Communicating with your Counsellor Online: Ethical Concerns

Have you ever emailed your counsellor? What about your kid’s teacher? Last fall, I took an eye-opening course on Cybercounselling. In the process, I gained a much clearer understanding of the ethical concerns associated with communicating with your counsellor (or kid’s teacher) online. Twenty-three years ago, in 1994, the head of the school Lawrence Murphy founded Worldwide Therapy Online. In 1998, together with with the National Board for Certified Counsellors, he created a distinct code of ethics “to address the unique situations created by Internet technology”. (Wow. I didn’t even have a computer in my office yet!)

The Backstory

You’ve come a long way, Internet.

Way, way back in 1995, as a fresh young graduate starting out in addictions counselling at a non-profit society, I didn’t even have a computer on my desk. Rather than emails, we copied interoffice memos and stuck them in our colleagues’ mailboxes. Sometimes, when I tried to reach a client, they didn’t even have an answering machine. Remember those days?

Flash forward about five years later: I have a memory of sending a quick email to a colleague, hearing an email ding, then looking up from my computer and catching her eye. Turned out she and I both had our office doors open. (We were across the hall from each other.) We both burst out laughing at the absurdity.

In the last decade funding sources slowly dried up and caseload pressures grew stronger. And yes, I took shortcuts. As email found its way into almost every home, it also became a very efficient time-saving tool in communicating with clients. The purpose of emailing may have been to share a resource, book an appointment time, or even respond to a concern or question. I simply did not have the time to deal with all of these communication needs by phone.

The thing is, I am not alone. “It is more than hyperbole to suggest that the use of insecure email by professional clinicians may be the single most ubiquitous breach of ethics in the history of psychotherapy” (Murphy, Cybercounselling Level 1 class, Worldwide Therapy Online Inc., September 2016).

So, you and your counsellor are communicating online. After all, that’s the world we live in now! Maybe you are getting some counselling, or maybe you are just scheduling your next appointment. What are the ethical considerations you need to think about?

Communicating by Video 

Many sources equate online counselling with Skype. Many counsellors are offering Skype counselling as a way to make things easier on some clients. If your counsellor is using Skype, are you aware that Skype is licensed for personal use only, not for business? Check your terms and conditions. Both of you have agreed (when you first signed up) that Skype can review content at any time. Or, your counsellor may use Skype for Business (launched in 2015). If so, you may want to ask her how its integration with MS Office impacts how data is shared between the programs. For example, are contact names shared?

In addition to privacy concerns specifically related to Skype, there are other ethical considerations that stand out. I have seen a counsellor’s web page that advertises their Skype sessions as “just like real life”. This is a misnomer. For example,  you may have noticed that it is difficult to meet the eyes of the person you video chat with. How do you hold a therapeutic conversation when the other person is looking at your chest the whole time?

There are also space and lighting concerns to think about, as well as technical! When we meet over video, where am I in your space? What can I see and hear in the background? How does the lighting and/or video quality impact my impressions of you?

Communicating by Email

Further considerations unique to email exist, especially if you are going to communicate with your counsellor through regular, non-encrypted email. They will not protect you completely but may go a little way towards keeping you safe.

  1. Avoid giving away personal information and/or names of individuals in the subject heading. (As a parent, I have been guilty of using my child’s name in the subject heading when sending an email to their teacher!)
  2. Avoid discussing anything personal, especially information that may be damaging, in the content of regular email communication. Once the two of you have developed a rapport (and given the informal tone of many emails), this can easily happen without thought. You need to know you are then making yourself vulnerable.
  3. Look for a counsellor that uses a generic domain name that does not immediately reveal their role. Eg. kirsten@kirstenluise.ca, rather than kirsten at rainstormcounselling dot com.

BEST PRACTICE: Look for a counsellor that provides secure, encrypted email that allows you to talk more privately!

Speaking of Encrypted Email…

My Cybercounselling teacher has said it is a breach of ethics to use regular email for any communication with clients. A conversation about an appointment time can easily slip into sharing information about something upsetting that happened that day. You may want your counsellor to be aware of it. After all, they are supposed to be a safe person for you to talk to, right?

“The rationale for encrypted email requires no more comment than does the rationale for a locked filing cabinet in a face-to-face counselling office” (Ibid, September 2016).

Very simply put, the web may route any email from within Canada through the US on particularly busy traffic days. Once it reaches the US the USA PATRIOT Act (and related legislation) applies. This is still the case even if you are sending elsewhere in Canada, and using a Canadian based email company. If you are using US based company such as Gmail, or Yahoo, the same American legislation automatically applies. It is not going far enough to exchange confidential information through regular email as long as they give informed consent. It is not going far enough to provide a warning in small print at the bottom of your email. The issues are too complex; we cannot be properly informed.

“It is akin to telling a client that you might break confidentiality ‘if bad stuff happens’ and then assuming they understand that disclosure of child neglect will lead to them being reported” (Ibid, September 2016).

Finally …

Online counselling goes by many different names: telemental health, cybercounselling, online counselling, e-counselling, and more. In all types, there are ethical concerns that cross the modes of communication. Whether it is by email, phone or video, you need to consider who else in your world can see and/or hear. Does anyone else know your password? Is there someone in the next room that you don’t want to hear you?

Working online can be notoriously unreliable. What if the application goes down? What if your account locks you out? What if there is an emergency? What if a space of time goes by when I don’t hear from you? Both of you need to have phone numbers you can use for backup, or in the event of an emergency. For crisis counselling, getting services online may or may not be the right choice. All of these things need to be considered carefully.

The new frontier, (especially for counsellors who work with young people) is communicating with each other by text. All of the above ethical concerns still apply. Free encrypted texting and email products are commonly available. (Most systems require both parties to sign up in order for the exchange to be encrypted.)

Are you feeling worried now?

Despite all these concerns, I am still a big believer in this form of therapy. (Check out another blog post I wrote to learn more about that.) When I started Rainstorm Counselling & Consulting I researched the various choices. Currently, I use Proton Mail for email and Signal for texting. (Communicating by video seems to be another matter. Several choices exist but they all cost money. Video counselling is coming soon!) Contact me if you have further questions about what I learned in my consumer research. If you are interested in getting training yourself, check out Therapy Online. This article only covers a small amount of what there is to learn.

A CBC article shows that more Canadians are worried about their privacy online. How about you? Do you communicate with your counsellor online? Have you ever tried out encrypted email?

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