E-Therapy and Online Counseling Ethics in 2022: Navigating the Evolving Landscape

This podcast episode, hosted by Dr. Donnelly Snipes, provides a comprehensive overview of the ethical considerations and practicalities surrounding e-therapy and online counseling in 2022. It highlights the significant shift in state board regulations since 2020, making e-therapy more mainstream and accessible, while emphasizing that it's not a one-size-fits-all solution. The discussion meticulously outlines the differences between e-therapy and traditional face-to-face counseling, delving into the benefits such as increased access to specialized therapists, cost-effectiveness, convenience, and a degree of anonymity, particularly for clients in rural areas or those with mobility issues. It also acknowledges the preference for e-therapy among younger demographics who are accustomed to technology-mediated interactions.

However, the episode equally stresses the critical drawbacks and challenges inherent in virtual practice. These include the initial setup costs and technical know-how required, the absolute necessity of Business Associate Agreements (BAAs) for all third-party services, and a thorough understanding of HIPAA and HITECH regulations to ensure client confidentiality and data security. Dr. Snipes points out the difficulties in crisis management, assessing client decompensation, or detecting substance influence remotely. Concerns are raised about the potential for session capture and redistribution, unique risks in domestic violence situations (e.g., keyloggers), and the reduced effectiveness for cultures relying heavily on high-context communication where non-verbal cues are paramount.

The presentation further details crucial considerations for determining client appropriateness for e-therapy, examining factors like technological comfort and access, cognitive capacity, maturity, and the nature of past and current medical or behavioral health diagnoses (e.g., psychosis, substance abuse, eating disorders). It underscores the importance of a robust client support system and a clear safety plan, especially for individuals with trauma or a history of self-injurious behavior. While acknowledging research supporting e-therapy's effectiveness for conditions like GAD, depression, and PTSD, it advocates for video-based modalities over text or email for richer communication.

Finally, a significant portion of the episode is dedicated to the expanded requirements for informed consent in telehealth services. This includes explicit discussions about potential misunderstandings in text-based communication, cultural and language differences, response times for asynchronous communication, time zone discrepancies, and a clear social media policy. Therapists are advised to include their credentials, physical practice location, and contact information, along with alternatives to e-therapy. Crucially, clients must be informed about internet security practices (like clearing cache/cookies), the dangers of public Wi-Fi, and the implications of using work computers for personal communications, ensuring they are fully aware of the risks and responsibilities associated with virtual engagement.

"many of the state boards that used to either prohibit or greatly restrict what they considered ethical for e-therapy they've changed their codes and guidelines."

"you need to be licensed in the state in which you are residing so if you're in tennessee you need to be licensed in tennessee and licensed in the state in which your client is."

"The American Counseling Association and others have been working really really hard over the past couple of years to put together something called the counseling compact."

"when it comes to technology-based counseling you have to be aware of not only hipaa which most of us know but also high tech."

"Research has indicated that people are generally more open when they're in their comfort zone they are not feeling like they are a you know lab rat on on display."

"With e-therapy it can be more difficult to handle crises and identify when somebody is decompensating cognitively or emotionally."

"All motivate therapy can be captured and redistributed it's important to recognize this somebody can have a screen capture running on their computer while you are talking to them."

"e-therapy is not as effective according to tip 60. it is not as effective with cultures that use high context communication."

"You must include a paragraph about the possibility of misunderstandings particularly with text-based forms of e-therapy."

"It's important to make sure that the person knows that you will not be friending them on social media."