Full text of the LMHC Board's "Policy on Distance, Online, and Other Electronic-Assisted Counseling: Policy No. 07-03"

Some relevant excerpts for MA-licensed LMHCs seeing patients IN Massachusetts:

This policy guideline is intended as a recommended protocol for the profession to follow. The guideline set forth below does not have the full force and effect of law

The Board's policy with regard to all distance or electronic-assisted provision of clinical services is as follows:

1. The services offered by licensees of this Board across a distance by electronic means, fall within the jurisdiction of the Board just as traditional, face-to-face services do. Therefore all Board policies and regulations will apply to these services.

7. Licensees are encouraged to carefully review the way in which the structure of their relationships with clients will be impacted by distance-therapy or counseling to ensure compliance with Board regulations and standards of practice.

8. The following are some areas of practice that licensees should carefully consider:

a. Informed consent

b. Confidentiality

c. Basis for making clinical judgments

d. Areas of competence

e. Avoiding harm

f. Fees and financial arrangements

g. Advertising

h. Abandonment of clients

i. Handling requests for obtaining clinical records

9. The Board expects licensees to understand and overcome the significant challenges inherent in providing counseling and therapy without face-to-face contact with the client.

10. Some of the challenges that licensees are expected to manage include, but are not limited to:

a. Full disclosure with regard to potential risks to confidentiality, including computer hacking and/or archiving of communications.

b. Full disclosure of the limits to confidentiality in the jurisdictions where the client, and where the clinician are located.

c. Full disclosure of mandated reporting requirements in the jurisdictions where the client, and where the clinician are located.

d. Full disclosure with regard to the potential disadvantages or limitations of electronic-assisted clinical services.

e. Redirection and/or referral of clients for whom electronic services will not be adequate or appropriate.

f. Full disclosure with regard to fees and billing practices.

g. Full disclosure with regard to licensing, credentials and areas of expertise.

h.Screening and local referral for critical and urgent problems

i. Verification of the identity and age of the client.

j. Obtaining consent to provide services by a guardian for minors or other vulnerable clients.

k. Management of any misunderstanding or compensation for any missing information, resulting from the lack of visual or auditory cues.

l. Managing the problem of incomplete or inaccurate diagnoses that may result from electronic-assisted services.

m. Managing the potential for technology failure

n. Procedures for contacting the clinician when he/she is offline