, have agoraphobia, or do not have a therapist in their area. Internet therapy could also prove more convenient and cost effective than conventional face to face services for many more users.

The potential drawbacks include the problem of ensuring confidentiality and identifying the right person for the job. It may be inappropriate, for example, for someone in the United Kingdom to be counselled by a therapist in the United States or the Netherlands, where rules of child protection and age of consent vary.

The number of sites offering online counselling services is vast. A request for an "online counsellor" produces 108 000 responses, and typing the word "counselling" produces over 680 000 results, according to the British Association for Counselling and Psychotherapy.

"Counselling and psychotherapy is an evidence based profession, and it is vital that it remains so," said Dr Goss. "The biggest single problem with the internet is in sorting out the good sites from the less good ones." He said that therapy provided over the internet held immense promise but it was important to know whether it worked and to ensure that it was done well. The guidelines are intended to provide a framework for both users and therapists wishing to offer an online service.

The guidelines are available from the British Association for Counselling and Psychotherapy, 1 Regent Place, Rugby CV21 2PJ (tel 0870 443 5252; bacp@bacp.co.uk).