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ORIGINAL ARTICLE

Ethical Practice in Telepsychology

Nicholas Gamble,1 Christopher Boyle,2 and Zoe A Morris3
1
Krongold Clinic, Faculty of Education, Monash University, 2School of Education, University of New England, and 3Faculty of Education, Monash University

Objective: Telepsychology has the potential to revolutionise the provision of psychological service not only to those in remote locations, or with
mobility issues, but also for those who prefer flexible access to services. Rapid developments in internet communications technology have
yielded new and diverse methods of telepsychology. As a result, ethical regulatory and advisory guidelines for practice have often been
developed and disseminated reactively. This article investigates how the core ethical principles of confidentially, consent and competence are
challenged in telepsychological practice.
Method: Through the application of existing ethical standards, advances in communications technology are considered and their ethical use in
psychological contexts explored.
Conclusion: It is expected that psychologists will have basic competencies for the use of everyday technology in their practice. However, the
use of internet communications technology for telepsychology has created new opportunities and challenges for ethical practice. For example,
telepsychology is geographically flexible, but there can be privacy concerns in cross-border information flow. Psychologists who engage in
telepsychology require a particularly thorough understanding of concepts such as data mining, electronic storage, and internet infrastructure.
This article highlights how existing technology and communication tools both challenge and support ethical practice in telepsychology in an
Australian regulatory context.

Key words: confidentiality; online therapy; psychological ethics; telemedicine; telepsychology; video counselling.

What is already known on this topic What this paper adds

1 Advances in internet communications technology, geographic
necessity, and national registration standards have enabled
telepsychology to become a growing modality for the provision
of psychological services in Australia.
2 Telepsychology can utilise a range of technologies for service
provision (e.g., email, video conferencing, internet technology,
and social media). Telepsychology also involves the transmis-
sion and storage of electronic data (e.g., cloud technology).
3 Telepsychology has the potential to broaden the reach of psy-
chology, increase the individualisation of service provision to
clients, and improve productivity.
1 Explores the ethical issues of confidentiality, competence, and
consent as they relate to use of telepsychology.
2 Australian psychologists who intend to use telepsychology as
part of their service delivery require technological competence
as well as ethical awareness.
3 The merits of telepsychology as well as its ethical challenges are
discussed.

With any new tool, technique, or communication method, psy-
chologists need to consider the ethical implications of its use in
addition to its clinical utility. Telepsychology, using internet-
based communication technology to provide psychological ser-
vices, offers tremendous potential benefits to psychologists and
service users. This is particularly the case given Australia’s large
geographical footprint and unified training, registration, and
ethical framework for all registered psychologists through the
Correspondence: Nicholas Gamble, Krongold Clinic, Faculty of Education,
Monash University, Room 1.31, 29 Ancora Imparo Way, Vic. 3800, Australia.
Fax: +61 3 9905 5127; email: Nicholas.Gamble@Monash.edu
Accepted for publication 13 April 2015
doi:10.1111/ap.12133
Psychology Board of Australia (Boyle, 2014). Telepsychology
has the potential to broaden the reach of psychology, increase
the individualisation of service provision to clients, and improve
productivity. However, telepsychology also has the potential to
increase the risk of confidentiality breaches, complicate the pro-
vision of services, and increase the likelihood of adverse client
outcomes (Boyle & Gamble, 2014). While important, this article
is not concerned with the efficacy of telepsychology or the best
practice methods for building therapeutic alliance in technologi-
cally mediated services. Rather, this article considers the poten-
tial ethical issues associated with the provision of psychological
services to clients using internet communications technologies.
Many of these tools will be familiar to most psychologists (e.g.,
Email, Skype), others will be commonly used but not well
understood (e.g., electronic storage). And finally the next

292 Australian Psychologist 50 (2015) 292–298

© 2015 The Australian Psychological Society
N Gamble et al.
generation of technology that may develop into the subsequent
phase of telepsychology (e.g., social media, wearable technol-
ogy) will be explored. While these tools will be in use by some
psychologists today, the theoretical and practical ethical impli-
cations of these communication methods need careful attention.
This article will consider the impact of telepsychology on the key
ethical issues of confidentiality, competence, and consent.
Telepsychology and related ethical issues are not new con-
cepts. As Mallen, Vogel, Rochlen, and Day (2005) highlighted,
the initial provision of remote healthcare services occurred
using the telephone in the 1970s. Practitioners used the tel-
ephone for a range of business and professional purposes and
began to employ it as a therapeutic communication device. In
much the same way, most Australian psychologists will have
used email, social media, and other forms of internet technolo-
gies for communication and organisation before they considered
using them for therapeutic purposes. The potential ethical issues
involved in using internet-based tools for service provision and
administrative tasks are substantial and often poorly understood
(Schwartz & Lonburg, 2011). With the recent advent of internet
connected smart phones and tablet computing, the risks have
intensified due to the portability and flexibility of these devices.
It is important to note, as Kramer and colleagues (2013, 2014)
highlight, that telepsychology is not a specific therapeutic tool. It
is the use of technology to provide psychological services to
clients who are not in the same physical location as the psy-
chologist. Psychologists should be cognisant that their tradi-
tional ethical obligations exist when they are using a
technological tool to deliver a psychological service. Also, psy-
chologists need to be aware of the different ways individuals
engage in electronic communications and how they may impact
on service provision (Martin, 2011; Weisband & Reinig, 1995)
and the application of existing ethical requirements in
telepsychology (The Australian Psychological Society [APS],
2011a). Psychologists should consider the ethical issues of
online interactions in the same way they do for traditional client
contact (Kramer, Kinn, & Mishkind, 2014). Using these criteria,
it would be unethical, in most circumstances, for a psychologists
to interact socially online with a client (e.g., accepting them as
a friend on Facebook), in the same way that a psychologist
would refrain from having a meal with a client. Further, some
risks may be elevated by the use of technology; for example,
concerning confidentiality, there is little chance that a client
would accidentally photocopy their therapeutic homework and
distribute it to all their friends.
However, accidentally adding additional recipients to an email
when returning homework to the psychologist is more likely to
occur. As with many ethical issues, the client should be
informed of the potential risks and benefits of using
telepsychological tools during the consent process. Potential
issues in providing services remotely include disruption (e.g.,
communication dropout), client inability to make contact with
the psychologist, and the storage of electronic data.
Specific resources and examples of effective and ethical prac-
tice in telepsychology are appearing in the Australian psycho-
logical literature. Telepsychology has been enthusiastically
employed in treatment in Australia (Simpson, Rochford,
Livingstone, English, & Austin, 2014) and has support for use
with a range of psychological conditions (Barak, Hen,
Australian Psychologist 50 (2015) 292–298
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Ethical practice in telepsychology
Boniel-Nissim, & Shapiraa, 2008; Newby et al., 2013). There are
also now guidance policies from professional psychological
bodies in Australia. APS published the document, Guidelines for
providing psychological services and products using the internet and
telecommunications technologies (APS, 2011a). The Social Media
Policy, developed by the Australian Healthcare Practitioner
Regulation Agency (AHPRA, 2014), applies to all healthcare
professions regulated under AHPRA including psychologists.
This sets out the minimum standards for the use of social media
by healthcare professionals. These resources, in addition to The
Code (APS, 2007), must shape the ethical use of telepsychology
to ensure best practice in this emerging practice area.
Confidentiality in Telepsychology
The issue of confidentiality is of greatest concern when consid-
ering ethical practice in the context of telepsychology. The APS’s
Code of Ethics (The Code: APS, 2007) has been adopted as the
national code of ethics for the psychology profession in Australia
by the Psychology Board of Australia (PsyBA, 2014). The Code
sets out ethical obligations in relation to the disclosure of client
information. While The Code does not cover internet technolo-
gies specifically, the obligations that exist within it are applicable
in telepsychological contexts (APS, 2011a). In accordance with
The Code, psychologists may not disclose confidential informa-
tion unless the client consents to it; there is a legal obligation to
do so; there is an immediate and specific risk of harm to the
client or third party or in some very limited consultations
(Section A.5.2). These principles underlie the requirement of
psychologists to maintain the confidentiality of client informa-
tion online. The Privacy Act 1988 will also be relevant to most
psychologists not working for a state or territory organisation,
although adhering to The Code is typically consistent with the
requirements in the Act (Boyle & Gamble, 2014; Symons, 2014).
This includes Australian Privacy Principle 8 (APP8), cross-border
disclosure of personal information. This principle highlights that
client information should not be disclosed (or transferred) to an
international third party unless the client has consented to it, or
that the international entity is bound by a substantially similar
privacy regime in their jurisdiction (Office of the Australian
Information Commissioner, 2014). APP8 also highlights that if
client information is going to be disclosed (or transferred) and
the international entity is not covered by privacy requirements
substantially similar to Australia, the client must be informed
and provide consent before the disclosure (or transfer) takes
place. While psychologists would not typically disclose confi-
dential information to any international third party, this article
will highlight that many telepsychological techniques may
subtly disclose client information to third parties and commu-
nication providers.
The internet by design is an open environment and much of
the information that passes across it is not encrypted. Only 3.8%
of the peak period internet traffic in North America is encrypted
and that falls to 1.4% in the Asia Pacific region; however, this
does increase to 6.6% for internet connections using mobile
devices in the Asia Pacific region (Sandvine, 2014). Given this,
psychologists need to consider the underlying risk that exists
when using the internet as the basis for any service provision. It
is also important to note that even secure systems are not
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impregnable as was demonstrated by the unauthorised release
of nude celebrity photos that were stored securely online in
August 2014 (Warren, 2014). There are developments in the
uses of security tools specifically developed for the protection of
sensitive healthcare information (Silva, Rodrigues, Canelo,
Lopes, & Zhou, 2013). However, it may take some time before
these types of tools are commercially and clinically viable for
telepsychology. Therefore, in the short to medium term, psy-
chologists who choose to use internet-based telepsychology will
need to maximise confidentiality using conventional internet
tools.
Email Use by Psychologists
Any use of email by psychologists, including basic practice man-
agement, needs to be carefully considered. Email usage may
potentially be problematic from a confidentiality perspective as
it is easily forwarded, retains all information verbatim, may be
subject to data mining, and can often be easily accessed by
non-authorised users (Gamble & Morris, 2014). Psychologists,
and their clients, should be judicious in using free online email
providers as part of the telepsychological service. Some free
email providers data mine (search) the content of emails sent to
and from their free accounts, and this can lead to targeted
advertising being shown to the user when browsing the inter-
net, which can have undesired emotional consequences
(Bowden, 2014). For example, a client seeking telepsychological
services relating to infertility may receive targeted advertising
for baby and pregnancy-related products. Encrypted email ser-
vices should be used where possible. However, even with
encrypted systems, once the email has been received and
decrypted, it can be viewed by anyone with access to the com-
puter (e.g., family members or computer support staff).
Employer monitoring, of either parties, email usage should also
be considered in relation to the confidentiality of any commu-
nications between a psychologist and client. Any email corre-
spondence between the client and the psychologist are
considered part of the client record (APS, 2011b). Therefore,
emails need to be stored, accessed, and protected in the same
way as other client records. It is also important to note that the
full email exchange between the psychologist and client may be
subpoenaed. This verbatim record of sessions is likely mean that
substantially more information is collected and available than in
traditional clinical notes.
Some consideration is also needed when examining the
devices that psychologists use to access their email. In 2013,
over 60% of American email was opened using a mobile device
(MovableInk, 2014). According the Australian Mobile
Telecommunications Association (2014), over 100,000 mobile
phones are lost or stolen each year. Psychologists need to care-
fully evaluate what security measures can be adopted to protect
client confidentiality if they engage in telepsychological activi-
ties using their mobile devices. These considerations are more
pertinent if client information is stored electronically.
Electronic Storage of Client Information
With the advent of eHealth records, paperless offices, and prac-
tice management software, the storage and management of
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N Gamble et al.
electronic records has become a necessity for many psycholo-
gists. Many technologies now rely on cloud storage to meet this
need (Maheu, Pulier, McMenamin, & Posen, 2012). Cloud
storage involves an online system that can be accessed from any
location with internet access which allows storage. These
systems offer very large storage with back-up/data recovery
services, security provisions, and easy access which potentially
make them extremely useful for storage and access. Platforms
such as Facebook, Gmail, Twitter, and online appointment man-
agement may also be considered cloud storage as they also allow
for the online storage and retrieval of information (Devereaux &
Gottlieb, 2012). The ease of access can make this form of storage
very attractive and reduces the logistical issues in file storage
within a psychological practice (Maheu et al., 2012). However,
cloud storage does physically exist on a computer server some-
where, potentially internationally, although the exact location is
often not known (Gamble & Morris, 2014). This can raise issues
in relation to APP8: if a psychologist is unaware of physical
storage location, it will be impossible to confirm if the informa-
tion will be stored with privacy protections equivalent to Aus-
tralia. While security systems within cloud storage systems can
be robust, they are not impregnable and often rely on the
security precautions taken by users such as having complex
passwords and not remaining logged in to services (Byington &
McGee, 2014). Psychologists also need to be mindful of auto-
matic back-up of their mobile devices.
Many computerised systems, especially smart phones and
tablets, automatically back-up their content on cloud storage
services. Psychologists need to consider the security of such
services especially if any client information is stored on an
electronic device. Even if more sensitive clinical records or
reports are not stored on a mobile device, confidential client
contact and administrative information may be. Automated
back-ups can also lead to issues when information needs to be
removed or deleted. In many situations, information stored on
back-up services maybe archived for future access even if it has
been deleted from the original device (Devereaux & Gottlieb,
2012). Psychologists should check their devices to confirm what
information is being “synced” or stored online.
Video Conferencing as Part of Telepsychology
Video conferencing as a means of telepsychology has been
employed since the 1950s with an increase in its use in the late
1980s (Rees & Haythronthwaite, 2004). Traditionally this had
been in the form of closed circuit television and more recently
video teleconferencing equipment (Luxton, Pruitt, & Osenbach,
2014). Current internet technologies allow video communica-
tion from many devices, including mobile phone, provided it
has a fast internet connection. While this allows tremendous
flexibility for clients to engage in telepsychology from any loca-
tion at any time, there are potential ethical issues in relation to
confidentiality.
With the flexibility in conducting video conferencing as a
form of telepsychology, the psychologist and the client will need
to negotiate appropriate locations. As Luxton et al. (2014) high-
light, there is the potential for family members or work col-
leagues to be present during the session, severely compromising
confidentiality. Given the narrow focus of most video lenses, it
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N Gamble et al.
is possible that the psychologist may not be aware of the loca-
tion of the client or if any other individuals are present. Typi-
cally, a psychologist would discuss with the client and any third
party the issues related to confidentiality and the protections
that they would put in place. This may not be possible if the
client is in a public place while using video technology as part of
telepsychology. The psychologist cannot control the client’s
location during the telepsychology session. Best practice would
be to ensure that the client is fully aware of the potential loss of
confidentiality depending on the location. There is a range of
free and fee-based video conferencing software and systems,
and psychologists need to consider the levels of confidentiality
and data security they offer.
Skype is a commonly used video conferencing tool in
telepsychology. There has been some discussion regarding the
adequacy of the level of encryption for telepsychology (see
Baker & Bufka, 2011). However, it is more secure than many
standard internet communication technologies. While the level
of encryption does provide some protection to confidentiality,
Skype’s (2014) privacy policy does note that they can employ
user information (including name, username, address, and sta-
tistics on page views) to “organise and carry out Skype’s mar-
keting or promotional operations/offers” (S2). Skype may also
use non-identifying information, in relationship with and use of
Skype’s websites, software, and products, “such as the destina-
tion of your calls, in order to provide advertisements likely to be
of greater interest to you” (S5). While it is possible to opt out of
some of these services, the quantity and nature of information
collected and used, does have the potential to negatively impact
on client confidentiality. Services such as this, or any other
video conferencing tool, should only ever be employed in
telepsychology if the psychologist involved has adequate com-
petence in understanding the technology and utilising it appro-
priately in a therapeutic setting.
Potential New Technologies in Telepsychology
In considering internet-based telepsychology, there are a range
of tools that could currently be used to provide direct services to
clients such as video-based communications, email, and text
(Drum & Littleton, 2014).
However, new technologies such as virtual reality, artificial
intelligence (Luxton, 2014), social media, and wearable tech-
nology (Morris & Aguilera, 2012) are soon likely to be employed
on a larger scale as part of telepsychology. These technologies
will bring with them new ethical challenges. Current tools such
as Facebook’s graph search (Facebook, 2014), which allows
users to search for any publically available information about a
person on Facebook (including their comments on public
content posted by third parties), has implications for potential
boundary crossings (Gamble & Morris, 2014). While AHPRA’s
social media policy and APS Code of Ethics do deal with such
issues, more radical challenges, which artificial intelligence and
virtual reality in telepsychology are likely to pose, will require
careful consideration within existing ethical frameworks.
Whichever technologies are employed in telepsychology, it is
vital that the psychologists using them have sound competen-
cies in the technical issues together with the clinical application
of the service being provided.
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Ethical practice in telepsychology
Competence in the Use of Internet
Communication Technologies
The APS (2011a) Guidelines for providing psychological services and
products using the internet and telecommunications technologies high-
light that “psychologists who provide psychological services
using the internet and other telecommunications technologies
develop and maintain their understanding of technological and
telecommunications modes of service delivery and enhance
their skills in the use of these forms of communication” (p. 55).
It is vital that psychologists have adequate practice, clinical, and
technical knowledge of the communications tools they use in
telepsychology in addition to any empirically supported service
provision.
Given that telepsychology can encompass a wide variety of
communication (e.g., text, video, audio), psychologists are ethi-
cally required to have the skills to ensure that they are not
missing important cues. Psychologists may need to develop and
empirically evaluate novel solutions. For example, the use of
graphical symbols to add depth to text-based telepsychology
communication. There are now hundreds of graphical symbols
(Emoji) that can be used on electronic communication devices
(Unicode Consortium, 2014). These small symbols are often
seen in text messaging as small animated images.
However, they portray a range of objects, emotions, feelings,
and situations. These include pictographic representations such
a “face with tears of joy,” “face with cold sweat,” and “pensive
face,” which may be useful when communicating with clients
via text-based mediums. Little research has investigated the
communicative advantages or ethical implications of using
Emoji in therapy, and this is an area that warrants further
attention. Psychologists may choose to refrain from utilising
Emoji themselves so that professional boundaries are main-
tained, thus graphical communication may be unidirectional.
Emoji-competent clients who possess limited emotional vocabu-
lary to convey emotional states may benefit from the potential
for added emotional depth to non-visual communication which
is often an area of concern in text-based telepsychology.
However, there are reported differences in the gendered use
of Emoji (Ogletree, Fancher, & Gill, 2014) and they may not be
suitable for individuals not familiar with technology.
Psychologists who work in the telepsychological field will
need to consider emergency management if a client is posing a
threat to themselves or others (Kramer et al., 2014). As a
minimum for all clients, the APS recommends that psycholo-
gists keep a record of an emergency contact person that the
client is comfortable with the practitioner communicating with
if needed (2011a). This is consistent with a recent coronal rec-
ommendation (Coroner’s Court NSW, 2009) and should be a
part of all consent processes for all clients. In telepsychological
contexts, technology may offer additional assistance. Increas-
ingly internet-connected devices are equipped with GPS which
can provide detailed geographical information. Many applica-
tions currently include a location as part of their use
(Geotagging). Developers of future applications (Apps) which
are specifically for telepsychology should consider, within
appropriate ethical boundaries, having the ability to turn on a
client’s GPS in an emergency situation to assist in alerting
appropriate services.
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The identity of the client can be a difficult issue when working
with some forms of telepsychology. Given that all interactions
may occur without face-to-face contact, concerns regarding age
and identity can be ethically problematic. The APS recommends
that all telepsychological service provision include a face-to-face
or video conference session before any telepsychological
activities take place (2011a).
However, this does not solve the issue as once non-face-to-
face interactions occur, there is only limited information avail-
able regarding the person receiving the service. There have been
some attempts to develop national compulsory online identities
in South Korea (Cho, 2013) but these have not succeeded.
Future Apps developed specifically for telepsychology may
include restricting the psychological services to specific Internet
Protocol addresses or International Mobile Equipment Identity
numbers which were used in the identity verification process.
This would provide additional verification of client identities.
Psychologists are ethically required to obtain and maintain a
wide range of skills when working in the telepsychological field.
A clear appreciation of the risks and benefits of technology and
a sound understanding of internet infrastructure is required in
addition to knowledge of the empirical support and clinical
application of techniques to be used over internet communica-
tions technology. Finally, psychologists need to be able to
convey this information to clients or appropriate third parties as
part of the consent process.
Consent in the Telepsychological Context
One of the core aspects of any psychological service provision is
the requirement that a psychologist fully inform their clients of
the processes, risk, and benefits, potentially involved in that
service. Section A.3 of The Code (2007) fully details the require-
ments for all psychological services including telepsychology.
When engaging in telepsychology, the key aspects that will
require additional clarification due to the use of technology will
be the foreseeable risks (Section A.3.3.b), the collection, reten-
tion, transmission, access and storage of information (Sections
A.3.3.b and A.3.3.c), and additional limits to confidentiality
(Section A.3.3.h). The use of technology will require additional
information to be presented to clients in relation to these issues.
Psychologists should ensure that their clients are aware of the
potential risk of using internet-based communication tools as
part of telepsychology. Given recent trends in perceptions of
privacy online (Jeong & Coyle, 2014), many clients may choose
to accept the risk of broad data collection online when
telepsychology offers convenient access to psychological
services and may provide greater privacy from their immediate
friends and family.
However, the onus is on the psychologist to ensure that the
risks and benefits are accurately conveyed and considered.
Given the perception of easy access to telepsychology, psy-
chologists will need to clearly define the times they will be
available for service provision and how often they will check for
messages (Drum & Littleton, 2014). This is also relevant to
meeting client needs in an emergency situation. As was detailed
above, psychologists should have well-developed processes for
emergency situations. This information needs be clearly con-
veyed as part of the informed consent process within the
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N Gamble et al.
telepsychological context. As part of the consent process, it is
essential that clients are informed of what to do in an emer-
gency situation (e.g., resources in the client’s physical location),
how the psychologist will attempt to contact, or locate the client
if the client is at risk of harm. Tools such as the Decision Assis-
tance Model for Australian Psychologists and the Client Risk-
Harm Determination could be used to assist decision making
(Boyle & Gamble, 2014).
While more information will need to be provided in the
consent process for telepsychology, the use of technology can
also potentially improve the access to and interpretability of
consent information. In technological fields, it is well known
that users rarely read terms and conditions; some reports
suggest that only about 10% of the text in terms and condi-
tions is actually read (Neilsen, 2008; Neilsen & Loranger,
2006). It is important that psychologists develop informed
consent procedures for telepsychology that are user friendly
and checks are in place to confirm that the client has viewed
them. An internet-based consent process would allow for the
use of a mix of written, video, and audio information to be
included in the informed consent process, potentially in mul-
tiple languages and with links to other resources. It is also
possible to monitor how long a client has spent reading each
section of a consent form to allow for follow-up if needed. The
use of such tools can allow for a more rigorous and inclusive
consent process.
Conclusion and Recommendations for the Ethical
Implementation of Telepsychology
Telepsychology is likely to be an important method of providing
psychological services for those who seek convenience or for
those who have difficulty physically accessing a psychologist.
While it has great potential to be a positive influence in
healthcare delivery, it is not without ethical issues. The key issue
currently is the potential lack of confidentiality inherent in
using existing internet communication tools. Some clients may
consider the ease of access and flexibility that telepsychology
offers to contain an acceptable risk.
However, psychologists should advocate for the development
of more secure communication tools. These purpose built tools
should encrypt communications and manage the storage of any
confidential information on devices. While these tools are
developing, psychologists should maximise security and confi-
dentiality protections when using existing tools and fully inform
clients about the potential risks.
As with many technological areas, new tools, and techniques
will be developed and implemented very quickly. Legislation,
research evaluation, formal training, and thus ethical prepara-
tion can lag behind. A summary of recommendations from the
authors can be found in Table 1. In Australia, psychologists
engaging in telepsychology should ensure that the practice
meets the standards governed by the Psychology Board of Aus-
tralia including the APS Code of Ethics. While new and devel-
oping technologies may make this challenging, practitioners
engaging in telepsychology should collectively develop shared
resources that address the need for supportive and detailed
guidance for the added complexities of ethical decision-making
in telepsychology.
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Table 1 Recommendations for Ethical Practice in Telepsychology

General • Regardless of the therapeutic setting or mode of communication, psychologists are required to uphold the code of ethics in their
work.
• Psychologists should actively maintain knowledge of the most recent policies, guidelines, and legislation relating to telepsychology
and privacy.
Confidentiality • Psychologists should consider if their use of third party support, platforms, or software constitutes cross-border disclosure of
information without client consent.
• Psychologists should maximise confidentiality by selecting the most superior internet security tools available.
• Care should be taken when communicating via email as it is easily forwarded and may be inadvertently intercepted or accessed by
colleagues, partners, or family members.
• All email and online communication with clients should be securely stored; such records may be subpoenaed and will provide a
verbatim record of sessions, a level of detail that is beyond most traditional client records.
• Psychologists should be aware of the risks associated with various data storage options (e.g., cloud, external storage) and negate
them as much as possible.
• While automated back-up (or “syncing”) protects against data loss, it may also provide opportunities for unauthorised access to
information particularly when devices are shared or if when devices are sold or transferred to others.
• The psychologist should discuss any third party issues related to confidentiality with the client and the protections that have been put
in place.
Competence • Psychologists who engage in technologically mediated communication or services with clients should be competent in their use, in
addition to empirically supported service provision.
• Novel solutions may be required to ensure important emotional cues are not missed in textual based therapy (e.g., the use of Emojis,
with the appropriate ethical precautions).
• Provisions for emergency management should be made to negate issues of client anonymity or unknown client location.
Consent • The psychologist should fully inform their client of the specific risk and benefits associated with psychological service provide by
telepsychology; in addition, the risks and benefits of the internet-based communication tools employed.
• Clients should be informed of the processes in place for emergency management as well as how potential technological difficulties
may be managed (e.g., drop-outs).
• The language of explanation of technological concepts should be at a level that is appropriate for the clients’ technological capability.

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