Ethical and Legal Issues In Online Therapy

Informed Consent and Duty to Warn

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Online therapy, also known as e-therapy, virtual therapy or internet/online counseling, among other names, is a fast-growing profession. Because online therapy does not involve real-world interactions with clients, however, some ethical and legal concerns become more complicated.

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 all of the risks and costs involved in a treatment. 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 Warn

In addition to informed consent, therapists have a legal duty to warn. Duty to warn refers to the responsibility of a counselor or therapist to inform third parties or authorities if a client poses a threat to himself or herself or to another identifiable individual.

Legal duty to warn was established in the case of Tarasoff v. Regents of the University of California (1976), where a therapist failed to inform a young woman and her parents of specific death threats made by a client. The young woman was subsequently killed and her family sued the murderer's therapist.

Duty to warn can be especially problematic online because a therapist may not even know a client's real name or geographic location. It is also difficult for therapists to gauge a client's potential for violence or self-harm because of the lack of body language and vocal cues if therapy is only conducted using audio without video.

Caution Is Important For Everyone Involved

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.

Therapists engaging in online or distance therapy need to be aware of security issues, such as the potential for emails to be read or video conversations to be hacked into. Because of these potential violations of privacy and confidentiality, therapists need to be very aware of the technology they are using and any potential limitations it may have and should also use software and applications that reduce the risk of a privacy breach.

They should also work to be on top of new technology that may better assist them in this endeavor.

Ethical Codes for Online Therapists

There aren't many accessible ethical guidelines on the internet; however, 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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