Learning through the lens: ethical considerations in videotaping psychotherapy

Psychiatry training programs have begun to use technology to enhance psychotherapy teaching. Videotaped interviews provide a window into the psychotherapeutic exchange, demystifying the process and capturing verbal and nonverbal interactions, facial expression, and tone of voice-which can illustrate therapeutic elements such as the alliance and resistance. The process of videotaping psychotherapeutic interviews, however, introduces issues related to consent, ethics, and the dynamics of therapy. By examining two cases in which residents asked their patients to videotape a session for didactic purposes and encountered divergent outcomes, we explore the ethical issues unique to providing informed consent for videotaping psychotherapy. Informed consent must be given verbally and in writing. Verbal consent must include discussion of the risks and benefits of therapy. The discussion must also include the risks inherent in memorializing sensitive material on an external device, with disclosure of the logistics of how data will be stored, who will view the recorded material, and when it will be destroyed. Therapists should be aware of the coercive power inherent in the physician-patient relationship and should individualize each informed consent procedure with this knowledge in mind. Despite these potential pitfalls, videotaping sessions provides a wealth of information about both patients and therapists that can improve psychotherapy teaching and supervision, and indirectly improve patient care.