Laura Groshong, AM, LICSW, the Policy & Practice Director of the Clinical Social Work Association (CSWA), wrote an article entitled, LCSWs and the Use of Texting in Mental Health Treatment, with co-author Margot Aronson, LICSW, CSWA’s Policy & Practice Deputy Director. The article explained the regulatory and ethical considerations in text therapy. They allowed Telebehavioral Health Institute (TBHI) to obtain a copy of the article and share to the TBHI Blog.
Text Therapy: Regulatory Considerations
Benign as texting seems, some texting platforms ask clinicians to communicate in ways that may violate state laws and regulations and/or federal laws and rules.
Most states require a clinical social worker to be licensed in both the state where the LCSW resides and the state where the client resides, if different, to provide therapeutic services. A text platform’s claim that text therapy is not psychotherapy but rather “therapeutic communication” is a blurry distinction not necessarily recognized by state social work boards. It is the LCSW’s obligation to ascertain and comply with relevant regulations of both state boards.
Licensed therapists are also responsible for making sure that the text platforms used by both client and therapist are HIPAA compliant. Further, the texts themselves are personal health information sent electronically (PHI) and must be kept private and secure. It has been reported that one text platform permitted employees – even non-clinically-trained employees – to review the content for training purposes. A Business Associate Agreement might provide a guarantee of the LCSW’s confidentiality standards, if the platform agrees to sign (HIPAA Basics for Providers, 2018.)
Text Therapy: Ethical Considerations
Most states use the NASW and CSWA Codes of Ethics as the basis for ethical clinical social work practice. Some text platforms have contractual terms that require the therapist to meet sales targets through their text exchanges. For a clinical social worker to engage in such a dual relationship, i.e., as a corporate representative for the texting services and, at the same time, as a therapist addressing mental health problems is a clear and serious ethical violation.
Some companies use marketing techniques that also may be ethical violations. One example, potentially misleading advertising, has been mentioned. Advertising with testimonials from former clients is another. From the NASW Code of Ethics (2016)
4.07(b) Social workers should not engage in solicitation of testimonial endorsements (including solicitation of consent to use a client’s prior statement as a testimonial endorsement) from current clients or from other people who, because of their particular circumstances, are vulnerable to undue influence.
Would the company agree to keep the LCSW provider from being caught up in these sorts of business-driven ethical dilemmas?
Basic to mental health treatment is thoughtful consideration of the conditions being treated and of the biopsychosocial needs of the client. The challenge for the LCSW is incorporating these basics, along with accepted standards of practice, regulatory requirements, and ethical considerations, into the texting format as contracted by the particular text platform. It is the responsibility as LCSWs to apply clinical social work standards of practice, ethics, and regulations to any work we choose to do.
This is Part 2 of the 2-part blog series. You can also read Part 1 below:
Texting Do’s and Don’ts
Explore clinical, legal & ethical requirements for text messaging with clients & patients.