I get many requests from high school and college students using the the Internet, for information about "interesting topics" in psychology. One thing I can be sure of, as a clinical psychologist, is that the person best qualified to say what is "interesting" or "cool" to you, is you! And if you choose something which is real interesting to you, it will probably be even more interesting when you share what you've learned with your teacher or classmates. This website is my attempt to share what I myself find "interesting" or useful, to me, to students like yourself, to fellow mental health professionals, and to the general public worldwide (thank you, Internet!).

It is nice to know that my website gets some visitors and is helpful, and might even help create interest in the topic of "psychology": the science of understanding our fellow human beings. I've gotten some nice comments as well as several requests for suitable topics for papers, or for speeches. I've also received requests for topics other than the ones I have highlighted on my webpages, and for my opinion on such difficult questions such as "What is an interesting topic?" or "What would a teenager find interesting?".

I've decided to post some of the inquiries I've gotten, along with my responses, in the hope that this might answer some questions--perhaps your own--about psychology, or about "good" research topics for students. This page is also for inquiring adult minds! There are some very interesting topics and issues raised here, and the complexity level varies widely.

Perhaps too I can bring you a smile if you are an educator or mental health professional who enjoys, as I do, the enthusiasm and perspective of today's on-line students. I hope this Q&A is helpful.

Ask Dr. Mike!

Frequently Asked Questions:

Adolescence

Q:   Hello My Name is Tina and I am working on my Bachalor's in Psychology. At the present time I am in Psychology of Adolescents, I am required to put togather a portfolio on all the topics in my text. I need to locate some stories or clippings on real life instences of a adolescent(s). Some of the topics I need to go into slight depth are; Sexuality, Peer relations, Physical development, Theories of Adolescence, Stress and Mental Disturbance.
I want to identify and put in my own words how these clippings or reports relate to the chapter's in my text. I want to create a portfolio that is brief yet to the point, and something that I can use in futhering my career in dealing and helping Adolescents get through the stages they must face. So if there is anything you know of that would help me in my quest ....

A: Tina-
Psychology of Adolescents is a specialty of mine, and a few of my web pages are basically your assignment, either in my interviews with adolescents (e.g., "What is Cool?"), links to sites by adolescents (e.g., by the sister of an anorexic, on my "Adolescent Mental Health" page), and tons of sites about adolescent disorders, for and by teens. Also my articles on the hallmarks of adolescence, like "Peer Pressure" and "Self Esteem". A large corporate foundation [Pepsi-cola] has distributed some of these things to high schools around this country and McGraw-Hill has asked to use them in textbooks in Europe, so I guess people find them useful. I don't know what of this you've seen, but I'd start on my adolescent mental health page, http://www.fenichel.com/adolhealth.shtml. I think this has articles or resources on everything you mention in your letter. Then, follow the link back to my main site, Current topics in psychology if you need more (http://www.fenichel.com/Current.shtml). In particular, on the self-esteem page (http://www.fenichel.com/selfest.shtml) there are 2 links, "Courageous Kids" and "Success Stories by Teens" which will have personal stories by teens, something you say you want ("real life instances"). You will definitely find some personal stories on sexuality (e.g., the value of abstinence and impact of motherhood) at the CFOC site, and between the "teen advice" sites and my own page on peer pressure you should come up with something on peer relationships. For physical development, try the Ask Dr. Marla page (a link on my adolescent health/mental health page), as there's lots of stuff there on normal development and issues around everything from puberty to acne, etc. As for stress, there are lots of links around my sites to "anxiety" mega-sites, and also a new collection of resources on violence, the most profound effect of "stress" - at http://www.fenichel.com/violence.shtml .

I don't off-hand know of anything on "theories of adolescence" [online], though I do have a link from my main site to theories of personality. But adolescence isn't something too theoretical, actually, as there are pretty universal stresses and phenomena, such as increased importance of peer approval, wish to be popular, damaged self-esteem due to failure, rejection, etc..... There may be some sites I've not seen on adolescence "theories", however, but I don't know of them offhand.

I hope some of this helps. There's a lot here for you to whittle down into a "brief yet to the point" portfolio. You seem to be very organized and motivated to do well, and you're also a really good writer! So good luck in your pursuits.

[Note: Like all these Q&A postings, permission to reprint here was obtained beforehand.]
[See also Body Piercing, below.]

Humor

I have gotten several requests for references on psychology and humor, or the use of humor in promoting healing. Hope this is useful:

John K wrote:

> Got anything on the value of humour in mental health care?

Hmmm, actually I do, somewhere! And you're about the 3rd person to ask about humor recently....

By coincidence (or synchronicity), I just put down my pile of today's (snail) mail next to the computer, and what do I see? An invitation to a forum by Harvard Medical School on "Mind/Body Training in Optimism, Humor, and Cognitive Restructuring". Sounds interesting. It's in Dublin, Ireland, Sept 12-15, 1999. Continuing with today's mail, there are several letters about "humor in therapy" in the May 1999 APA Monitor, including references to an entire focus on the healing power of humor back in the March issue....

Here you go, titled "More psychologists are finding that discrete uses of humor promote healing in their patients." [This article no longer online, circa 2010, although humor can be easily researched and continues to be both an important topic - and asset. See below for a more recent study on the role of humor, as reported in the November 2007 APA Monitor:]

http://www.apa.org/monitor/nov07/thejoke.aspx.

And now, miracle of miracles, I have actually located the response I'd prepared for someone elso on the topic of humor and psychology. The letter follows, complete with some humor at the end, and several links relevant to the topic....humor seems to be a growing topic--and necessity, in today's stressful world.

Body Piercing

Deliberate Self Harm (DSH)/Self-Injurious Behavior (SIB)

Aggression and Violence

Q:

A:

Now, being involved with biology rather than psychology, I know you may really want to look at what biological factors there may actually be (e.g., violence due to brain injury, or demographics of violence due to mental illness, or whatever, as well as any information about "heredity"). I've got a major resource for you, which could keep you busy a long time researching this site. It's the Social Psychology page at Wesleyan University, http://www.socialpsychology.org/

As soon as you go to this page, you'll see a search screen there. Leave it set to search only their own site (the default setting it will be on), and type in the word "aggression". You'll get a list of tons of journals specific to resarch and discussion about aggression.

Aggression is something that you might have a problem with only because there's too *much* written about it, rather than too little. I'm sure you'll find things on "nature vs. nurture", or "heredity versus environment", and even a search engine search will get you millions of articles. (Some good search tools are at http://www.fenichel.com/search.shtml )

However, even if biologists might think there's a major role for heredity, the overwhelming findings of social science research suggest, as I said, that "violence is a learned behavior", which offers hope for our violent society if only we start looking at that learning process. Oh yes, one last thing. If you'd like to sift through some of the presentations at the century's last psychology convention, there are some reports on current research about violence, and the way it's learned through the media, neighborhood violence, pro wrestling, and so forth. That's pretty interesting reading too, at http://www.fenichel.com/APAlive.shtml , but it might be boring or not what you're interested in unless the topics of "Internet Addiction" and societal violence are interesting to you in terms of their *psychology* (as opposed to biology).

So, what did you expect from a *psychologist*? :-)

Hope some of this does the trick for you. Good luck!

---

Note: In the years since that question was asked and answered, I've attended and reported on some presentations by some of the most accomplished psychologists in history addressing some of the large questions about the nature of behavior, and why some good people end up doing bad things, or why there is so much hatred in the world, as reflected in daily life, politics and the media. One presentation made at the APA Convention in 2007 saw two legends of psychology - Phil Zimbardo, social psychologist, and Aaron T. Beck, "father of cognitive psychology" - address the topic of Evil, Hate, and Horror. This is highly recommended as an excellent starting point for pithy, advanced-level discussions about aggression & violence, thinking & behavior, and the nature of human beings. From a psychological point of view.

Learning Disability

On the main page is a very good site by the National Institute of Mental Health, called Anxiety Disorders, which is basically on on-line brochure explaining in basic terms some of the more common anxiety disorders, including "Generalized Anxiety Disorder", a technical term very close to agoraphobia.

I also just put up a page on "School Phobia", which is written by a colleague of mine and it is the only thing like it that I've seen on the Internet, a 2-page discussion of this very specific, rare and interesting form of anxiety disorder. The reason this is related, is because some psychologists (including myself) have seen instances of "school phobia" where a child is just so anxious about "everything", that they may qualify as agoraphobic (unless they're extremely anxious in their own home and "safety zone"). Then again, there are adult agoraphobics who may have a unique kind of "traumatic stress disorder" which blossoms into "agoraphobia", as opposed to an ongoing "generalized anxiety disorder" which overwhelms 99% of ability to function in a non-hospital setting. Agoraphobia is a very interesting topic, and much has been written about it.

The School Phobia page, if you're interested is at:
http://www.fenichel.com/schoolphobia.html

Online Addictions

Dear Dr. Fenichel:

I found your article on "Internet addiction" very enlightening, since most of the research I've encountered has more or less defined and categorized the "Internet addict"(like it can be easily diagnosed).

I am trying to find more information on people who not only frequent the Internet, but also online auctions. These "online auction addicts" seem to mix "Internet addiction" with compulsive shopping. I guess it could also be described as a certain type of gambling since the shoppers are bidding on the products without any knowledge of whether they'll "win" or not.

My questions:

*** Do you think there is such a thing as "online auction addiction"? If someone came to you with this problem, how would you treat it?

*** If this is a "problem," can it be solved? Would a person with this problem have to completely avoid online auctions, like an alcoholic has to stay away from alcohol? Or is that even a fair comparison?

Well, again, you're asking me to speculate on a treatment plan without having an individual person in front of me, nor any research or guidelines on your identified "problem". A problem could indeed occur if someone bids "only $40,000" for a used Rolls Royce because "it's a bargain", when they can't afford to pay their mortgage or buy food for the kids or the cat. If a wealthy retiree spends hours each day acquiring Russian art via Internet auction, is that a "problem"?

Can "it" be solved? First (sorry to repeat myself), as a scientist, I need a definition of terms, as to what "it" is, which is "the problem". Unplug the computer, problem is fixed. Run out of money and get sued by the auctioneer for non-payment, "the problem" gets resolved differently. You ask if complete abstinence "like an alcoholic" is the only solution. Notwithstanding my concerns about what "solution" should be without fully identifying "the problem", if it is truly a manifestation of an "addictive personality" gone amuck specifically with regard to online auctions, your analogy may be a good one, bringing in the role of "enablers", the need for supports and a lifelong pledge of abstinence, if the AA "12-step" model is to be employed. Then again, just as there are differences between an "alcoholic" and someone with an alcohol problem, the same may be true for the person who binge-auctions but can go without, versus the person whose entire life is oriented around the next drink.

*** Would you classify being addicted to online auctions as a type of "Internet addiction"?

(See above re "classification"). I think, to a large extent, addiction is addiction, though the physiology differs (for example "needing a fix" to avert the Joneses may be different than anxiety and stress when ripped away from the computer). If a "shopping" or "auction addict" (as I suspect you would use the terms) is pursuing this relentlessly, and *only* online, then I'd say that the *reinforcement*, *control*, and *feedback* aspects of having the computer instantly respond to impulses and keystrokes would be driving the addictive component still further. Kimberly Young, ("Pathological Internet Use" researcher) spoke at the 1997 APA Convention about families torn apart and (before AOL stopped charging per-minute) homes lost for non-payment of mortgages, due to the addictive power of the computer. I allude to the drug-like reinforcement, I think, in my article. I think the specific forms of "Internet addiction" typically combine several factors, ranging from "addictive" predisposition, to compulsive or depressive tendencies, or worse, and that the computer has for some people replaced social interactions, a family pet, or one's own quiet sense of self, with all it's immediacy, stimulation, and ease-of-relationship.

*** If so, do you think this is a minor problem, or a problem that is going to expand as the Internet grows?

So far I only know of one person who has identified this "problem": you. However, I do think you're on to something, and there certainly is room for expansion. In fact, Madison Avenue, AOL, Wall Street, and Amazon.com are all banking on it, just as they count on "television addiction" to sell products now.

***Or do you think that mental health professionals too easily classify people whom enjoy being online as "online junkies"?

Again, this is one humongous generalization! I think the majority of mental health professionals are either not on line at all, or limited to email and/or a bit of web surfing. [1996]
I think that movies such as "You've Got Mail" will actually make a big impact on further absorbing Internet experiences into the fabric of everyday American life. I do *not* think mental health professionals (other than the few you find with sites about it online) are at all pre-disposed to formally diagnose "online junkies", though certainly almost everyone can name a friend, patient, or family member who has displaced television or whatever with time spent online. And we all know how some may go overboard. But I believe most well-trained and experienced psychologists and psychiatrists, anyway, will (as I did above) look at the overall functional lives of individuals in the context of relationships and behavior, and not be quick to "blame the Internet" in and of itself.

I would greatly appreciate your insight on the subject. Thank you for your time and consideration. Sincerely, Stephanie P.

You got it! Interesting questions and topic. Thank you for giving permission to reprint your mail.

Note: Shortly after this exchange, in January 1999, I observed my first "E-Bay Addict"! Only small things are purchased, and inexpensive (so far), but lots of time and energy is being spent online!

For an early article on Compulsive Shopping/"Shopoholism", Click Here.

Fast forward to 2012 and there is a new online resource page specific to "shopping addiction" with an overview on "How to Manage Shopaholism" which you may find interesting, in terms of both the 'addictive' and 'OCD'ish' aspects. [Tnx, Cindy!]

New for the 21st Century: There is growing concern about Facebook Addiction! Is it everywhere? Is it a "disorder"?

Clinical Psychology

Date: Tuesday, October 27, 1998 5:17 PM
Subject: Information on Clinical Psychology

Dear Dr. Mike I am currently a student rat the university of North Carolina at Wilmington and I am doing a research paper on clinical psychology and was wonder if you could answer some questions for me about the filed of clinical psychology. I just need some basic info as to how you got into the career that you are currently in and what is required of a clinical psychologist. If it was not too much trouble could you please just send me some basic info on your field and some personal info as to why you chose this career . Any help you can give me will be greatly appreciated.

Sincerely,
Cameron

----

Hi Cameron,

OK, here's a quick perspective. I'm not sure if I'm helping with you here with a term paper or graduate school decision here, but here's a brief overview.

Clinical psychology has evolved as a specialty within psychology, which is very broad and basically covers the science of behavior and human mental experience. Psychology spans a broad number of areas, ranging from child development (thinking, language, etc.) through experimental and industrial psychology, and the study of human relationships, to name a few major aspects. Clinical psychology has become identified with the study, in clinical settings (laboratories and therapy sessions) of the individual human being, in all it's psychological manifestations-- intelligence, thinking (cognition and perception), socializing, and communicating, and a few other biggies in the area of clinical psychology.

In most states, "clinical psychologists" are licensed, at the doctoral level (Ph.D., Psy.D., Ed.D.) only after years of graduate training, and a one or two year internship in applied (i.e., clinical) settings, typically in hospitals, outpatient clinics, and other mental health facilities. There are relatively few clinical psychologists, among all the varieties of people you'll find who are working as "psychologists". Some have licenses or certificates which are for work in "exempt" settings like schools and government agencies, where they work only under supervision rather than independently.

In the old days (pre-1990's), clinical psychologists, some of whom also studied psychoanalysis (along with some psychiatrists), often enjoyed thriving practices with individuals and groups. Patients were covered for much of the cost by insurance companies, and research showed that providing mental health services was a cost-effective way to keep employees healthy, productive and happy. Lately, however, much has changed since health care has become "managed" by insurance companies, rather than left up to the doctors and therapists. But that's another story, about "managed care", which negatively affects health care by *all* our licensed mental health care professionals, not just clinical psychologists.

What else...you want personal info on what got *me* interested in clinical psychology and how I got into it?

OK, (are you writing my biography?)... Actually, you're helping me in return for my taking the time with this letter to you. I get asked "why" I got into psychology often, so unless you object, I'd like to post my response to you on my "Questions and Answers" page... You ask some important questions, so I'm trying to give you a thoughtful response.

Believe it or not, without getting *too* personal, I think I was interested practically since I was born (if not before), in psychology. I just didn't know what it was. Everything about people fascinates me. The way we talk, and walk, and express our feelings, and our ideas, to name a few things which are worthy of real reflection, for me at least. In junior high and high school, right after they invented the telephone, (that's a joke!), many of my teen friends would call me up, and say "I need my shrink!". They must've known something I didn't know. I guess I like to listen to people's stories. And people like to be heard. In high school I worried about normal high school stuff, dating, hanging out, being a rock star, things like that.

I went to college not really knowing what I'd be doing in 10 years, only where I'd be living for 4. But I sampled all kinds of courses my first year at a good liberal arts college, studying music and philosophy and psychology, mostly. And then I had PSYCH 101, and my life changed. In a humongous lecture hall, as we sat back in our seats the first of 3 professors taking turns teaching this class walked in front of the stage and to the lecturn. He calmly said "CS" and shot off a gun into the air. We all jumped. A minute later he did it again, and again we jumped. Finally he paused a moment and calmly said again "CS". We all cringed but this time he didn't fire the gun. He explained that we'd just been the subject of Pavlovian conditioning. The next professor did a crazy "turkey dance" onstage, and spoke about "species-specific responses". He'd been communicating a mating ritual, so it seems. The third professor talked about about mental processes, mental illness, and the history of psychological testing and psychotherapy. I was hooked.

It's not easy getting into Ph.D. clinical psychology programs, but I was determined to do it, after 2 years of getting a masters degree in "personality, psychopathology and psychotherapy", which was pretty useless, career-wise. I worked first as a volunteer, and then in a community for schizophrenics, where I was called a "social worker" and I ran a newspaper which was reported by, typed, and distributed by "de-institutionalized mental patients". I taught them how to work in corporate settings, and I produced music and photography in my spare time. (Hah! I dimly remember spare time.) And then finally, I was ready. I applied to a dozen or so programs and was lucky enough to have been accepted to several. In graduate school I focused on my continuing interests in psychotherapy, language, thinking, and interpersonal relationships. And my friends still refer to me as "my shrink". :-)

Beyond that, it's really irrelevant to your questions about my initial interest and how I got into it. I followed my heart and my instincts. I'd advise the same for you, be it clinical psychology, social work, art, or music or medicine...whatever. Do what you feel you're good at, or try out various things until one clicks. Sometimes it comes early, sometimes it takes a while. I had great experiences in psychology which didn't come until graduate school and internship. And I learn more all the time.

One other quick suggestion: There are many aspects of clinical psychology reflected across my web pages, but one in particular may be useful to your pursuit. The American Psychological Association has a great page about careers in psychology, and if your motivation lies in making a personal decision about clinical psychology versus another type of psychology (rather than psychologist versus NBA star, preacher or lawyer)...check out the APA website. It's grown very dense and sometimes the pages disappear, but here's a good start, at the APA site beginning with their description of the many divisions and programs within the field of psychology:      Divisions of APA

Good luck! I hope this answered your query and is useful.

--

UPDATE (2012)

I continue to read queries (in emails and online posts) about study in psychology, online and off. Here is my current short-version:

Clinical psychology is a fairly well known entity in the US, but can be completely different relative to other specialty areas in Europe and elsewhere. Within the U.S., clinical psychology Ph.D. programs are among the most difficult programs in terms of acceptance rates, usually with small programs and an emphasis on clinical and/or research skill-building on an individual level. Great for therapy, research or teaching, but a long road. Academic programs also include important topics such as social psychology (which looks at everything from social media to social trends, and how groups and systems shape behavior), industrial/organizational psychology, child/educational school psychology and more. I hear a great interest lately in 'cyberpsychology', and this seems to be on the way towards being a focus area but as yet is not widely offered as a specialty area of study. And there is statistics, tests & measurement, community psychology, developmental psychology, experimental psychology, cognitive science and brain specialization, and more.

My latest advice continues to be: familiarize yourself with "what's out there", and put some thought into what will be required in terms of time and cost, and what will be necessary to actually find employment where you want to live, doing something which you will find satisfying, maybe even fascinating and personally/professionally rewarding. I generally suggest, after narrowing one's interests and goals to match the landscape of what's available, supplement the guides by speaking with faculty and students from specific programs. To begin with, one can get a list of schools with APA-accredited programs (especially important for clinical psychology) and on the graduate level peruse the APA Guide to Graduate Study in Psychology. There are also, of course, lots of 'insiders guides' to campus life and so on.

While there is great interest lately in online education, some programs (and experiences) are still most powerful f2f - with classroom instruction, lab work, and practicum experience (with f2f supervision) all part of the training. There are some risks too, as many people are finding out, of doing online degree work only to learn that one's state of residence does not accept a given school's accreditation. Know these things in advance!

Online Therapy

QUESTIONS:

1. As a practitioner, what do you regard as the biggest challenge in internet counseling?

2. How would you deal with a client who expresses intent to suicide in his or her email? What are the steps an on-line counselor could do to resolve this issue?

3. As a licensed Psychologist in New York State, what is your take on the regulation that only licensed Psychologist of California could provide internet psychological services to residents of California?

Actually, I just finished a new article which I've been working on for a while now, and hope to publish within the next few weeks, specifically on the topic of "technical difficulties" with online work. (It's not quite ready to share, but focuses on issues of personality and behavior styles, technology, legal/ethical issues, phonemic versus textual processing, visual cues, and cognitive styles.) But I'll stick to answering your questions for now!

1. As a practitioner, what do you regard as the biggest challenge in internet counseling?

That's not so simple to answer, for a multitude of reasons, including that most of my work is still primarily f2f, as is most "counseling" or "therapy" nationwide and worldwide. I'll try to respond wearing my "practitioner hat" rather than my supervisor/researcher hat, with which I am doing a great deal of examination (with colleagues) regarding online work.

In general, most practitioners (but not all) regard the greatest limitation of pure online work to be the lack of visual cues, in particular. Research, moreover, suggests that e-mail lends itself to distortions of meaning, and is often so poor at expressing *nuance* (despite emoticons or parenthesized grins and so forth) that supportiveness may be interpreted as sarcasm, or humor/sarcasm as hostility, etc. I mention a (Harvard) study about email vs. phone vs. f2f negotiation outcomes in an article I wrote about the APA's Town Hall Meeting about "The Digital Crossroads", at http://www.fenichel.com/TownHall.shtml.

In essence, I see the biggest single challenge as the ability to become "in sync", therapist and client. Your predecessor at Columbia-TC, Carl Rogers, did some of the earliest basic research (with Truax) on the main ingredients of effective counseling, and came up with "warmth, empathy, and genuiness", often collectively termed "the nonspecific factors" of psychotherapy. Some argue that the use of e-mail is liberating, allowing for spontaneity and disinhibition, as the counselor doesn't see the client physically, and is less likely to be perceived as critical. (Not every f2f counselor, apparently, practices "unconditional positive regard"!) It is said that email communication also fosters "time compression" where people get right to the heart of the matter (without shame or self-consciousness) as it feels like writing a diary, and feels "safe". (Others, however, might argue, as I point out in my article, that this might also create or mask a "false identity", or maintain "as if" dissociative tendencies, or even positively reinforce "internet addiction" or social isolation. Even as it is sometimes noted that such online access may provide the *only* incentive to seek help from some who are geographically or socially isolated.)

So, all these big issues aside--and ignoring the fact that for some licensed professionals a big obstacle is also fear of doing something illegal or unethical--from a *practitioner* point of view, the biggest challenge is in establishing and maintaining a connection through the "threads" of dialogue, whether e-mail or chat-based, and building a relationship which feels genuine to both parties, and where the client also feels supported and hopeful based on what the counselor imparts. This requires to some extent, enough computer savvy on the part of both counselor and client so that the "communication" channel being employed is transparent, and not an obstacle. The human factor. It must feel natural, and not intimidating. In a best case scenario, having the written text can be an additional bonus, but in other circumstances it can be used like ammunition.

2. How would you deal with a client who expresses intent to suicide in his or her email? What are the steps an on-line counselor could do to resolve this issue?

This is a very hot and important issue. It is an ongoing topic of discussion in the peer supervision Case Conference Group co-facilitated by myself and Dr. John Suler. Many clinicians, including those of us who helped develop practice guidelines which relate to this concern, feel that it is imperative to have solid contingency plans established before undertaking treatment. (I am partial to having a good intake interview with new clients, and feel this is important in deciding whether online work would be appropriate.) Ideas that have been expressed include requiring the client to provide the name of a primary care physician (which many felt was too restrictive) and most of my colleagues feel strongly that there need to be emergency phone numbers exchanged before undertaking treatment with anyone. Tarasoff Law requires mandated mental health professionals to honor a "duty to warn" where possible harm to others appears imminent, and that is very difficult as well..... Sometimes it simply appears prudent not to take on high-risk cases online. (Others feel crisis work is perfect for the Internet. Still others vehemently defend the need for total anonymity.)

The short answer is, with a potentially suicidal client, I'd want to make sure all sorts of contingencies are in place, local to that client, as well as in regard to my own responsibility. I personally would not willingly take on an actively suicidal patient online. In fact, the most problematic aspect of doing online work in general is probably the issue of how to do an assessment without meeting face to face prior to "treatment". Of course, some people simply do "coaching" or help with self-help or advice...

3. As a licensed Psychologist in New York State, what is your take on the regulation that only licensed Psychologist of California could provide internet psychological services to residents of California?

Have you followed the very intense discussion about precisely this issue, on the ISMHO list-serv? Without going too far afield, the issue here is basically the right (or duty) of California to protect it's citizens from unqualified professionals. That's why lawyers, physicians, architects, and electricians (along with psychologists) are regulated. What is unique about the California situation is that the web page of the State Licensing Board for Psychology (but no other profession!) carries a statement to the effect that the provision of psychological services is limited in California to those licensed to provide those services in California. And, they explicitly state that therapists located elsewhere who appear via the Internet in California, must be licensed to practice there.

Well, the arguments go like this: If I'm in my office in New York, and someone from L.A. writes to me as a supposed expert in some area, and I offer to provide "psychological services" to this person, I might well believe that I am still in my office, at my own computer, in my own State, and so I am practicing here. California's interpretation says no, their resident is receiving the service there, which is being, in essence, imported into that State even though I've not gotten a license to provide the service there. (As Dr. Bob Hsiung likes to use as an analogy, municipalities do have the right to ban alcohol or whatever else from coming into their borders. In this case they're banning outside psychologist contraband, however.)

Some point out this is protecting their residents from harm by professionals their State is unlikely to prosecute (although States can "reach out" across borders on behalf of citizens). Legalists say, "Yes, only if the resident is harmed where he or she lives can they seek remedies from their own State government, while they're free to sue anywhere." Some professionals say, "C'mon, this is just a guild protection law which protects local professionals from competition, and doesn't protect the citizens, who remain free to leave the state and see professionals elsewhere of their own free will". So where exactly does the counseling take place? And what if you don't call it "counseling" or "psychological services", but offer "personal coaching" or advice, or consultation? Keep in mind, also, that "counseling" is not a protected professional title everywhere-- and that corporations and HMO's might be content to provide services by the least-qualified provider, and can simply elect not to use psychologists, or to set policies that they can only work within the state of their license.

My take is: I don't personally want to be the test case. I hear that often. (Actually, last week Yahoo! became that test, being sued by France, successfully, for providing Internet access to materials prohibited by French law. Their reaction, like some of the stalwart online therapists is, "let's see if they really have the power to enforce it".)

I am in favor of licensing to ensure qualifications of health professionals and other professionals. I argue for "license reciprocity" or "portability", appreciating that different states might have different requirements under law (e.g., in reporting abuse or threats of homicide), but believing that most states have similar professional standards and that often consumers are hurt rather than helped. (E.g., when they find professionals unwilling to help them out of fear another state will come after them, or a client will seek damages should something go wrong and it's learned the counselor is unlicensed in their state.) It's a quagmire. But one point of view is: Why not just practice as one always does, but within one's own State? Or get a few licenses if need be? (Simply add Internet communication to the telephone and office as possibilities!) Florida's nurses have an interesting licensing concept, which Dave Nickelson of APA calls the "driver's license" model, whereby it is assumed that when one is competent to drive in New York, they can also drive in California, or Florida, while passing through. They allow for temporary practice, similarly, for visitors in their state, recognizing that helping people may be similar across boundaries.

Perhaps more important than a professional's "right" to access populations in other states, it can be argued, is the consumer's right to know that the person they're trusting with their life is qualified, and accountable. (That's the consumer point of view!) I'd add that it might also be important to know that the counselor is well-trained and experienced in using the Internet as a tool.... Just as it is important to know that the consumer gives "informed consent" which verifies their comfort level with the technology, risks, and potential benefits. To quote the clothing store ad (Sy Syms), "Our best customer is an informed consumer". Which was the premise of APA's Dot.Com Sense brochure (a guide to consumers which unfortunately ceased being available online in Spring 2004).

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Questions - on "Suitability" for Online Treatment
(4-2001)

Dear Dr. Fenichel,

I am a student...researching a paper for Psych. Counseling theories. I decided to do this paper on Online therapy and have found your site after much research of one of your articles. I had previously e-mailed two therapists but had not received a reply. One of the questions on your site answered one of my questions. The other questions I would like answered are:

What types of therapy do you find suitable for the practice of Online Therapy?

What types of behaviors or problems of patients are best treated on the Internet? ie. Anorexia, Buliima. Obsessive Compulslve Disorder, Depression

thank you for your time - any response will be greatly appreciated

--Lillie D.V.

Psychoanalytic Theory

Interesting Topics