Informed Consent for Online Therapy

These days I’m hearing many of you ask: Do I need to have a separate informed consent for online therapy, and if so, what do I need to include?

This is certainly a timely question! In this article, I name the components to consider when creating an informed consent for online therapy.

Are we Required to have a Separate Informed Consent for Online Therapy?

Many states (but not all) require that you have consent forms for online therapy. Personally, I think it’s a good practice to do this regardless of whether it’s required by your state or not.

If you offer exclusively online therapy services, you can have just one consent form that includes everything related to teletherapy within it. If you see some clients in-person and some virtually, you might have separate consent forms specific to each.

However, I know many of us these days are figuring out how to switch our in-person clients over to teletherapy. So in this article, I’m going over what to include in your informed consent for online therapy – separate from the other items that are important to cover in your informed consent. (You can find my video about everything you need to know related to informed consent here)

Note that I compiled information from the APA as well as the California Board of Psychology and the California Association of Marriage and Family Therapists. Please check your specific state laws around telehealth informed consent to make sure you’re in compliance with your jurisdiction.

What to Include in Your Informed Consent for Online Counseling

Above and beyond what might be required by your state, these items are worth considering including in your online therapy consent form:

Benefits and Risks of Online Counseling

Sound familiar? This is part of all informed consent, and is the biggest component of your online informed consent. Here are a few areas to highlight as risks of online counseling:

1. Confidentiality

It’s important to note that online therapy presents unique risks to client confidentiality. This includes variables on the client’s end, such as others in their vicinity overhearing the conversation and captured internet transmissions. Keep in mind that this reflects ALL virtual interactions, including emails. Emails accidentally forwarded or sent to the wrong email address are examples of confidentiality risks online.

This is also a helpful place to remind clients that your obligation as a mandated reporter for items such as suspected child abuse still applies during online interactions.

It’s not uncommon that clients will attempt to use semi-public spaces for remote counseling. This is a good section of your consent form to remind clients to find as private a space as possible during online counseling.

This is also a good place to remind clients that nobody will record the session (the therapist or the client) without express written permission to do so from the other.

2. Clinical Limitations

There are a number of clinical limitations with online therapy. Most obviously, therapists may have more difficulty seeing nuances in facial expressions or body language. Depending on your training and specialty, there may be some formats of therapy that are more complicated to provide online, or that require special training that you may not have.

3. Transmission Difficulties

Naturally, the internet or phone may cut out during your session. It’s important to name your back up plan for this issue when it arises. For example, I have a policy that I will try restarting a video session three times, after which we will switch to a phone call or, if the client prefers, we can reschedule our session. This is also a great place to remind clients to position themselves near their WiFi signal or use an ethernet cable if available.

4. Ability to respond to emergencies

Naturally, there are some aspects of crisis response that look different remotely than in-person. Inform clients how you respond if you believe they are in immediate danger while meeting remotely, and let them know of your remote availability between sessions. For example, how long they can expect to wait before you respond to an email.

Insurance Coverage

If you bill insurance or if your client plans to apply out-of-network insurance benefits, this is a helpful section to remind them to check with their insurance provider to see if their coverage applies to online therapy and if it differs from their in-person coverage. State your policy for what you do in case their insurance provider doesn’t cover virtual therapy.

Online Platform and HIPAA

Name the virtual counseling platform that you use here, including what tools clients must have access to (e.g., computer with webcam, smartphone, an app, a login, etc). This is a helpful place to name the precautions you take to protect your client’s protected health information.

Discretion of Appropriateness of Teletherapy

In some circumstances, you may determine that online counseling is no longer appropriate for certain clients. It’s helpful to name this in your informed consent in case you find yourself in this situation down the road.

This just about covers it! It might seem like a lot, but it’s also not too much.

Additional Resources – Informed Consent for Online Counseling

The APA has a helpful checklist that you might like to consider including in your teletherapy consent form. I encourage you to check it out, as there are items you might not have thought of otherwise that will feel relevant to include in your informed consent. You can find that checklist here: APA Informed Consent Checklist

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If you’re helped by having examples to pull from in order to develop your own informed consent, many therapists have theirs posted publicly online. If you type, “sample online therapy informed consent” in a Google search, you’ll find several pop up and you can check those out if you find it helpful to do so.

How can Clients Sign Informed Consent Virtually?

I know the natural next question from here is: How do you have clients sign this form online? There are several ways to go about this. I have a video covering one option using SignNow, which you can find here: HIPAA Compliant Signatures for Online Therapy Using SignNow.

I hope you found this article helpful as you offer online counseling services. I’m looking forward to posting more articles on the topic of teletherapy, but in the meantime you can check out my YouTube playlist: Tools for Online Therapy. You might find what you’re looking for!

Until next time, from one therapist to another: I wish you well!

-Marie

Photo by Lauren Mancke on Unsplash