The use of technology-assisted mental health services by both practitioners and clients is increasing significantly so the telepsychology clinicians need to get ready to give competent care in this constantly changing service delivery environment. The “Guidelines for the Practice of Telepsychology” were published by the American Psychological Association in 2013 and, comparable guidelines for therapeutic online work have been published by the British Association for Counselling and Psychotherapy (BACP) in the UK. The aforementioned advancements highlight the growing fascination with virtual therapy among the counselling and psychotherapy fields. They have cleared the path for “telepsychology,” commonly referred to as online therapy, e-therapy, or e-counselling abroad, to gain official recognition.

The human interaction that is essential in a counsellor’s office is merely not feasible through computers or phones (Maples & Han, 2008). Therefore, in a therapeutic relationship, a lack of physical presence can impede the formation of a therapeutic alliance between the therapist and the patient. Misunderstandings can occur more frequently when there are no visual or auditory cues present, such as body language, tone of voice, or facial expressions. This suggests that boundaries are quite important in telepsychology. Counsellors and clients mostly communicate face-to-face through body language, posture, eye contact, and other nonverbal cues. Reading nonverbal cues is undoubtedly a crucial part of counselling. Since these nonverbal cues are invisible when receiving counselling online, their absence may compromise the effectiveness of the session.

Psychologists today are challenged as ethical decision makers by the ever-expanding development and use of digital technology in their own lives and in the lives of their clients. Boundaries are generally helpful from a clinical standpoint because they help clarify the nature of the therapeutic relationship and assist both the client and the clinician in controlling their conduct in a way that optimizes benefits and reduces risks (Borys, 1994). In addition, boundaries can support various other therapeutic goals such as creating a trustworthy working alliance, teaching the client assertiveness techniques, increasing the client’s sense of value (by honoring their autonomy and rights), and maintaining the integrity of the relationship (Borys, 1994; Smith & Fitzpatrick, 1995). Appropriate boundaries shield physicians from damage in addition to protecting the client.

BOUNDARY RELATED ISSUES
Time-related considerations and issues
Time boundary problems are not unusual in traditional in-person therapies; they usually manifest as early or late session arrivals, session extensions, meeting at strange or inappropriate hours, excessive contact outside of sessions, and booking specific clients for the last appointment of the day (Zur, 2007). These problems can definitely arise in telepsychology contexts as well, and they might even be more common because of the medium’s flexibility, the idea that it is convenient for both sides, and the possibility of a less controlled and regulated work environment.

Aspects and problems connected with settings
The adaptability of telepsychology and the capacity to work at any time and from any location offer one difficulty. Because of this flexibility, therapeutic interactions between clients and clinicians may occur in public places. While social interactions in public places might seem harmless at first, they can have serious repercussions. In addition to putting the client’s confidentiality at danger (for example, by using an insecure public internet connection or inadvertently letting others access the therapeutic discussions), the clinician can face legal and professional repercussions for their actions. Apart from jeopardizing the client’s anonymity, this could potentially undermine the therapeutic gains since the surrounding stimuli could operate as distractions and hinder the client’s ability to fully comprehend the therapeutic material.

Considerations and issues specific to the therapist
Boundary difficulties can also develop in other contexts that are unique to the therapist, such as when the therapist faces challenges to their own self-imposed limits, when they are concerned with language and phrase choices, or when they are concerned with safeguarding their work. Regarding obstacles to one’s own personal limits, specialists may find themselves working at hours that they would not ordinarily work due to the flexibility that telepsychology services allow.

RECOMMENDATIONS

• Be mindful of the session times and observe professional hours.

• Make sure that feedback is given on time and consistently, and their is control over communication.

• Establish a Confidential, Uniform, Expert, and Culturally Appropriate Environment.

• Protect Non-Clients’ Privacy and Avoid Inadvertent Self-Disclosures.

• Make Sure the Technologies Used for Telecommunication Project Professionalism.

• Establish Proper Self-Boundaries.

• Protect the Therapist’s Work Privacy.

• Speak professionally and take into account alternate interpretations.

• Assure Competence in Telepsychology Practice

Telemedicine Practice Guidelines, published by the Indian government lately, legitimize teleconsultations. However, there is not much discussion of psychotherapy methods in these guidelines. These evolving psychotherapy delivery technologies will raise an increasing number of moral and legal questions. Concerns regarding the safety of therapists are also raised by the paucity of research documenting instances of harassment experienced by them in virtual environments. Few psychologists are equipped to handle such difficult circumstances since the ethical concerns raised when clients threaten, stalk, or harass their psychotherapists online have typically received little attention in the literature. Thus, both the patient and the therapist will benefit from greater research in this field.

References

Borys, D. S. (1994). Maintaining therapeutic boundaries: The motive is therapeutic effectiveness, not defensive practice. Ethics & Behavior, 4(3), 267-273.

Drum, Katherine B. and Littleton, Heather L. (2014). Therapeutic boundaries in telepsychology: Unique issues and best practice recommendations. Professional Psychology Research and Practice, 45(3); 309-315.

Hudson-Allez, G. (2006). The stalking of psychotherapists by current or former clients: Beware of the insecurely attached!. Psychodynamic Practice, 12(3), 249-260.

Kotera, Y., Kaluzeviciute, G., Lloyd, C., Edwards, A. M., & Ozaki, A. (2021). Qualitative investigation into therapists’ experiences of online therapy: Implications for working clients. International journal of environmental research and public health, 18(19), 10295.

Lokai, A. D., Liqiaonan, C., Terry, K., Eubanks, C. F., & Muran, C. (2021). Transitioning to virtual space: Teletherapy in the time of COVID-19. Psychotherapy Bulletin, 56(2), 29-34.

Maples, M. F., & Han, S. (2008). Cybercounselling in the United States and South Korea: Implications for counselling college students of the millennial generation and the networked generation. Journal of Counselling & Development, 86(2), 178-183.

Mateescu, V. M. (2021). Distance and boundaries issues in the transition from face-to-face talking therapy to online therapy in the time of Covid-19. Studia Universitatis Babes-Bolyai-Sociologia, 66(2), 113-123.

Mondal, I., Anand, N., Sharma, M. K., Kohli, T., Thakur, P. C., Kande, J. S., … & Ajith, S. J.

(2020). Telephonic psychotherapy in India: A reminder of challenges in times of COVID-19. Asian journal of psychiatry, 53, 102432.

Smith, D., & Fitzpatrick, M. (1995). Patient-therapist boundary issues: An integrative review of theory and research. Professional psychology: research and practice, 26(5), 499. Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical issues in online psychotherapy: A narrative review. Frontiers in psychiatry, 10, 498439.

Wu, K. S., & Sonne, J. L. (2021). Therapist boundary crossings in the digital age: Psychologists’ practice frequencies and perceptions of ethicality. Professional Psychology: Research and Practice, 52(5), 419.