Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 23, 2024
Date Accepted: Jun 10, 2025
Psychotherapists’ ethical dilemmas regarding online and face-to-face psychotherapy during the COVID-19 pandemic
ABSTRACT
Background:
During the Covid-19 pandemic, mental health professionals were forced to find an appropriate form of work with patients that would ensure the continuity of therapy while taking into account the restrictions related to counteracting the spread of the virus. Modifying the traditional form of therapy has been associated with several ethical doubts and challenges for psychotherapists.
Objective:
It was decided to check: 1) Have psychotherapists experienced ethical dilemmas (face-to-face) during the COVID-19 pandemic? 2) Was the occurrence of these dilemmas related to the therapist's personal characteristics, such as age, sex, professional experience, or therapeutic approach? 3) What ethical dilemmas related to online psychotherapy and face-to-face therapy during the pandemic?
Methods:
An international study was conducted with 177 psychotherapists from four European countries (Sweden, Poland, Germany, and Portugal) using online platforms. An original interview questionnaire was used to collect data on the personal characteristics of psychotherapists, professional functioning, and ethical dilemmas arising from online and face-to-face therapy.
Results:
Ethical dilemmas related to online therapy were reported by 58,76% therapists,, while related to face-to-face therapy was reported by 61%. The study showed that these dilemmas are independent of the personal and professional characteristics of therapists. Dilemmas related to online therapy were: concern about online therapy, the issue of privacy and confidentiality of sessions, the effectiveness of online therapy, the issue of limitations that may hinder clinical work, and concerns related to the broader systemic and institutional context. On the other hand, for the face-to-face form, ethical dilemmas mainly concerned health and safety, limitations in communication and quality of relationships due to wearing masks, and technical and logistical limitations.
Conclusions:
The results indicate the direction of further consideration, the effect of which should be specific ethical and legal guidelines that consider the concerns and dilemmas reported.
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