Objective The use of video technology in synchronous psychotherapy has increased over the last few years, with a particularly rapid uptake following the onset of the global COVID-19 pandemic. This systematic review aims to provide an understanding of the key ethical considerations when providing video-based therapy.

Method Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, a systematic review was conducted of 15 studies that met the inclusion criteria. Studies were grouped based on characteristics and aims, and a thematic analysis was conducted based on a synthesis of the findings.

Results Four themes were identified in the literature—applying traditional ethical concerns to video-based psychotherapy, unique security and data safety concerns related to the use of video and streaming technologies, the establishment of clear boundaries prior to therapy beginning, and the accessibility and suitability of video-based therapy.

Conclusion Focus areas for best practice were identified. Areas for further research include consideration of cultural safety, equity of accessibility of care, and ethical concerns in video-based psychotherapy from the perspective of the client.