Avoiding hazards in online therapy

Why we chose video

Why we chose chat

Dangers to avoid

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Updated April 24, 2020

Communication technology: avoiding privacy breaches

* Video and chat: A professional online therapist is required to use a platform that is compliant with PHIPA, PIPEDA and other laws governing the confidentiality of medical records. They should not use Skype, Facetime or other platforms that are not designed for confidential medical information. (Skype is encrypted in transit, but is recorded on the Skype servers in the US.) There has been a lot of confusion lately about whether Zoom meets privacy standards. They have a plan that they market for telehealth, but it costs $200 a month, so most therapists in private practice won't have it. Because of recent high-profile security problems it would be best to avoid Zoom until they are fixed.

* Telephone: Know that your phone messages and texts can potentially be read from your phone, even after you have deleted them. Telephone conversations are not especially secure, but a corded phone is more secure than one that is broadcasting a signal that could be picked up in the surrounding area (accidentally or not).

* Email: Before putting anything confidential in an email, know who can read it. Gmail is encrypted in transit between two gmail accounts, and probably can't be read by your IT department if you use the web interface while at work; however it is recorded on the Gmail servers in the US, which could make it available to snoops. Hushmail, Protonmail and similar services offer very good privacy--so long as it is sent between accounts with the same company and is not forwarded to an email account with a different company. (No system is infallible, though.) A password-protected attachment should be safe unless your computer or smartphone (or your therapist's) is stolen, in which case it can be read. However an attachment should be checked for viruses before being opened. Licensed counsellors are required to take precautions to maintain security, but most are not IT experts, and occasionally therapists' computers have been infected. Also, a government-licensed counsellor's computer should be encrypted--but don't be afraid to ask.

* More: For more on privacy in psychotherapy and clinical counselling, see privacy in mental health care. The part about technology applies to all of Canada; however the article is written for Ontario, and some of the legal hazards and protections could be slightly different in other provinces.

Unqualified counsellors

A commercial outfit can have an expensive and professional-looking website and claim that the "professionals" they provide or list are "licensed", "approved" etc. Licensed where? By whom? Can you check on it?

For a therapist who actually is licensed it would be foolish to be on such a website, because they could lose their licence. The licensing of mental health therapists is at the state or provincial level. In Ontario and Quebec it is illegal for anyone who is not regulated in the province to provide a mental health service to their residents. Similar legislation is in the works for Alberta. As with doctors, all government-licensed mental health counsellors are required to have malpractice insurance for the protection of their clients.

Appropriateness and safety of treatment

Except as an adjunct to care you are receiving at your local clinic, distance counselling should not be undertaken by anyone who is unstable or has any condition that could pose a danger to self or others if it escalates--for example, addiction to hard drugs, anorexia, drunk driving, bipolar disorder, violent anger, or suicidal tendencies. If you have any such condition, do not seek supplementary online therapy unless it is approved by the doctor in charge of your treatment.