The internet has provided an avenue where individuals can communicate across the globe, share ideas and acquire goods and services. The ubiquitous nature of the internet community presents an opportunity through which counsellors can also provide psychotherapy for individuals with emotional, spiritual, psychological as well as physical problems. Tele health is continuously growing as more people become connected through devices such as phones, tablets and computers (Bertholet et al, 2015). While some counsellors and clients may have a higher preference to online counselling in comparison to the face-to-face approach, a number of ethical issues arise with regard to use of online counseling. As much as use of technology could be more appealing and convenient, issues related with technology itself such as confidentiality, security and privacy undermine the use of online counselling (King, 2009). Additionally, online counselling may have a limited focus, fail to utilize non-verbal cues, and have a shallow scope in establishment of therapeutic alliance by building a strong counsellor-client relationship.
A huge number of individuals have been beneficiaries of online counselling. These include people affected by post-traumatic stress disorder, anxiety disorders, depression and many others (Barros-Bailey & Saunders, 2010). Despite the existing impediments of online counselling, the success of the sessions highly depend on the qualification of the counsellor and the willingness of the client to regain mental health. According to Shaw and Shaw (2006) there is a specific challenge, however, when the using such services because the client may not be able to verify the qualifications of the counsellor. Hence, most people suffering from psychological disorders may fall into the trap of unscrupulous online users who may masquerade as counsellors only to financially extort these vulnerable individuals (Ross, 2016). It is therefore upon the counsellors to comply with the ethical guidelines for online counselling and expand their research on appropriate application and practice of online psychotherapy.
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It is important not to overlook the benefits of online counselling. Online therapy has been shown to as effective as face-to-face approach in tackling problems related to depression, eating disorders and anxiety (Barros-Bailey & Saunders, 2010) In places where physical access to a qualified psychotherapist either due to limited number of professionals or remoteness, online counselling can suffice. Homebound patients who may have limitation of movement due to physical or psychological issues can also benefit largely by use of online counselling. Couple and family counsellors find it more convenient to offer their services online because they allow for flexibility of schedules. However provision of these services creates an environment where several ethical issues may arise with regard to confidentiality.
Confidentiality is a sensitive issue in which users of any technology must be cognizant about. Use of cellphones, tablets, computers and other communication devices exposes the client information to a number of risks. The confidentiality may be breeched in the case of leakage or eavesdropping of the conversations by third parties. Barros-Bailey and Saunders (2010) state that auditory confidentiality issues revolve around the possibility of a third party listening to the conversations between the client and the counsellor during the sessions. In addition to this risk, there is also a possibility of breech of visual confidentiality in cases where the email trails, text messages, videos and other private client information may be viewed by another individual (Tossmann et al, 2011). Keeping electronic records of the client information and communication via computer networks also vulnerable to cyber related attacks such as malware, spoofing and sniffing. There is the need for counsellors to weigh the risks versus benefits of staring online counselling services in as far as patient confidentiality is concerned (Hertlein et al, 2015). Protection of client information must remain an integral measure in all engagements so as to ensure trust and for medico-legal purposes. Furthermore, clients must remain conscious of the risk of exposing their sensitive information to other online users.
Online counselling involves getting into close contact with the client and sometimes this may involve linking with clients via social networks such as Facebook, Twitter, Myspace and many other sites. As King (2009) notes, such a contact may lead to realization of the client information they may not have disclosed before during the counselling sessions. The approach of the counsellor towards this additional information that they may come across presents an ethical dilemma. In as much as the counsellor may find this out in good faith or coincidentally, whether they should use this for the benefit of the client or totally disregard it is an issue that may bring a misunderstanding (Haberstroh et al, 2014). In much as the relationship between the client and the counsellor should remain private and confidential, this may breeched when the curiosity of other close friends of the clients drives them into prying such relationship via social media circles.
Further, counsellors may have the challenge in determining the appropriateness of a client for online counselling as some of them may harbor life-threatening issues such as suicidal tendencies. Assessment of the client’s ability to distinguish and appreciate the value of maintaining professional boundaries, the extent of their illness and whether the client is likely to turn homicidal may be difficult via use of online means (DeZee 2t al, 2013). Misdiagnosis is also likely to occur given that there is lack of physical touch is crucial for complete evaluation of a patient. Online counselling may presents concerns with regard to the 1996 Health Insurance Portability and Accountability Act. What happens when a client and the counsellor engage each other outside the legal areas of licensure still remains unclear according (Rummell & Joyce, 2010). As a requirement of the above mentioned act, ethical issues related to record keeping, informed consent and the use of third party payers may be hard to address in online counselling. Distant counseling may also mean that the counsellor could lack a referral point for the client in case they may need emergency attendance or may have a high risk of causing self-harm (DeZee et al, 2013). This further raises the ethical question of whether a counsellor should engage in offering services outside their state of licensure, given that they may lack the emergency zip codes for oversees locations.
The impact of an online client-counsellor relationship is questionable. The information sent via online platforms can be misunderstood or misinterpreted for both sides. Given that efficient communication plays a fundamental role in design of therapies and greatly impacts the outcome, hurdles to this can have lasting effects in the therapy process. There is a high likelihood of missed information, inadequate disclosure and insufficient establishment of a therapeutic bond between the counsellor and the client (Tossmann et al, 2011). A counsellor may also miss important aspects of human communication by not being able to read the non-verbal cues. The key component of social interactions is also lost via online communication. Information relayed through body language and the value of personal contact in relieve of emotions is also absent. Online counselling therefore presents a low quality and superficial approach to a client thus neglecting the importance of holistic approach to client issues (Ross, 2016). This difficulty in assessment of patients wholesomely creates a huge gap that can only be bridged via face-to-face interactions with the clients.
In conclusion, the relationship between the client and the counsellor may become blurred when a breach of the boundaries occurs. For example, this may occur when the client has access to the therapist email or personal contact details. As such, the client my unnecessarily engage the counsellor unprofessionally, which could lead to the break of the code of conduct. Individuals with some mental disorders may become exceedingly bothersome even outside the working hours making it difficult to maintain the relationship within the confines of professionalism. To address the ethical issues, policies regarding online counselling need to be more stringent and conclusive on the various matters. Regulatory bodies should be at the forefront in ensuring licensing occurs to only qualifying individuals and that protection of the client rights is maintained. Counsellors need to stay cognizant of the various ethical implications of their professional conduct and the need of ensuring that the best interest of the client is maintained at all times.
References
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DeZee, K. J., Wink, J. S., & Cowan, C. M. (2013). Internet versus in-person counseling for patients taking varenicline for smoking cessation. Military medicine , 178 (4), 401-405.
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Shaw, H. E., & Shaw, S. F. (2006). Critical ethical issues in online counseling: Assessing current practices with an ethical intent checklist. Journal of Counseling & Development , 84 (1), 41-53.
Tossmann, D. H. P., Jonas, B., Tensil, M. D., Lang, P., & Strüber, E. (2011). A controlled trial of an internet-based intervention program for cannabis users. Cyberpsychology, Behavior, and Social Networking , 14 (11), 673-679.
