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.
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.
The Rise of Teletherapy and Ethical Implications
Before diving into telehealth ethical issues and legal issues, it's essential to understand the recent growth of teletherapy as an option for mental health treatment.
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. As telemedicine technology rapidly improved, 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. 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 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.
Maintaining Client Confidentiality and Data Security
Teletherapy sessions are often held via live video chat or (in some cases) phone call. 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.
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. 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.
Managing Boundaries and Dual Relationships
Maintaining professional boundaries can also be challenging due to the nature of online counseling sessions. When distractions inevitably occur, teletherapists are tasked with establishing and maintaining professional boundaries and avoiding dual relationships with patients as much as possible.
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. 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. Unfortunately, this isn't the case with virtual counseling sessions, which can create challenges for therapists compared to in person care . 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, what telemedicine practice guidelines can mental health professionals follow in their work?
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). This can improve patient data privacy while giving clients added peace of mind in their interactions with teletherapists.
Establishing Clear Professional Guidelines
Despite the more casual nature of video chats versus in-person therapy appointments, teletherapists are still tasked with establishing clear professional boundaries with patients. This should include maintaining consistent routines in scheduling and carrying out appointments. 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. 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. Video should be used whenever possible to enhance non-verbal cues and overall communication between therapists and clients.
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 . Not only will this ensure that therapists are better informed, but it could also help them stay out of legal trouble.
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.
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.
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.
Building Confidence in Ethical Decision-Making
Making ethical decisions is at the core of what therapists and counselors do on a daily basis. 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, it is likely that additional ethical considerations and challenges will arise. While nobody knows exactly what the future will hold regarding ethical codes , there are some things worth keeping in mind 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. 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 . 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
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.
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!
Sources
https://www.indwes.edu/program/ma-counseling/marriage-and-family-counseling/
https://societyforpsychotherapy.org/the-evolving-nature-of-the-ethical-practice-of-psychotherapy/
https://pmc.ncbi.nlm.nih.gov/articles/PMC6493245/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10172520/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7493571/
https://www.indwes.edu/program/ma-counseling/clinical-mental-health-counseling/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9162131/
