Because online therapy does not involve real-world interactions with clients, some ethical concerns become more complicated. Therapists should be sure to obtain informed consent from all e-clients and be cautious to respect professional boundaries. Informed consent is a legal procedure to ensure that a patient or client knows all of the risks and costs involved in a treatment. The elements of informed consent includes informing the client of the nature of the treatment, possible alternative treatments and the potential risks and benefits of the treatment.
Some questions you should asked 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 e-therapy sessions?
- How will you determine that goals have been met?
- What happens if you are unhappy with the services provided?
Duty to Warn
In addition to informed consent, therapists have a legal duty to warn. Duty to warn refers to the responsibility of a counselor or therapist to inform third parties or authorities if a client poses a threat to himself or herself or to another identifiable individual.
Legal duty to warn was established in the case of Tarasoff v. Regents of the University of California (1976), where a therapist failed to inform a young woman and her parents of specific death threats made by a client. The young woman was subsequently killed and her family sued the therapy provider.
Duty to warn can be especially problematic online, because a therapist may not even know a client's real name or geographic location. It is also difficult for therapists to gauge a client's potential for violence or self-harm because of the lack of body language and vocal cues.
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 difficult to enforce.
Ethical Codes for Online Therapists
- Psychologists Use of E-mail with Clients: Some Ethical Considerations
- APA Statement on Services by Telephone, Teleconferencing, and Internet
- Suggested Principles for the Online Provision of Mental Health Services
More About E-Therapy: The Advantages and Disadvantages of Online Therapy