With the continuous expansion and utilization of technology as a primary form of everyday communication, many medical services and practices are being offered and administered through modes of telecommunication. So much of our daily interactions take place over the Internet through email, social networking cites, teleconferences, etc. These advances in technology have made it possible for psychologists to offer aid to clients through email, blogging, audio and video recordings, and video chats by providing more avenues for services like psychoeducation and psychotherapy (Kolmes, 2012). Moreover, more and more apps for mobile devices are being created to help with improving treatment, assessing progress, and to develop therapeutic mediations. Psychologists also use social media and other websites like LinkedIn to market their services and connect with other clinicians in the hopes of encouraging those clinicians to think about referring patients to them (Kolmes, 2012). Further, clients and clinicians alike are utilizing social media as a way to garner more information about each other. The Internet is an extremely public place, regardless of privacy settings. Most anything that you post to the Internet is, in some form or another, archived. This makes it easy for people to gather information about you that you might not otherwise wish them to have. In theory, and because of how technologically advanced our world is becoming, some of these sort of measures and engagements would naturally seem like a fairly good idea and quite advantageous to certain populations; for example, populations in rural areas where there may not be enough clinicians to meet the demands of the number of clients needing help. Additionally, with the progression towards telehealth/telepsychology, benefits to these kinds of practices can largely be seen in being provided services at home, lower costs, and, as aforementioned, accessibility in rural and remote areas where there may not be enough clinicians to handle in-person cases. Nevertheless, just as with anything else, there are some unique cons and challenges that arise with this kind of practice, and these challenges are typically experienced within the ethical realm.
Publicly disclosing private information online can result is some severely adverse outcomes. This is true not only for everyday users, but most especially for clinicians who may unintentionally or intentionally use this mode of socializing irresponsibly. Self-disclosure is a purposeful act; however, it can be unintentional as well. This presents unique challenges for clinicians in the sense that they must always be aware of their online engagements, as clients may view this information and it could potentially harm clients and compromise therapeutic relationships (Bratt, 2010). Further, while clinicians are trained to behave and interact with their patients in certain ways, exhibiting non-judgmental and empathetic attitudes, this may not always be true in the online environment. For instance, Bratt (2010) states, “counsellors may, in their personal lives, respond or offer ribald humour, engage in political criticism, or even demonstrate prejudicial attitudes” (para. 8). This sort of socially “unacceptable” and/or questionable behavior can ultimately result in severely blemishing the clinician’s professional reputation. Therefore, it is imperative for professionals to always strive to conduct themselves in socially appropriate ways in the online environment. This includes maintaining professionalism, respecting the confidentiality of clients by not venting online, putting provisions in place to ensure the clinician’s own personal privacy (e.g. tailoring privacy settings on social media accounts), and avoiding instances where the ethical issue of multiple relationships could arise.
I think some of the most prominent ethical and professional issues to consider are confidentiality, maintaining a professional relationship, informed consent, ethical and informed practice, possible jurisdictional issues, and insurance issues. These sort of ethical dilemmas can be navigated successfully and ethically when the APA’s code of conduct is utilized as a guide. Overall, clients have the rights to confidentiality, privacy, and to have no harm done to them. There are specific standards and principles put in place to ensure that the rights of the client are upheld at all times. As a rule of thumb, if it would be considered unethical within the clinician’s setting of practice, then it should not be done outside the professional setting as well. For example, if a psychologist is not allowed to obtain information without the prior informed consent of the patient and/or their caregivers when providing services one-on-one/face-to-face, then it should not be allowed in the online environment without informed consent either. Moreover, when employing these services, psychologists are obligated to discuss risks to clients’ privacy and limits to confidentiality.
While there still aren’t any clear and specific policies set in place to cover the depths and dynamics of online interactions, research, and practices within the mental health field, professionals should always strive to remember their oaths to abide by the APA’s Ethical Principles for Psychologists and Code of Conduct. In coming years, with more exposure to this kind of treatment, I believe that new policies will be made to ensure that both professionals and clients are safeguarded and able to carry out ethical online therapeutic relationships.
In terms of increased ease, convenience, and experience satisfaction outweighing potential negative outcomes, with populations in rural and remote areas this form of treatment may be more beneficial if done correctly. What this means is that evidence-based online therapy can be valuable as long as clients are properly assessed as part of it. Still, there are downfalls that really must be considered heavily; for instance, professionals run the risk of not picking up on important cues that they would generally get if they were to meet with a patient in-person. For example, a patient may tell the clinician they are doing better with their depression and anxiety via telecommunication and the clinician would ultimately have to take their word for it. However, say that person isn’t doing as well as they claim and this would typically be seen in their non-verbal cues, such as a disheveled appearance, excessive fidgeting, etc. Thus, perhaps a combination of in-person and telehealth services would best suit some individuals more than others in diverse treatment populations.
References:
American Psychological Association. (2010). Ethical principles of psychologists and code of conduct: Including 2010 amendments. (Links to an external site.)Links to an external site. Retrieved from http://www.apa.org/ethics/code/index.aspx
Bratt, W. (2010). Ethical considerations of social networking for counsellors. Canadian Journal of Counselling and Psychotherapy, 44(4),335–345. Retrieved from https://library.ashford.edu/ezproxy.aspx?url=http%3A//search.proquest.com/docview/818788035/969B22225CCB4827PQ/1?accountid=32521
Kolmes, K. (2012). Social media in the future of professional psychology. Professional Psychology: Research and Practice, 43(6),606–612. doi: 10.1037/a0028678
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