ABC’s of Internet Mental Health Services

What is “e-therapy”?


THE ISSUES: What you need to know about e-therapy




© Copyright 1995-2001 Martha Ainsworth. All rights reserved.


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Confidentiality: is it safe to talk?

Talking to a therapist online is probably as safe as talking to one in person. Both are very confidential, and neither is 100% perfect.

How to keep your online therapy safe

Can you be anonymous?

We might as well admit it up front: this is an imperfect world. Therapists consider it a sacred duty to protect your confidentiality. But confidentiality can be compromised even in the best of circumstances. Internet e-mail is not a 100% secure means of communication.

But, to be fair, it is probably at least as safe as visiting a therapist in an office. Very rarely, accidental breaches of confidentiality happen in office settings. Someone you know might see you entering or leaving your therapist’s building, staff members might see your file, and sometimes walls and doors are not as soundproof as one would hope.

But therapists take very seriously their responsibility to protect your privacy and confidentiality and they do everything in their power to safeguard your interactions, whether in person or online. No credentialed psychotherapist would ever reveal to anyone the fact that you are corresponding with them, let alone what you are corresponding about. (Important exception: they are required by law to break confidentiality if necessary to protect you or someone else from imminent danger of harm.)

Recently, some large e-therapy clinics (and a few private practitioners) have begun to offer an increased level of security on their websites, to better protect you. They use secure, web-based messaging systems, instead of regular e-mail. These secure web pages are similar to e-commerce or to the technology that banks use to let you access your accounts online; if it’s safe enough for banks, it’s probably safe enough for your therapy. On these sites, instead of sending regular e-mail to your therapist, you log on to a secure web page, and send a message via a password-protected, secure form.

How to keep your online therapy safe

In the highly unlikely event that someone finds out about your correspondence, it would probably be because of an inadvertent error you made. You might compromise your privacy...
  • if someone else has access to your computer, and is able to read e-mail or files stored on your computer
  • if you print e-mail on paper, and someone finds the paper
  • if you use a workplace computer--your employer has a legal right to read your e-mail on that machine
  • if you accidentally mis-address an e-mail to your therapist, by clicking on the wrong name in your address book for instance
  • if someone obtains the password to your e-mail account
  • if you talk about it to someone
  • if your e-mail is observed in transit by a hacker; this is theoretically possible but I don’t know how much it really happens

SECURE YOUR E-MAIL: Although most people are perfectly satisfied with the safety of regular e-mail for correspondence with a therapist, it is probably more responsible to choose a therapist who offers encryption, and bear the slight inconvenience. These are some popular applications for secure e-mail:

  • ZixMail - easy secure e-mail application, $24/year
  • Zip-Lip - free (but slow) secure web messaging; nothing is saved on your own computer
  • HushMail - free (but slow) secure web messaging; nothing is saved on your own computer
  • PGP - security software you install with your e-mail
  • POP3Now - check e-mail securely through the web, $5/year

Therapists! Free document: click to download (Adobe Acrobat format):
“Safeguarding Patient Confidentiality in E-Mail”

IMPORTANT REMINDER: Do not ever send credit card or checking account information over the Internet using regular unencrypted e-mail or an unsecured form on a website. If you will be paying with a credit card or online electronic check, only send your information by means of:

  • secure form (your browser will tell you if it’s secure), or
  • telephone (make sure the number actually belongs to the therapist), or
  • fax (make sure the number actually belongs to the therapist)

The therapist should offer a secured payment service, or allow you to mail a check or money order. (more about payment methods)

Can you remain anonymous?

You may be drawn to the idea of consulting a psychotherapist via the Internet because it feels more private. You may wish to be anonymous in your contact with the therapist, especially if you plan to discuss a sensitive or embarrassing topic. There are still plenty of e-therapists who will allow you to remain anonymous, until you feel comfortable revealing your identity to them. But more and more e-therapists are insisting that you give them your name, street address and phone number before they will talk with you.

Why? They have a professional responsibility to protect you. Knowing who you are, and where you are, helps them give you the best possible care. And in the unlikely event of a serious crisis, the law requires them to intervene to help you. So you will find most e-therapists now ask (or even require) that you give your name, street address and telephone number.

Also, remember that trust is mutual. Just as you want to be sure of a therapist’s identity, the therapist probably wants to make sure you are bonafide. Some therapists have been burned by hoaxes too. If you ask a therapist for real-world information, it’s only fair to give yours in return.

Additional reading on this subject:

Next: Does e-therapy work?>>

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