Online Therapy Ethics
E-therapy is different from face-to-face counselling and we need to consider how online therapy ethics differ from that of in-person counselling.
The British Association for Counselling and Psychotherapy (BACP) have recognised that a different set of online and telephone counselling competencies are required when offering online therapy.
Traditionally, as face-to-face therapists, we serve our local community within a certain radius of our practice. Running a successful practice perhaps means we hire a counselling room or set aside part of our home in which to see clients, and we rely on our client to make their way to us.
Online therapy is of course very different.
Disadvantages of online counselling
Online therapy can include video, telephone, text and email counselling and these may seem to hold the promise of breaking down geographical boundaries, allowing therapists to work with more clients, save travel time and reduce overheads.
However, there can be a darker, unseen side to working remotely. Things can – and do – go wrong.
When an issue fractures the therapeutic relationship in a face-to-face setting, we get a chance to repair this with our client.
When such issues arise online, it can play out very differently, as we have no control over the environment. When online therapy goes wrong, it can have devastating effects for both you and your client.
While we can never pre-empt every possible difficulty, we can do a lot to minimise the risk both to our own professional reputation and career and to the safety of our clients by ensuring that we practise online only if we are competent to do so.
This is the cornerstone of good practice when working online, just as it is in face-to-face practice.
Identifying Whether You Are Competent
The best place to start when assessing whether or not you are ready to work safely and ethically online is your professional body, which will likely have its own competence framework, identifying the knowledge, skills and abilities required.
As the practitioners on our team are based in the United Kingdom and belong to the British Association of Counselling and Psychotherapy (BACP), we focus here on its set of competences.
We can do a lot to minimise the risk both to our own professional reputation and career and to the safety of our clients by ensuring that we practise online only if we are competent to do so.This is the cornerstone of good practice when working online, just as it is in face-to-face practice.
BACP Competences for Telephone and e-Counselling
The BACP published a set of competences specific to telephone and e-counselling in April 2020, following the announcement of the COVID-19 pandemic lockdown.
Based on research evidence into effective practice, this is designed to be used by therapists, trainers, supervisors and organisations to make sure that counsellors working online and/or by telephone have the skills and knowledge that they need to practise safely and ethically.
The overall framework is as follows:
The BACP competences are further developed into sub-competences, which itemise the key components of each competence.
The BACP’s sub-competences for safe and ethical practice as an online therapist cover the following areas:
- knowing about the culture of internet communities
- managing risk when providing telephone and e-counselling
- managing the counsellor’s anxiety in relation to risk
- establishing the identity of the client
- assessing psychological suitability
- assessing suitability for working online
- assessing suitability for text-based therapy
- adjusting the intervention to the individual when telephone/e-counselling
- managing the therapeutic relationship.
- managing the impact of disinhibition
- communicating audio-visually, e.g. using telephones, VoIP (voice over internet protocol) or video-conferencing
- using writing – both synchronous (e.g. live chat) and asynchronous (e.g. email) – as the medium for telephone and e-counselling
- managing attachment and rejection in the context of telephone and e-counselling.
You can read more detail about each of these sub-competencies in the full BACP document.
How to Use Your Competence Framework
You may wish to use the competence framework published by your professional body to do a self-audit of your own knowledge, skills and abilities.
You could share this with your clinical supervisor. This can help you ensure that you practise safely and ethically online. If you identify any gaps in your competences, you can then access the appropriate training.
Counselling service managers in agencies and other organisations that provide therapy may also use this model to help assure the quality of the services they provide, as part of their online therapy policy and guidelines.
For all counsellors and psychotherapists – regardless of practice context – it is important to have a solid understanding of the technological, legal and insurance-based aspects of working online. Getting the right training is vital.
Business and Other Competences
In addition to the competences identified above, therapists who are operating in private practice rather than an agency may also need to look at additional competences that are specific to this context.
For example, you may wish to think about whether you have the necessary business competences to market your online counselling service effectively.
For all counsellors and psychotherapists – regardless of practice context – it is also important to have a solid understanding of the technological, legal and insurance-based aspects of working online.
Again, getting the right training – which you can count towards your annual requirement for continuing professional development – is vital.