The following article has been written by online therapy expert Phillipa Weitz about ‘Skype August 2015’ (1).
You may be aware that I and many other leading online practitioners have taken a position where Skype is not considered an acceptable part of online practice. This has been well-documented at http://pwtraining.com/resources-for-working-online/ (2)
The brief history so far
Skype has been owned by Microsoft since 2011. In 2014 I approached both The Information Commissioner’s Office (ICO) and Microsoft to ask their opinion and advice. You can read the summary of these conversations at the above website, but the long and short of it was that they both agreed at Skype is not suitable for therapeutic purposes.
Primarily because Skype is not fully confidential. The ICO representative was at pains to point out that it was our responsibility as therapists to protect the confidentiality of our clients, and that it was not alright, even if we explained the situation to the client and the client still wanted to use Skype.
The Conclusion to the BAPC Guidelines for online counselling and psychotherapy (3) summarises: “The onus at all times is on the practitioner to assess the best and most appropriate medium and course of action.”
Similarly, UKCP’s Ethical Principles and Code of Professional Conduct (4), highlights in at least three areas items that relate to this point directly:
1 “The psychotherapist takes responsibility for respecting their client’s best interests when providing therapy.”
2 “The psychotherapist commits to respect, protect and preserve the confidentiality of their clients…..”
3 “The psychotherapist commits to safeguard the welfare and anonymity of clients when any form of publication of clinical material is being considered ….”
These items identify clearly that it is the therapists’ responsibility to ensure and safeguard the client’s best interests and confidentiality ….
Although I could quote chapter and verse I am not going to waste precious space arguing about Skype previous to August 2015, as this information is now redundant in the light of Skype August 2015’s imminent arrival. I just wanted to start by setting the scene and giving you the flavour of the problem.
What is Skype August 2015?
Over the years Microsoft has acquired a number of different companies and they want to merge their policies into a comprehensive Service Agreement and Privacy Statement. That makes sense, but does it change anything for the online jobbing psychotherapist? The short answer is no. Let’s see why.
One of the original problems with Skype was that they accessed the material on Skype. This I believe to be truer of Skype Chat than Skype Video. Given that Chat is one of the fastest growing ways of delivering counselling and psychotherapy online this therefore is an issue as identified in the UKCP ethical principles mentioned above.
Why Skype August 2015 changes nothing
The following is one short section of the new Microsoft policy (extracted from https://www.microsoft.com/en-gb/servicesagreement/faq.aspx (1)) will help to explain this.
|August 2015 New Skype Policy Extracts||Philippa Weitz’s comments on these extracts|
|2. Your Content. Many of our Services allow you to store or share Your Content or receive material from others. We don’t claim ownership of Your Content. Your Content remains Your Content and you are responsible for it.
2a. When you share Your Content with other people, you understand that they may be able to, on a worldwide basis, use, save, record, reproduce, transmit, display (and on HealthVault delete) Your Content without compensating you. If you do not want others to have that ability, do not use the Services to share Your Content. You represent and warrant that for the duration of these Terms, you have (and will have) all the rights necessary for Your Content that is uploaded, stored or shared on or through the Services and that the collection, use, and retention of Your Content will not violate any law or rights of others. Microsoft cannot be held responsible for Your Content or the material others upload, store or share using the Services.
|“2a: If you do not want others to have that ability, do not use the Services to share Your Content”This implies that if you are not happy for the data loaded onto Skype to be disseminated by Microsoft that we should not use the service. This falls in line with what Microsoft told me in June 2014, that Skype is not suitable for therapist purposes – I see no change with the new agreements.
One further thought – when something is free you are the product.
|2b. To the extent necessary to provide the Services to you and others, to protect you and the Services, and to improve Microsoft products and services, you grant to Microsoft a worldwide and royalty-free intellectual property license to use Your Content, for example, to make copies of, retain, transmit, reformat, display, and distribute via communication tools Your Content on the Services. If you publish Your Content in areas of the Service where it is available broadly online without restrictions, Your Content may appear in demonstrations or materials that promote the Service. Some of the Services are supported by advertising. Controls for how Microsoft personalizes advertising are available at http://choice.live.com. We do not use what you say in email, chat, video calls or voice mail, or your documents, photos or other personal files to target advertising to you. Our advertising policies are covered in detail in the Privacy Statements.||2b and here is the problem “you grant to Microsoft a worldwide and royalty-free intellectual property license to use Your Content, for example, to make copies of, retain, transmit, reformat, display, and distribute via communication tools Your Content on the Services”
Whilst these statements remain as part of the Microsoft Agreements I do not believe that we as members of the counselling and psychotherapy online profession “in the know” can ignore these statements. We cannot “un-know” what we know. Microsoft made it quite clear they access and use our content.
These points, in my opinion, breach the Ethical Principles mentioned above. These are illustrative and I could have quoted the BACP ones with a similar outcome.
If you are unsure, then look at the new Privacy Dashboard http://account.microsoft.com/privacy:
“Microsoft uses your data and preferences to personalise your experiences, send you marketing info and advertise things we thing you’ll like …….”
How much clearer could it be that Microsoft is accessing the information you are sharing with your client in what should be as confidential as possible as setting?
So for me, Skype pre August 2015 and post August 2015 agreements change nothing.
However, let’s consider what the ICO has to say on the confidentiality and security requirements within its Data Protection Principles (5). Principle 7 specifically relates to security. The ICO recommends that the individual practitioner should apply cost and security appropriate measures to ensure the confidentiality of the client. For example, a private practitioner would not be expected to apply military grade encryption at vast cost for their clients. The cost needs to be commensurate to the risk and the client group. In my opinion, within the context of counselling and psychotherapy, where spending £2,000 a month on ensuring client private is excessive, spending £20 – £50 per month, depending on the number of clients you have, may be in line with what might be expected.
The problem is that we are used to having Skype (and other similar services) free, and we don’t see why we should pay or them now. Sadly this may not be taken seriously or resolved until a client makes a complaint against a therapist for breach of confidentiality.
There is a further problem which complicates matters further, which I hope will be resolved within the next few months: there is no affordable comprehensive online platform available that is fully functioning providing in one place
-secure asynchronous messaging like email,
-a whiteboard, library and resources area
-an area for the client and therapist to store records securely.
There are a number of platforms that have some of these – but only a couple that have attempted the whole lot and for the moment they are not fully functioning. THIS IS A MAJOR PROBLEM FOR EVERY ONLINE COUNSELLOR AND PSYCHOTHERAPIST and is preventing the online profession from going forward in a professional manner.
I therefore have every sympathy with all the 100s of therapists that I know who are still using Skype. Although VSee, for example, is more compliant, it is not totally. I would recommend anyone working online to use VSee (www.vsee.com) for the moment pending an online platform being launched. It is free.
Call to arms to the professional membership organisations!
I would encourage you all to lobby your professional membership associations to work on developing an online platform as part of your professional membership service. You pay them money each year at least in part to represent your interests, and here is something they really can do, and with the numbers involved this becomes possible. The development of an online platform is likely to be well in excess of £100,000 + ongoing support costs, and the professional membership organisations with their large numbers can negotiate this and lead the way in a way that is impossible for the private practitioner.
I believe that the lack of leadership from the professional membership organisations on this is not helping and is holding back the development of a professional specialism that can lead the world. Let’s be clear, they should be negotiating an online platform that is part of our membership service.
If the professional membership organisations were doing this then practitioners will of course need to be aware of these issues, but that comes with the expected training that an online practitioner will have received, as recommended for example by BACP in section 1.3 on their online guidelines (3).
However, at the moment it is like the Wild West out there with practitioners being expected to know ridiculous amounts about internet safety etc. All this will be unnecessary, bar the sorts of issues that need to be included in social media policies and basic issues of security and confidentiality, and then we can return to being specialist online practitioners instead of mini and not very efficient experts in security and confidentiality.
One thing is clear, in future, the online practitioner will need to pay for the secure online practice platform, just as they would pay for a consulting room. Using Skype is cutting the corners and we all know what happens when you cut corners. It’s like borrowing a mate’s room for face-to-face sessions and not being in total control of who has access.
Private Practice Hub is currently doing some research about working online and one of its questions is about how many are working on Skype. The figures are very high – and every one of those practitioners is putting themselves at risk professionally if the Information Commissioner’s office decided to act, and of course they are putting their client’s confidentiality at risk.
About the author
Philippa Weitz is one of the leading experts in the UK on counselling and psychotherapy online, with a special interest in security, confidentiality and jurisdiction. She lectures and teaches widely around working therapeutically and safely online.
Philippa Weitz is a qualified teacher, trainer and psychological counsellor with more than 25 years in the mental health sector. She is currently Clinical & Security Advisor at HealthBridge Technology, Commissioning Editor for the UKCP Book Series, Director of UK Counselling Online and Online Counselling 4 Brits, Managing Director of Philippa Weitz Training Ltd. as well as author/editor of Psychotherapy 2.0: where Psychotherapy and Technology Meet.
(1) Skype August 2015 https://www.microsoft.com/en-gb/servicesagreement/faq.aspx [accessed 20th June 2015]
(2) http://pwtraining.com/resources-for-working-online/ [accessed 30th June 2015]
(3) Guidelines for online counselling and psychotherapy, third edition British Association for Counselling and Psychotherapy http://www.bacp.co.uk/members/online/members/index.php [accessed 30th June 2015]
(4) Ethical Principles and Code of Professional Conduct, United Kingdom Council for Psychotherapy [accessed 20th June 2015]
(5) Data Protection Principles, Information Commissioner’s Office, https://ico.org.uk/for-organisations/guide-to-data-protection/ [accessed 20th June 2015]