Ethical practice online: An exploration of provider liability risk among practitioners in the emerging field of online therapy

Abstract

Little attention has been given to liability issues and practitioner vulnerability in the rapidly emerging modality of online therapy. The purpose of this study was to explore ethical issues and identify potential risks of liability faced by mental health professionals in three areas of online practice: qualifications and training, domain of practice, and delivery of services. A sample of 232 online providers who were members of the International Society for Mental Health Online (International Society for Mental Health Online) completed an online survey containing items asking about their online therapy procedures and ethical practice. Descriptive statistics, including frequencies and percentages, were used to examine the distribution and patterns of item responses. In addition, t tests were used to compare responses of the participants grouped by two key online therapist characteristics, gender, and domicile of practice. Results indicated that participants were well qualified to provide mental health services with respect to educational and credential requirements (licensure). Issues of possible liability were uncovered with respect to domain of practice in the virtual world, with a significant number of therapists delivering online services outside their licensed geographical boundaries. Although most online practices were congruent with those of traditional therapy, the majority of providers did not know if their malpractice insurance covered online therapy, putting them at risk in the case of a practice lawsuit. Comparison by gender revealed no differences, and by domicile few differences suggesting that risk of liability were concerns experienced by online therapists in general. Results of this study will be useful for professional organizations and educational institutions as basis for increasing the level of clarity about ethical practice as well as providing the necessary elements for future trainings, and by regulating bodies to establish consistent standards and develop legal safeguards to guide and protect practitioners in their practice. And finally, information from this study can be used to focus further research on ethical practice in online therapy and provide a baseline for future studies examining the relationship between the ethics and efficacy of online therapy.