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Myth 5: Online mental health services are unaffected by geography

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    May 28, 2014

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    mental health, digital therapy, Cognitive Behavioural Therapy

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May 28th, 2014 – At first glance, therapy services provided via the internet might appear to be unaffected by geography. It doesn’t matter where you are located, if you can access the internet, you can access the majority of pages and the services they may offer… surely? The internet is ‘anytime/anywhere’!

No. This is not the case. Online mental health services must adhere to the laws and industry regulations associated with the client’s geographic location; especially those that involve the participation of a licensed practitioner.


The Internet does not explicitly recognise territorial limitations. Internet users, on the other hand, remain tied to a physical jurisdiction and are therefore subject to the laws relating to that geographical location. So, in theory, a user in one country, conducting a transaction with another user in a second country, through a server in a third country, could be subject to the laws of all three countries throughout any online transaction.

The non-geographically specific structure of cyberspace raises judicial issues and this has resulted in an ongoing global debate. It has been suggested that the Internet should be self-regulated as an independent ‘trans-national nation’, but these laws are still under discussion.

Scope of Practice

In the meantime however, Scope of Practice laws are clear and apply online as well as off.

“Scope of Practice indicates the specific area to which a practitioner may practice. Scope of practice in many geographic areas also defines where a practitioner may practice; whether the practitioner may practice across various geographical boundaries and within what parameters a practitioner may practice. Practitioners also follow local and regional laws and codes of ethics as applicable.” Excerpt from the Online Therapy Institute website, Ethical Training

In the United States, for instance, a licensed practitioner may only be legally entitled to interpret certain personality tests in some states and not others, due to the legalities specific within those states. In California, it is illegal for any practitioner to counsel state residents unless they are licensed in California.

In Europe, however, freedom of movement and the right to work anywhere in Europe is a key EU objective. Cross-border health care is supported by a patient’s right to choose their own provider, even if that means going beyond national borders. Transnational counselling is supported throughout the European Union (EU) by the European Commission’s (EC) Professional Qualifications Directive 2005/36, which recognises professional qualifications across EU countries, allowing therapists (among other professions) to practise on a temporary basis in another EU country. This, of course, includes online counselling. It should be noted however that European law regarding which type of information practitioners must furnish to the patient health record may differ from one country to another.

While the European Union is working to support professional migration, it is important for practitioners to understand and respect the specific laws and limitations of a potential client’s geographic location on a global scale. This is particularly important in online situations, where geographic boundaries can be fuzzy. Scope of Practice law relates to the location of the client.

Myth busted

Myth 5 busted! While offering far greater accessibility in terms of both time scheduling and geography, than traditional face-to-face therapies, online therapies are subject to some geographic limitations. For now, national jurisdiction must be considered for all nations involved in any service transaction, but clinicians can glean the most straightforward understanding of their limitations through practitioner licensing law rather than cyberlaw. Luckily however, national jurisdiction throughout the European Union does cater for cross-border professional practice within Europe itself.

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