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If we email to clients, does it mean we are conducting tele-health or e-therapy?

If the emails involved are primarily dealing with administrative issues, such as scheduling, they are not likely to fall under the definition of tele-health or e-therapy. However, if they are clinically oriented (i.e., including assessment or interventions), extensive, and used routinely, they may be viewed as tele-health or e-therapy. There is not a clear line in the sand yet, differentiating between tele-health and face to face therapy, and mixing the two modes can be effective and ethical when done ethically, competently and properly.

Are these emails part of the clinical records, and can they be subpoenaed just like chart notes in the unfortunately not uncommon event of legal action?

Generally, emails between therapists and clients are considered as part of the clinical records and can be subpoenaed, just like chart notes.

Guidelines to using email with clients

The subject and discussion about the role of email in therapy is common, relatively new, unsettled, and very complex. There are a few things that therapists can do to keep clients informed, increase therapeutic effectiveness, and help protect themselves from board complaints and other liabilities.

Clarify to yourself your thoughts and feelings regarding email communication with clients. What are your preferences, your limits, etc.?

Discuss the issue of email communications with clients, when relevant, in the first session. Learn from them about their expectations and clarify your expectations and boundaries. Continue the dialogue as clinically and ethically necessary throughout the course of therapy.

Make sure that your office policies include a section on the use of emails.

If you are conducting tele-health, follow state laws, relevant codes of ethics, and have a separate informed consent, which is required in some states, such as California.

Make sure your computer has a password, virus protection, firewall, and back up system.

Make sure that each email includes an electronic signature that covers issues such as confidentiality and security.


This article can be found on the Zur Institute website http://www.zurinstitute.com. Permission to reprint this article was kindly granted by Ofer Zur.



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