Online Therapy Security, Ethics, and Legal Issues

Online therapy, also known as teletherapy, virtual therapy, or internet/online counseling, among other names, is rapidly expanding. Because online therapy involves patient-therapist communication via computers or mobile devices rather than through face-to-face interactions, security issues come into play that you otherwise wouldn't worry about.

Additionally, some ethical and legal concerns become more complicated with teletherapy. If you are getting started with online therapy, it's important to understand how a therapist or digital platform will keep your private information safe and follow all of the appropriate protocols.

Security

Therapists and patients engaging in online therapy need to be aware of potential security threats to data and private information, including:

  • Computer viruses
  • Hackers
  • Damage or theft of devices
  • Inadequate security systems or software
  • Unsecured electronic files
  • Phishing scams

As with any other common practice that has moved online in the digital age, such as banking or shopping, security and privacy must be top priorities for any telehealth services.

If you are seeking therapy, you don't want to have to worry about exposing information about your physical or mental health, your credit card number, or any of the private details you may share during a session.

Because of these potential violations of privacy and confidentiality, both therapists and individuals seeking therapy need to be very aware of the technology they are using and any potential limitations it may have. Both parties should do what they can to ensure that online therapy does not introduce any security-related stressors to the relationship.

Use safe, updated software and applications that reduce the risk of a privacy breach, and be aware of any new technology or online programs that may better assist you in this endeavor. As with any online activity, you must be extremely protective of your personal information, and not share anything private unless you feel comfortable that you and your therapist are using a safe, secure program.

Guidelines

The American Psychological Association provides specific guidance for therapists who use telecommunication to treat patients. Their advice—which can also apply to those using teletherapy services—includes the following precautions:

  • Do your best to understand the technology you are using, including any necessary security measures.
  • Take care with your use of social media, and be aware that even your search history is a potential security risk.
  • Know that electronic communication has a higher risk of being made public.
  • Use robust passwords, data encryption, and other similar security measures

Therapists are also encouraged to safely and securely destroy data and other private information when appropriate. And any platform must comply with the federal guidelines set by HIPAA.

If you are a patient, you may want to discuss these issues with your therapist to make sure that they are following safe technology practices, just as you would want a therapist to keep your in-person sessions safe and confidential.

Online Platforms

You may be accessing online therapy through a former in-person provider who has gone digital, but many people utilize subscription-based platforms like Talkspace and BetterHelp that can quickly and easily connect you to a therapist if you are in need.

Many of these platforms boast high-grade encryption services to ensure that your data will be protected. While doing your research, it's worth checking FAQ sections on these sites to see for yourself how your privacy will be protected.

It is still important, of course, to continue taking your own security measures, even if you fully trust the platform you're using. As more and more aspects of daily life move online, these strategies will be increasingly useful, whether or not you continue using online therapy.

Informed Consent

Therapists should be sure to obtain informed consent from all e-clients and be cautious to respect professional boundaries.

Informed consent is a legal procedure to ensure that a patient or client knows the potential risks and benefits of a healthcare intervention before giving permission for treatment or disclosing information.

The elements of informed consent include informing the client of the nature of the treatment, possible alternative treatments, and the potential risks and benefits of the treatment. These will be the same online as they would be in person.

Some questions you should ask before giving informed consent include:

  • What are the therapist's fees?
  • When are you expected to make payments?
  • Does your insurance cover any of the costs?
  • What results can you expect from your e-therapy sessions?
  • How will you determine that goals have been met?
  • What happens if you are unhappy with the services provided?

Duty to Protect

Although the therapist has an obligation to protect the patient's confidentiality, there are exceptions to this rule. This is described as duty to protect. The therapist may have an obligation to disclose or warn third parties if they feel the client presents dangers to another person (duty to warn), there are concerns for child or elder abuse, or the person poses a risk to themselves. It may be challenging for the online therapist to meet this ethical obligation where the therapist may not know the patient's real name or geographic location.

The Importance of Caution

While therapists can treat clients from all over the globe, they should adhere to the laws and ethical guidelines of the state or country where they are licensed to practice. Unfortunately, the global nature of the Internet can make codes of conduct difficult to enforce, so if you are thinking about using an online counselor, be sure to look into his or her certification and credentials.

Ethical Codes for Online Therapists

There are several professional associations that have posted ethical guidelines for telehealth. For example, the National Board for Certified Counselors (NBCC) is one licensing organization that adheres to a strict policy for counselors providing distance services. This policy and its list of standards can be found on their website.

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