It’s Gotten a Lot More Complicated: Ethics and Risk Management in the Age of Internet Communication and Information Technology

For the mental health practitioner, there have always been challenges in terms of practicing effectively and ethically. In recent years, these matters are more complicated than ever.

Technology has added the ability to communicate by visual access to voice across great distances, such as through Skype. That technology is more appealing for many psychotherapy clients than just using the telephone. However, even telephone-only therapy sessions may have risks involved, depending upon the circumstances.

A consistent emphasis of risk management and ethics pertains to privacy. The HIPAA focus on patient privacy is central. For example, the corporation that owns Skype makes no claim that it is HIPAA compliant in terms of privacy.

Privacy is also a key point in patient records. There is much discussion and considerable adoption of electronic medical records. However, practitioners and healthcare organizations must take great care that their electronic medical record management meets legal privacy standards.

Even though there are many clinical circumstances in which it would appear to make sense to conduct therapy sessions even with an older technology such as telephone, in some situations it could violate the law. For example, a practitioner may have a client who has moved out of state but wishes to continue therapy sessions by telephone. Chances are good that the practitioner is not licensed to practice in the state to which the client has moved. Therefore, depending upon the relevant state statutes and administrative regulations, the practitioner might be carrying out unlicensed practice in the state where the client resides. To be on the adequately cautious side, the practitioner may wish to contact the relevant licensing board of the state where the client lives to ask whether conducting sessions and their type of manner is permissible.

However, because a representative of that licensing board may not be a completely accurate source of information about that question, the practitioner should examine the matter further. More specifically, the therapist should find and read the relevant statute that governs licensing for that therapist’s mental health discipline to determine whether the phone therapy issue is addressed there. Also, there are likely to be administrative rules that pertain to that statute that would need to be examined in the same way.

Another important layer of complication in this matter of cross-state telephone psychotherapy is the matter of the health insurance company, assuming the client has been using their insurance and wants to continue to do so. A number of insurance companies simply do not pay for telephone sessions of any type, and others may make payment only under extremely unusual circumstances.

Obviously, a lot of communication that used to take place just by telephone now occurs via text or e-mail. A psychotherapy client might want to schedule appointments or even communicate about more substantive matters by e-mail with the psychotherapist. Once again, a core issue is the privacy and security of the e-mail.

Of course, other common Internet features, whether social media like Facebook or LinkedIn, or the fact that information about millions of people can be found just through a Google search, can complicate the patient-therapist relationship, often in awkward ways. Many therapists have commented that they have had clients who have asked to friend them on Facebook. Other clinicians have described that LinkedIn has presented them with unwanted opportunities to potentially connect with current or former clients. There have been discussions in the professional literature about ethical concerns versus possible clinical benefits of the therapist searching for online information about a client.