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Is online counseling really safe? Can't hackers compromise confidentiality?

answered 12:26 PM EST, Tue March 13, 2012
I am working on my MS in Psychology and we recently discussed the current trend of online counseling and confidentiality. How do you know you are speaking to the client, how do you know when he/she is telling the truth, and how do you know when or if he/she is suicidal by his/her behavior? Confidentiality via hackers can be violated, wouldn't you say this would be a true statement?

Art Matthews Says...

I am always amused by people who think a big, bad boogie man has walked into the room when I mention online counseling. Most mental health professionals see crisis lines and suicide hotlines as staples in the mental health arena. One key component to "distance counseling" is the use of phone sessions. We have been connecting via distance for decades. The internet does have its own set of risks and vulnerabilities, but educating yourself as a therapist and the client as a consumer can help overcome much of the problem. But don't get me wrong, I'm not trying to minimize your concern. It is valid.

The answer to two of your questions ("How do you know when he/she is telling the truth?" and "How do you know you are speaking to the client?") is the same regardless of whether you are in person or online. You never get to know for certain if a client is telling the truth or not, but you have to know what to look for and to trust your gut instincts. How do I know I am talking to the client? Well, usually I meet the client face-to-face first and have confirmed their identity via photo identification. Most on-line counseling takes place as an adjunct to face-to-face counseling and not as stand-alone counseling. I mainly use video teleconferencing with distance clients so I know what they look like. But in the case of text based counseling online, I come up with a code word that only the client and I know. We often have spoken previously so I know when they intend to contact me, and I question when things come out of the blue.

The latter question regarding suicidality is a bit trickier and again I question, how do you KNOW that a client in person is suicidal or not. I do not recommend online counseling for clients in crisis or who are suicidal. It is much better for them to seek out ground based services in their area. However, using video conferencing I can see indicators of de-compensation such as: obvious lapses in self-care and hygiene, lack of attending or participation, missing appointments, avoidance of "eye contact" with the screen/camera, incongruent affect with speech content, etc. Some research has suggested that text-based online counseling actually has a greater disinhibition effect for clients, allowing them to get to their real issues more quickly. Some have suggested this is because there is no "face" of a counselor to cause the feeling of being observed and judged. Yes, I know... all counselors are taught to be non-judgmental, but even skilled helpers cannot control how their clients interpret their body language and facial expressions.

Online counseling should not be practiced by just anyone with a counseling shingle. Counselors should be trained specifically in distance counseling and the ways to reduce risk and educate clients on how to reduce the risk (see the Center for Credentialing and Education - CCE website for Distance Credentialed Counselor). Distance counselors should also gain experience while being supervised by a more experienced counselor working in the modality. Distance counselors have to be part IT technician as well as full-time therapist.

Confidentiality most definitely can be compromised in the online environment and for that reason; I have a different Consent for Treatment for Online Therapy that addresses the risks and ways that clients can reduce their risk of being hacked.

Online counseling exists because it serves a purpose for many people that conventional therapy cannot. I do not believe people will ever seek it out solely because they can do so from the convenience of their bed while in their PJs. People who have mobility issues, transportation issues, agoraphobia, or who travel for their jobs often cannot make regularly scheduled appointments with a therapist in the office. Should we deny them the right to continue in therapy if they have been advised of the risks and ways to reduce them, and are willing to take the risk? It becomes a cost-benefit analysis for many clients and they have to decide if the benefits of regular and continuous care are greater than the risk to their confidentiality. Even in face-to-face counseling, we advise clients of the risks of entering into therapy, do we not? None of what we do is without risk.

Before any client connects with a counselor or therapist (online or not) they should do their due diligence and research the person, their modality and their credentials and experience. State boards of licensing provide information on current license status, complaints, and outcomes of formal complaints and sanctions. The Center for Credentialing and Education (which credentials Distance Credentialed Counselors, or DCCs) has a site to locate a DCC in your state (http://www.cce-global.org/Pub/Search).

There are lots of reputable resources for distance counseling, such as:

The digital frontier can seem like the Wild West when it comes to online counseling right now, and rightly so. Many states are ignoring the practice and choose to believe their state laws on the books cover distance provision of counseling services. I suggest that they do not. I encourage you as a student in training to learn more about the reality of distance counseling and to pressure your state to protect its citizens with updated rules and regulations that take into account the reality of today's digital world.

Best of luck to you in the future. Remember as you learn and grow to question everything!

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Page last updated Mar 13, 2012

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