The Future Is Here: Ethical Practices of Telemental Health

By Swenson, John Eric, III; Smothermon, Jennifer et al. | Journal of Psychology and Christianity, December 1, 2016 | Go to article overview

The Future Is Here: Ethical Practices of Telemental Health


Swenson, John Eric, III, Smothermon, Jennifer, Rosenblad, Sherry R., Chalmers, Brandy, Journal of Psychology and Christianity


The internet has drastically changed the way people communicate and obtain information and has become the most popular networking tool. Today, anyone with internet access can obtain a variety of mental health services, including online counseling via video conferencing (the focus of this article), private and public chatting, asynchronous and synchronous emailing, and texting. Proponents of online counseling contend that interventions delivered via telemental health are as effective as in-person delivery and that telemental health increases access to those with limited mental health services (American Telemedicine Association [ATA], 2013a; ATA, 2013b; Haberstroh, Barney, Foster, & Duffey, 2014). Professional associations and licensing and regulating boards have been steps behind this ever-growing trend when it comes to updating ethical codes of practice, rules, and regulations as various ethical issues and dilemmas arise. "Jurisdictional, liability, and malpractice issues blur when state lines and national boundaries are crossed electronically" (National Association of Social Workers and Association of Social Work Boards [NASW], 2005, p. 4). The APA Guidelines for the Practice of Telepsychology (2013) state:

The practice of telepsychology involves consideration of legal requirements, ethical standards, telecommunication technologies, intra- and interagency policies, and other external constraints, as well as the demands of the particular professional context. In some situations, one set of considerations may suggest a different course of action than another, and it is the responsibility of the psychologist to balance them appropriately. (p. 2)

In general, professional associations and state licensing boards consider telemental health to simply be another modality of professional practice, and the codes of ethics and guidelines for practice include the basic ethical standards for inperson practice, with the assumption and intention that practitioners are held to the same ethical standards whether they are practicing online or in person. Codes and guidelines attempt to direct ethical provision of telemental health and specify or clarify issues that may be unique to telemental health (Haberstroh et al., 2014). In the paragraphs that follow, we summarize the ethics codes from the major mental health professions as they pertain to telemental health.

Marriage and Family Therapists

The American Association for Marriage and Family Therapy (AAMFT) updated their Code of Ethics at the beginning of 2015 and included language specific to technology-assisted professional services, which includes both therapy and supervision utilizing technological means. Marriage and Family Therapists (MFTs) notify clients and supervisees in writing of potential risks and benefits of engaging technology. They consider if the technology is appropriate for the particular client or supervisory relationship and ensure security to the highest degree possible when using technology. MFTs only engage in technology assisted services after they have adequate training, supervision, and/or experience using the technology. The MFT bears the responsibility of maintaining confidentiality through the use of secure platforms and informs the clients of potential issues surrounding confidentiality. MFTs safeguard records containing confidential or identifying information and inform clients of potential limitations. MFTs practice only within their allowed jurisdiction. They select advanced technology that optimizes service and security in the best interest of the client or supervisee (AAMFT, 2015).

Professional Counselors

The American Counseling Association (ACA) updated their Code of Ethics in 2014 with a section addressing distance counseling, technology, and social media. The ACA code encourages counselors to consider the use of technology in practice as a resource while protecting confidentiality and following legal and jurisdictional guidelines. …

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