and take precautions to ensure that they are texting with clients by using a code word or some form of identity verification. Counselors should consider whether they are comfortable with texting as a therapeutic process, whether they can successfully maintain appropriate therapeutic boundaries with clients, and whether texting is in the client’s best interest. Texting can be used in direct or indirect service delivery (AMFTRB, 2016). Counselors who support the use of texting with clients might argue that asynchronous communication has the potential to allow deeper reflection in the counseling process by both counselor and client, as well as greater availability (Harris & Birnbaum, 2015; Richards & Vigano, 2013). Other therapists might find it useful to limit texting to scheduling and communicating about appointments (i.e., “I’m running 10 minutes late,” “I have a flat tire”). Many do not support client-therapist texting, as content and urgency can get lost in translation.
Whatever decisions counselors make considering texting with clients, it is imperative that they clearly articulate the policies in the informed consent outlining boundaries for appropriate use and response time for text messaging. Documentation should be included in the client file as outlined by state and local statutes. Limits and potential risks to confidentiality should be explored with clients, who should be allowed to make informed choices.
Social Media
Social media is a ubiquitous part of modern life, and it becomes complicated when combined with HIPAA and Health Information Technology for Economic and Clinical Health Act regulations and counselor ethics. Counselors often use social media in their personal lives, to promote their practices, or to network with other mental health professionals in their area. It is imperative that they be mindful of the risks and maintain appropriate boundaries and confidentiality. It is a counselor’s ethical responsibility to understand the risks involved in using social media and take appropriate precautions. Counselors should construct and share with clients a clear policy regarding the use, limitations, and risks of social media with current and former clients. This policy should be included in the informed consent (ACA, 2014; AMFTRB, 2016; NBCC, 2016a, 2016b).
The first step in setting appropriate boundaries is to maintain separation between personal and professional social media use. It is recommended that separate accounts be created if a counselor plans to use social media for professional purposes. Just as one would maintain separate personal and professional lives, one’s virtual life should include similar boundaries (ACA, 2014; AMFTRB, 2016). Counselors should become aware of the security settings available on their various social media platforms and use them to protect the public accessibility of information. These boundaries should be clearly articulated in their social media policy included in the informed consent.
Discretion should be exercised when using and sharing social media. Counselors should never share confidential information in private or public chats and forums. They should refrain from diagnosing anyone even if they are historical or public figures. Counselors should avoid posting anything they would not say in real life (ACA Government Affairs, n.d.). Although venting about difficulties or frustration is common on social media platforms, it is recommended that counselors refrain from posting anything that would be deemed derogatory or unprofessional. Although separate accounts are recommended, there are times when personal social media accounts might be reviewed for jobs or for professional service (i.e., by state licensure boards, state committees, etc.).
Although it is common practice in social circles to research new people on social media, the ACA Code of Ethics (ACA, 2014) forbids counselors from exploring clients’ social media without written consent. This has been likened to peeping into a client’s living room windows without having been invited.
The risks of using social media should also be assessed. Counselors who use social media applications should remain aware of how the permissions settings in the platform function when creating social media accounts. Access to confidential client information might be allowed unintentionally. Most user agreements give access to other elements of the user’s device, including contacts, photos, and other content. Client information might be vulnerable to snooping and unintentionally breached. Doffman (2019) cautioned that appropriate protection from social media applications comes down to the users themselves.
Voice-Assisted Technology, Bluetooth, and Gaming Communication on Devices
On many mobile devices, such as cell phones and tablets, voice-assisted technology is common. Arcuri Sanders (2020) noted that many are familiar with Apple’s Siri, Amazon’s Alexa, and Google’s Assistant, and it is important to know that when voice-assisted technology is enabled, the device may be constantly listening. This can create an issue for counselors who use technology as well as for any technology that may enter a counseling office. Voice-assisted devices are designed to listen for commands and to hear information to adapt and customize services to the individual user. Clients, office staff, and counselors could be breaching confidentiality without realizing that this is happening. A few steps can be taken to help safeguard clients’ privacy and limit this digital snooping. First, it is imperative that counselors turn off voice-assisted technology that is connected to Wi-Fi, cell phones, tablets, computers, and any other electronic devices. Second, they should craft policies that instruct clients to turn off voice-assisted technology, especially in situations in which they may compromise others’ confidentiality as well as their own (e.g., group counseling settings). Finally, counselors should include in the informed consent language that outlines the risks of voice-assisted technologies and instructions for clients to temporarily disable those services (Arcuri Sanders, 2020).
Bluetooth connections might also unintentionally compromise the confidentiality of clients. Counselors must encourage clients to be aware of their Bluetooth connections and to take measures to avoid unintentional breaches of confidentiality. For example, if a client is accessing counseling services through a videoconferencing app on their phone, and the phone is linked to their car’s Bluetooth, anyone in the car might have access to the session. Programs that run in the background might also pose a risk to clients. For instance, programs such as Discord and Overtone, which are used to communicate in online gaming, often run in the background and might be such an integral part of clients’ social life that they do not remember to disable them while engaging in telebehavioral health services. This is another consideration worth mentioning during intake and informed consent, especially when the client identifies as a gamer.
Informed Consent
One of the most critical elements of risk management is a thorough addition to a standard informed consent. The ACA Code of Ethics (ACA, 2014) recommends that the document contain the typical components of a face-to-face counseling informed consent with the following additional elements.
Distance Counseling Credentials
Many states have requirements for specific training or continuing education. Distance counseling training and credentials should be clearly outlined.
Physical Location of the Practice and Contact Information
Although mailing addresses and phone numbers are typically included in an informed consent, it is imperative to include the physical location of the counseling practice, even when one is meeting primarily in an online format. This has legal implications on various levels. If the counselor will practice in a location outside of the practice, this should be disclosed.
Time Zone
Counselors should identify any differences in time zone between themselves and their clients. (This can be an issue in some states, even when one is providing face-to-face counseling.)
Risks and Benefits of the
