Amisha Agrawal¹, Anya Chabria², Clarise Han³, Tyler Shern⁴, Lillian Sun⁵, Serena Yang⁶, Brooke Ellison⁷

¹Emory University, Atlanta, GA 30322, ²Duke University, Durham, NC 27708, ³Massachusetts Institute of Technology, Cambridge, MA 02138, ⁴Columbia University, New York, NY 10027, ⁵Thomas Jefferson High School for Science and Technology, Alexandria, VA 22312, ⁶Dougherty Valley High School, San Ramon, CA 94582, ⁷Center for Compassionate Care, Medical Humanities, and Bioethics, Health Science Center, Stony Brook University, Stony Brook, NY 11794

*Editors: Lillian Sun, Junsang Yoon, Jessica Guo

 

When evaluating the use of telecommunications in psychological therapy, it is important to address the ethical concerns. While administering therapy through telecommunications could result in economic advantages, such as increased accessibility, the downsides of having technological issues, such as confidentiality breaches, make it unreliable for treatment.^[1] The two positions present compelling benefits and consequences that must be weighed before telehealth can be fully implemented for psychological treatments.

 

Benefits of tele psychotherapy include increased access and flexibility, economic advantages, and anonymity. Digital psychotherapy enhances availability to health care services, especially for those living in rural or remote areas. It is perceived as convenient by both therapists and patients because the flexible format of tele psychotherapy is able to easily satisfy the needs of both parties.^[1] The integration of a wider range of care in the form of online materials allows for data and documentation revision of therapeutic techniques for patients.^[2] In addition, viable alternatives to in-person treatment have been implemented to allow for further flexibility in treatment.^[3]

 

As telehealth is more cost-efficient than in-person visits,^[4] more low and middle-income individuals can afford digital psychotherapy. Therapists have more flexibility online and can reach out to underserved populations. This is especially true in developing countries, such as India.^[5] Furthermore, receiving digital therapy can increase a patient’s sense of privacy and anonymity. If therapy is sought anonymously, the patient can potentially discuss personal and emotional issues more freely, leading to a better recovery.^[6]

 

Privacy and security are concerns. Therapists administering psychotherapy may not be able to avoid data breaches and hacking within their communication software.^[1] Additionally, the use of digital psychotherapy lends to the potential impediment of effective communication between therapists and their patients. If the mode of communication chosen is messaging, for instance, the therapist may not be able to use nonverbal cues to evaluate and treat patients.^[7] This issue is exacerbated if therapists are not trained for online counseling,^[1] or if there are extreme situations (e.g., a patient with suicidal thoughts) that require risk assessment.^[7]

 

Since tele psychotherapy has only recently been popularized, there has been an insufficient amount of concrete research studies conducted, and the effectiveness and efficacy of digital psychotherapy may be significantly less than that of in-person treatments.^[4] According to Dr. Bufka, the American Psychological Association’s associate executive director of practice research and policy, the companies that are developing tele psychotherapy may not be fully equipped with the healthcare knowledge to develop effective platforms.^[7] Additionally, the lack of regulatory guidelines and standards in the field leaves many ethical considerations unaddressed, especially in terms of cross-border practice, cultural differences, licensing, and quality of care.

 

In sum, the lack of privacy, effective communication, regulatory and emergency guidelines, and clear efficacy of treatment must be considered when considering the viability of telemedicine in the field of psychotherapy. New innovations that arise in tele psychotherapy must overcome these ethical issues before being fully considered as legitimate and prospective tools for treatment.

 

References

[1] Stoll, Julia, et al. “Ethical Issues in Online Psychotherapy: A Narrative Review.” Frontiers in Psychiatry, vol. 10, 2020, doi:10.3389/fpsyt.2019.00993.

[2] Johnson, G. R. “Toward uniform competency standards in telepsychology: A proposed framework for Canadian psychologists.” Canadian Psychology/Psychologie canadienne, 55(4), 291–302, 2014, doi:10.1037/a0038002

[3] Brenes, Gretchen A et al. “Benefits and Challenges of Conducting Psychotherapy by Telephone.” Professional psychology, research and practice vol. 42,6 (2011): 543-549. doi:10.1037/a0026135

[4] Barnett JE, Scheetz K. Technological advances and telehealth: Ethics, law, and the practice of psychotherapy. Psychother: Theory Res Pract Training (2003) 40(1/2):86–93. 10.1037/0033-3204.40.1-2.86

[5] Malhotra S, Chakrabarti S, Shah R. Telepsychiatry: Promise, potential, and challenges. Indian J Psychiatry (2013) 55(1):3–11. 10.4103/0019-5545.105499

[6] Chester A, Glass CA. Online counselling: A descriptive analysis of therapy services on the Internet. Br J Guid Couns (2006) 34(2):145–60. 10.1080/03069880600583170

[7] Novotney, Amy. “A Growing Wave of Online Therapy.” Monitor on Psychology, American Psychological Association, Feb. 2017, www.apa.org/monitor/2017/02/online-therapy.