Presented by: Imtisal Bukhari

Alqa Jabbar
Areej Pervaiz
Shahzaib
Presented to: Ma’am Sara Israa
 Topic of presentation
Marriage and family counselor’s perceived
ethical issues related to online therapy.
The article was published in 2015
 Introduction
Technology in online therapy and ethical issues related to it
 Rapid change in profession by technology
 used in both medical and mental health disciplines
 Elaboration of online therapy and technology assisted distance
counselling
 Use of online therapy and how it works
 Advantages
 Usefull in rural areas
 Clients who are housebound
 Couple and family councellors
 Still have some ethical concerns
Ethical issues in online therapy
 Visual and auditory confidentiality concern
 Issue in boundary management or getting connected on social
media accounts
 Management crisis
 Method
 Mixed method approach
 Survey data
 Sample –(part and full time counsellors and students in MFT
programs )
 Recruitment of participants took place in three ways
1. Internet posting
2. Advertisement at the AAMFT
3. Couple and family therapy themed conference
 Recruitment procedure ( contact with 2000 potential participants and
resulting in 226 participants of the study
 The method took place between two groups
 This research was approved by a university Institutional
Review Board and funded by the Alaska Association for Marriage and
Family Therapy.
Perceived Ethical Issues and Drawbacks in it
Six themes emerged with regard to the ethical issues and
drawbacks that emerge in online therapy:
 (a) licensing and liability issues
 (b) issues related to crises and risky clinical situations
 (c) training and education.
 (d) confidentiality,
 (e) impact to the therapeutic relationship
 (f)Reduced Quality of Therapy
Licensing and liability issues
Licensing
Official permission for therapist
Liability
risk faced by therapists, psychologists,
and mental health professionals who
provide counseling services. 
Cont…
Another issue was the process of conducting interstate
treatment as counselors may not be licensed to practice
with clients living in another state.
This theme was also related to the conduction of
treatment with individuals at risk.
For example, one participant wrote: ‘‘if a client has an
emergency and you are not accessible, could you be
held responsible?’’
Issues related to crises and risky clinical
situations

Some of the issues identified within this theme

include difficulty in
monitoring self injurious behavior
safety of the client
 compromised ability for the counselor to intervene
immediately.
•Implications for training
This theme was emerged that the necessity of having proper
training and education to deliver and conduct therapies online.

Participants noted the responsibility of the counselor to be

knowledgeable about how to conduct sessions over the
Internet
Other ethical concerns
Potential ethical issues related to cyber-treatment that
are addressed in one’s informed consent.
Mental health professional, need to establish a
procedure by which they are able to confirm someone’s
age, legal status, and identification prior to
engagement in an online therapeutic relationship.
Determine that electronic therapy is appropriate for
clients, taking into account the clients’ intellectual,
emotional, and physical needs
Security
Case study
Neuro transmitter, Psy.D. works in Paramus, new jersey,
and provides services through shrinkMe.com of Dallas,
Texas. One afternoon he is connected on a video call
through Skype with Hedonia of Simi valley, California.
Soon he realized that she is suffering from severe
depression. He gently suggests she ought to think about
hospitalization near home. Hedonia replies Even you
don’t are about me That’s it. And disconnects.
Confidentiality

“Confidentiality means that the information is restricted to those authorized to have

access to it. The one main is access restriction in confidentiality”.
Confidentiality include concerns about privacy, concerns about who could view
the video or feedback and authenticity of the users.
Confidentiality was also related to the issue of security of some participants.
According to the participants, security online is not granted.
Therapeutic Relationship
 A therapeutic relationship is defined as an interactive relationship with a
patient and family that is caring, clear, boundaries positive and professional.
 Several patient noted that messages sent may be miss-interpreted or
misunderstood, thus compromising client are therapeutic process.
 One participant exemplified this by writing there may be missed
information lost feelings understanding lack of intimacy and disclosure.
Reduced quality
Online therapy was also characterized as one of reduced
quality resulting in dilute treatment due to the lack of
face-to face interactions and personal connection.
Web-based therapies were also perceived as contributing
to greater degrees of difficult in properly assessing clients.
 Instrument
The survey tool was composed of Likert-type, multiple
choice, and open-ended item, and mixed-methods research
approach
social networking sites with their clients and colleagues, e-
mailing to clients and colleagues, and other ways they might
use technology with these groups.
Results
Community therapy was also characterized as one
of reduced quality due to the lack of face-to face
interactions and personal connection.
it is more difficult to use body language and
positioning to create change and build rapport.’’ As
summed up by one participant, the ‘‘quality of
service via Skype/e-mail/chatrooms does not equate
to therapy the client would receive face-to-face
Implications for Clinical Practice
The iteration of the ACA’s Code of Ethics highlights specific practice with regard to
Internet based counseling. These include practical guidelines
the ACA ethical code identifies the importance of communicating with a client about the
presence of social media and the limits and boundaries accompanying use of such
technologies
Implications for Research
The sample in this study represented a group of MFTs
who, by in large, refrained from using technology or
web-based devices in their practices.
perceptions about the ethical challenges related to the
practice of online therapy and web based
communication with clients is limited to those who do
not necessarily practice this work.
Limitations
This study presents the responses of those who have
little practical knowledge about the subject, and
therefore provides little new information for the field
of MFT.
MFTs in the study who exclusively used web-based
practice as their primary treatment modality.
Case study
Background
The provision of psychotherapy over distance using technology is a
growing market reaching many patients and therefore the risks and
benefits need to be known by all psychotherapists whether they
themselves practice online or not. This comprehensive review of the main
ethical arguments for and against different forms of online psychotherapy
aims to enhance discussion of ethical issues in this growing area.