Grey areas in ethics inevitably occur for therapists during the course of treating many different patients. The advent of new technology poses situations for therapists that offer challenges to issues of informed consent and confidentiality. The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct can provide guidance to therapists in dealing with the grey areas in ethics.
Informed Consent and Confidentiality:
A patient of Dr. Walker, Tami, is in treatment for substance abuse as well as other problems. She is going away with her family on vacation for a month, and asks Dr. Walker if she can continue her therapy via webcam with him while she is away.
While interruption of psychological services is never desirable, as section 3.12 of the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (Ethics Code) states, this situation demonstrates a grey area in confidentiality for the client (Pope & Vasquez 340). As Ford writes in the Confidentiality section about ethics in psychotherapy and counseling that therapy “should always be conducted in a private setting designed to minimize the chances that a therapeutic exchange will be overheard” (106). Since Dr. Walker cannot control Tami’s therapy setting if she wants to receive therapeutic service by webcam while she is away, there is a chance her confidentiality could be inadvertently breached. A few examples are if family members overhear the therapy session, if strangers overhear it if she is in a public location, or if hackers compromise the security of her computer.
Consent is also an issue in this situation. A therapist must ensure the patient understands the risks involved in any treatment. The therapist could recommend that if she decides to continue her therapy via webcam that she ensures her computer is well protected from cyber-intrusion. In addition, the therapist could suggest the sessions only take place in a private location such as her room where she is staying, and to protect her own privacy from family members and others during a session by closing the door, using headphones, and so forth. If the computer is one that is also used by others, she may also want to make sure that any information she wishes to keep private is erased when the session is over so that confidential information is “secured against accidental discovery” (Pope & Vasquez 281). Once the patient has all the information about the dangers to confidentiality when considering therapy via webcam, “the patient must decide whether to undertake this course of assessment and treatment, whether to start now or delay, and whether to try an alternative approach or an alternative therapist” (Pope & Vasquez 173).
The APA Ethics Code does not suggest that treatment via webcam is unethical. However, section 4.02c Discussing the Limits of Confidentiality states that therapists “who offer services, products, or information via electronic transmission inform clients/patients of the risks of privacy and limits of confidentiality” (Pope & Vasquez 341). If Dr. Walker feels he does not have secure computer equipment or enough training to properly inform his patient of the risks involved in webcam therapy, he may choose to participate in additional training as section 2.01c of the Ethics Codes suggests in order to provide competent information and services to his client (Pope & Vasquez 335). If this is not possible, Dr. Walker may refer his patient to another therapist who is competent to provide the information and services required, or suggest delaying treatment if that is undesirable to his patient.
The results of this grey-area situation rely on two main factors. First, the results depend on the therapist’s competence in this type of treatment and ability to inform his patient of treatment risks. Finally, and of greatest importance, an informed patient retains autonomy in making a decision on how or whether to continue treatment and by what method.
Ford, G. (2006). Ethical Issues in Psychotherapy and Counseling. Ethical Reasoning for Mental Health Professionals (pp. 99-129). Thousand Oaks, CA: Sage Publications.
Pope, K.S. & Vasquez, M. J. T. (2011). Ethics in Psychotherapy and Counseling: A Practical Guide (4th ed.). San Francisco, CA: Jossey-Bass.