Should Therapists Use Skype for Web-Based Therapy?

In the Showtime series Web Therapy, Lisa Kudrow plays a narcissistic therapist who administers questionable therapy over the Internet. Life often imitates art, and web-based therapy is no exception, though the therapists engaged in web therapy—also known as distance therapy—are nothing like Kudrow’s character. They’re qualified professionals who want to help people.

Several large and well-respected websites now offer web-based therapy or provide advertisements for therapists who do. The advent of online therapy raises important ethical issues that online therapists may not be fully ready to address.

Skype Therapy: Risks and Benefits

At first glance, online therapy might seem like little more than another way technology makes life easier and more convenient. After all, a therapist who doesn’t have to maintain a brick-and-mortar office can probably afford to charge less. People concerned about being seen going into and out of a therapist’s office may feel more comfortable with web-based therapy, and the easy accessibility of the service means that people can choose from therapists across the country rather than being limited to a specific geographic location.

The problem is that the technology has not caught up to the ethical and legal demands of therapy. Skype and similar technologies may retain records of conversations and calls, but therapists have little control over what happens to this information. The Health Insurance Portability and Accountability Act, better known as HIPAA, mandates that mental health professionals protect client privacy and data, but even the best therapists can’t guarantee that their Skype conversations are private or safe.

The American Psychological Association weighed in on this issue in an April 2014 practice update. The APA explained that “liability for failure to comply with HIPAA is now shared equally by covered entities and business associates—third parties that provide services to covered entities and may have access to [protected health information]. So it is critical for practitioners to have business associate agreements in place. Yet Skype does not offer business associate agreements for health care professionals who want to use it for telehealth purposes.”

The ongoing controversy about government use of Internet records compounds the concern. The National Security Agency (NSA) may review Skype metadata, and some privacy advocates have expressed concern that government entities have access to everything a user does on the Internet—even web therapy.

At a time when it can be more challenging than ever to protect client privacy, ethical norms are placing an increasing premium on such privacy. The American Counseling Association’s 2014 Code of Ethics requires therapists to protect the privacy of both current and prospective clients. This means an email asking about therapy or a brief online conversation with a prospective client are now forms of health care data that professional ethics mandate must be protected.

Virtual therapy such as Skype poses some other, more tangential concerns as well. For example, it can be harder for a therapist to read body language over a video call, and the environment in which people seeking therapy conduct video chats could be anything but relaxing. Such challenges could reduce the effectiveness of therapy, particularly among therapists who don’t actively work to prevent these problems.

What Could Possibly Go Wrong?

We live in a world where video cameras can be seen on every corner and employers regularly snoop through employees’ email, so privacy can feel like an increasingly remote concept. But confidentiality is a cornerstone of ethical and effective therapy. Marlene Maheu, PhD, an expert in online therapy, has repeatedly argued that Skype can pose serious challenges to professional ethics. “Ultimately, my strong suggestion is that providers proceed with great caution when using Skype or similar non-HIPAA-compliant platforms,” Maheu told GoodTherapy.org.

Consider the following ways Skype therapy can compromise a client’s well-being:

• When the records of a Skype call remain on a person’s computer, it’s easy for the person’s spouse, children, or even employer to see he or she is going to therapy—and perhaps even see the contents of Skype chats.
• Skype does not offer a privacy policy that is compliant with HIPAA, which means no one really knows what Skype does or does not do with user data. A user’s therapeutic chats could conceivably be sold as marketing data to third parties.
• If the NSA or other government branches store Skype metadata, then people who utilize Skype therapy may be revealing that they talk to a therapist even if they don’t want to make such a revelation.
• It’s a very real risk that Skype chats can be hacked and intercepted. If a user feels safe with his or her therapist, he/she may reveal highly personal information that can then be used against him by a person with malicious intent.

Balancing Privacy and Convenience

The challenges posed by Skype don’t mean that mental health professionals have to give up on web-based therapy altogether. Maheu argues that there are other options. “The beauty of Skype is that it is easy and free,” she said. “The truth is that several HIPAA-compliant platforms are also free and/or low cost, as well as easy to use.” Maheu maintains a list of HIPAA-compliant platforms on her website.

People who want to give online therapy a shot should ask their therapists the following questions:

• What specific steps do you take to protect my privacy?
• Is the platform you use HIPAA compliant? Would you consider switching to a HIPAA-compliant platform?
• Are my conversations with you saved in any way? If so, how do you secure the files?
• Are our sessions encrypted?

There’s no denying the convenience offered by Skype, but the consequences of poor privacy standards can vastly outweigh the convenience of distance therapy. Both therapists and people seeking therapy should proceed with caution before sharing personal information via Skype.

References:

1. Huggins, R., LPC, NCC. (2014, April 2). Initial client contact by email & the 2014 ACA Code of Ethics. Retrieved from http://www.personcenteredtech.com/2014/04/initial-client-contact-by-email-the-2014-aca-code-of-ethics-vs-hipaa-1st-in-a-series/
2. Maheu, M. M., and McMenamin, J. (2013, March 28). Telepsychiatry: The perils of using Skype. Retrieved from http://www.psychiatrictimes.com/blog/telepsychiatry-perils-using-skype
3. Practitioner pointer: Does the use of Skype raise HIPAA compliance issues? (2014, April 24). Retrieved from http://www.apapracticecentral.org/update/2014/04-24/skype-hipaa.aspx
4. Zur, O. (2014). Utilizing Skype and VSee to provide TeleMentalHealth, E-Counseling, or E-therapy. Retrieved from http://www.zurinstitute.com/skype_telehealth.html#debate

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.