I attended Lisa Erickson's Professional Ethics & Technology workshop today, sponsored by Cascadia Training. Here's what I came away with:
Skype, the computer phone and video-phone service, is encrypted and hard to break into. If Skype's employees wanted to listen in, they could. But why would they?
The picture can freeze, fragment, or lag. You can't do eye contact. And it's still often better than the phone because you can see each other.
If you are "skyping" or emailing a session, have a back-up plan in place (like the phone) in case the technology fails.
Many of us in the workshop wouldn't use Skype for regular sessions, but would use it for sessions if the client or therapist was out of town. Some do and many would use it for consultation or supervision.
You can only legally do long distance psychotherapy if the client resides in a state in which the therapist is licensed.
Add a new section to your consent form stating your rules about technology. For instance:
- I never "friend" anyone who is or has been a client of mine.
- Email is not 100% secure. Email security can be breached. My email policy is this: Either: "I don't do it with clients." OR "You may email me only for changes of appointment." OR "You may send me emails to update me on your status, but I don't return them." OR "I will try to respond within 24 hours, but if I don't, please call me on the phone, because I may not have gotten the email." And/OR "I will charge $2 per minute for reading and responding to any email longer than one brief paragraph." (With some clients who seem to want to move the therapy to email, I stop accepting emails except for appointment changes.)
- "Please do not send me emails, or Skype me from any place that is not secure and private, including the library, an internet cafe, your job, or any public network or place. I don't want your confidentiality breached."
- "If you want to show me something on Facebook or your blog or any other social media, you can show me during our session from your account or print it out for me. I want to be sure to protect your privacy, even from me."
- "I don't google my clients, so if you want me to know something, tell me."
- "Since we live in different areas and do therapy through the computer, I will provide you with a list of emergency services available in your area."
- Conversations by cell phone or cordless phones may be picked up by people in the area. The only completely safe phone call is from one old-fashioned corded phone to another. When we have a phone call, be sure that you can't be overheard.
Other random issues
- Online or phone sessions are not covered in 39 states. Telemedicine is covered in the other 11, and it's unclear if therapy is "medicine" in all of them.
- On your website, provide links to relevant state licensing boards to protect your clients' rights.
- Make sure you do online work with people who have the equipment, technical savvy, access, and ego strength to do it well.
(a few of the many that Lisa Erickson gave us)
M. Maheu has a great technology/therapy blog: http://telehealth.net/blog/
Mahue, Pulier, Wilhelm, McMenamin, & Brown-Connolly (2005) The Mental Health Professional and the New Technologies
metanayoia.org: Safeguarding Patient Confidentiality in email.