Presence, Space, and Boundaries in Digital Practice

What Integrity Means in Online Clinical Work

Integrity is often spoken of as a static trait, but in clinical work—especially virtual care—it functions more as a living practice. It is not merely the avoidance of ethical errors; rather, integrity is the continuous alignment between one’s clinical values, ethical commitments, and therapeutic presence. This alignment becomes more complex, and more crucial, in the context of telehealth.

In virtual therapy, integrity requires intention. The absence of a shared physical space means clinicians cannot rely on environmental cues or office-based rituals to communicate professionalism, presence, or containment. Instead, therapists must actively construct integrity through their environment, tone, pacing, and boundaries.

Where traditional therapy benefits from the “holding environment” of a private office, virtual care asks:
What holds the space now?

Reflection for Practice

How do your values show up—not only in what you say—but in the rhythm of your sessions, the way you set boundaries, the tone of your emails, the backdrop of your camera?

Why is this in the room with your client? Countertransference? Agenda? Anxiety? Fear? Irritation or boredom? Do you take the easy way out hoping the medium can save your observation? Why did you get into this and how is this represented regardless of the medium?

I ask in honesty, and understanding the loop holes we make in our minds so we can use an educational degree or idea of what we “know”:as a way to no longer be uncomfortable. You are lying to yourself. if you wrote on a piece of paper why you do this..does the answer match?

The invitation in virtual care is not to replicate the office, but to reinvent the container—one that is ethical, relational, and present. That is the heart of Virtual Integrity™.