Online Therapy: Security, Ethics, and Legal Issues

Online therapy, also known as teletherapy, virtual therapy, or internet/online counseling, among other names, rapidly expanded during the COVID-19 pandemic, and it continues to grow. Because online therapy involves communication via computers or mobile devices, it has security issues that are different from face-to-face therapy.

Additionally, some ethical and legal concerns become more complicated with teletherapy. If you are getting started with online therapy, it's important to understand how a therapist or digital platform will keep your private information safe and follow all of the appropriate protocols.

This article discusses the ethical, legal, and security issues related to online therapy. It also discusses some special concerns including recent changes due to world events.

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Is Online Therapy Secure?

Therapists and patients engaging in online therapy need to be aware of potential security threats to data and private information, including:

• Computer viruses
• Hackers
• Damage or theft of devices
• Inadequate security systems or software
• Unsecured electronic files
• Phishing scams

As with any other common practice that has moved online in the digital age, such as banking or shopping, security and privacy must be top priorities for any telehealth services.

Because of these potential violations of privacy and confidentiality, both therapists and individuals seeking therapy need to be very aware of the technology they are using and any potential limitations it may have. Both parties should do what they can to ensure that online therapy does not introduce any security-related stressors to the relationship.

Use safe, updated software and applications that reduce the risk of a privacy breach, and be aware of any new technology or online programs that may better assist you. As with any online activity, be extremely protective of your personal information. Do not share anything private unless you feel comfortable that you and your therapist are using a safe, secure program.

Guidelines

The American Psychological Association provides specific guidance for therapists who use telecommunication to treat patients. This advice—which can also apply to clients using teletherapy services—includes the following precautions:

• Do your best to understand the technology you are using, including any necessary security measures.
• Take care with your use of social media, and be aware that even your search history is a potential security risk.
• Know that electronic communication has a higher risk of being made public.
• Use robust passwords, data encryption, and other similar security measures.

Therapists are also encouraged to safely and securely destroy data and other private information when appropriate. And any platform must comply with the federal guidelines set by the Health Insurance Portability and Accountability Act (HIPAA).

If you are a patient, discuss these issues with your therapist to make sure that they are following safe technology practices, just as you would want a therapist to keep your in-person sessions safe and confidential.

Online Platforms

You may be accessing online therapy through a former in-person provider who has gone digital. Or, you may use a subscription-based platform like Talkspace or BetterHelp that can quickly and easily connect you to a therapist if you are in need.

Many of these platforms boast high-grade encryption services to ensure that your data will be protected. While doing your research, it's worth checking FAQ sections on these sites to see for yourself how your privacy will be protected.

It is still important, of course, to continue taking your own security measures, such as using a strong password and changing it often, even if you fully trust the platform you're using. As more and more aspects of daily life move online, these strategies will be increasingly useful, whether or not you continue using online therapy.

Technology Challenges

Teletherapy is more accessible and convenient for many. Still, it also presents challenges for people who lack technology skills or do not have access to the resources needed to attend therapy sessions. Access to private spaces and internet services can also be more challenging for vulnerable or underserved clients.

This can be a particular concern among older adults. Lack of digital proficiency is frequently a barrier to telehealth services for people in this age group.

The American Psychological Association suggests that online therapists can combat this issue by partnering with community organizations. These organizations can offer private spaces with secure internet connections and technology so that clients can attend online therapy sessions. 

Ethical Codes

Several professional associations have posted ethical guidelines for telehealth. For example, 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.

Informed Consent

Therapists must obtain informed consent from all teletherapy clients. They must also take care to respect professional boundaries.

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 online therapy sessions?
• How will you determine that goals have been met?
• What happens if you are unhappy with the services provided?

Duty to Protect

Although the therapist has an obligation to protect the patient's confidentiality, there are exceptions to this rule. This is described as duty to protect. The therapist may have an obligation to disclose or warn third parties if they feel the client presents dangers to another person (duty to warn), there are concerns for child or elder abuse, or the person poses a risk to themselves.

It may be challenging for the online therapist to meet this ethical obligation if the therapist does not know the patient's real name or geographic location. If you or a loved one is seeking online therapy, it is important to balance the need for privacy with safety concerns.

Changing Guidelines

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 challenging to enforce, so if you are thinking about using an online counselor, be sure to look into their certification and credentials.

While states have differing laws, many specify that therapists must see clients within the state where they are licensed. Many states temporarily suspended these requirements due to the COVID-19 pandemic. With many of these changes now expiring, some clients may have to change therapists in order to conform with state guidelines.

A practice agreement known as the Psychology Interjurisdictional Compact, or PSYPACT, may change this. It is an interstate licensing agreement that allows therapists to practice remotely across state lines in those states participating in the agreement.

PSYPACT reports that 30 states have now enacted legislation to allow the interstate agreement, and more are in the process of enacting or introducing it. 

A Word From Verywell

Online therapy is here to stay. During the pandemic, 98% of therapists practiced teletherapy. However, many online therapists have knowledge gaps, indicating a need for specialized training and education for more effective online therapy.

If you are interested in online therapy, spend some time researching your options. Learn more about the platforms and technology that online therapists use as part of their practice.

The U.S. Department of Health & Human Services maintains a list of HIPAA-compliant video communication products that online therapists and potential clients can consult. Using such tools can help safeguard privacy and safety, but it is also up to therapists and individuals to protect their personal information.