Informed Consent For Distance Counseling

Every day I speak to therapists who are interested in growing their practices.  Many are exploring the possibility of providing distance counseling.  I’m happy to have Lauren Ostrowski back with us again this week to share with you her thoughts about the informed consent process that is unique to distance counseling.

(If you are interested in writing a guest post, check out the guidelines here.)

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A Guest Post by Lauren Ostrowski, MA, LPC, NCC, DCC

Informed consent is arguably one of the most important parts of the counseling process and requires one of many professional documents you will need in private practice. Typically, an informed consent form is lengthy, includes a lot of different information, and is largely dependent upon ethical codes specific to a particular mental health discipline.  When your practice includes distance counseling,*  there are special considerations that must be addressed in your informed consent form.

Please note that this guest post only discusses elements of  informed consent that are unique to distance counseling and are not sufficient for your entire informed consent process or document.

My informed consent document has not been reviewed by an attorney. It was written with requirements from each of the following in mind: the American Counseling Association’s Code of Ethics (2005), the Code of Ethics for the National Board for Certified Counselors (2013), the National Board for Certified Counselors Policy Regarding the Provisional Distance Professional Services (2013), and the Online Therapy Institute’s Ethical Framework for the Use of Technology in Mental Health.

Sounds complicated, doesn’t it?  It took me quite some time to make sure that I had satisfied all of the requirements for each of them.

General Information

Adding information related to distance counseling into an already lengthy informed consent makes it almost unwieldy.  I explain this at the beginning of my document and  specifically say that it is important for the clients to read the document at their own pace and ask questions as needed.  This guest post specifically focuses on internet counseling, as this will constitute a large majority of my client interactions. It is important to be mindful of phrasing – a lot of what is being addressed is highlighting the negative aspects of distance counseling so balance is key.

Confidentiality and Distance Counseling

Clients are responsible for the confidentiality of their own environment. (This statement constitutes its own paragraph in my informed consent because it is incredibly important).

In face-to-face counseling, the counselor can do a fair amount to make changes to increase privacy in the therapeutic environment. This is not possible when doing distance counseling. Related to confidentiality in distance counseling, you will also want to discuss the following with your client:

• The computer and all data has potential to contain confidential information;
• Be mindful of leaving a computer window open and moving away from the screen;
• Consider who may have (whether authorized or not) access  to your information;
• Be aware of the possibility of key logging software, which can be used with or without your knowledge;
• It is recommended not to put your counselor’s e-mail in your address book so that you are less likely to accidentally send confidential information to the wrong person;
• E-mail is not typically confidential.  The exception to this is when e-mail is sent / received through HIPAA-compliant platforms like Hushmail. Many other programs or applications may not be HIPAA compliant.
• Verbatim correspondence from client-counselor interactions should not be revealed publicly.  However, it’s important to note that within the context of  distance counseling, this possibility does exist.  As an example, consider that a counseling e-mail could end up in a Facebook post.

Other Important Concepts

• There may be a requirement that the client be in the same state as the counselor or in a state where a counselor is currently licensed.
• It’s important for counselors to check with their liability insurance carriers to insure proper coverage of distance counseling.
• Verification of client’s identity is important.
• Some states require that clients be over the age of 18 to consent / engage in distance counseling.
• Similar to face-to-face counseling, privileged communication does not apply when someone else is in the room.  It is important to note that this includes anyone else being around the client (for example, the computer is in living room and a family member is sitting nearby).
•  It is common for clients to find it easier to disclose personal information faster than they would in a face-to-face session – this can be tempered by pacing sessions.
• It is possible that a client’s privacy may be breached by a  third-party knowledge despite the fact that precautions are being taken’
• When communication occurs in writing, it is important for both parties to be open to asking questions and receiving clarification or feedback to minimize the possibility of misunderstandings.
• Advantages and disadvantages of distant counseling are a major component of the consent form.
• Flexibility in client and counselor schedules is one of the biggest advantages.
• Lack of insurance coverage can be a big disadvantage for some clients.
• Procedures for crisis or emergency situations need to include both local and national resources.
• Procedures to address unexpected failures in technology need to be addressed.

What other questions do you have about distance counseling and informed consent?  Did you learn anything that you could incorporate into your already existing document?

* Distance counseling refers to counseling that transpires through the use of technology.  
  Technology can include the telephone, texting, internet-based interactions, and others.
  Actual counseling interaction must take place in a HIPAA-compliant environment and 
  distance counselors typically have a separate website to advertise their services and 
  discuss other practice-related information that is not confidential. 

  The Distance Credentialed Counselor (DCC) is the credential is offered for mental health 
  professionals through the Center for Credentialing &Education.  The training for this 
  credential is provided through ReadyMinds and Associates.

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About the Author: Lauren C. Ostrowski, MA, LPC, NCC, DCC is a counselor in a community mental health agency in Pennsylvania.  She is also a Distance Credentialed Counselor and is excited about beginning a limited private practice using distance (online) counseling.