9 Observations About the Practice and Process of Online Therapy, Part 5

Do Unique Ethical Principles of Online Practice Exist?

Several major organizations offer ethical or 'best practice' guidelines on online therapeutic work (ACA, 1999; APA, 1997; ISMHO, 2000; Kane & Sands, 1998; NBCC, 2001), making them freely available to both consumers and professionals via the web.[3] Yet, as far as I can tell, no fundamentally new ethical territory has been created by the advance of technology which enables online counselling to take place. There is, rather, merely new technological territory. These 'guidelines' are primarily what ethicists call technology assessment documents, providing introduction and orientation to the technological context and its ramifications for our existing normative principles, such as the principles of non-maleficence or fidelity embodied in BACP's Ethical Framework (Bond, 2002). Technology assessment documents are subject to debate and disagreement, are virtually never complete, and typically go out of date quickly -- unlike the underlying normative principles themselves, which do not change with technology. (Consider the normative principle of non-maleficence, for example: it will not suddenly become right to harm clients merely as a result of someone's inventing a new way of communicating.)

Moreover, the application of existing normative principles to the online context, in all its complexity, does not lend itself particularly well to codification in the form of technology assessment guidelines. Unfortunately, the preponderance of available guidelines may nonetheless encourage some online practitioners to accept adherence to them as a substitute for the technical competence required to support ethical decision-making and risk assessment in situ.[4]

By way of analogy, consider a f2f counsellor's duty to evaluate the extent to which a consulting room is sound-proof before using it, a duty which derives from the normative principle of fidelity and respect for client confidentiality. Judgements about the suitability of a particular room are not a matter for prescriptive mandate (e.g., "practitioners should only use rooms with wall thickness exceeding 14mm"); instead, they require well-informed personal experience and awareness. In this example, that awareness presupposes an ability to hear, and a hearing-impaired counsellor would not be able to practise ethically -- with vocalizing clients, anyway -- without taking steps to evaluate sound-proofness in some alternative way. She cannot guarantee ethical practice merely by adhering to prescriptive guidelines about wall thickness any more than a technologically unskilled online practitioner can work ethically by merely keeping to 'best practice guidelines'.

An online therapist operating without intimate knowledge of her technological context is akin to a hearing-impaired counsellor who hasn't checked whether her clients can be overheard outside the consulting room. It is not enough for an online practitioner merely to propose something along the lines of "I'm going to focus on my clinical skills and not worry about the technology" -- like an underwater welder saying "I'm going to focus on my welding skills and not worry about the swimming".

Continue to acknowledgement, references, and notes...