{"id":13848,"date":"2013-11-16T08:15:44","date_gmt":"2013-11-16T13:15:44","guid":{"rendered":"https:\/\/webhostinggeeks.com\/blog\/?p=13848"},"modified":"2021-10-19T06:50:55","modified_gmt":"2021-10-19T10:50:55","slug":"skypetherapy","status":"publish","type":"post","link":"https:\/\/webhostinggeeks.com\/blog\/skypetherapy\/","title":{"rendered":"Geek Ethicist: Skype Therapy"},"content":{"rendered":"

Dear Ethicist\u2014 Which FaceTime<\/a>\/Skype<\/a> apps are the most HIPAA<\/a> compliant? I am a therapist and have had clients request<\/a> these type of sessions. However, I\u2019m worried about privacy and heard that FaceTime<\/a> was recently hacked. I need to know which of these apps would be the best and safest for my therapy sessions. Sign Me\u2014 Psychotherapist Trying to Keep Up with Technology<\/p>\n

<\/p>\n

Hi Psychotherapist\u2014 First, a disclaimer<\/strong>: The ethicist is NOT a lawyer. Advice given here is for informational use only and should not be considered legal advice. Opinions expressed here are of the ethicist and not necessarily those of WebHostingGeeks.com. Any advice given here is taken at your own risk. That said, your question is more complex than it sounds. I\u2019m not an app or technology reviewer<\/a>, so it\u2019s not my place to weigh in on the best tool for remote counseling sessions. However, using ethics and reasonable judgment it is possible to answer this question for yourself. Let\u2019s look at the real issues:<\/p>\n

1.) \u00a0 Professional Boundaries<\/strong><\/p>\n

Establishing clear, professional, therapeutic boundaries is paramount, and in fact a challenge, in any psychotherapeutic situation. \u00a0Every competent therapist recognizes the potential for counter transference, or allowing the therapist\u2019s own personal psychiatric needs to drive the therapy rather than the patient\u2019s needs. \u00a0\u00a0So prudent, reasonable psychotherapists must keep clear boundaries in place to avoid counter transference. \u00a0Never forget: You are not your own patient in your session if you are getting paid for it. \u00a0You, as the therapist, are professionally obligated to create and maintain the boundaries that make this relationship therapeutic, otherwise you risk ethics violations and outright malpractice liability if there is foreseeable injury. \u00a0In other words, if something goes badly because you let the boundaries break down and you should have known better it could cost you plenty, including your license!<\/p>\n

Obviously most therapists recognize they shouldn’t have cyber sex with their patients, but giving gifts to entice patients to continue therapy, \u00a0or doing personal or professional favors for them online, \u00a0or even carrying on personal relationships external to the therapeutic environment online are also boundary infractions and potential ethics violations, as are carrying on non-therapeutic activities online within the sessions. The problem is the online environment may soften therapeutic boundaries and make the slippery slope of counter transference even slipperier and more dangerous. \u00a0So this should be the very first thing you keep in mind if you begin online therapy. \u00a0This ain\u2019t Lamebook<\/a>: keep your distance.<\/p>\n

2.) \u00a0 Venue<\/strong><\/p>\n

When meeting in an office, certain parameters are already in place: some of these may need to be re-established when meeting over the phone. For example, is the person being counseled in a private location? How long will the session last? What will you do if there are technical difficulties? Do you have a separate phone for this, as using your personal phone may violate your personal privacy and undermine your counselor\/client relationship? These should all be addressed by you before beginning this type of counseling.<\/p>\n

3.) \u00a0 Will you get paid or arrested?<\/strong><\/p>\n

It\u2019s insurance fraud if the session isn\u2019t full length or what happens in therapy isn\u2019t actually therapy!\u00a0Many insurance companies will not\u00a0cover<\/a>\u00a0sessions via Skype\/Facetime: best to check on this before agreeing to this type of session with a client.\u00a0In Academia, there is heated discussion right now about synchronous vs asynchronous online teaching because the teacher can be out fishing when the class is working away.<\/p>\n

4.) \u00a0 HIPAA SCHMIPPA<\/strong><\/p>\n

Be cautious of thinking that HIPAA protects a person\u2019s privacy to the degree that you assume. HIPAA means your neighbor doesn\u2019t know you have chlamydia, but your doctor, the billing department, the pharmacist, possibly your employer and the government will know. \u00a0HIPAA does not promise absolute privacy and often gives an exaggerated sense of privacy to patients. If you don\u2019t believe me, check out The Tatiana Tarasoff ruling<\/a> and consider duty to warn vs. confidentiality.\u00a0It\u2019s hard enough to figure out if your patient\u2019s words are bluster or a serious threat when you are looking at them red-faced in your office. \u00a0Now imagine having to make that determination online. Digitized\/online medical records are not safe<\/a>. Period<\/a>. So which method of protecting a person\u2019s privacy is safest? This is a moving target. \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0<\/strong><\/p>\n

Rule of thumb<\/strong>: What would a reasonable, prudent person accept as a safe interface? This is how legal liability is established. So the question for you is, which app\/platform would you expect to most preserve your client\u2019s privacy, assuming #1 has been addressed? Research the different apps and make an informed decision based on your research and you will have done due diligence in protecting your clients.<\/p>\n

5.)\u00a0\u00a0 Don’t worry this won’t hurt a bit.<\/strong><\/p>\n

All medical ethics begins by determining whether or not a patient has given\u00a0informed consent<\/a>\u00a0for a medically indicated treatment<\/em>. They really have to know what they agreed to including the real risk of having their privacy compromised online. \u00a0\u00a0Misunderstanding or manipulation for the patient\u2019s own good are not \u00a0informed consent.\u00a0\u00a0 In other words, even if a patient seems to have agreed with a treatment does not mean the patient has given informed consent.\u00a0 We all know how easily misunderstanding happens online. \u00a0Catfishing anyone? \u00a0That itself should give any online therapist pause.\u00a0 Maintaining a cash cow client<\/a>\u00a0year after year after year is also pretty clearly a COI (Conflict of Interest), and this dirty little COI is finally beginning to receive some long overdue scrutiny by the insurance companies.\u00a0 So, if you have received demonstrable informed consent, the person is reasonable, there is no conflict of interest that leads to exploitation of your patient, and you have chosen the best option available to you\u00a0(and there are more options than\u00a0Skype<\/a>\u00a0and\u00a0FaceTime<\/a>–see list below) then you are probably ethically fine\u2014it doesn\u2019t matter what app\/platform you use. If you think you are going to do therapy on Facebook<\/a>, however, you are out of your mind.<\/p>\n

Other encrypted alternatives for online therapy are: Secure Video<\/a>, VSee<\/a>, Lync, Vidyo<\/a>, Secure Telehealth<\/a>, VIA3<\/a>, Telemedicine, eTherapi<\/a>, PASS<\/a> (This list is by no means exhaustive: there are many more options<\/a>\u00a0out there.)<\/p>\n

***************<\/p>\n

Emily Cantin researched, co-authored and created original artwork for this article.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dear Ethicist\u2014 Which FaceTime\/Skype apps are the most HIPAA compliant? I am a therapist and have had clients request these type of sessions. However, I\u2019m worried about privacy and heard…<\/p>\n","protected":false},"author":15,"featured_media":9966,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wds_primary_category":0,"footnotes":""},"categories":[3557,1,9,3556,3558],"tags":[6944,6954,4502,628,6943,4498,6946,6953,6947,6952,6955,6945,6951,6948,6957,102,3233,6956],"class_list":["post-13848","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mobile-world","category-random-stuff","category-security-issues","category-social-media-2","category-web-technology","tag-counseling","tag-due-diligence","tag-ethics","tag-facebook","tag-facetime","tag-geek-ethicist","tag-hippa","tag-informed-consent","tag-medical-ethics","tag-medical-records","tag-medical-reporting","tag-online-therapy","tag-personal-security","tag-psychology","tag-psychotherapist","tag-security","tag-skype","tag-therapist"],"views":220,"_links":{"self":[{"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/posts\/13848","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/users\/15"}],"replies":[{"embeddable":true,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/comments?post=13848"}],"version-history":[{"count":0,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/posts\/13848\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/media\/9966"}],"wp:attachment":[{"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/media?parent=13848"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/categories?post=13848"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/webhostinggeeks.com\/blog\/wp-json\/wp\/v2\/tags?post=13848"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}