Ethics and the Internet Essay Example

Ethics and the Internet Paper The Internet and social networking are offering a number of new clinical and ethical challenges for those who provide face-to-face mental health services. These challenges include extra-therapeutic contacts between therapists and their clients, questions about what distinguishes personal and professional activities online, and a lack of clearly developed policies related to our online behaviors and interactions. No form of client communication is 100 percent guaranteed to be private. Conversations can be overheard, e-mails can be sent to the wrong recipients and phone conversation can be listened to by others. But in todays age of e-mail, Facebook, Twitter and other social media, psychologists have to be more aware than ever of the ethical pitfalls they can fall into by using these types of communication. Its easy not to be fully mindful about the possibility of disclosure with these communications because we use these technologies so often in our social lives,   says Stephen Behnke, PhD, JD, director of APAs Ethics Office. Its something that we havent gotten into the habit of thinking about.   The Monitor sat down with Behnke to discuss the ethical aspects of the Internet for psychology practitioners and how to think about them. Does the APA Ethics Code guide practitioners on social media? We will write a custom essay sample on Ethics and the Internet specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Ethics and the Internet specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Ethics and the Internet specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Yes. The current Ethics Code was drafted between 1997 and 2002. While it doesnt use the terms social media,  Google or Facebook, the code is very clear that it applies to all psychologists professional activities and to electronic communication, which of course social media is. As we look at the Ethics Code, the sections that are particularly relevant to social media are on privacy and confidentiality, multiple relationships and the section on therapy. The Ethics Code does not prohibit all social relationships, but it does call on psychologists to ask, How does this particular relationship fit with the treatment relationship?   Is the APA Ethics Office seeing any particular problems in the use of social media? Everyone is communicating with these new technologies, but our ethical obligation is to be thoughtful about how the Ethics Code applies to these communications and how the laws and regulations apply. For example, if you are communicating with your client via e-mail or text messaging, those communications might be considered part of your clients record. Also, you want to consider who else might have access to the communication, something the client him- or herself may not be fully mindful of. When you communicate with clients, the communication may be kept on a server so anyone with access to that server may have access to your communications. Confidentiality should be front and center in your thinking. Also, consider the form of communication you are using, given the kind of treatment you are providing. For example, there are two very different scenarios from a clinical perspective: In one scenario, youve been working with a client face-to-face and you know the clients clinical issues. Then the client goes away on vacation and you have one or two phone sessions, or a session or two on Skype. A very different scenario is that the psychologist treats a client online, a client he or she has never met or seen. In this case, the psychologist has to be very mindful of the kind of treatment he or she can provide. What sorts of issues are appropriate to treat in that manner? How do the relevant jurisdictions laws and regulations apply to the work you are doing? Thats an example of how the technology is out in front of us. We have this wonderful new technology that allows us to offer services to folks who may never have had access to a psychologist. At the same time, the ethical, legal and regulatory infrastructure to support the technology is not yet in place. A good deal of thought and care must go into how we use the technology, given how it may affect our clients and what it means for our professional lives. APA needs to be involved in developing that ethical, legal and regulatory infrastructure and needs to be front and center on this. What do you want members to know about using Facebook? People are generally aware that what they put on their Facebook pages may be publicly accessible. Even with privacy settings, there are ways that people can get access to your information. My recommendation is to educate yourself about privacy settings and how you can make your page as private as you want it to be [see further reading box on page 34]. Also, educate yourself about how the technology works and be mindful of the information you make available about yourself. Historically, psychology has talked a lot about the clinical implications of self-disclosure, but this is several orders of magnitude greater, because now anyone sitting in their home or library with access to a terminal can find out an enormous amount of information about you. Facebook is a wonderful way to social network, to be part of a community. And of course psychologists are going to use this, as is every segment of the population. But psychologists have special ethical issues they need to think through to determine how this technology is going to affect their work. These days, students are inviting professors to see their Facebook pages and professors are now privy to more information on their students lives than ever before. Whats your advice on this trend? Psychologists should be mindful that whether teaching, conducting research, providing a clinical service or acting in an administrative capacity, they are in a professional role. Each role comes with its own unique expectations, and these expectations have ethical aspects. I would encourage a psychologist whos considering whether to friend a student to think through how the request fits into the professional relationship, and to weigh the potential benefits and harms that could come from adding that dimension to the teaching relationship. Of course, the professor should also be informed about the schools policy concerning interacting with students on social networking sites. How about Googling clientsshould you do this? In certain circumstances, there may be a good reason to do a search of a client. There may be an issue of safety, for example. In certain kinds of assessments, it might be a matter of confirming information. But again, we always need to think about how this fits into the professional relationship, and what type of informed consent weve obtained. Curiosity about a client is not a clinically appropriate reason to do an Internet search. Lets put it this way: If you know that your client plays in a soccer league, it would be a little odd if on Saturday afternoon you drove by the game to see how your client is doing. In the same way, if youre doing a search, thinking, What can I find out about this person  that raises questions about the psychologists motives? What about Twitter? Again, you first want to think about what are you disclosing and what is the potential impact the disclosure could have on the clinical work. Also, if you are receiving Tweets from a client, how does that fit in with the treatment? These questions are really interesting because they are pushing us to think clearly about the relationship between our professional and personal lives. We all have our own social communities and networks, but we also have to be aware about how we act and what we disclose in those domains, which are more accessible. Someone might say that this technology isnt raising new questions, its raising old questions in different ways. How about blogs? Be aware that when you author a blog, youre putting a lot of yourself into it. Thats why youre doing it. So again, you need to be mindful of the impact it will have on your clinical work. It also depends on what the blog is about. For example, if youre blogging about religion, politics or movies, in this day and age, some of your clients are going to read the material. If you are sharing your personal views on some important societal issue, be mindful of how that might affect the work you are doing. When is the next Ethics Code due out and will it more specifically address social media? The next revision hasnt been scheduled, but if I had to guess, probably in the next two to three years, APA will begin the process of drafting the next code. I can say with a very high degree of confidence that when APA does draft the next code, the drafters will be very mindful of many issues being raised by social media. Its important to think about ethics from a developmental perspective. As our field evolves, new issues emerge and develop. Not all the questions about social media have crystallized yet. We have to make sure that we have a pretty good sense of the right questions and the right issues before we start setting down the rules. Part of that process is exploring where the potential harms to our clients are. We are just defining the questions, issues, the risks of harm to the client and were going to have to let the process unfold. In the meantime, we have to be aware that these technologies are very powerful and far-reaching and bring with them wonderful benefits, but also potential harms. Stay tuned. As his patient lay unconscious in an emergency room from an overdose of sedatives, psychiatrist Damir Huremovic was faced with a moral dilemma: A friend of the patient had forwarded to Huremovic a suicidal e-mail from the patient that included a link to a Web site and blog he wrote. Should Huremovic go online and check it out, even without his patients consent? Huremovic decided yes; after all, the Web site was in the public domain and it might contain some potentially important information for treatment. When Huremovic clicked on the blog, he found quotations such as this: Death makes angels of us all and gives us wings. A final blog post read: I wish I didnt wake up. Yet as Huremovic continued scanning the patients personal photographs and writings, he began to feel uncomfortable, that perhaps hed crossed some line he shouldnt have. Across the country, therapists are facing similar situations and conflicted feelings. When Huremovic, director of psychosomatic medicine services at Nassau University Medical Center in New York, recounted his vignette last year at an American Psychiatric Association meeting and asked whether others would have read the suicidal mans blog, his audience responded with resounding calls of both yes! and no! One thing was clear: How and when a therapist should use the Internet and even whether he or she should are questions subject to vigorous debate. We are just beginning to understand what ethical issues the Internet is raising, says Stephen Behnke, ethics director for the American Psychological Association. To write rules that allow our field to grow and develop and yet prevent [patient] harm at the same time: Thats the challenge. In fact, the tremendous availability online of personal information threatens to alter what has been an almost sacred relationship between therapist and patient. Traditionally, therapists obtained information about a patient through face-to-face dialogue. If outside information was needed, the therapist would obtain the patients consent to speak with family members or a previous mental-health practitioner. At the same time, patients traditionally knew little about their therapists outside the consulting room. Now, with the click of a mouse, tech-savvy therapists and patients are challenging the old rules and raising serious questions about how much each should know about the other and where lines should be drawn. Among the questions under debate: Should a therapist review the Web site of a patient or conduct an online search without that patients consent? Is it appropriate for a therapist to put personal details about himself on a blog or Web-site or to join Facebook or other social networks? What are the risks of having patients and therapists interact online? Neither the American Psychiatric Association nor the American Psychological Association has rules specifically governing therapists online behavior, but ethics advisers with the psychiatric association maintain that online searches are not wrong as long as theyre done in the patients interest and not out of therapist curiosity. Many therapists contend its more important to discuss such questions than it is to dictate behavior. Its not whether a particular application is right or not, says Sheldon Benjamin, director of neuropsychiatry at the University of Massachusetts Medical School in Worcester. Its whether you do it mindfully whether you understand how it changes the doctor-patient relationship. To Google or Not to Google Benjamin, 53, swears by his iPhone and enthusiastically tells of sampling the Internet in its infancy. At the same time, Benjamin, who directs psychiatric training at UMass, advocates caution when it comes to mixing the Internet with therapy. He says he has never searched a patients name online and worries that doing so could dilute the therapeutic process by bringing in information from outside the patient-therapist discussion. When patients have asked Benjamin to read their blogs, he has agreed, with one caveat: that he do so during a regular counseling session. Even if you brought me a disability form, Id fill it out in the room with you, says Benjamin. I was taught to make the time with the patient the time when the work is done. Suena Massey takes a different approach. Massey, 35, an assistant professor of psychiatry at George Washington University Medical Center, considers Googling a patient a valuable professional tool. One of the duties of a psychiatrist is to corroborate what patients say, Massey explains. To that end, online searches can be helpful when traditional approaches obtaining the patients consent to contact his previous psychiatrist or family members are not available. One such case involved a patient who presented with symptoms of mania, a component of bipolar disorder. The man claimed to be well connected in Washington. After their meeting, Massey typed the patients name into a search engine. Up popped postings suggesting that the mans claims were accurate. In a subsequent session Massey told her patient she had Googled him, and he was okay with it. She ended up treating him for bipolar disorder; had his claims been false, she says, she would have considered his condition to be more severe. Massey says she will warn a patient about her possible use of Google searches if she thinks the patient might have a problem with it. You could almost make the argument that its negligent not to search online when there is public information available and it might help treat a patient, she says. If youre just looking things up out of personal interest, I think most doctors would feel uncomfortable with that. Public vs. Private But what happens when the circumstances are reversed? What happens when a patient seeks information about his therapist online or pursues a relationship with his therapist on Facebook, MySpace or via another social network? Most therapists are not alarmed by the idea of a Google search. I know my patients Google me, Massey says. I think its their right as consumers. Some providers anticipate such searches by maintaining Web sites detailing their professional qualifications. However, there can be problems when personal details are available. Take the case of a man who, after developing romantic and erotic feelings toward his therapist, typed her name into a search engine and found a Web site featuring personal photographs of the therapist, including a bathing-suit shot. The man quit treatment and reported the discovery to Behnkes office. He knew the image of his therapist in her bathing suit was going to be so present to him that he wouldnt be able to concentrate on his psychotherapy, Behnke explained in a telephone interview. There was material on the Internet that had an impact on this psychologists clinical work. Behnke cautions therapists to assume that most clients will conduct online searches, and he urges them to make sure they remain vigilant about what gets posted. Although most therapists say its inappropriate to have relationships with patients via social networks, there is little agreement on whether its okay for therapists to join such sites, and, if they do, just how private their information should remain. For Huremovic, 39, social network abstinence is safest. I have an understanding that if you choose to be a psychiatrist and a psychotherapist that you have to be very private in other parts of your social being, he says. But some therapists, especially younger ones for whom using the Internet is a way of life, dont share this view. For instance, psychologist Stephanie Smith, 35, has a Web site, and she has a presence on Twitter. Smith tweets to market her Colorado practice and to allow colleagues and other interested parties to monitor happenings in psychology. Typical posts provide tips for managing stress, announce a recent studys findings or refer followers to psychology blogs. Smith, who says Twitter has increased traffic to her professional Web site, admits to the rare tweet about her children or celebrity news. Its my style, but I know some people would not be comfortable with her disclosure of nonprofessional information, she says. Smith also has a Facebook account for her personal life. After teenage patients discovered that account and sent her friend requests, Smith enacted a policy forbidding past or current clients from engaging her online. She informs new clients of the policy and obligates them to comply. This is the type of problem that UMasss Benjamin wants to avoid. To me, its a much bigger issue than bumping into a patient in a restaurant, he says. Youre putting out there,Hey, these are my contacts. And someone then wants to enter your social circle. It puts you in a position where you must take a stand. Keely Kolmes, a California psychologist who writes and lectures on Internet ethics, recommends that therapists make clear distinctions between their professional and personal lives online. Younger clinicians get the Net but dont completely understand ethical and boundary issues that can come up, she says. A former computer consultant, Kolmes, who is in her early 40s, goes to great lengths to keep her lives separate. On her personal Facebook account, for instance, she does not use a photo of herself on her profile page and she doesnt make reference to her professional name. She also restricts her public tweets and blogs to news of a professional nature. Still, she recognizes that any online sighting of ones therapist changes the dynamic for a patient. A lot of patients really want to think about you as existing in just that one space [of the therapy room,] and suddenly theyre seeing you on Twitter and blogging, she says. They can see that youre online at night posting things. I realize my choice to do that suddenly shifts my relationship with them.