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Ethical arguments in favor and against online psychotherapy.

Ethical arguments in favor of online psychotherapy
Increased access, availability and flexibility	1–6, 8–23, 25–61, 63–70, 72–81, 83, 84, 86–105, 107–112, 114–229
Therapy benefits and enhancements in communication	1–43, 45–49, 51–58, 60, 61, 63–74, 76–79, 81–98, 100–102, 104–109, 111–115, 117, 119–124, 126, 128–158, 160, 161, 163, 165–167, 169–179, 181–188, 190–193, 196, 197, 199–217, 219–237
Client characteristics	1–4, 10–25, 27–37, 39–54, 56–61, 64, 66–68, 71, 72, 74, 76–84, 86–107, 110–121, 123, 125–131, 133–140, 142–148, 151, 152, 154–159, 161, 163, 168–172, 175–188, 190–198, 200–205, 207–209, 211–213, 215–217, 219, 222–224, 226, 228, 238
Convenience, satisfaction, acceptance and increased demand	1–3, 5, 8, 10–19, 21–35, 37–46, 48, 50–53, 55–57, 63–70, 72–74, 76–78, 80, 81, 83, 84, 86, 88–92, 94–96, 100, 101, 104, 106–108, 111–113, 115, 118, 120–122, 128–130, 132, 134, 135, 137, 139–141, 143, 144, 146–148, 152, 153, 155, 156, 159, 160, 163, 165, 169, 170, 172, 175, 176, 178–180, 184–188, 190–194, 197, 200, 201, 203, 206, 207, 209–213, 215, 217, 219, 223, 224, 226, 231, 235, 236, 238
Economic advantages	1, 3–5, 8, 10–16, 18, 20–24, 27–37, 39, 40, 42, 43, 45, 46, 49, 51–53, 56–58, 64–68, 73–78, 81, 83–88, 90, 91, 93, 96, 101–104, 107, 108, 110–112, 116–124, 126, 128–132, 134–136, 139, 140, 142–152, 154, 161, 162, 164, 165, 169, 170, 173, 175–179, 182–185, 187, 189–193, 197, 200–202, 207, 208, 210, 212–214, 216, 218–224, 226, 228–231, 238
Anonymity and privacy	3, 10, 11, 13–16, 18–23, 25, 27, 29–31, 33, 35, 37, 38, 41, 42, 47, 51, 56–58, 61, 64–67, 72, 76–79, 84, 86, 87, 89, 91, 95, 96, 98–101, 103, 105–107, 112, 115, 117, 120, 121, 128, 130, 133–135, 137, 139–141, 144, 146, 148, 149, 152, 155, 156, 158, 159, 163, 169–171, 176, 178–187, 189, 192, 198, 200, 201, 204, 207, 211, 212, 216, 217
Eliminating barriers to engage in psychotherapy	3, 5, 10, 12–16, 19–23, 25, 27, 29–33, 35–37, 41–43, 47, 51, 56, 58, 59, 61, 64, 66, 67, 69, 76, 77, 84, 86, 87, 89, 91, 92, 95, 96, 101, 102, 107, 109, 111–113, 117, 121, 128, 130, 132, 134, 135, 139, 140, 154, 156, 158, 159, 161, 163, 169, 170, 173, 176, 179, 181, 184, 185, 189, 194, 195, 197, 204, 213, 216, 217, 219, 224, 238
Therapeutic relationship	1, 3, 10–12, 14–16, 19, 20, 22, 23, 29–31, 35, 37–40, 43, 47, 49, 54, 56, 60, 61, 64, 66, 68–70, 72, 74, 78, 84, 85, 91, 94, 102, 107, 113, 117, 119, 121, 122, 124, 128, 133, 137, 139–141, 143, 144, 146, 147, 152, 154, 156, 161, 171, 172, 175–179, 181, 184, 186, 189, 197, 204, 209, 211–213, 215–217, 219, 224
Online teaching and supervision	1, 8, 14, 19, 21, 22, 32, 34, 35, 38–40, 42, 43, 45, 47, 48, 51–55, 60, 66–68, 74, 78, 83, 87, 88, 91, 94, 98, 99, 103, 104, 117–119, 130, 131, 134, 147–149, 156, 166, 169, 171, 172, 175–178, 181, 184–187, 191, 193, 200, 203, 204, 207, 211–213, 215, 222, 227, 229, 230, 234, 236, 238
Reducing stigma	3, 5, 8, 10, 11, 13–16, 19–23, 29, 31–33, 35, 36, 41, 42, 45, 51, 56, 64, 76, 78, 84, 86, 89, 91, 92, 95, 96, 101, 107, 109, 113, 133–136, 139, 140, 155, 156, 163, 171, 178–180, 182, 184, 191, 194, 204, 211, 216, 220, 224
Patient empowerment and increased patient control	1, 3–5, 7, 16, 19, 20, 30, 39, 42, 43, 49, 51, 52, 58, 60, 61, 69, 72, 74, 76, 78, 79, 81, 83, 86, 88, 90–92, 100, 104, 107, 113, 128, 132, 147, 156, 157, 169, 171, 177, 178, 184, 185, 187, 193, 196, 200, 204, 207, 208, 211, 216, 218, 219, 224, 238
Worldwide and cross-border psychotherapy	7, 12, 13, 19–21, 23, 25–27, 31, 32, 35–37, 45, 48, 50, 51, 57, 58, 61, 70, 76, 89–91, 99–103, 105, 113, 117, 118, 120, 127, 136, 138, 142, 146, 159, 163, 165, 169–171, 175, 176, 178, 181, 185, 200, 202–204, 211, 219
Emergencies	1, 3, 5, 12, 15, 19, 23, 25, 30, 33, 36, 37, 39, 42, 48, 49, 54, 57, 58, 61, 64, 69, 76, 80, 87, 91, 92, 97, 103, 104, 111, 113, 117, 126, 128, 132, 134, 139, 143, 148, 159, 168–170, 185, 193, 196, 207, 211, 212, 215, 216, 226
Adaptability of services and personalized care	1, 5, 7, 19, 21, 22, 30, 35, 39, 44, 45, 57, 86, 107, 108, 132, 135, 142, 152, 169, 175, 219, 224, 227, 228
Adherence and compliance	1, 8, 11, 13, 19, 20, 31, 46, 56, 72, 82, 88, 90, 93, 94, 114, 122, 132, 166, 175–177, 216, 219, 224
Opportunities for research	7, 13, 32, 43, 47, 52, 58, 61, 66, 67, 79, 83, 87, 108, 120, 121, 146, 185, 200, 203
Unethical not to provide online psychotherapy	29, 48, 52, 67, 103, 142, 155, 158, 159, 205–207, 216, 231
Freedom for therapists	17, 29, 49, 50, 67, 96, 107, 169, 187, 197, 200, 216
Enhancing accountability	42, 51, 52, 55, 150, 184–186, 204, 207
Protection of the therapist	23, 31, 53, 97, 143, 196, 207, 217
Social media	7, 26, 40, 54, 103, 155
Diminishing intimacy	12, 55, 67, 217
Informed consent	56, 57, 72, 117
Prohibition against free market	58
Ethical arguments against online psychotherapy
Privacy, confidentiality and security issues	1–3, 5–20, 22, 23, 25–39, 41–74, 76–82, 84, 85, 87–105, 107, 108, 110–114, 116, 117, 119–122, 124, 127–134, 137–144, 146–150, 152–155, 157–181, 184–195, 197–201, 203–214, 216–219, 221–223, 225–236, 239–248
Therapists' competence and training	1–3, 5, 6, 8–12, 14–16, 18–27, 29–33, 35–39, 41–53, 55–58, 60–74, 76–78, 81, 82, 84, 85, 87, 89–96, 100–105, 107–110, 112–114, 116–122, 124–134, 137–144, 146, 147, 149, 150, 152–167, 169, 170, 172, 174–181, 184, 186–191, 193–197, 200, 203–206, 210–213, 218, 219, 221, 223–229, 232–235, 239–242, 244, 246–248
Communication issues	2, 3, 5, 7, 9–17, 19, 20, 22, 23, 25–35, 37, 39, 41–48, 51, 52, 55–61, 63–70, 72–74, 76–81, 84–95, 97–103, 105, 107, 111–113, 115–120, 124, 126–132, 134, 136–144, 146–150, 152–159, 164–181, 183–189, 191–193, 195–197, 200, 201, 203, 204, 206–209, 211–213, 216, 217, 219, 223–227, 230, 232–236, 239, 241–244, 247–249
Research gaps	1–3, 5–7, 9, 11, 13–19, 22–24, 27–35, 37–39, 41–43, 45–47, 49, 51–61, 64–74, 76–80, 82, 84–92, 96, 98, 100, 103, 104, 107, 111–114, 117–119, 121–124, 127, 128, 130–132, 134, 137, 140–144, 146, 147, 149, 151, 152, 154–158, 164, 169–173, 175–178, 180, 181, 183–185, 187, 189, 191–197, 201, 203, 204, 207, 211–220, 224, 227, 228, 231, 233, 235, 237–239, 241, 244, 245, 249
Emergency issues	2, 3, 5, 9–13, 15–19, 22, 23, 25, 27, 28, 30–32, 34–37, 41–43, 45, 48, 50–61, 63–77, 79, 80, 84, 88, 89, 91–95, 97, 98, 101–105, 111, 113, 114, 116–120, 124, 126–129, 132–134, 137–140, 143, 144, 146, 148–150, 152–156, 158, 159, 162, 164, 165, 167–169, 174–176, 178–181, 185–187, 189, 191, 192, 195–199, 201, 203, 204, 206–209, 211, 212, 216–219, 223, 225–227, 234, 235, 241–245, 247
Informed consent issues	1, 2, 6, 9–12, 14, 16, 18, 19, 22, 23, 25, 27–30, 32, 35–37, 41, 43–46, 48, 49, 51–58, 60, 63–67, 69–74, 77, 78, 81, 84, 88, 89, 91, 94, 95, 102–105, 113, 114, 116–121, 124, 127, 129–134, 138–142, 144, 146, 148–150, 153, 155, 158–161, 163–167, 169, 171, 173–175, 178–181, 183, 184, 186, 187, 189, 191, 192, 194, 195, 197, 199, 201, 203, 204, 206–212, 218, 219, 221, 223–228, 231, 233–235, 241–244, 247, 248
Technological competence	1–3, 5, 9, 11, 12, 14, 15, 19, 20, 22–25, 27–32, 35, 37, 41, 43–45, 48–53, 56, 57, 59–71, 73, 74, 78, 80, 81, 87, 89–95, 101, 104, 105, 107–110, 112–114, 116–122, 124, 128–130, 132, 134, 138–142, 144, 146, 147, 150, 152, 153, 155, 156, 159–161, 163, 164, 166, 167, 169, 174–182, 184, 188, 189, 191–193, 197, 200, 201, 203–206, 211–214, 219, 223, 225–227, 229, 230, 232, 234, 239–241, 245–247
Absent or incomplete guidelines	1, 3, 4, 7, 9, 10, 12, 14–16, 18, 20, 22–24, 28–32, 34–37, 39, 42, 43, 45–50, 52, 53, 55, 57, 59–61, 63–65, 67, 68, 70–75, 77–81, 84–87, 89–91, 93, 94, 96, 97, 100, 102–105, 107, 110, 112, 113, 116, 118, 120–122, 129–131, 134, 136, 137, 140–143, 146–150, 152, 154, 155, 157–159, 161, 165, 169–173, 176, 177, 180, 181, 185, 186, 189, 191, 192, 194–196, 198, 203–205, 207, 212, 213, 216, 217, 223, 224, 226–228, 231, 233, 235, 237, 239, 241, 243–245, 247
Legal issues	1–4, 6, 9, 10, 12, 13, 15, 16, 18, 19, 23–27, 29–32, 35–37, 41–45, 49–51, 53, 55–59, 61, 64–68, 70, 74–77, 79, 84, 85, 87, 89–94, 96, 97, 102, 105, 107, 108, 111–114, 116–119, 121, 124, 126, 128–131, 134, 136, 137, 140–144, 146, 148–150, 154, 155, 158, 159, 161, 164, 167, 169–171, 173, 176–180, 183, 185, 186, 189, 191, 195, 196, 200, 201, 203, 207, 210–212, 214, 216–219, 221, 223–225, 227, 229, 231, 237, 239, 243–245, 247
Practicing across borders	2, 3, 6, 9, 10, 12–20, 22, 23, 25–27, 29–32, 35–37, 41–43, 45, 48–51, 53, 55–59, 61, 64–77, 79, 85, 87, 89–92, 94, 96, 97, 99, 100, 102–105, 109, 113, 114, 116–120, 128–130, 133, 134, 136, 137, 140, 142, 143, 146, 148, 149, 154, 155, 158, 159, 163, 164, 168–171, 173, 174, 176, 180, 181, 183, 185, 186, 189, 191, 195–198, 200, 201, 203, 204, 210–212, 218, 221, 223, 225–227, 229–231, 239, 243–247
Patient characteristics	2, 3, 10–13, 15–20, 22, 24, 26, 27, 30–34, 37, 39, 41–45, 48, 51–53, 58, 59, 61, 63, 64, 66–74, 76–78, 80, 81, 84, 87–89, 91, 92, 95, 97, 103–105, 107, 112–114, 117–122, 128, 131–133, 137, 139, 140, 142, 144, 146, 148, 150, 152, 153, 155, 156, 158, 159, 163, 168, 169, 174, 176, 177, 179–181, 184, 185, 191–193, 195, 196, 198, 204, 208, 209, 211, 212, 214, 216, 217, 219, 223–226, 235, 236, 238, 239, 248
Technical issues	1–3, 10, 11, 13, 16–20, 22, 23, 26, 29–32, 34, 36, 37, 39, 41, 45–48, 51, 52, 56, 57, 59, 62–67, 69, 71, 73, 76–79, 84, 89–91, 94, 95, 101, 103–105, 111, 113, 114, 116, 117, 119, 120, 127–129, 131–134, 137, 139–142, 144, 147–150, 152, 153, 155, 156, 158, 162–164, 166–169, 171, 174–176, 178, 180, 181, 183, 184, 186, 189–192, 197, 200, 203, 204, 209–213, 217, 219, 223, 225, 226, 232, 235, 236, 239, 243, 244
Payment and insurance issues	2, 3, 6–10, 12, 15–17, 19, 20, 22, 23, 25, 26, 29–32, 35–37, 41–43, 45, 48, 53, 55, 58, 59, 64–71, 73–77, 84, 88–91, 94, 95, 99, 100, 105, 113, 114, 116–119, 124, 128, 129, 133, 134, 137, 138, 140–142, 146, 149, 150, 154, 155, 158, 159, 162, 164, 166, 167, 169, 171, 173–177, 179, 180, 188, 191–194, 197, 201, 203, 207, 208, 210, 211, 216–219, 221, 223–225, 230, 239, 241, 243–245, 247
Therapeutic relationship issues	1, 3–5, 7, 11–13, 15, 16, 19, 20, 22, 23, 26–28, 30–32, 34, 35, 37, 39, 43–49, 51, 52, 54–56, 58–61, 63–68, 72, 75, 78–81, 84–87, 90, 91, 93, 94, 100, 102–104, 107, 111, 113, 118, 120, 126, 128, 130, 132–134, 136, 139, 141–143, 146, 147, 149, 153, 155, 156, 158, 159, 169, 171, 172, 174, 175, 181, 184–186, 188, 189, 191, 195, 197, 199, 201, 203, 204, 207–209, 211–213, 217, 230, 233, 239, 245, 248
Availability and access issues	1, 5, 7, 9, 10, 12, 15, 18–20, 22, 23, 26, 29, 30, 32, 35, 37–39, 41, 42, 44, 45, 47, 48, 51, 54–58, 60, 61, 64, 65, 67, 69, 73, 74, 77–81, 84, 87–89, 91–93, 95, 101, 103–105, 113, 114, 117–119, 121, 124, 126, 129, 130, 132, 134, 144, 149, 150, 152, 153, 155, 156, 158, 160, 163, 164, 167, 169, 172, 174, 177, 180, 181, 184–189, 191, 193, 195, 199–201, 203, 204, 206, 207, 211–213, 223, 225–227, 234, 235, 238, 239, 241, 242
Identity and verification issues	3, 5, 9, 11–13, 16, 19, 22, 23, 25, 27, 29, 30, 32, 35, 37, 41–43, 45, 47, 51, 55–59, 63–73, 75–77, 79, 84, 89, 91, 92, 95, 96, 98, 100–105, 107, 112, 113, 116, 117, 119–121, 126–129, 134, 137–140, 144, 146, 148–150, 154–156, 158, 159, 162, 164, 169, 171, 172, 177, 179–181, 183, 186, 191, 192, 194, 195, 197–199, 201, 203, 204, 206, 210, 211, 223, 225, 226, 230, 234, 235, 241, 242, 245
Image, tradition and therapists' attitude	1, 5, 13, 15–17, 19, 24, 28, 29, 32, 37, 39, 43, 47, 50, 52, 54, 58–60, 66–68, 72–74, 78–80, 82, 84, 89, 91–93, 96–98, 104, 107, 108, 110, 112, 113, 124, 131, 134, 137–139, 142–144, 147, 148, 150, 155, 156, 158, 159, 172, 180, 184–187, 191, 195, 197, 200, 203, 207, 211, 216, 217, 219, 224, 226, 227, 233, 243–245, 249
Misuse and harm	12, 15, 18, 19, 23, 29, 30, 33, 37, 41–43, 47, 51, 55, 56, 58, 59, 61, 64, 70, 72, 74, 78, 81, 84, 85, 87, 89, 94, 95, 101–103, 105, 107, 117, 119, 120, 124, 133, 136, 138, 143, 146, 148–150, 156, 177, 180, 181, 184–186, 195, 200, 203, 223, 239, 244
Boundary issues	2, 3, 10, 16, 19, 26, 31, 38, 39, 48, 51, 54, 56–58, 60, 63, 67, 71, 73, 74, 80, 82, 88, 89, 93, 95, 103, 113, 120, 124, 126, 130, 133, 134, 136, 143, 155, 156, 160, 172, 174, 177–179, 188, 189, 191, 192, 206, 211, 223, 225–228, 236, 239, 242
Comparability to in-person treatment	1–3, 7, 14, 16, 19, 29, 30, 32, 33, 39, 42–44, 46, 56, 57, 64, 66, 67, 70, 72, 76, 80, 81, 84, 86, 90, 91, 104, 111–114, 117–119, 126, 134, 136, 155, 159, 179, 191, 192, 195, 198, 201, 203, 204, 221, 226, 233, 244, 245, 247, 249
Increased costs	1, 3, 9, 12, 16, 21, 23, 32–34, 36, 39, 42, 45, 48, 49, 51–53, 58, 61, 64, 65, 68, 83, 87, 89, 91, 97, 99, 101, 128, 129, 132, 143, 144, 147, 154, 159, 162, 169, 171, 180, 201–204, 207, 213, 214, 219, 223, 229, 231, 239, 248
Increased liability and litigation	3, 15, 22, 23, 29, 32, 35–37, 42, 52, 57, 59, 67, 68, 70, 74, 77, 80, 89, 92, 94, 96, 97, 113, 124, 126, 129, 130, 134, 142–144, 158, 164, 165, 169, 180, 181, 183, 189, 194–198, 201, 207, 218, 231, 233, 243, 245
Negative influence of technology use	5, 7, 10, 20, 47, 54–56, 60, 61, 64, 66, 67, 69, 72, 84–86, 95, 98, 108, 109, 115, 121, 128, 133, 134, 137, 140, 152, 157, 158, 166, 169, 172, 179, 181, 203, 211, 216, 217, 223, 237, 249
Social media	2, 3, 10, 18, 26, 48, 54, 57, 60, 63, 69, 71, 93, 103, 105, 113, 120, 130, 134, 155, 157, 160, 164, 172, 174, 188, 189, 205, 206, 211, 223, 226, 227, 242, 247
Financial gain	9, 23, 25, 27, 30, 44, 45, 49, 58, 59, 72, 76, 81, 85, 90, 92, 100, 102, 103, 117, 120, 126, 130, 144, 164, 169, 180, 186, 189, 208, 224, 226, 241
Loss of therapeutic control	16, 17, 26, 28, 41, 45, 48, 57, 60, 63, 73, 80, 86, 124, 126, 130, 134, 138, 164, 166, 181, 196, 207, 208, 211, 217, 247
Adherence issues	10, 11, 16, 20, 41, 69, 75, 87, 101, 103, 132, 152, 154, 156, 165, 169, 187, 191, 196, 208, 211
Online supervision and teaching issues	2, 19, 54, 66, 116, 126, 157, 159, 186, 226, 236, 239
Dependence and loss of control by the patient	48, 58, 88, 107, 177, 206, 207, 216, 219
Autonomy issues	28, 45, 48, 60, 81, 132, 134
Dehumanization	15, 28, 68, 89, 90, 178
Stigmatization	29, 91, 113, 138