CONFIDENTIALITY

All interactions between a client and counselor are confidential, even that you are a client is confidential.  All that is said or transpires during our sessions will not be discussed with anyone.  However, you should know according to California law that all mental health professions are required to report: incidences of child or elder abuse; an intention of a client to commit suicide; any threats to do harm to yourself or other.

CALIFORNIA BUSINESS AND PROFESSIONAL CODE, SECTION 2290.5 sets forth requirements for the practice of online telemedicine.

ON-LINE ETHICS POLICIES

The suggestions that follow address practice issues which relate directly to on-line provision of mental health services:

The terms "services" "counselor" and "client" are used only for simplicity and clarity.

1.  Informed Consent

As a client, you should be aware that misunderstandings are possible with text-based modalities such a email (since your counselor does not have the benefit of facial cues and body language) and even videoconferencing can be affected (because bandwidth is always limited).

2. Turnaround time

You should be informed when communication primarily happens asynchronous "not in real time" as to what the time limits are.  For example, you should know as to when you will receive a response to your email.

3. Privacy of Counselor

Online counseling creates more emphasis on privacy issues.  You the client are provided confidentiality as stated above, and your counselor may wish to restrict the use of any copies of recordings you make of sessions.

4. Counselor

Because the client and counselor do not meet in person, the client may be less able to assess the counselor and make a decision about whether treatment would be effective with her or him

NAME - You should always be informed of the counselor's name, even if a pseudonym is used online

QUALIFICATIONS - You as a client should be informed of the qualifications of the counselor: degree, license type and number, and certifications.  The counselor may also provide you with information of specialty areas and appropriate training and experience.

A WAY TO CONFIRM - You should be given a telephone number or URLs of relevant institutions.

In California:  Board of Behavioral Sciences (916) 445-4933 or www.bbs.ca.gov, and California Association of Marriage and Family Therapists @ www.cfamft.org or (888)892-2638.

5. POTENTIAL BENEFITS

There are many potential benefits of online counseling: (1) being able to send and receive messages at any time, day or night; (2) never having to leave messages, voice mail, or play "telephone tag"; (3) just taking all the time you need to compose and reflect upon emails or recorded sessions; (4) having a record of sessions as through emails; (5) feeling less inhibited than in person; (6) avoiding traffic and travel time; (7) saving money.

6. POTENTIAL RISKS

As a client you need to know there are potential risks of therapy online.  Here are some concerns: (1) messages not being received; (2) confidentiality could be inadvertently breached; In the area above: email might be incorrectly addressed or a counselor may not notice.  Hackers pose a threat online.  Safeguards should be considered when a computer is shared by your family members, students or library patrons.

7. SAFEGUARDS

The above potential risks can be eliminated or diminished.  For example, a "return receipt" can be requested when sending your email; (2) "passwords" can be used to access the computer or an encryption can be utilized

8.  ALTERNATIVES

You know, of course, that you can see a counselor in person in his or her office; talking to a friend or minister is helpful; self-help books and recordings are useful; or such activities as meditation or exercising are often suggested.

9. PROXIES

If you as a client are not in a position to obtain counseling, due to age or other reason, consent should be obtained from a parent, legal guardian or other authorized party -- and the identity of that party should be verified.

10. STANDARD ACCEPTED PROCEDURES

A counselor should follow the same procedures online as she or he does when providing clients services in person.

11. REQUIREMENTS TO PRACTICE

Licensing requirements should be met where the counselor is located as well as required online requirements.

12. BOUNDARIES OF COMPETENCE

A Counselor should only attempt to address areas within his or her scope of practice and experience.

13. STRUCTURE OF THE ONLINE SERVICE

The counselor and client should mutually agree on how they will communicate, the fee, estimated cost of client's therapy and the method by which payment of fee takes place.

14. EVALUATION

A counselor should evaluate each client before counseling commences -- so as to determine whether client will be helped by online therapy.

15. RECORDS

The counselor should maintain records of online therapy.  If she or he records sessions, the client must be informed..

16. ESTABLISHED GUIDELINES

The counselor should follow all legal directions and other established ethical guidelines such as those of professional organizations that apply to him or her.

17. EMERGENCY PROCEDURES

Counselor and client should discuss what to do in an emergency. (Especially in the area of post-traumatic stress, repressed events or frozen feelings, flashbacks and other trauma based phenomenon may come to the surface).  Clients should have knowledge of how to create a "safeplace."  However, because a situation could arise where the counselor could not immediately be reached online, a "local back-up" support person, counselor or counseling center needs to be in place should any emotional reactivity take place.

LOCAL BACK-UP

Local backups is especially needed when the counselor is a distance from the client.  Client's file should include names and telephone numbers, for example, of support persons, family members, a mental health provider or primary physician.

©2004 ADD Pathfinders
Fresno, California