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sk8rgrl23 November 5th, 2011 11:41 AM

ethical ramifications of e-mail
I am providing DBT therapy on an individual basis for a client referred to me from a psychiatric inpatient facility, dx Borderline Personality Disorder. Dr. Linehan, who developed DBT for BPD, recommends offering clients contact in between therapy sessions, and with this one client, I have made this available. She recently lost access to cell phone service, and she also prefers to communicate by e-mail. Normally, I have limited this to discussions about appointments and such, but with this client I have allowed her to communicate in between sessions. She has been seeing a therapist for several years, and they have a longstanding agreement that she seek help when feeling suicidal so that the therapist doesn't become a 24 hour crisis center. The client has upheld the agreement over the years, and seems highly motivated for DBT.

I find the e-mails extremely helpful, both for my understanding of the client's particular schemas, and also for the client to receive support and guidance between sessions. I also prefer e-mail over phone as a means of contact, as I can read and answer on my own time, the client has a written response they can keep going back to, and for me, on a sensory level, it's just easier.

We have talked extensively about the limits of this, and her responsibility for maintaining safety, and I continually review this with her. I respond briefly with validation of the client's experience, and a suggestion of how to use the DBT skills. It seems to be helpful and I think from an attachment disorder perspective this helps correct the anxiety/nurturing/trust function. I recognize the capacity for transferrence in this (we have discussed this also), and though she is contemplating leaving her other therapist (feels she has reached a plateau), she has agreed to seek out another therapist and I have provided her with several referrals.

I believe the benefit of this strongly outweighs the risks. My computer is always in a locked place, and I am the only one who ever uses it. I have virus protection with a firewall. I have a close friend that does maintenance on my computer and I am present when he works on it. I maintain limits that don't consume much of my time (reading and responding might take 15 minutes) and gently let the client know what my limits are so that my not responding in an expected amount of time doesn't result in a crisis on her part.

Anything else here I should be aware of?

Da Friendly Puter Tech December 29th, 2011 02:50 PM

Re: ethical ramifications of e-mail
Hey Monica,

I think that there is one technical step you ought to take. A firewall and virus protection does not offer enough protection on it's own. Its a solid start - but there is no such thing as 100% virus protection on the market. I would get some encryption software and encrypt any files that contains confidential information. This way should malicious software get on your computer, or should your computer be stolen those files cannot be accessed.

There is one more risk with email that I think your client should be aware of. This risk is minimal, but not completely unlikely. When you send out email the mail itself passes through several servers - for one email to get to its destination the email will typically pass between 3 - 15 servers. At each server the email sits on that computer unprotected. Server administrators can, and has occasionally read private emails. This is indeed not a large risk - most likely the person would have no clue who your client is, or not even live near to you. Admin's also rarely read emails as a routine thing - but it happens. This is why sending credit card information via email is highly unsafe unless the file is encrypted.


William Reid February 12th, 2012 08:21 PM

Re: ethical ramifications of e-mail
Great comment!

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