The main issue has become what is the proper use of email in psychotherapy? To add to the complexity, there are several legal, ethical and clinical questions that are related to emailing our clients.
The main question is how do we deal with clients who expect us to respond quickly and/or read lengthy and numerous emails between sessions? The answer lies in the communication between our clients and us. We must be clear about our parameters in regard to general use of emails, time, frequency, etc. While our office policies should attend to these issues, personal communication is likely to be much more effective in bringing clarity to the email dilemma. This issue is not likely to be resolved in one conversation. With some clients who rely heavily on online social networking, it is likely to be a continuous dialogue about expectations, disappointments and boundaries.
If you are ready to engage in dialogue and treatment via email in conjunction with face-to-face therapy, state this to your clients. In this case you many need to inform them how you charge, if you do, for such e-services. Do you charge per email, per minute, or other ways? I suspect that most therapists prefer to use emails primarily for administrative purposes and only at special times for distinct clinical purposes. In this case I would explain it verbally either in the first session or when the right time comes. Our office policies that we give to each and every client at the beginning of therapy should have a section on policies regarding emails. This section should discuss issues of privacy, confidentiality, security, availability, response time, content, emergencies, etc. [An example of which can be found on page 11 under the heading Emails, cell phones, computers and faxes.]
There are a number of other questions that come up in relation to emails between therapists and clients. They include:
Are emails considered psychotherapy or counseling?
Yes. These emails, whether profound or mundane, are part of the therapeutic process and are considered part of the clinical records.
If I give my email address to my clients, must I check my emails often?
The fact that you give your email address to your clients does not obligate you to check often or even weekly. What is important is that you provide your clients with written information and verbal communication about how frequently you check your email, if you respond to emails, and what are your general policies regarding emails (see details in the body of the article).
What about confidentiality and privacy?
Confidentiality and privacy are applied to emails in the same ways that they are applied to any other verbal or written exchanges between psychotherapists and clients.
Must emails be encrypted?
At the present time, emails between therapists and clients do not need to be encrypted, as long as clients are informed about the vulnerability of emails being read by unauthorized people, and they elect to use email. (For more details, see above note about office policies and the next question.)
What is an email signature and what may it look like?
An email signature goes at the end of the email. It can be set automatically. Make sure that every email to a client or patient includes an electronic signature that covers issues such as confidentiality and security. Following is a sample of such an email signature:
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