Teletherapy for Behavioral Health: Ethical Considerations

Introduction

The provision of behavioral health services has increasingly shifted from traditional in-person therapy to teletherapy. The use of telehealth, a form of online psychotherapy, expanded widely — particularly during the COVID-19 pandemic. Physical distancing measures necessitated the inclusion of telehealth services such as teletherapy for behavioral health conditions. Despite its continued use, Sauter (2022) points out that policymakers and providers continue to weigh its advantages and disadvantages in the treatment of conditions such as substance use disorders and mental illness. This is especially relevant given that the use of technology in psychotherapy carries inherent benefits and risks.

Dr. Joe Markowits, a research psychiatrist and professor of clinical psychiatry, states that despite the fact that many patients feel teletherapy is beneficial, therapists tend to feel otherwise — indicating that teletherapy cannot be compared to in-person therapy (Sauter, 2022). Markowits also notes that while teletherapy increases accessibility to behavioral health services, that accessibility is economically unfair to individuals who lack adequate insurance coverage. He referred to this inequity as a disgrace, particularly for a country with an advanced insurance sector. Failing to provide telehealth services to patients who lack insurance is, in his view, unethical — a wealthy nation's insurance system ought to serve all its citizens. In light of Markowits's observations, there exist various ethical considerations both for and against the use of teletherapy in behavioral health.

There are several ethical considerations that support the use of teletherapy. The first is that teletherapy increases accessibility to psychotherapy as well as flexibility and availability of services (Stoll et al., 2020). Online psychotherapy enhances access to evidence-based care, particularly for underserved populations and those living in remote or rural areas. Services provided through teletherapy also offer greater flexibility in that they can be accessed at any time and from any location.

Ethical Considerations in Favor of Teletherapy

This aligns with patient rights — specifically, the right to receive compassionate and respectful treatment without discrimination based on disability, national origin, identity, gender, age, religion, or race (Lemberg, 2019). Failing to provide care for mental health and physical needs constitutes a form of neglect. Beyond accessibility and flexibility, online psychotherapy also facilitates more frequent engagement between therapists and patients (Stoll et al., 2020). This ensures that individuals with behavioral health problems can more readily access specialized care, and that emergency care is available when required (Lemberg, 2019).

Second, teletherapy can enhance communication while ensuring that therapy remains beneficial to patients. For example, teletherapy can integrate additional online materials such as videos and websites into the therapeutic process. Documentation and data recording are also easier to manage and can be revisited by both patients and therapists as needed. According to Lemberg (2019), this enables patients to access their medical records and add information to them when necessary.

Enhanced Communication and Cost-Effectiveness

Third, Stoll et al. (2020) find that online psychotherapy is more cost-effective than in-person therapy. Beyond cost savings, teletherapy helps reduce waiting lists that are worsened by staff shortages in mental health care. Fourth, Stoll et al. (2020) note that teletherapy can enhance privacy and anonymity — a patient does not need to be seen entering a psychiatric institution. As a result, more individuals may be willing to seek the relevant services.

On the other hand, several ethical concerns warrant consideration. The first disadvantage relates to issues of security, confidentiality, and privacy. According to Stoll et al. (2020), some communication tools used in teletherapy may be unencrypted, and certain websites may be unsecured and thus vulnerable to hacking, which compromises data security. Lemberg (2019) notes that a healthcare provider is required to disclose the risks of any proposed treatment methodology. Liem et al. (2020) further indicate that behavioral health providers should address confidentiality by describing its limits within the informed consent process.

Conclusion

Insurance and payment issues may also be a major stumbling block in teletherapy. As Markowits states, patients who do not have adequate insurance may not be able to access treatment (Sauter, 2022). According to Stoll et al. (2020), online psychotherapy involves issues including — but not limited to — billing, fee structures, reimbursement, and payment. Furthermore, some insurance plans may decline to cover teletherapy services due to concerns about liability and malpractice. Taken together, the ethical landscape surrounding teletherapy in behavioral health is complex, encompassing both significant benefits and substantial risks that require ongoing attention from policymakers, providers, and insurers alike.