Information for Psychiatrists and Other Medical Professionals Regarding Online Therapy or Counselling Services from Dr Greg Mulhauser

Do you have a patient or client seeking internet-based therapy or counselling? Is one of your patients also a client of Dr Greg Mulhauser? This page is designed to provide psychiatrists and other doctors and medical professionals with information about this site’s services and about how I work together with clients’ medical practitioners.

Practice Background

During my first three years of online practice, I completed just over 1 million words of individual, email-based counselling/therapy work with clients from several countries. For most of these clients and for those with whom I have worked in the years since then, the service has provided their sole current contact with a counsellor or other mental health professional.

However, since the online service was launched in 2003 (originally at CounsellingResource.com), I have also worked with several clients who have previously been diagnosed by a psychiatrist as having one or more DSM axis I disorders (including a much smaller number with axis II comorbidity), and who have been, as a result, under the contemporaneous care of a psychiatrist or other medical professional.

In most instances, the overlap between psychiatric services and this counselling service has been nil; very occasionally, I have been involved more directly — at the explicit request of a client/patient — in discussions with their psychiatrist. (Examples include discussing the impact of medication regimens on the client, or in assisting the client in assessing their own physician-approved modulations of drug regimens, such as for bipolar clients advised in advance by their psychiatrist to modulate drug dosages in a particular way).

Clarifying Roles and Aims

In all cases in which I undertake work with a client receiving contemporaneous care from a psychiatrist, the client and I discuss how the work with both psychiatrist and counsellor may (or may not) complement one another, and I encourage the client to discuss the arrangement with their psychiatrist.

My Primary Concern Regarding Concurrent Working

When working with a client who is under the concurrent care of a psychiatrist, my primary concern is that the aims and processes developed within the two relationships complement, rather than conflict. In virtually all instances of concurrent working which I have undertaken, this complementarity has been easy to achieve through mutual understanding by all three parties of the nature of the two relationships.

Contra-indications

Of those circumstances specifically related to concurrent working, the primary circumstance under which I consider counselling to be contra-indicated is down to the client’s assessment of complementarity or conflict between the aims and processes of the two working relationships: if the client does not feel it would be useful or helpful to them to work concurrently with both psychiatrist and counsellor, we do not.

More frequently, it happens that a psychiatrist may respond to their patient initially by attempting to dissuade their patient from undertaking any counselling work via the internet until the psychiatrist can make independent checks on the specific service provided; this page exists largely to enable that checking to occur more easily!

AMA Guidelines and Professional Ethics

In the United States, American Medical Association standards of conduct discourage the prescribing of medications based upon internet consultations in the absence of a physical examination or pre-existing doctor-patient relationship. Some medical professionals may, with AMA guidance in mind, be inclined to categorize the ethics of online therapy or online counselling together with those of prescribing via internet consultations, and take a dim view of both.

However, I am not a physician, I do not prescribe medications, and I do not undertake any form of medical practice via the internet.

More importantly, my practice operates in full accordance not just with the ethical framework of my own professional organization, the British Association for Counselling and Psychotherapy, but also in full accordance with the internet counselling guidelines published by the United States National Board of Certified Counsellors, the internet therapy ‘suggested principles’ of the International Society for Mental Health Online, and the ethics code of the American Psychological Association (also see their note on services via telephone, teleconference, and internet).

Therefore, I ask psychiatrists and other medical professionals to consider online therapy or online counselling ‘on its own terms’, as it were, and not as an extension of medicine.

In every case I have experienced so far, any initial concerns expressed by psychiatrists or other medical professionals (at least, those with whom I share a client/patient!) have been resolved very rapidly.

Counsellor-Psychiatrist Contact

On very rare occasions, a client/patient may request that direct communications occur between counsellor and psychiatrist, and it is only on condition of direct client request that I will respond to queries regarding specific patients of psychiatrists or other medical professionals.

In this case, I ask that all electronic communications be encrypted via an OpenPGP-compatible encryption method. We will further communicate only with contact details supplied directly by the client.

Therefore, if you would like to communicate directly concerning a patient who is also a counselling client, please discuss this with your patient in the first instance, and where appropriate your patient can then pass on details to us.