Academic journal article Journal of Mental Health Counseling

Text Messaging and Private Practice: Ethical Challenges and Guidelines for Developing Personal Best Practices

Academic journal article Journal of Mental Health Counseling

Text Messaging and Private Practice: Ethical Challenges and Guidelines for Developing Personal Best Practices

Article excerpt

The impact of technology on mental health practice is currently a concern in the counseling literature, and several articles hare discussed using different types of technology in practice. In particular, many private practitioners use a cell phone for business. However, no article has discussed ethical concerns and best practices for the use of short message service (SMS), better known as text messaging (TM). Ethical issues that arise with TM relate to confidentiality, documentation, counselor competence, appropriateness of use, and misinterpretation. There are also such boundary issues to consider as multiple relationships, counselor availability, and billing. This article addresses ethical concerns for mental health counselors who use TM in private practice. It reviews the literature and discusses benefits, ethical concerns, and guidelines for office policies and personal best practices.


Technology is evolving rapidly (Haberstroh, Parr, Bradley, Morgan-Fleming, & Gee, 2008) and can help clinicians free up time and space (McMinn, Orton, & Woods, 2008). In particular counselors are using cell phones to conduct business (Baker & Bufka, 2011; McMinn et al., 2008) because they provide options for communicating with clients at the clinician's convenience (McMinn et al., 2008).

Cell phones can be used to connect with clients for administrative tasks like scheduling, cancelling, and rescheduling; to send appointment reminders; and to communicate brief thoughts or questions between face-to-face (FTF) meetings. Smartphones may have the ability to connect to the Internet and interact with others in a variety of ways, but almost all cell phones at least have a text message option.

Individuals are increasingly communicating via short message service (SMS), better known as texting or text messaging (TM; Boschen & Casey, 2008; Militello, Kelly, & Melnyk, 2012). TM is now used clinically to provide support or interventions for certain conditions and populations (Merz, 2010). Text messages can include pictures, videos, and text up to 160 characters (Goss & Ferns, 2010; Merz, 2010; Militello et al., 2012). Although TM usually occurs between cell phones, messages can also be sent from email and web sites (Merz, 2010). For counselors in private practice, TM is a low-cost and convenient tool.

All forms of technology have ethical implications that raise concerns for counselors (Baker & Bufka, 2011; Baltimore, 2000; McMinn et al., 2008; Van Allen & Roberts, 2011; Zur, 2010). As a result, every conversation about using technology in practice must discuss ethics and ethical decision-making (McMinn et al., 2008). Centore and Milacci (2008), who studied distance counseling, reported that counselors experienced decreased ability to fulfill their ethical duties for all types of distance counseling, which underscores the need for training on the ethical issues in using technology in practice. Studies addressing best practices for specific types of technology (Baker & Bufka, 2011), including TM, are lacking.

This article explores TM benefits and ethical concerns for counselors in private practice and offers guidelines for personal best practices. It reviews the literature on use of technology in private practice and of TM for clinical interventions. Specific clinical benefits and ethical concerns are outlined. Although they are likely to use TM to communicate with clients, because private practitioners are not likely to have received technology training, they have the greatest need to manage ethical risks carefully. As Bradley, Hendricks, Lock, Whiting, and Parr (2011) said about e-mail, my purpose is not to decide for counselors whether or not they should use TM in private practice but rather to raise awareness of ethical concerns to help them make more informed decisions.


Private Practice

McMinn, Buchanan, Ellens, and Ryan (1999) conducted one of the earliest studies on use of technology in private mental health practice (N = 429). …

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