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  • Writer's pictureJames Marston

Privacy and Confidentiality in Online Therapy

Confidentiality and privacy are essential to mental health treatment. The confidence that you can be yourself and allow yourself to be vulnerable without fear of embarrassment or betrayal is essential to mental health treatment. Informed consent–a client knowing exactly what is being done with their information, who has access to it, what it’s being used for, and how it's being protected–is essential to mental health treatment.

So when I hear about a therapist taking a call from a client on their personal cell-phone in a public place, I have trouble believing that it’s good mental health treatment. When I hear about big business online therapy clearinghouses asking for personal information to use in matching prospective clients with therapists remotely, I get nervous.

What steps are businesses taking to protect that client’s information? What are they doing with the meta-data? Do they use that information to target advertisements? Do they sell that information to other people to target their advertisements?

What steps are the remote therapists taking to protect client information? How are they securing their devices? What’s the informed consent process like? Who is checking to see if the therapist is licensed in the state where the service is being provided? If the therapist is doing something unethical, does the client know who will hold them accountable?

When I read about the FTC fining online therapy clearinghouses for millions of dollars, I get nervous. Or, if I’m really honest, I get angry. Selling a client's medical information, like any of our personal information, is big business. When the penalty for an activity is a fine, then the activity only ends when the fine is greater than the money made by the activity. Otherwise, it’s just the price of doing business.

I’m not alone in my anxiety. We’ve seen comments from people who are starting to lose faith in mental health treatment globally after seeing how clients’ personal information is being treated. Between that and how challenging it can be to find any therapist at all, I can imagine people giving up on finding treatment.

I encourage you not to give up, and not to settle. There are practices out there that let ethics, legality, and morality guide their practice. As a practice owner, I care deeply about the integrity of our business. As a therapist, I care deeply about the integrity of my practice. As a human, I care deeply about the commitments I make to the people who trust me with the intimate details of their lives. I know I’m not alone in those principles.

If you’re considering seeking out any sort of mental health treatment, I urge you to ask questions about your data and information. Who has it? How is it being used? How is the person you are giving it to profiting from it? What steps are they taking to protect it? Who are they giving it to? How is it being given? How is it being received? Are they selling your information? Are they using your information to target you with advertisements?

When you are talking to a remote therapist, ask them where they are. Ask them who could overhear them. Ask them how secure their device is. Ask them if they take notes during a session, and what they do with those notes? Is it on a piece of paper? Is it in an online storage service? Is that service protected? Is it HIPPA compliant? Is their internet connection secure? How do they secure it?

When the pandemic hit, our practice was not prepared. Up to that point, we’d never considered telehealth or teletherapy as an option. We didn’t have the knowledge or infrastructure to offer those services, and if I’m honest I’d never had the intention of ever offering those services. I felt that therapy was about the human connection between therapist and client, and I was skeptical that I could form that connection online.

However, when I was faced with asking people to choose between going without treatment or exposing themselves and my family to risk, I didn’t feel like there was another option. So, we set out to learn very quickly what telehealth entailed. We took classes. We read articles and journals. We invested in technology. We made a plan and we adapted.

I found, to my surprise, that telehealth was fine. Most of the time, it was just as effective as in person counseling for most clients. I prefer in person, but the human connection I felt so strongly about could be created in an online space. It takes effort and practice, and technology and internet connectivity certainly play a role, but telehealth can work. It is certainly better than not having therapy at all, and has the advantage of making therapy more accessible for some people. In the final analysis, for me, telehealth is a valuable tool that helps me help more people in more ways. It’s not my preferred tool, but it’s a good one.

On the therapeutic side at our practice, we did trainings, we practiced, and we got better at telehealth. On the technological side, the public emergency declarations of the Federal and State governments lowered the standards for telehealth in terms of privacy and security to increase access in light of the pandemic. We take our ethical and legal responsibilities really seriously around here, so we decided early in the process that if we were going to establish the infrastructure and policies for telehealth, we didn’t want to go halfway. We established practices that would meet the non-emergency standards and took a long look at the technology at our disposal.

My business partner and office manager has a background in electronic information security, so she was uniquely suited to the task. She took a look at every step of our process, looked at our devices and the programs we used, and put things in place to make sure our clients’ information was protected.

We use company owned devices loaded with only the software we have vetted and researched. We use a VPN to protect our internet traffic. We use encrypted email to deliver information and communicate with our clients. We have secure video-conferencing software and have a BAA (Business Associate Agreement) in place to ensure that our sessions are as private as we can possibly make them. We talked to our therapists to make sure that they were responsible with their devices and made sure that they were physically located in private areas. Providers use ear-buds to further enhance privacy. We put measures in place that would allow us to wipe devices remotely, along with all the information on them. We don’t allow our therapists to use their personal devices to communicate with clients, instead using only the secured software provided by the company.

All of that, and we are still imperfect. We learned the hard way that we cannot eliminate risk, only lower it. Humans make mistakes and all we can do is learn from them and improve. Every time we discover a weakness in our practice or infrastructure, we refine it.

If you’re considering seeking out therapy with us, ask us about how we do things. Scrutinize our practices. If we can’t answer you, we’ll find the answer. If your question uncovers a weakness in our practices, we’ll correct it. If you’re not satisfied with the answers, we hope you find someone else to receive treatment from. You deserve to feel comfortable and secure with the people you are trusting with your mental health.

Please, don’t give up on finding the help you need. Don’t compromise when it comes to your privacy.



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