Online security and counselling
For the past three years I have attended the OCTIA annual conference, either in person or online. This is an annual conference for counsellors who work on the internet. This year there was a lot of talk about security and protecting our clients’ confidentiality online.
Part of this was a discussion about what platforms we should be using, which I will discuss below. The other part was about how to help clients understand what we mean by confidentiality. We heard stories about clients who were discovered to be attending their scheduled online counselling session on a train, or in cafes using the free wifi, and even one client who was having an instant messaging (IM) session whilst in bed beside her husband. Looking at the much more relaxed and casual attitudes some have towards their therapy online, we can only ask would these same clients feel comfortable having a face-to-face therapy session in the middle of a café or where other people could easily overhear? What do they think is the difference?
So to move on to the main topic of this article. What is the security issue about the platforms being currently used and what should clients be encouraged to use for instant messaging and other online modalities?
When the Prism scandal broke in 2013 it caused much discussion in the online counselling community and this has continued ever since! Edward Snowden, as the whistle-blower, exposed Microsoft, Google and other well-known internet companies as being compelled by the US National Security Agency (NSA) to hand over information about their users’ private content (conversations etc) without their consent.
In the USA the use of Skype by physicians and other healthcare professionals such as counsellors, is forbidden by HIPAA (Health Insurance Portability and Accountability Act). There are a number of HIPAA compliant platforms that counsellors are encouraged to use instead.
In the UK the Information Commissioner’s Office (https://ico.org.uk) who are an independent body set up to uphold information rights in the public interest such as Data Protection; as well as our professional counselling organisations such as the British Association for Counselling and Psychotherapy (BACP) and the UK Council for Psychotherapy (UKCP) have yet to issue clear guidelines about what platforms we in the UK should be using. Counsellors generally feel very confused about whether it is acceptable to use Skype or not. Many find their clients are reluctant to try another platform. They are already familiar with Skype, through use with family, friends or for work.
The current consensus amongst online counsellors seems to be that the use of Skype for video/webcam whilst we still await formal guidance, is perhaps acceptable. However, for Instant Messaging (IM) this is definitely not the case. IM sessions are recorded and kept on Skype (now owned by Microsoft) servers for at least three months, even after you have deleted your conversation from both (the counsellor and the client’s) profiles and the NSA keeps all communications indefinitely.
Thus those of us who use text based counselling see the need to use a different platform and finding one that fits our requirements has not been an easy task. Most lack Skype’s friendly little pencil showing that the other person is writing. Therefore it is important to use other strategies to know when the client/counsellor still has something they wish to say, such as “…” which indicates that they haven’t finished yet. And to type “end” when finished, so that the other person isn’t left wondering whether they are still writing, or reflecting about what to write next.
A couple of platforms that are free, meet HIPAA requirements (not forgetting that these are American not British) and which trained and professional online counsellors are now using include VSee and Zoom. These do not record IM conversations.
So the discussion about what is an acceptable platform for online counselling continues and the fact remains that no matter what security measures are put in place, we can never give a 100% guarantee of confidentiality online. No more than we can in fact, for face-to-face counselling. Most counsellors have stories of poor sound insulation in GP surgeries or other counselling rooms. Even a locked office with securely locked filing cabinets containing client notes can be broken into by a determined thief. However, we can only continue to do our best in making our counselling environment as safe as possible and in educating our clients.