Distance Counseling and Supervision

Counselors must identify the limits of confidentiality when retaining electronic records or using technology in the counseling process. There are authorized and unauthorized risks involved in the use of technology. Counselors must inform clients of these risks. In addition, counselors should anticipate these potential risks and take appropriate precautions to mitigate them. Appropriate encryption should be used in an effort to protect confidential information. Client identification protocols should be in place to verify clients’ identity throughout the counseling process. Ongoing verification might include alpha or numeric code words, graphics, or other nondescript identifiers (ACA, 2014).

Throughout this book, there are conversations around risk and recommendations to avoid intentionally or unintentionally breaching confidentiality; however, here are a few basic steps to follow to avoid breaches of confidentiality.

Remember that when physical client files are stored, they must be secured behind two locks (a file cabinet and a locked door or something similar). Consider where you leave your technology and who has access to it. Often, a phone or laptop is such an accoutrement to daily life that it can go unattended. Individuals allow children to play on work phones or watch videos and play games on their laptops. Be aware of the location of and contact that is allowed on work devices. It might be prudent to purchase separate devices for home use and work use to maintain healthy boundaries and security. Keeping digital devices secured physically and through encryption is as imperative as protecting a paper client file.

Counselors should remain aware of the security settings on their devices and understand how programs use them. Do not jailbreak or root devices in an effort to bypass security settings, and remain aware of a device’s capacity to use a kill switch or other mechanism in the event that it is lost or stolen (Wheeler & Bertram, 2015). Remain aware of loading applications that allow access to phones or computers, and use security settings. Remain aware of the way in which your phone or computer accesses the internet, and avoid public or unsecured Wi-Fi.

Each state has regulations governing various elements of distance counseling and technology integration that are constantly evolving. Many changes are made in response to questions or situations posed by practicing counselors or complaints from the public. It is essential to remain current on these ongoing changes by attending state licensure board meetings or visiting licensure board websites for updates and rule changes. In addition, it is important to explore your professional liability insurer’s risk management guidelines and policies to understand how they view technology-assisted services in contrast to face-to-face services. Additional insurance riders may be required to supplement the standard policy. The risk management team may also provide recommendations for safeguards. Wheeler and Bertram (2019) warned that eventually counselors may need to explore cyber-risk insurance as a part of their liability insurance coverage or as a stand-alone policy. Please explore Chapter 6for more information on hardware and software safety.

One of the major concerns with the integration of technology into the counseling process is the inability to read nonverbal cues and interpret nonverbal communication, as this provides critical information. Synchronous videoconferencing allows the counselor and client to see each other in real time and captures the facial and body signals communicated during the session. In addition, the synchronous connection has a significant impact on rapport and the therapeutic alliance. In some situations, licensing boards and insurance companies recognize synchronous videoconferencing similarly to face-to-face interactions, but they regard email and text services very differently.

The security of the texting platform is another aspect to consider, as many texting applications and services are not considered secure and others might be accessible from several access points. Text messaging in the therapeutic process is one of the more controversial modes of communication. Wade (2015) stated, “It may or may not be a good idea, and there are a number of considerations that can determine the answer” (p. 11). Counselors should identify whether clients are comfortable with the use of text, recognize and communicate the limitations of text messaging, and take precautions to ensure that they are texting with clients by using a code word or some form of identity verification. Counselors should consider whether they are comfortable with texting as a therapeutic process, whether they can successfully maintain appropriate therapeutic boundaries with clients, and whether texting is in the client’s best interest. Texting can be used in direct or indirect service delivery (AMFTRB, 2016). Counselors who support the use of texting with clients might argue that asynchronous communication has the potential to allow deeper reflection in the counseling process by both counselor and client, as well as greater availability (Harris & Birnbaum, 2015; Richards & Vigano, 2013). Other therapists might find it useful to limit texting to scheduling and communicating about appointments (i.e., “I’m running 10 minutes late,” “I have a flat tire”). Many do not support client-therapist texting, as content and urgency can get lost in translation.

Whatever decisions counselors make considering texting with clients, it is imperative that they clearly articulate the policies in the informed consent outlining boundaries for appropriate use and response time for text messaging. Documentation should be included in the client file as outlined by state and local statutes. Limits and potential risks to confidentiality should be explored with clients, who should be allowed to make informed choices.

Social media is a ubiquitous part of modern life, and it becomes complicated when combined with HIPAA and Health Information Technology for Economic and Clinical Health Act regulations and counselor ethics. Counselors often use social media in their personal lives, to promote their practices, or to network with other mental health professionals in their area. It is imperative that they be mindful of the risks and maintain appropriate boundaries and confidentiality. It is a counselor’s ethical responsibility to understand the risks involved in using social media and take appropriate precautions. Counselors should construct and share with clients a clear policy regarding the use, limitations, and risks of social media with current and former clients. This policy should be included in the informed consent (ACA, 2014; AMFTRB, 2016; NBCC, 2016a, 2016b).

The first step in setting appropriate boundaries is to maintain separation between personal and professional social media use. It is recommended that separate accounts be created if a counselor plans to use social media for professional purposes. Just as one would maintain separate personal and professional lives, one’s virtual life should include similar boundaries (ACA, 2014; AMFTRB, 2016). Counselors should become aware of the security settings available on their various social media platforms and use them to protect the public accessibility of information. These boundaries should be clearly articulated in their social media policy included in the informed consent.