Security and Online Therapy

by Kellen Von Houser, M.A.

Security in online interactions becomes especially important when using the internet to engage in psychotherapy. Privacy and confidentiality have always been a cornerstone in therapeutic interactions and maintaining these standards on the internet is just as important. There are no absolute guarantees of privacy and confidentiality, not even if therapy occurs face-to-face. Someone you know could see your car parked in the therapist’s parking lot. You could bump into someone you know in the waiting room or lobby, or while paying your bill at the receptionist’s desk. Though these problems are avoided when engaging in online therapy, there are other issues which merit consideration.

What can clients do to ensure that their communications with a therapist remain confidential?

  • Do not access therapy emails or chats at work. You can almost count on such emails being monitored. Ideally, online therapy should occur on a private computer that is not shared with other users.
  • Protect the access to your computer. The greatest vulnerability is allowing others to access your computer, and therefore, your email. ,/li>
  • If you must use a shared computer, always close the browser when you have finished your session and do not allow the operating system to save any of your passwords.
  • Do not share your computer or email passwords with others.
  • Double check all communications between and your therapist to be sure they are properly addressed. Confidentiality breaches often occur when clients or therapists click the wrong name in their address book.

What does the therapist do to ensure that our communications remain confidential?

Therapist may utilize several techniques to ensure privacy and security of online communications and patient files. Clients are advised to ask their individual therapist about their specific practices. Below are some recommended practices for securing emails, the computer the therapist uses to perform therapy (the “therapy computer” vs. other computers which may be in the therapist’s house), digital files and paper documents (such as psychotherapy notes or insurance forms).

Securing email communications
  • Therapists may utilize the “return receipt” option of their email program and ask that the client do the same. This allows them to ensure that the message was indeed received by the client and allows the client to know that the therapist received their response.
  • The email program the therapist uses to provide online therapy should be password protected. Therapists should not share their passwords with anyone.
  • The therapist should not share the email account they use for their therapeutic work with anyone.
  • Both the client and the therapist should use the “Reply” command when answering email rather than typing in an address or utilizing the address book. This greatly eliminates the possibility of mistyping or misclicking an address and sending a response to a therapeutic exchange to the wrong person.
Securing the “therapy computer”
  • The computer should utilize a password protected screen saver.
  • No one should have access to the computer except the therapist at any time. If other household members need to use a computer, a separate computer should be provided.
  • No one should be in the room with the therapist during therapy sessions.
    • Securing paper documents
    • Therapy notes should be stored in a locked file cabinet.
    • No one should have access to the cabinet or the key except the therapist.
    • If a receptionist or bookkeeper files insurance forms for the therapist, that person should not have access to the therapy notes. Only financial, demographic, and billing information should be handled by an assistant.
    Securing digital documents
    • The computer on which the documents are stored should be password protected.
    • No one should have access to the computer on which the documents are stored except the therapist.

    Online security is a concern which should be addressed by both clients and therapists when engaging in online therapy. However, with a few simple precautions the interaction should be able to occur with the same degree of privacy and confidentiality of face-to-face interactions.
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