Ethics of E-Therapy

With the growth of the Internet and related technologies, “E-therapy” and all of its derivations are only going to expand in use, and so the ethical implications are something that we should all look into. I personally was inspired by the article, “So wat do u want to wrk on 2day?”: The Ethical Implications of Online Counseling, by Christina M. Rummell, Nicholas R. Joyce. I am actually considering incorporating some type of digital therapy in my career at some point. I hadn’t really ruled it out before, but I didn’t take it too seriously. Now, I think that there may be some interesting and useful aspects to it.

The article directly addressed some of the main assumptions that I had when approaching this issue for the first time. The main thing being that doing therapy over the Internet seems to lose something that one has in a person-to-person live interaction. And researchers were cited in the article that felt like this was the case. For example, unless one is using synchronous video chatting, the therapist can’t really assess the non-verbal behavior of the client as can be done in their actual presence. But, interestingly, others argued that using only text to do therapy may have certain advantages, because of this lack.

This viewpoint was counterintuitive to me at first, but afterwards I felt persuaded. The basic idea is that, while clients could definitely lie or fail to express thoughts or emotions in their messages, the upside is that therapists don’t have to worry about being biased or misled by non-verbal behavior that is being analyzed on the fly in the real therapy room. If the interaction is asynchronous, that is, in the way that email or text messaging is done, where the therapist and client respond to each other at their own time and pace, then the therapist also has time to think further about what they will say back to the client, potentially leading to more effective therapy. In this sense, the therapy is more coordinated and less “improvised” and time-pressured.

The obvious downsides of this, despite much therapeutic efficacy (which is supported by research on e-therapy), are the issues related to confidentiality. The client could be lying, acting as a different person, etc. Also, the messages, texts, videos, or any other recordings of the therapeutic interaction could be saved and used in an unethical way. This rings true to me, but as the article mentions, I think that this fear is not too far away from the regular concerns of “physical” therapeutic practice. Yes, the client will also now have more responsibility to delete files or do whatever with them. But with proper precautions, I think this process could go as smoothly as any other traditional form of confidentiality practice.

Another thing that is potentially hazardous in this realm is the potential for clients who are reporting suicidal or abusive issues. The therapist would have to have information beforehand, such as an awareness of the client’s physical location and perhaps telephone number, so that the therapist could contact the necessary authorities in the area if someone needs to get to the client immediately. I think this is a real concern, but again, this issue shouldn’t blind us into thinking that we should avoid e-therapy type practices altogether. The therapist should simply take the necessary steps in order to prepare for such situations. Yes, they are a little bit different from being in the physical therapy room, but one just needs to make a couple of preventative choices as the therapist before starting such a venture.

The view of the luddites and traditionalists in this area claim that the ethical and professional implications of doing therapy through the Internet are just too qualitatively different to even consider. To them, the therapeutic relationship is sacrificed, and the ethical problems aren’t worth it, anyway. The prospect, and current reality, of e-therapy stretches some issues, yes. For example: client identity and confidentiality, the possibility of the client being in one state and the therapist in another, hence crossing state laws, and the need to be able to access the client in a state of emergency. The NBCC and ACA have taken affirmative, proactive movement on this issue and setup guidelines for e-therapy. Other mental health professional organizations such as APA, have been silent, and the Clinical Social Work Federation (CSWF) has actually pronounced its opposition to the practice. My view, and the conclusion of the article, is that the position represented by the CSWF is essentially backward. The ethical differences between e-therapy and traditional face-to-face therapy are not so much qualitative as they are quantitative. The same issues are there as they were before, but we just need to learn to change what we do to fit the changing technological landscape. We will find solutions, and e-therapy is going to be a part of the future of counseling.

References

1. “So wat do u want to wrk on 2day?”: The Ethical Implications of Online Counseling. Christina M. Rummell, Nicholas R. Joyce
   Ethics & Behavior
   Vol. 20, Iss. 6, 2010