Questionnaire

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 today’s 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.

“It’s 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 APA’s Ethics Office. “It’s something that we haven’t 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?

Yes. The current Ethics Code was drafted between 1997 and 2002. While it doesn’t 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 client’s 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, you’ve been working with a client face-to-face and you know the client’s 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 jurisdiction’s laws and regulations apply to the work you are doing?

That’s 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. What’s 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 who’s 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 school’s policy concerning interacting with students on social networking sites.

How about Googling clients — should you?

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 we’ve obtained. Curiosity about a client is not a clinically appropriate reason to do an Internet search. Let’s 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 you’re doing a search, thinking, “What can I find out about this person?” that raises questions about the psychologist’s 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 isn’t raising new questions, it’s raising old questions in different ways.

How about blogs?

Be aware that when you author a blog, you’re putting a lot of yourself into it. That’s why you’re 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 you’re 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 hasn’t 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.

It’s 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 we’re 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.