Today we are discussing whether it is true that online clinical work requires direct control by a clinician or therapist.
Clinical Counselling Versus Psychotherapy
Clinical counselling and / or psychotherapy are professional jobs, requiring a professional to carry out that work accurately, ethically and appropriately.
The aim of counselling is to return a client to pre-crisis functioning. Psychotherapy, on the [Face-to face therapy] other hand, is generally longer term and seeks to make changes to the personality structures of an individual. In particular how they relate to themselves, others and the world.
In both cases, for therapeutic change to occur, clients need to be able to 
contact their emotional experience and find ways to articulate, express and reflect on their experience. In doing so, they develop new personal meanings. So, any clinical work – whether face-to-face or online – needs a professional to guide this process effectively.
The Evolution of Online Evidence-based Treatments
In recent years evidence-based treatments have been repurposed for their delivery online. In some cases, these are completely self-administered and users have reported benefits from their use. In cases where the user also has additional support while engaged with the programme content, they actually do better. It is likely that human support with users improves adherence. Consequently, the user experiences more of the intervention, and therefore increases the possibility for positive outcomes.
Low Intensity Online Support Is Successful
There has been a lot of progress in the delivery of evidence-based interventions for depression and anxiety disorders that have used a variety of types of supporters. However, these are not clinicians, but rather psychological wellbeing practitioners or online supporters. They generally monitor the user and provide feedback and guidance on intervention use. This can be considered minimal support. They do not claim to carry on the same work as a fully qualified clinician, but they are a testament to the development of new models of service delivery that have evolved with the growth of internet-delivered interventions.
In other cases, graduate students from social work and psychology engage users as online supporters. While not fully qualified, they can bring some extra therapeutic benefit to their feedback and guidance for users.
The success of low-intensity support may indicate that when users are aware of the support level provided that they progress accordingly. The key differentiation is that between high-intensity and low-intensity interventions both require trained professionals or paraprofessionals to carry out that work accurately, ethically and appropriately.
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Myth Busted
Myth 6 busted! Fundamentally, the idea that all types of online clinical work require direct control by a fully qualified high-intensity clinician or therapist is simply not true. New models of service delivery and support have developed with the advent of e-therapy. While guidance has been demonstrated to improve user outcomes for online behavioural health and wellness programmes, those supporting the online user do not necessarily need to be qualified clinicians or therapists for retention to be increased and the programme to be successful.
