Skype prohibits Skype counselling or therapy

[David Baxter PhD]

Now Skype is Getting Nervous
The Business End of Psychotherapy
October 25, 2010

Hey, get a Skype session going and provide therapy anywhere in the state! Sounds easy enough. But there are a lot of ways things can go wrong. For example, how do you know that the ?container? at the client end is in fact private? Or, if a client across the state rapidly declines and then hangs up on you, what do you do?

Now it looks like Skype is getting the willies about possible litigation stemming from the use of Skype as a therapy container, at least for their ?Skype Prime? directory of service providers (referred to as ?Call Providers?).

The Admin for the Skype community comments:

Call providers are not permitted to offer services relating to the following categories:

• Content or Service, which is adult, sexual , pornographic or paedophiliac;
• Content or Service which is offensive or promotes or legitimates racism, revisionism, or any other form of discrimination;
• Content or Service relating to the offering of gaming, betting and lotteries;
• Content or Service provoking violence
• Content or Service provoking or encouraging reprehensible or illegal actions.
• Content or Service relating to health and therapy
• Content or Service relating to legal or tax advice

Call providers must not promote their service or content on web pages which may be contrary to public order or good morals or likely to violate any law or to constitute a criminal offence.
​

Read more...

 

[Ade]

I think you will find that that relates to the skype prime and it does not relate to skype it self: Skype - The Big Blog - Skype Prime

This is the normal tos regarding the use of skype
3.3 Content of communications: Skype does not control, or have any knowledge of the content of any communication(s) spread by the use of the Products. The content of the communication is entirely the responsibility of the person from whom such content originated. You, therefore, may be exposed to content that is offensive, illegal, harmful to minors, indecent or otherwise objectionable.

There is an issue with using Skype prime but not skype its self

 

[David Baxter PhD]

Did you read the article? There are concerns about privacy/security with Skype but also ethical concerns about clients in distress or suicidal.

 

[Ade]

Did you read the article? There are concerns about privacy/security with Skype but also ethical concerns about clients in distress or suicidal.

I only saw the ongoing list that never seemed to end stating the Skype prime terms of use. yes I have read it once from top to bottom and I am not doing it again

Concerns about confidentiality using Skype are more to do with the security of the computer its self, Skype calls are encrypted so the breach of security has to be from viruses intercepting the information at one end as I understand it, so all we can do is use best practice to keep the computer safe, I don't use the pc I use for therapy for general use only therapy, I have encryption for data storage and the usual anti virus and firewall security, I try to make the client understand the necessary precautions to take and inform them about possible problems they may need to think about at their end.

In all honesty I don't think this is any thing else other than some people finding change hard to cope with, we call our banks over the phone and hand out personal and confidential information all the time, people talk to doctors and therapists via the phone and yet the phone security is easer to breach than Skype's.
There is no such thing as total confidentiality nothing is totally secure and that includes face to face sessions, all any therapist can do is put in place good working practices and as much security as is feasible and possible.

High risk clients are in my opinion not suitable for Skype or the phone but any therapist could find them selves in a position that was unforeseeable when the client was first assessed as safe to help over such a medium, we can be fooled or make an error as we are only human.

In such cases we also need to understand that if a client wants to kill them selves sadly there is little we can do, in face to face sessions if a client states they are going to kill them selves and leaves the building you do what, I can't restrain them or lock them up I can only call the emergency services and leave it to them to sort out. generally if they are committed to ending their life they will probably succeed.

Yes there is a risk but that has to be balanced against the benefits of providing such a service, there are many who do find help and support over Skype that other wise they would have to do without. the motorised transport we love to use kills thousands of men women and children every year but we still use it as the benefits out way the disadvantages.

I can't find the article but the arguments have been well publicised in the past and yet on-line therapy is still becoming a fast growing medium of providing therapy, the demand is there and progress maybe unsettling for some but it probably is unstoppable.

 

[David Baxter PhD]

My concerns are not with online counselling per se - there are many clients (e.g., in Canada's northern territories, now Nunavut; or Australia; etc.) who have no other options. But, like much on the net these days, it is caveat emptor since there are really no regulatory bodies and many of the people operating as online counsellors have dubious credentials and don't even have basic training in psychotherapy or ethics.

Additionally, I still think you're missing the point: Whether it applies to Skype Prime or any and all usage of Skype, what do you think is the reason for Skype to issue such a warning? They are obviously concerned about the risks of Skype counselling and worried about legal liability. Anyone using Skype for online swessions should be even more worried than Skype, both in terms of the welfare of the client/patient and in terms of their own professional and legal liability.

 

[Ade]

I am no legal expert and probably that would be best answered by a lawyer, to me is seems sensible for any company to protect it self from a possible legal issue, if you understand that skype took a fee for providing this service and I think I am right that in such a case they are deemed as partly responsible for any actions taken by users of such a service, a bit like some company renting out the office space and are deemed responsible for health and safety of all who use the office space.

Your going to have give me a bit of help here, I can find this

Call providers are not permitted to offer services relating to the following categories:

? Content or Service, which is adult, sexual , pornographic or paedophiliac;
? Content or Service which is offensive or promotes or legitimates racism, revisionism, or any other form of discrimination;
? Content or Service relating to the offering of gaming, betting and lotteries;
? Content or Service provoking violence
? Content or Service provoking or encouraging reprehensible or illegal actions.
? Content or Service relating to health and therapy
? Content or Service relating to legal or tax advice
Call providers must not promote their service or content on web pages which may be contrary to public order or good morals or likely to violate any law or to constitute a criminal offence.
The following categories are currently available to describe service calls:

Astrology & Spiritual
Business & Finance
Computing
Creative services
Coaching and tutoring
Relationships
Sport
Others

And there is a part relating to therapy but not only therapy, its lumped in with tax advice and any health related business and that would include a qualified Doctor giving advice, so I don't see it as a statement that therapy via skype is a bad thing in its self just that they do not want the responsibility and the possible legal implications to involve them.
I am no lawyer but that seems to make sense to me.

Regarding qualifications I agree but just as there are people with poor qualifications providing a poor or bad service as there are therapists with lots of qualifications also providing a poor and bad service.

What the answer is I don't know, in the UK its all gone a bit screwy after so much arguing and clashes of idealism it was quite evident that regulation is still quite a way off and that's a major lost opportunity. even if we had a simple register that excepts qualifications from some training schools and evidence of insurance etc that would be a good start.
But some people tried to push self interest over the need to offer some protection to the general public and that ruined it, ( in my opinion).

 

[megk]

Payment for services aside, I'm not sure I see a difference between skype counselling and anonymous call centres with respect to client safety.

 

[David Baxter PhD]

Payment for services aside, I'm not sure I see a difference between skype counselling and anonymous call centres with respect to client safety.

What do you mean, Meg? Are you talking abiout crisis centres?

 

[megk]

Yes. It seems to me that the risk is just as great for those that use crisis lines. Many of those places are volunteer based and callers may assume that counselors are fully qualified. In addition, the anonymity creates similar risks as it would with skype.

 

[David Baxter PhD]

Yes. It seems to me that the risk is just as great for those that use crisis lines. Many of those places are volunteer based and callers may assume that counselors are fully qualified. In addition, the anonymity creates similar risks as it would with skype.

Two points:

1. Yes they are volunteers but they are given specific training in crisis intervention and confidentiality issues before they ever take a call.

2. It is far easier to compromise or intercept an internet transmission than a telephone transmission, especially in the day of wireless internet accdess, so there are additional securioty precautions that need to be taken for online counseling.

 

[Ade]

Two points:

1. Yes they are volunteers but they are given specific training in crisis intervention and confidentiality issues before they ever take a call.

2. It is far easier to compromise or intercept an internet transmission than a telephone transmission, especially in the day of wireless internet accdess, so there are additional securioty precautions that need to be taken for online counseling.

It still seems that people believe that its easy to intercept Skype to Skype calls but in truth it is much more secure than any normal phone line and even basicaly impossible for any normal person to do and as it is encripted from sourse so even hacking the PC will only allow access to the encriped call and not the unincripted content. (as far as I understand it at this time)
So far only goverments have the ability to listen in on skype calls with Skype providing the support needed to do it.

K
Skype Calls May Be Impossible to Wiretap - Science News | Science & Technology | Technology News - FOXNews.com

urt Sauer, Skype's chief security officer, said there are no "back doors" that could let a government bypass the encryption on a call.

Even if you can gain wirless access to someones internet you can't gain access to their PC, you would still need to bypass their firewall first etc


But you also need to think why would someone bother to spend all that time trying in the first place, even face to face sessions can not be gaurenteed to be secure and suffer from the same possibility of snooping via bugs left by clients to monotor other sessions.

today there is no such thing as total confidentiality and all anyone can do is balence risk against the possibility and put in place as many safe guards as are reasonable to expect.

After all phone calls can be intersepted and yet we still use them to deliver personal information in confidence whild taking to our banks or Doctor and our partners.

 

[megk]

Two points:

1. Yes they are volunteers but they are given specific training in crisis intervention and confidentiality issues before they ever take a call.

2. It is far easier to compromise or intercept an internet transmission than a telephone transmission, especially in the day of wireless internet accdess, so there are additional securioty precautions that need to be taken for online counseling.

I suppose that it is more likely that someone will tap your internet than your phone, however stealing an internet connection is likely not for the same purpose as tapping a phone line.

Regarding your point about crisis lines, I'd have to say I disagree. I think many callers would be surprised by the credentials and training of the crisis "counsellors". Not to mention the fact that they are not personally bound by a regulatory body.

Despite its shortcomings, online therapy is becoming very popular and, although I really like the idea, I hope that some structure is put into place soon.

---------- Post added at 03:48 PM ---------- Previous post was at 03:46 PM ----------

It still seems that people believe that its easy to intercept Skype to Skype calls but in truth it is much more secure than any normal phone line and even basicaly impossible for any normal person to do and as it is encripted from sourse so even hacking the PC will only allow access to the encriped call and not the unincripted content. (as far as I understand it at this time)
So far only goverments have the ability to listen in on skype calls with Skype providing the support needed to do it.

Even if you can gain wirless access to someones internet you can't gain access to their PC, you would still need to bypass their firewall first etc

Interesting, I was not aware of that.

 

[David Baxter PhD]

It still seems that people believe that its easy to intercept Skype to Skype calls but in truth it is much more secure than any normal phone line and even basicaly impossible for any normal person to do and as it is encripted from sourse so even hacking the PC will only allow access to the encriped call and not the unincripted content. (as far as I understand it at this time)

If you have access to the PC, you have access to everything.

Even if you can gain wirless access to someones internet you can't gain access to their PC, you would still need to bypass their firewall first etc

I think you need to read some of the publications on computer and internet security. If an infected computer can steal passwords and credit card details with which to compormise bank accounts, I doubt that Skype would present a major challenge.

But you also need to think why would someone bother to spend all that time trying in the first place

There are reasons people might want to do that (e.g., estranged or ex-partners) but my point is more general than that. Why do hackers hack web sites and personal computers? Often just to prove they can do it.

even face to face sessions can not be gaurenteed to be secure and suffer from the same possibility of snooping via bugs left by clients to monotor other sessions.

That would require access to your office and technology that is beyond most people. Compromising computer security can be done by teenagers using so-called "kiddy scripts" posted all over the internet.

After all phone calls can be intersepted and yet we still use them to deliver personal information in confidence whild taking to our banks or Doctor and our partners.

Yes, but see above. Compromising a computer is an easier task for most people than tapping phones.

See also: http://forum.psychlinks.ca/online-counseling-and-therapy/24858-is-skype-hipaa-compliant.html

 

[David Baxter PhD]

Regarding your point about crisis lines, I'd have to say I disagree. I think many callers would be surprised by the credentials and training of the crisis "counsellors". Not to mention the fact that they are not personally bound by a regulatory body.

I do know people who volunteer at crisis lines in my area. Yes it's true there is no regulatory body but they do receive training.

Despite its shortcomings, online therapy is becoming very popular and, although I really like the idea, I hope that some structure is put into place soon.

I do, too. My point in this and the other thread is to get both consumers and service providers thinking more about the risks and security issues involved. I have been asked more than once to provide Skype sessions and to date have not done so. I really would like to see convincing evidence that the risks are minimal. And I would like to see some regulation of the medium by legislated regulatory bodies.

Interesting, I was not aware of that.

Not surprising. It's not true.

 

[megk]

I do think that someone hacks a computer for more reasons than to prove they can do it. I also think that hacking is quite difficult and the average teen would not succeed at it.

 

[David Baxter PhD]

I do think that someone hacks a computer for more reasons than to prove they can do it. I also think that hacking is quite difficult and the average teen would not succeed at it.

Some do. Some have more basic reasons, like theft of money or information. And the average teen doesn't have to know how to do it - just how to download a script to do it for him or her.

"kiddie scripts" malware - Google Search

"kiddie scripts" - Google Search

 

[Ade]

Quote Originally Posted by Ade View Post
Even if you can gain wireless access to someone's internet you can't gain access to their PC, you would still need to bypass their firewall first etc

I think you need to read some of the publications on computer and internet security. If an infected computer can steal passwords and credit card details with which to compromise bank accounts, I doubt that Skype would present a major challenge.

Hacking a wireless connection gives you access to the network not the pc, the wireless router provides internet access to a pc on the network, my router allows for up to 8 connections through my router via wireless and cable.
Every pc should still have its own firewall etc

Regarding viruses that risk is always there and yet banks provide on-line banking, if it was that risky they would say its un safe as they are regulated by the banking code and would not provide the ability to gain access to personal and private information if the risk was unacceptable.
A pc running security software is not easy to hack.
The soft target is the user.

Computers are used for most things and provide a secure connection if safe guards are installed and good practice followed but no security is totally secure and there is always some risk.
Yes you do have to educate clients some times and check for security but that's just another assessment stage.

That would require access to your office and technology that is beyond most people. Compromising computer security can be done by teenagers using so-called "kiddy scripts" posted all over the internet.

There lots of devices that are able to eavesdrop on conversations and are easy to use but as you say they probably are beyond most people the same goes for PC hacking.

See also: http://forum.psychlinks.ca/online-co...compliant.html

As it says it is secure and probably compliant but nothing is with out risk.

I do, too. My point in this and the other thread is to get both consumers and service providers thinking more about the risks and security issues involved. I have been asked more than once to provide Skype sessions and to date have not done so. I really would like to see convincing evidence that the risks are minimal. And I would like to see some regulation of the medium by legislated regulatory bodies.

The evidence is always going to be subjective, technology is always evolving and the same arguments were given when phone counselling was used but is now excepted and widely used, regulation regarding phone or skype will always remain in the domain of the people who oversee the service such as Telecom regulators and the provision of therapy can only be regulated by provision of good practice guides and common sense and risk assessment.

Risk regarding clients going into melt down and hanging up are real, risk assessments before taking on a client are important and are never going to be fool proof.
There are two categories of clients known and unknown, some wish to remain anonymous and as such care is needed before proceeding and the known clients you have information about such as doctors information and other personal information that allows some emergency contact ability.
Another risk to take into account is connection problems and hardware problems that can end a call at a crucial time for minuets or even days is some cases.

Yes there is risk with using any technology but the risks can be reduced to an expectable level but that is about what you see as being acceptable.
There is also client preference and in today's world many people not only understand and use technology to provide there communications but also use it as a support network and also understand the risks regarding privacy.

 

[David Baxter PhD]

I am concerned that you are still (a) overestimating the difficulty of hacking a PC, in part because you are (b) overestimating the knowledge the average person has about computer security. And of course the overall security of Skype counselling or other online counselling depends on the security of the connections at both ends of the interaction. Even if yoiu have "fully protection" at your end, it's still an insecure transaction of the other end is unsecured.

The number of people who fail to use even basic encryption of their wireless connections would probably surprise you, based on what you're writing here. Whetherr I'm at home or at my office, it is rare that I am not able to find at least one unsecured or "open" wireless network connection. As for firewalls and routers, the majority of individuals do not even change the default password for those routers - there are lists of default passwords for various moidels available for free all over the net, just as their are hacking scripts available for free (see my post above).

See also How to capture data and passwords of unsecured wireless networks with SniffPass and SmartSniff

And again, my purpose here is not to disparage distance counselling. I am fully aware that many people have limited resources for face-to-face counselling. Rather my purpose is to raise awareness about security issues for both practitioners and clients (consumers).

And I also understand from your signature that you make your living via online counselling. I would suggest that you do not do yourself or your clients any favors by underestimating the security risks. On the contrary, you might be further ahead to provide materials to all new clients instructing them as to how to make their sessions more secure on their own computers and/or networks.

 

[Ade]

All clients need to be assessed regarding security and if needed educated and changes implemented.
All clients need to understand what is required regarding safe networking.

You will find that the people who use the internet for therapy are normally well informed and are used to the medium on a daily bases, in the assessment stage any prospective clients must show that the security they have is implemented and working also that they understand the risks and what is considered good practice.

No computer is totally safe even apple mac and Linux are not totally immune but the risks are not as bad as made out by some, I have not had my internet hacked or had any viruses, I use good practice and the normal security as well as a few extras such as encryption.

Opening SPAM e-mails and looking at bad sites and not updating as well as downloading from bad sites is the usual way to get infected, hacking a firewall is on its own probably impossible except for the very few.

As long as you take a few precautions using a PC on the internet is safe, there is always risk but if it was so bad no bank account would be safe from exploitation or any information private.
There are unsecured networks just as there are people using a pc with no firewall or anti virus but at the assessment stage this is corrected or if they tell me it is and it is not then that is a responsibility they have to take into account.

Therapy via Skype is very possible and low risk if a few simple steps are taken, the only other option is to ban it for providing a valuable service.
I would never use e-mail to provide therapy because of the difficulty securing e-mails and the fiddly way of encrypting them but for some clients its not an issue and I often get asked to provide such a service.

Its about peoples perceptions and assessments of the risks involved and what is judged as safe or inappropriate, cars are judged as safe but kill many thousands every year but we understand the risks and use them.
I have been providing on-line therapy for some time and have found that people who use this service are normally internet orientated and the very few who are not are able to understand and implement changes asked of them with not much help from me.