● ACA (2014) states that counselors actively attempt to understand the evolving nature of distance counseling and they make every attempt to protect confidentiality when using distance counseling technology (Section H) and make every attempt to ensure confidentiality and security. (Standard H.2.d). ● NBCC (2023) states that counselors provide telehealth services only if qualified, they follow legal requirements, they ensure that communications are encrypted and secure, and they set clear boundaries with clients about the type and timing of telehealth therapy. They should provide the client with written information about the protection of confidentiality and security measures. (Standards 91-97). ● AAMFT (2015) states that it is the therapist’s responsibility to choose technology platforms that adhere to the best practices related to confidentiality, quality of services, and applicable laws (Standard 6.3) and they ensure that they are well trained and competent to provide technology-assisted services. (Standard 6.6). ● APA (2017) states that psychologists have a primary obligation to protect confidential information obtained through any medium (Standard 4.01) and has published guidelines specific to the practice of telehealth. Chenneville and Swartz-Mette (2020) discuss many of the ethical considerations that may be an issue when providing telehealth services. Among those is the boundary of confidentiality and the potential for its limits to be crossed or expanded. They note that in a telehealth situation there is the potential for outside parties to listen in on the therapy session, the therapists’ or clients’ comfort with the technology may impact confidentiality (e.g., being hacked), and the client themselves may be able to record the session without the therapist’s knowledge or consent. Stoll and colleagues (2020) reviewed databases for topics on ethics, online, and therapy. They also found that the most discussed disadvantages of using telehealth technology
for therapy were the risks to the boundaries of privacy, confidentiality, and data security. Telehealth has become a common modality for providing clinical services and is likely to only continue to expand. Barnett (2019) offers several recommendations for counselors who provide telehealth services as a way of maintaining safe and ethical boundaries. ● Counselors should apply all relevant ethics code standards, regulations, and guidelines just as they would for in-person therapy. ● They should remain current on the research literature for telehealth effectiveness in the treatment of various mental health concerns. ● They should become competent in the use of technology and the safeguards necessary to protect confidentiality. ● They should keep their clients’ best interests in mind when deciding if telehealth is the most appropriate way to meet their treatment needs. They should consider options and alternatives as well as the potential risks and benefits of each. ● They should assess each prospective client’s treatment needs fully, including diversity factors such as culture and language, when considering use of telehealth. ● They should treat all online relationships with clients as similar to in-person therapy relationships. ● They should address the use of telehealth technology and limits and boundaries of this form of therapy with clients at the outset of treatment. Clinical Consideration : Provision of telehealth services poses unique risks to the boundaries of privacy and confidentiality. Providers and clients should have a clear understanding of the risks and benefits of the services, and they should have knowledge about security issues prior to using this modality. ● They should be knowledgeable about relevant emergency resources available in the clients’ community in the event of a crisis or emergency. or not. They do not have sexual contact with the client’s relatives or those close to the client. They do not engage in sexual activity with former clients, and if they do, they bear the full burden of proof that the client was not exploited, coerced, or manipulated. Social workers do not provide services to individuals with whom they have had a prior sexual relationship (Standard 1.09). ● NBCC (2023) states that counselors will not engage in any form of sexual or romantic contact with a client or former client for at least 5 years following termination of counseling services. (Standard 24). ● ACA (2014) states that in-person or electronic sexual or romantic relationships with current clients, their partners, or clients’ family members are prohibited. They are prohibited from providing counseling services to previous romantic or sexual partners. They are prohibited from having a romantic or sexual relationship with a former client or their family members for 5 years after the termination of therapy. This applies to in-person and electronic modalities (A.5.a–A.5.c). ● AAMFT (2015) states that sexual intimacy with current or former clients or members of the client’s family system is prohibited (Standards 1.4-1.5). Despite these very clear professional standards prohibiting sexual relationships, these serious boundary violations do occur.
BOUNDARY VIOLATIONS
Sexual Misconduct Sexual relationships with clients at any level are
unequivocally unethical, they are firm boundary violations, and they are illegal under licensing laws in all states. All therapists are instructed during their education and training that sexual contact with current clients is prohibited without exception. Sexual misconduct can range from subtle uncomfortable behaviors to those that are blatant, coerced, manipulative, physically intrusive, and highly traumatic and can include comments, looks, invasive touching, sexual contact, and rape (Steinberg et al., 2021). Every profession’s code of ethics addresses this behavior as it has clear potential for harm, trauma, and exploitation. ● APA (2017) prohibits sexual intimacy with current clients or individuals who are close relatives, guardians, or significant others of current clients, and therapists cannot terminate therapy to circumvent the prohibition. They do not accept as clients those with whom they have had a sexual relationship. They do not enter a sexual relationship with former clients even after a 2-year waiting period except in unusual circumstances, and if they do, they bear the burden of demonstrating that there has been no exploitation. (Standards 10.05–10.08). ● NASW (2021) states that under no circumstances do social workers engage in sexual activity, inappropriate sexual communication, or sexual contact with current clients regardless of whether the contact is consensual
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Book Code: PYTX1325
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