Geek Ethicist: Skype Therapy

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Dear Ethicist—

Which FaceTime/Skype apps are the most HIPPA compliant? I am a therapist and have had clients request these type of sessions. However, I’m worried about privacy and heard that FaceTime was recently hacked. I need to know which of these apps would be the best and safest for my therapy sessions.

Sign Me—

Psychotherapist Trying to Keep Up with Technology

Hi Psychotherapist—

First, a disclaimer:

The ethicist is NOT a lawyer. Advice given here is for informational use only and should not be considered legal advice. Opinions expressed here are of the ethicist and not necessarily those of Any advice given here is taken at your own risk.

That said, your question is more complex than it sounds. I’m not an app or technology reviewer, so it’s not my place to weigh in on the best tool for remote counseling sessions. However, using ethics and reasonable judgment it is possible to answer this question for yourself.

Let’s look at the real issues:

1.)   Professional Boundaries

Establishing clear professional therapeutic boundaries is paramount, and in fact a challenge, in any psychotherapeutic situation.  Every competent therapist recognizes the potential for countertransference, or allowing the therapist’s own personal psychiatric needs to drive the therapy rather than the patient’s needs.   So prudent reasonable psychotherapists must keep clear boundaries in place to avoid countertransference.  Never forget: You are not your own patient in your session if you are getting paid for it.  You, as the therapist, are professionally obligated to create and maintain the boundaries that make this relationship therapeutic, otherwise you risk ethics violations and outright malpractice liability if there is foreseeable injury.  In other words if something goes badly because you let the boundaries break down and you should have known better it could cost you plenty, including your license!

Obviously most therapists probably recognize they shouldn’t have cyber sex with their patients, but giving gifts to entice patients to continue therapy,  or doing personal or professional favors for them online,  or even carrying on personal relationships external to the therapeutic environment online are also boundary infractions, and also potential ethics violations, as are carrying on non therapeutic activities online within the sessions. The problem is the online environment may soften therapeutic boundaries and make the slippery slope of countertransference even slipperier and even more dangerous.  So this should be the very first thing you keep in mind if you begin online therapy.  This ain’t Lamebook keep your distance.

2.)   Venue

When meeting in an office, certain parameters are already in place: some of these may need to be re-established when meeting over the phone. For example, is the person being counseled in a private location? How long will the session last? What will you do if there are technical difficulties? Do you have a separate phone for this, as using your personal phone may violate your personal privacy and undermine your counselor/client relationship?

3.)   Will you get paid or arrested?

It’s insurance fraud if the session isn’t full length or what happens in therapy isn’t actually therapy! Many insurance companies will not cover sessions via Skype/Facetime: best to check on this before agreeing to this type of session with a client. In Academia the whole discussion is about synchronous vs asynchronous online teaching.  The reason is that the teacher can be out fishing when the class is working away.


Be cautious of thinking that HIPPA protects a person’s privacy to the degree that you assume. HIPPA means your neighbor doesn’t know you have chlamydia, but your doctor, the billing department, the pharmacist, possibly your employer and the government will know.  HIPPA does not promise absolute privacy and often gives an exaggerated sense of privacy to patients. If you don’t believe me, check out The Tatiana Tarasoff ruling and consider duty to warn vs. confidentiality. It’s hard enough to figure out if your patient’s words are bluster or a serious threat when you are looking at them red-faced in your office.  Now imagine having to make that determination online.

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Digitized/online medical records are not safe. Period. So which method of protecting a person’s privacy is safest? This is a moving target.

              Rule of thumb: what would a reasonable, prudent person accept as a safe interface? This is how legal liability is        established.

So the question for you is, which app/platform would you expect to most preserve your client’s privacy, assuming #1 has been addressed? Research the different apps and make an informed decision based on your research and you will have done due diligence in protecting your clients.

5. Don’t worry this won’t hurt a bit.

All medical ethics begins by determining whether or not a patient has given informed consent for a medically indicated treatment. They really have to know what they agreed to including the real risk of having their privacy compromised online.   Misunderstanding or manipulation for the patient’s own good are not  informed consent.  In other words, even if a patient seems to have agreed with a treatment does not mean the patient has given informed consent.   We all know how easily misunderstanding happens online.  Catfishing anyone?  That itself should give any online therapist pause.  If you have received demonstrable informed consent and the person is reasonable and you have the chosen the best option available to you (and there are more options than Skype and FaceTime–see list below) then you are ethically fine—it doesn’t matter what app/platform you use. If you think you are going to do therapy on Facebook, however, you are out of your mind.

Other encrypted alternatives for online therapy are:

Secure Video, VSee, Lync, Vidyo, Secure Telehealth, VIA3, Telemedicine, eTherapi, PASS

(This list is by no means exhaustive: there are many more options out there.)

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Geek Ethicist: Does Technology Make Lazy Parents?

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Dear Geek Ethicist—

I just read about the new parental control app for Kindle Fire that has a “timer feature to lock Kids Place after specified amount of time.”

Come on: isn’t this just making lazy parents lazier? I get that parents want to block certain content, but auto shut off is taking it a little too far.

You’re the ethicist: what do you think?

Sign me,

Annoyed At Lazy Parents

Dear Annoyed—

There are two ways to answer this letter: as a non-parent and as a parent.

As a non-parent, I would commiserate with you on the lazy parents of the digital native generations and conjecture about the kinds of kids these parents are raising.

As a parent, I would have a different perspective. First, Parenting is not a vocation for the lazy. If you need proof of this, spend the day with a friend who has kids. Kids, plural. And make sure you spend the whole day. No time off, no coffee breaks: an entire, grueling day. When you see that parents are not even allowed the luxury of a bathroom break without company, you will begin to understand how tiring parenting is.

Assuming a non-lazy parent, why would s/he need auto-shut off for the kids’ devices?

Mom is about to take the Kindle Fire away from little Johnny when:

A.)   The dog pukes on the floor

B.)    A pot on the stove boils over

C.)    A neighbor knocks on the door

D.)   Johnny’s sister starts crying/screaming

E.)    Johnny’s little brother falls down and bloodies his lip

You know what the answer to that is?

F.) ALL OF THE ABOVE. Mom returns to the task of plying the Kindle away from Johnny after the hour or so it takes to deal with each of those episodes. Whereas, if the Kindle had auto-shut off? One last thing Mom (or Dad) has to remember to do, on top of laundry, dishes, breakfast/lunch/dinner, cleaning, shopping, etc.

The crying and screaming that Johnny will inevitably do when his toy shuts off: Mom will have to hear that and deal with it just as she would if she had physically removed the Kindle from his grip. No ease of pain there, just the convenience of knowing something will happen when a parent wants it to happen…for a change.

A recent survey from Northwestern University indicates that technology isn’t making parenting easier, it’s making the job more difficult.

Which brings me to another question: Why do parents let their kids use technology?

1.)    It’s convenient. In an article for the NYTimes, Steve Almond admits: “we park the kiddos in front of SpongeBob because it’s convenient for us….” Notice he doesn’t say it makes his life easier. But sometimes as a parent you just need a few moments of peace so you can think…and drink enough coffee to deal with the rest of the day.

2.)    All the other kids are doing it. I mean, your kid can’t be the only kid in kindergarten who is unable to work an iPad, right? It might say something about your child’s intelligence….

3.)   Technology is not all bad. Check out this article on the seven myths about young children and technology: there are good and bad things about children’s technology use. The good things are really good and the bad things aren’t as bad as we think.

4.)    Learning in Disguise! Technology gives children access to information and learning tools, in the guise of fun and games.

5.)    Overuse is a myth. Screen time, contrary to popular belief, is well managed by parents. In a 2013 national survey by Northwestern University, average screen time of a child one year old and younger was one hour, fifteen minutes; for those children aged two to five years old, average screen time was 3 hours. If parents were truly lazy, those numbers would be much, much, much higher. 

Technology gives parents amazing tools for streamlining their job(s), educating their children and enriching everyone’s lives. Moms connect on social media, like Facebook and collaboratively solve problems, share advice and swap/barter/sell used and new baby gear. Parents make use of the Internet and YouTube to figure out how to fix the *#&$ % broken stroller, plan a healthy dinner, treat a bee sting and help Junior come up with an idea for his science project. Parents can have diapers delivered to their door monthly (one less thing to think about!), find the best local service providers, and research learning apps.

For all the potential pitfalls of technology, there are equal advantages. People of all kinds, not just parents, have to learn to navigate them. There will always be lazy people: we can’t blame laziness on technology. This goes for parents and non-parents alike.

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Geek Ethicist: YUCK! Maybe Not

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“Dear Ethicist–

A couple of months ago I was sitting in a waiting room, flipping through magazines when I found an article that said smartphones (and tablets!) have more germs on them than your average toilet: Here! Here!  Here! and Here!

Of course, the very next day my co-worker wanted to show me some pictures of her kids…on her smartphone. I was terrified–and still am. I don’t want to touch anyone else’s cell phone and now clean mine at least once a week.
I guess my question is one of etiquette: How can I politely decline to touch anyone else’s cell phone? I don’t want to be rude, but I don’t want to subject myself to those kind of germs, either.


Sign Me–

iPhone Germaphobe”

Dear IG,
I don’t want to guess what doctor’s office you were waiting in, but this sounds a bit like the fears of someone with an actual phobia.  We now know that the amount of Oxazepam (used to treat anxiety and depression) and tons of other psych meds we take are actually beginning to make the fish in our rivers crazy. Yes, our love of Prozak is poisoning our fish.  Now that is an excretory problem to worry about. Unreasonable fears, phobias and minor mental discomforts have become a booming secular religion across the developed world, financed by innumerable industries from the pharmacological giants to sustainable natural herbalists to cleaning products companies. Yes, there is plenty of poop on our Iphones, our TV remotes, our shoes, and our kids are just about covered all over in filth.  Let’s not get too anxious about it. Save the fish.

After you touch someone’s iPhone or any keyboards, even your own, probably wise to wash your hands before you stick your fingers in your face. And recognize that the articles you referenced are all selling cleaning products in one way or another. What you are reading is the power of PR to crush the prudence of common sense. Shaking hands with a half dozen people or helping a child tie his sneakers is likely to smear your hands with more than enough yuck to have the same effect as looking at your friend’s baby pictures on her smart phone.  Be pleasant, coo over her pictures; then go wash your hands in the bathroom, especially if you have an immune disorder.

E Coli:  Why we wash our hands after touching your dirty smart phone!

E Coli: Why we wash our hands after touching your dirty smart phone!

Far from being a cause of illness, the smart phone has now actually become a medical device that saves thousands of lives and soon billions of dollars in health care costs. As this NBC video demonstrates, iPhone apps are now used to provide everything from echo cardiograms to cardiac sonograms.

So rather than worrying about germs, just use common sense when touching people’s personal items including their handkerchiefs, combs, TV remotes, razors and personal keyboard devices.

The more interesting aspect of the dirty smart phone phenomenon is that we now take the whole world with us into the bathroom when we take care of our most personal business.  I still find it plain old creepy hearing men talking to their wives while sitting in the toilet stall next to me in a public bathroom.  Though it is so common, now I should scarcely notice.  Still, what we really need is public bathroom etiquette for mobile device use.  How about: Keep your privates private especially in a public restroom!  I don’t like knowing your wife or whoever (!) might hear ME too.  But then that may just be something between me and my own drug-dispensing secular minister therapist to work through.

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Geek Ethicist: Love Liars Online

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“Dear Ethicist–

What’s wrong with “sculpting” the truth on online dating sites? Women get breast implants, which is essentially false advertising (or “falsies advertising”) but men fall for that. So what’s the harm in shaving off a few years from your age or adjusting your photo on a dating site? I mean, sometimes no one will give you a chance until you do these things. And in real life people go on first dates and lie about all kinds of stuff from where they live to how many cats they have. What do you think?

Sign Me–
Looking for Results”

Dear Looking,

In a word, nothing.  Nothing is wrong with “sculpting the truth” so long as no one has actually been deceived.  Paradoxically, some socially expected sorts of lying are not really dishonest, but actually required.  “Well sorry, gotta go.”  But real lying requires intentionally co-opting someone else’s ability to make a decision by giving them misleading information.  “Loan me ten bucks I promise I’ll pay you back.”  “No, I’m not married.”  Other sorts of lying are just downright pathetic.  Lying on online dating sites falls into this final category.  Because, let’s be honest about lying on online dating sites, sooner or later the falsies always come off.  And if what is exposed is entirely unexpected, that’s probably going to be a very embarrassing last date.

On online dating sites it is generally accepted that everyone will lie appropriately, but only very little.  According to research by Jeff Hancock of Cornell University, surprisingly, people are generally more honest online and in email than in person.  We tend only to tell little forgivable lies in online dating sites:  Men will round up their height to the next inch — 5’9 plus even an iota becomes 5’10” — but rarely more than that, and women tend to lie slightly about their age, and everyone lies a little about their weight.  And this small amount of lying makes perfect sense, since when the coffee date finally comes, if what shows up is a brazen falsifier, unrecognizable by her given description, well that is a certainly going to be deal breaker.

According to the Rules of the Internet  30, “There are no girls on the internet.”  As a Nerdfighter female friend recently explained to me, this doesn’t just mean every member of every anonymous online love chat room, is really an overweight sweaty old bald man with gray stubble, it also means if you happen to be female online you cannot play the girl card, ever.  “Omergerd! I am totally gonna kill you on EverQuest even though I am a cute girl, cuz I am a really tough Dark Elf! Grrrlz are very tough and gnarly too.” Fail.

Which leads to the colossal cringe-worthy fail of pathetic football star Manti Te’o:  A fake dead girlfriend?  Talk about “falsies!”  The whole bit from falsie girlfriend through falsie leukemia to falsie death, sounds like a guy creating a falsie “beard”  for himself with a “catfishing” scheme.  As more comes out it seems pretty well certain the whole thing was concocted as much by Te’o himself  as by his “falsie” friends. His fake girlfriend dying of fake cancer while he fakes emotional strength sounds pathetically like a super fake macho guy embarrassed by some very real carnal problems with women of flesh.  “See Mormon Mom and Dad?  I really do have a girlfriend, really.  And I would have loved for you to meet her… but…  (tears,sighs and courage) she died.

Still this entire fabricated hoax is really the exception when it comes to online lying.  In fact, as it turns out, the real lying machine is the telephone.  We scarcely pick one up without starting to lie.   But we all recognize these lies as part of telephone culture.  “Gotta go something came up.” That’s almost always a lie.  And even though we all know it’s a lie, we usually appreciate that fabricated pleasantry over the brutal truth: “Now you’re boring me to death so I’m hanging up.”

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Geek Ethicist: Robot Wives and Android Prostitutes

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“Dear Ethicist–
How come I don’t have a robot wife yet?
Sincerely– Still Waiting”

Dear SW, You won’t have to wait long.  “Lovotics” Robot Love is already in the geek lexicon.

The term refers to the loving robots.  The concept made a categorical leap forward last year with the work of  Hooman Samani, an artificial intelligence scientist from the Social Robotics Lab at the National University of Singapore who developed a robot with artificial hormones that respond to affection.  His work  demonstrates that humans easily have the capacity to use robots as surrogates for our human love objects.  Our real human hormones respond to the robots’ fake hormones.  (Yes, robots fake everything.) Among other hot-bots, Samani linked two pairs of robot lips so a person on one side of the world can transmit an authentic kiss to another person on the other side of the world.  But certainly it  is just a matter of time before someone develops the AI to allow a computer to kiss back all on its own. So the AI love-bot is only a small step away. Prosti-bots are already, so to speak, in the pipeline and are expected on the market within the next five years.  Imagine the market for really hot mindless prostitutes for rent or sale with no risk of jail or venereal disease!

Some years back a Nobel prize scientist Dr. Nüsslein-Volhard wrote that everyone should have a wife. She wanted one herself.  Naleighna Kai wrote a book with a similar plot: a wife fights for custody of her soon to be ex-husband’s mistress. And there is no getting around it, wives really are great.  So clearly everyone should have one.  Married women especially need wives to help them manage the big three: houshold, husband and kids.  But everyone also needs a chainsaw and a box of wrenches; so robot husbands might be helpful too.  Put it all together and robo-spouse is inevitable.

All that joy aside, the realm of robo-love is filled with real danger for humans. I refer you to Matthias Scheutz, David Levy, and Blay Whitby on this.  The primary problem is people really do fall in love, and hate, with both animate and inanimate entities.  We even get jealous of inanimate objects.  Who hasn’t felt jealous of a partner’s fascination with a new computer game?  So, in Scheutz’s terms,  the dangers of “Unidirectional Emotional Bonds” (we love robots that remain indifferent to us)  are enormous, as are the risks of inter-human jealousy caused by unidirectional robo-love.  Would you kill a person to protect your indifferent robo-spouse? or harm your human spouse for loving an indifferent android prostitute? or punch your partner for kicking your little cutesy Roomba?  Perhaps.

So, should humans even go down the dangerous path to loving our robots?  I say a big YES!  The problem, however, is not that we will begin to love robots deeply and they will at best fake empathy and everything else. The biggest problem is, if our robo-spouses seem to love us, will we have a duty to show them genuine respect in return?  Will their merely apparent cognitive abilities earn them real rights?  And here too, I’m afraid the answer is yes.

If  we actually love our robots then we will have to respect them. This is also the foundation of pets’ rights. Your dog does not love you like you love your dog.  For your dog, you are at best Alpha. But for us, pooch can be like a child. And it is only our human love for our pets that gives our pets their rights. There is a world of difference between a pet chicken and a fryer, but they cluck exactly the same.

Since no one would want to be exploited, no one should exploit others.  And the way empathy works, it would be impossible to love something that is not, in principle, exploitable.  Yes we love ideas, but that is an entirely different category of love than loving our children and our spouses or even our pet chickens and our prostitute-Roombas.  Love requires the willingness to sacrifice a bit of yourself for the well-being of those you love.  If you really love little Roomba you will sacrifice for that little cutie too. And the paradox of love is that humans gain a personal benefit from our empathy for those we love.  So… if you really loved your robo spouse regardless of its indifference to you, you’d still have to go to movies you don’t really like that much for the sake of maintaining real robo-love.

Does my screen look fat in this case?  No! Your screen looks –wow– just great, honey, really just great.

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Geek Ethicist: Murphy’s Law of Email

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“Dear Ethicist–
I recently received a long, personal email from a complete stranger. The email was not addressed to me, so I can only guess that they misspelled the email address and ended up sending this email to me instead of it’s intended recipient. This must happen pretty often. My question is: what should I do? Delete it and pretend I never got it? Reply to the person informing them they sent it to the wrong address? What would be the proper ethical thing to do?

Sign me-

Dear Wondering:
Stop wondering. The instant you discovered you were not supposed to receive that email you should have done THREE things: 1. Stop Reading. 2. Delete it. 3. Forget about it.

There is a legal concept called “larceny by finding.” It means if you find a wallet and take the cash you are a crook. Same idea applies to a found personal email. It ain’t yours; don’t read it. And since you cannot return it without risk to yourself, delete it immediately. After all, if you return it that means you probably read what wasn’t yours to read.

Some might urge you to be a good Samaritan. After all, the sender does not know the email went adrift and may be harmed by his ignorance. The cavalry will never come to his rescue if they never receive the message and now you alone hold that urgent plea for help…

No! Stop. Not here. Stranger danger!

To be a real, good Samaritan you have two obligations. First, you should not put yourself at undue risk. Second, and maybe even more important, you have to be absolutely sure you really can help. That’s called prudence. You are not really being a good Samaritan if you attempt amatuer open-heart surgery in a parking lot because you think it might help the guy clutching his chest. It’s not quite murder, but foolish enough to be pretty darn close.

You have absolutely no idea of the context in which this email was sent or why. Every email is part of a larger story, and this email may well have been an attempt to pull you into that story. That could be a real danger to you. So again, if you receive an email not meant for you? Stop. Delete. Forget. Be prudent.

Now, what if you are the sender who discovers YOU have made that mistake?

Murphy’s Law of Email (MLE) says:

“Any time you send an email to the wrong email address it will be highly personal, very embarrassing, and may well lose you at least one friendship and/or possibly your job.”

 Five Things Never to Forget Before You Hit Send:

1. Never Reply to All

Holy Cow! At first I thought you must have been reading MY email too. I recently sent a near career-ending Reply to All email. I only discovered it when I received this response from an intended recipient: “Reply All: the work of the Devil.” This is the Joe Biden effect: When you have something you want to say, particularly when you think it is true, the tendency not to use caution regarding Reply to All is very high. But Truth is no excuse for stupidity. And thinking that through experience you know better is no protection from being stupid about telling the truth. Make it a habit never to hit Reply to All. As Aristotle tells us, Ethics requires Good Habits. Use email groups and send to those groups and add in people as needed. Sometimes your boss’ peculiar managerial style is best discussed privately in person, never behind her back in front of her face and dozens of others because of Reply to All.

2. Double and triple check email addresses

I know Outlook and Gmail are just trying to be helpful, but don’t trust them. A helpful fool is still just a fool. Your email auto address is a fool. Always check that your email is actually going to the right John Smith, maybe not the human resources John Smith.

3. Always proofread your email

Even the Oatmeal  hates bad grammar. Because sometimes a comma does mean more than you expect: “Oh well, let’s just eat grandma.” Spell check and Autocorrect allow for some crazy Freudian slips as well! I refer you to “Damn You Auto Correct“ if you require proof. Sure, that “trip to Virginia may have advanced your career here,” but be sure that is actually what emailed. Your helpful fool may have said something else.

4. Use a separate account for personal email

Anything you send or receive on your business account is legally a part of the business record. Virtually every institution has guidelines for saving and deleting company emails since they can become a part of any legal investigation from IRS to whistleblowing. In this age of free email accounts, there is no reason to put yourself at risk by sending personal emails through your work email account.

5. Emoticons are lame (email is not the same as actual speech)

Irony easily becomes literalized in email. So, when in doubt, just be literal because odds are your email will be received as if it were. This problem arises because the speed of email makes it easy to confuse email with speech, but the written word never winks, and emoticons don’t work. Repeat: emoticons are always pretentious and slightly insulting. The human species evolved over hundreds of thousands of years to read facial and body expressions, even micro expressions, and we use these expressions when we speak to each other to add meaning to our speech. You may think that because someone knows you well they will get the irony or sarcasm of your statement, but think again! It’s only email.


Send your ethical dilemmas to  I’ll give you my ethical analysis and you may find it helpful…or not.

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