Ethical Considerations in Teletherapy

Long gone are the days when seeking mental health support required patients to sit face-to-face with counselors or therapists. Today, just as the rise of telehealth technology has made it possible to receive routine medical care without leaving your house, online therapy is changing the way people care for their mental health. Telehealth and telemedicine have transformed service delivery in healthcare, enabling remote access to care and reshaping how services are provided.

Whether you’re already working as a counselor or have plans to get into this important field, understanding some key ethical considerations, their implications, and teletherapy best practices is a must. An ethical framework is essential for guiding ethical practices in telehealth, ensuring that professional standards and moral principles are upheld.

Empirical evidence is essential for validating new approaches in telehealth and teletherapy.

 The Rise of Teletherapy and Ethical Implications

Before diving into telehealth ethical issues, legal issues, and legal and ethical aspects, it’s essential to understand the recent growth of teletherapy as an option for mental health treatment.

This rise brings new ethical implications, including relevant ethical issues and considerations grounded in biomedical ethics, which are key considerations in teletherapy.

 The Growth of Teletherapy in Mental Health

During the COVID-19 pandemic, the use of telemedicine spiked as people grew apprehensive about sitting in doctor’s office waiting rooms and potentially exposing themselves to illness. Telehealth's ability to improve access to care and enhance patient safety became especially clear during this time. As telemedicine technology rapidly improved, relevant technologies played a key role in enabling the expansion of teletherapy and its potential applications in mental health counseling and therapy were discovered.

Today, studies suggest that “this modality of therapy delivery is here to stay.”

Why Ethics in Teletherapy Matters

Ethics in therapy is critical, and this fact doesn’t change when mental health counseling goes digital. The foundation of ethical teletherapy is built on core moral principles such as autonomy, beneficence, non-maleficence, and justice, which guide professional conduct and decision-making. In fact, the virtual nature of teletherapy lends itself to a number of potential telemedicine legal issues and ethical challenges, particularly as they relate to confidentiality, client data, informed consent, and maintaining professional boundaries. More than ever, then, mental health counselors need to understand the importance of telehealth ethics, with autonomy often serving as the primary theme in telehealth ethical discussions, to provide the best care.

Key Ethical Challenges in Teletherapy

Challenges surrounding ethics in teletherapy are expansive, ranging from issues around client confidentiality and data security to licensing and jurisdictional obstacles, and also encompass the broader ethical aspects of telehealth practice. Failing to address these ethical challenges can lead to potentially negative consequences for both practitioners and clients.

Maintaining Client Confidentiality and Data Security

Teletherapy sessions are often held via live video chat or (in some cases) phone call, which requires careful handling of patient information and a strong emphasis on maintaining patient privacy. However, because these sessions may be held in a client’s home (where there may be other people around) rather than in a counselor’s private office, this can create confidentiality concerns. Likewise, when connections aren’t properly secured, this could lead to unauthorized access and further data privacy issues. It is essential to respect patient privacy in all teletherapy interactions to maintain trust and comply with ethical standards. Additionally, the choice and placement of telehealth equipment, such as videophones or cameras in the home, can impact privacy and confidentiality, so providers must ensure these devices are used appropriately to protect patient privacy.

Informed Consent in Digital Counseling

In therapy, informed consent is a critical process where mental health professionals provide patients with details about the potential risks and benefits of treatment, as well as goals and limitations. It is also essential to discuss available treatment options, ensuring patients receive comprehensive information about how telehealth technologies may impact care delivery and decision-making. On a digital platform, however, the informed consent process can be difficult because communicating the potential risks (including privacy concerns) is often more challenging in a virtual setting, and it is important to ensure the patient's ability to understand and participate in their care. Patients should also have a basic understanding of teletherapy processes, provider credentials, and the technology used to make informed decisions and engage effectively.

Managing Boundaries and Dual Relationships

Maintaining professional boundaries can also be challenging due to the nature of online counseling sessions. The health professional plays a crucial role in setting standards for appropriate conduct and ensuring clear boundaries are upheld. When distractions inevitably occur, teletherapists are tasked with establishing and maintaining professional boundaries and avoiding dual relationships with patients as much as possible. Telehealth practitioners must also be aware of ethical boundaries unique to digital settings, ensuring that principles such as autonomy and trust are respected. By maintaining these boundaries, teletherapists can enhance the overall patient experience in teletherapy, supporting patient autonomy and satisfaction.

Licensing and Jurisdictional Issues

Because teletherapy is still a relatively new concept, licensing and jurisdictional laws can be convoluted and confusing for mental health professionals. Professional organizations play a key role in guiding licensing and jurisdictional standards for teletherapy, helping to clarify requirements and advocate for consistent regulations. This may be especially true for counselors providing services to clients from another state or jurisdiction where laws may be different.

Crisis Management and Duty to Report

In a face-to-face setting, counselors have many resources at their disposal to intervene in crisis and emergency situations. Special considerations are needed for unwell or frail patients, vulnerable patients, and frail patients in crisis situations, as these groups may face increased risks and challenges adapting to telehealth technologies. Unfortunately, this isn’t the case with virtual counseling sessions, which can create challenges for therapists compared to in person care, highlighting the importance of face to face care and physical examination when teletherapy is insufficient. Some professionals may also have a more difficult time determining when they have a duty to report certain issues, especially since gauging a person’s mental state through a virtual therapy session can be challenging.

Best Practices for Ethical Teletherapy

With so many ethical issues surrounding teletherapy, telehealth practice, and the importance of maintaining high service quality, what telemedicine practice guidelines can mental health professionals follow in their work?

It is also essential to adapt clinical practice standards to ensure effective and ethical care in teletherapy settings.

Choosing Secure and Compliant Technology

First and foremost, teletherapists need to ensure that their virtual connections with clients (including video/voice software) are as secure as possible, and that it aligns with compliance laws and regulations (including HIPAA). Information technology plays a crucial role in enabling secure teletherapy by providing the infrastructure and security protocols necessary for safe remote care.

This can improve patient data privacy while giving clients added peace of mind in their interactions with teletherapists. Additionally, understanding telemedicine technologies and mobile health applications is essential for secure and effective care, as these tools require proficiency and awareness of their features and limitations to maintain compliance and ethical standards.

Establishing Clear Professional Guidelines

Despite the more casual nature of video chats versus in-person therapy appointments, teletherapists, along with other health care professionals, are still tasked with establishing clear professional boundaries with patients. This should include maintaining consistent routines in scheduling and carrying out appointments. Health care professionals must also provide competent care and provide clinical services in accordance with ethical standards to ensure patient safety and quality of care. Similarly, telehealth informed consent should include a detailed explanation of virtual therapy’s benefits and potential limitations.

Ethical Communication Strategies in Teletherapy

A lack of face-to-face, in-person interaction can present some unique communication challenges in a teletherapy setting. Effective patient-physician interactions are essential in teletherapy to build trust and ensure quality care. With this in mind, teletherapists should make every effort to minimize distractions in their own work environments prior to taking a call with a client. It is also important to handle individual health queries responsibly in digital communication, ensuring privacy and appropriate follow-up for each client's concerns. Video should be used whenever possible to enhance non-verbal cues and overall communication between therapists and clients. Clear communication is crucial for delivering care effectively in teletherapy.

Staying Informed on Ethical Standards and Legal Updates

Cross-jurisdictional issues and other legal updates can create challenges for teletherapists, which is why it’s so crucial for those in the mental health profession to stay informed on any changes as they occur and to follow appropriate protocols. In addition, transparency regarding financial or other interests is essential in teletherapy to maintain ethical standards and patient trust. Not only will this ensure that therapists are better informed, but it could also help them stay out of legal trouble and highlights the importance of taking steps to eliminate conflicts of interest. Physicians engage ethically with patients in digital settings by upholding transparency, managing conflicts of interest, and ensuring secure, competent care.

Preparing Graduate Students for Ethical Teletherapy Practice

As teletherapy inevitably continues to rise in demand, future generations of mental health counselors and therapists need to be properly educated and trained on ethical teletherapy practices, with a focus on understanding the unique needs and experiences of telehealth patients.

Additionally, the growing role of mental health services and health services delivered via teletherapy highlights the importance of preparing students to address diverse patient needs in remote care settings.

Integrating Ethics Training Into Counseling Education

While any reputable program will include some dedicated coursework on professional ethics, schools may need to revamp their curricula to include specific information and training on ethics in virtual therapy settings. Teaching an ethical framework for teletherapy is essential, as it provides a structured set of moral principles to guide students in navigating the unique challenges of online counseling.

Supervision and Mentorship in Digital Counseling

Meanwhile, ongoing supervision and mentorship opportunities could be extremely valuable to new mental health professionals navigating the complexities of virtual therapy. By seeing first-hand how to handle common ethical issues in a digital setting, mental health professionals can practice with greater confidence and have trusted resources for further guidance.

Additionally, effective mentorship and supervision in teletherapy can lead to improved clinical outcomes by supporting best practices, enhancing patient safety, and ensuring high-quality care.

Building Confidence in Ethical Decision-Making

Making ethical decisions is at the core of what therapists and counselors do on a daily basis. Prioritizing patient welfare is essential in all ethical decisions, as it helps maintain trust and ensures competent, transparent, and confidential care, especially in telehealth and telemedicine settings. However, ethical decision-making may not always come naturally and may instead require lots of practice, especially in virtual settings. This is where the right education can make all the difference in helping professionals in this field build their own confidence.

The Future of Ethics in Teletherapy

As telehealth technology continues to evolve, so do telehealth service and telemedicine services, bringing new ethical considerations and challenges. While nobody knows exactly what the future will hold regarding ethical codes, it is important to plan for future episodes of care, ensure continuity, and provide follow up care in teletherapy as the profession moves forward.

Adapting Ethical Guidelines for Emerging Technologies

As technologies emerge and make telehealth more accessible for many, mental health professionals may find that they need to revisit and revise their own ethical guidelines to match constantly. Unlike traditional care, teletherapy does not require the clinician and patient to be in the same physical location, and the physical location of each party can influence safety, ethical considerations, and the dynamics of the professional–patient relationship. This includes ethical principles set forth in the American Psychological Association’s code of conduct.

Expanding Access While Maintaining Ethical Integrity

Speaking of accessibility, this is another common issue in the emerging world of teletherapy. Some have made the argument that access to teletherapy is limited to those who can afford to pay for it, as not all insurance plans currently cover it, which may hinder efforts to promote access. There is also an ethical imperative to ensure equal access to teletherapy for all patient groups, so that disparities are addressed and fairness in healthcare delivery is promoted. At the same time, efforts to expand access could come at the cost of ethical integrity if the situation isn’t handled carefully.

The Ongoing Evolution of Ethical Standards

Ethical standards in therapy/counseling have evolved significantly over the years, especially with the introduction of technological advancements like teletherapy. As these standards continue to change, decision-makers must keep some core ethical principles at the forefront, including:

• Respect for patient autonomy
• Non-maleficence in client interactions
• Fair and equitable treatment of all clients

It is essential to place patient welfare at the center of ethical teletherapy practices. Addressing medical issues and adhering to medical ethics are also crucial to ensure safe, effective, and responsible care in teletherapy.

Believe it or not, it wasn’t until the early 20th century that some of the first ethical guidelines were set in the field. In the grand scheme of things, ethical standards in mental health counseling and therapy are still very much in their infancy and will need to constantly be updated to reflect the current landscape of the field. Therapists have a responsibility to provide clear information patients need for informed decision-making in teletherapy settings.

Learn More in a Counseling Program at IWU

As teletherapy becomes increasingly popular, counselors and therapists will need to be prepared to overcome the ethical challenges and obstacles that come along with using this format. By knowing how to maintain client confidentiality, manage boundaries, and handle other ethical issues in telehealth, professionals in this field can continue to provide the highest standard of care.

Interested in advancing your career in mental health counseling? Indiana Wesleyan University offers a number of graduate-level programs to suit your needs, including our Master of Arts in Marriage and Family Therapy and our Master of Arts in Clinical Mental Health Counseling. Both of these programs are offered in your choice of online or on-campus format, so you can choose the option that works best for you.

Learn more about any of our programs or explore everything IWU has to offer by getting in touch. Ready to get started? Feel free to complete your online application here!