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Book Forum: Textbooks and Handbooks   |    
Online Counseling: A Handbook for Mental Health Professionals
ANDREI PIKALOV, M.D., Ph.D.
Am J Psychiatry 2005;162:638-638. doi:10.1176/appi.ajp.162.3.638
View Author and Article Information
Rockville, Md.

Edited by Ron Kraus, Jason S. Zack, and George Stricker. Boston, Academic Press (Elsevier), 2004, 278 pp., $49.95.

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The title of this book intrigued me because I have been conducting online consultations for some of my patients. I chose patients who were stabilized and in need of ongoing treatment and offered them future contact through secure e-mail instead of office visits. I enjoy this small part of my work, which is going on without major glitches.

This volume is a much more detailed and thorough work than I expected. It focuses mainly on online psychotherapy, but it has invaluable information for any mental health professional who deals with online technology to communicate with patients. Overall, this volume is a timely resource for those who are interested in learning how to translate their practice to an online medium.

There are four major sections, and each is divided into chapters. The impressive list of contributors has 22 names of authors with different backgrounds, including internationally recognized specialists, supporting the idea that online consultation is a worldwide phenomenon.

A noticeable feature of this book is the structure of chapters. Every chapter starts with short editor’s note (summary) and ends with conclusion, a list of key terms with definitions, study questions, and references. The foreword and introduction, authored by the editors, set the tone for the book. Online counseling, as an example of distance service provision, deals with the dilemma of maintaining a psychotherapeutic relationship without face-to-face contact, regulatory and ownership concerns, and liability and reimbursement issues.

Chapter 1 presents an overview of online behavior, communication, and experience. It is a short and a bit too general introduction to the Internet for those who are new to the concept. The second chapter, "Psychology of Text Relationships," might be a useful academic discussion for those who plan to conduct psychotherapy online. In contrast, the next chapter reviews historical developments in the online counseling business. The last chapter of this section is devoted to a discussion of research done in relation to the topic, with the key conclusions that studies are scarce, outcome measures are ill defined, and "understanding of the dynamics involved in online counseling is outside of our grasp at this point."

Part 2, Practical Aspects of Online Counseling, is a step-by-step start-up guide. It has a chapter on the technology involved, a separate chapter covering legal and ethical issues, and a chapter on business aspects of online counseling. This is the most practical part of the book and is the place to go for readers who are limited in time and just looking for an "operational manual" to move into online business.

Part 3, Clinical Issues in Online Counseling, is an exploration of psychotherapeutic issues involved in treatment without personal contact with a patient. I think this would be of most interest for those who are planning to engage in any sort of counseling online. Topics of the chapters in this section include online counseling skills, online groups, online testing, and multicultural issues. My personal experience tells me that this fairly limited number of issues can be resolved if online communication is limited to abbreviated medication checks or progress reports with an established patient.

The last section of the book contains only one chapter, on the future of online counseling, described as "filled both with risk and opportunity" and depending on multiple variables: licensure, legislation, reimbursement, technology, and privacy to name a few.

My overall recommendation to the future reader is to use this volume as a reference to consult on specific aspects of physicians’ needs in the world of online counseling or distance communication with their patients.

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