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.
For example, the British Association for Counselling and Psychotherapy (BACP) has recognised that a different set of online and telephone counselling competences 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/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
In 2021, the BACP published an updated Online and Phone Therapy (OPT) framework that identifies the competences required by therapists who wish to work with clients online and/or by telephone. This is based on research evidence into effective practice, and is designed to be used by therapists, trainers, supervisors and organisations to ensure that those counselling clients online and/or by telephone have the necessary skills and knowledge to do so safely and ethically.
The OPT framework contains 18 competences, divided into five areas:
Knowledge
1 Knowledge of the different ways of offering OPT and of the associated technologies
2 Knowledge of the benefits and constraints of OPT
Professional Competences
3 Knowledge of, and ability to operate within, legal, professional and ethical guidelines when offering OPT
4 Knowledge of, and ability to work with, issues of confidentiality and consent, including data protection, GDPR and ability to monitor own digital footprint and that of the clinical work
5 Ability to negotiate a contract for OPT
6 Ability to recognise, acknowledge and respond to issues of equality, diversity, and inclusion pertinent to OPT
7 Ability to make use of appropriate supervision for OPT
8 Ability to work internationally
Therapeutic Competences
9 Ability to use effective language and communication processes specific to OPT
10 Ability to work remotely with psychological processes
11 Ability to manage endings for OPT
12 Knowledge of and response to practitioner self-care and well-being related to OPT
Assessment, Planning and Referral
13 Ability to assess suitability for OPT
14 Ability to identify, assess, acknowledge and respond to existing and/or emerging risk during OPT
15 Knowledge of referral and signposting pathways
Meta-Competences
16 Assessment
17 Risk
18 Adjusting the intervention to the individual when providing OPT
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Online Therapy Competences
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.