Psychological interactions through electronic communication and its implications

The therapeutic environment is being transformed by the ever-growing technological developments of 21st century communication. Communication technologies are vastly contributing to the accessibility of information, which necessitates attention from the counseling community. We feel it is important to discuss the implications to psychological disclosure in particular, as disclosure is taking on a considerably new form through the availability of new communication technologies to the public. These technologies have redefined the meaning and application of disclosure in mental health professions, because clients are now able to find an abundance of information about their therapists that wasn’t available in the past. Similarly, therapists have equal access to information regarding their clients.

This changes the dynamics of the therapeutic relationship and the control mental health professionals now have regarding disclosure. The issue of disclosure is one that has existed in the profession for many years, but now that technological advancements are creating new avenues for information, mental health professionals and students must consider those communication mediums as possible paths of disclosure as well. APA Ethics Director, Stephen Behnke said that these new technologies are raising the same questions we’ve had, in different ways (Martin, 2010).

An increasing number of therapists are joining social media networks and posting professional websites or blogs, which include extensive information. Additionally, media-assisted psychological services, such as Telepsychology, are becoming more prevalent in the counseling profession. These media-assisted interactions between clinician and client run the risk of information being unintentionally exposed. The Ohio Psychological Association has taken lead in developing Telepsychology Guidelines within their psychology regulations, including steps to ensure the security of information that is electronically available. Their guidelines mention that with these new technologies emerging, we must agree on how to best apply them (OPA, 2009). Until clear guidelines are in place as to what the clinical approach should be to technology-assisted communication, we should closely monitor the information exchange that exists through these mediums.

Because electronic communication, such as that facilitated by social media, has the ability to distort the bounds that exist in the therapeutic setting, careful thought of the purpose of this communication is essential (Kaslow, Patterson, & Gottlieb, 2011). When a connection with a client has taken place, we should consider the motivating factors that could have lead to the inquiry taking place. We should ask ourselves what the client hoped to gain from the inquiry and how to use this information to assist in promoting the well being of the client. Zur, Williams, Lehavot, and Knapp (2009) said that paying attention to the client’s motivation in connecting online, a therapist could find opportunities to improve that client’s treatment (Zur, Williams, Lehavot, & Knapp, 2009). A thorough examination of the benefits or harm to the therapeutic relationship and the possible implications is necessary. Upon reviewing all of these factors, a decision should be made as to what the best course of action would be that could ultimately advance the client’s therapeutic progress. We should also examine the clinical, ethical, and legal consequence of digital disclosure and perhaps establish office policies for digital connections (Zur et al., 2009). This is a critical step in the process, as it provides us with a framework on how to approach electronic communications with clients.

Significant thought and care must go into how we use Internet technologies in psychotherapy, given how it may affect our professional atmosphere. Clinicians should assess situations that arise with the client’s welfare as the primary focus (Zur et al., 2009). A client’s benefits must be behind the reasoning for a digital connection. If clinicians initiate contact, especially through social media platforms, their motive must be purely clinical. For example, should a therapist concern for their client’s safety, a search may be warranted.  A search based on curiosity or to confirm a fact, does not fit within the therapeutic realm and is not considered ethical (Tunick, Mednick, & Conroy, 2011). Additionally, substantial self-disclosure via the Internet (i.e. friending and posting on walls) should be documented and its clinical significance should be discussed in the client’s clinical records (Zur et al., 2009).

Today’s concept of disclosure has morphed into a hybrid of the original beliefs of self-disclosure as a therapeutic technical error and some more realistic beliefs of the digital society we live in today. Digital disclosure is a more advanced form of what we’ve come to know as unavoidable small world hazards, (Taylor, McMinn, Bufford, & Chang, 2010). The rapid growth of the Internet has left psychologists exposed to information they may not have otherwise shared with the world and has mandated that they approach disclosure as it applies to today’s technology-centered society. The rapid nature and growth of communication media is likely to multiply with future generations, which means that we must prepare ourselves for its current and future implications. Preparation means that a clear set of guidelines must be constructed to direct clinicians on how to approach technological situations that may arise in practice. Clinicians will need APA involvement in creating these guidelines.

Although no concrete technology guidelines exist within the latest APA Ethics Codes, the APA Ethics Director does recommend applying the current standards to Internet activities. According to Stephen Behnke, the APA Ethics Code was intentionally written in a way that indicates that it applies to electronic communication (Martin, 2010). He goes along to mention that the next revision of the APA ethics codes will attend to the issues that are being raised by the Internet (Martin, 2010). Behnke said that the Ethics Committee has to be mindful of the important factors prior to creating a set of guidelines (Martin, 2010). The outlook for the inclusion of technology standards in future versions of the APA Ethics Codes is promising, although this may not occur for a number of years. Since digital transparency is still a present-day issue, then clinicians must work intelligently in assessing the possible issues that could surface until the next version of the codes is available for reference. Clinicians are not required become experts in these technologies, but to have an understanding and appreciation to the possible harm and possible benefits of using electronic communication (Nicholson, 2011).

The American Counseling Association has created a Code of Ethics that may serve as a good resource that psychologists can review as a reference to technology use. The ACA Code’s section A.12. Technology Applications refers to the benefits and limitations of technology, technology-assisted services, inappropriate services provided via technology, access to information, informed consent, and website use on the World Wide Web (ACA, 2005). This code, along with the OPA’s Telepsychology Guidelines, and the literary works mentioned here, could all serve as good reference for the current use of electronic communication in a therapeutic setting.

References

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct, 2010 Amendments. American Psychologist, 57, 1060-1073.

American Counseling Association. (2005). ACA Codes of Ethics (PDF, 284KB). American Counseling Association, 6-7.  Retrieved from http://www.ncblpc.org/Laws_and_Codes/ACA_Code_of_Ethics.pdf (PDF, 284KB)

Behnke, S. (2008). Ethics in the age of the internet. Monitor on Psychology, 39(7), 74.

Kaslow, F. W., Patterson, T., Gottlieb, M. (2011). Ethical dilemmas in Psychologists accessing internet data: Is it justified? Professional Psychology, 42(2), 105-112.

Martin, S. (2010). The Internet’s Ethical Challenges. Monitor on Psychology, 41(7), 32.

Nicholson, I.R. (2011). New technology, old issues: Demonstrating the relevance of the Canadian Code of Ethics for Psychologists to the ever-sharper cutting edge of technology. US: Educational Publishing Foundation, 52(3), 215-224.

Ohio Psychological Association Communications & Technology Committee. (2010). Telepsychology guidelines, revised. Columbus, OH: OPA. Retrieved from www.ohpsych.org/

Taylor, L., McMinn, M.R., Bufford, R.K., Chang, K.B.T. (2010). Psychologists attitudes and ethical concerns regarding the use of social networking web sites. Professional Psychology, 41(2), 153-159.

Tunick, R.A., Mednick, L., Conroy, C. (2011). A snapshot of child psychologists' social media activity: Professional and ethical practice implications and recommendations. Professional Psychology, 42(6), 440-447.

Zur, O., Williams, M.H., Lehavot, & K., Knapp, S. (2009). Psychotherapist self-disclosure and transparency in the Internet Age. Professional Psychology, 40(1), 22-30.

About the Authors

Mariel Buque, BA, is a candidate for the Master of Arts degree in Psychological Studies at Seton Hall University, South Orange, New Jersey. She is a student affiliate of the APA.

Sandra S. Lee, PhD, is professor of professional psychology in Seton Hall’s Department of Professional Psychology and Family Therapy. Her research interests include stress and resilience, ethnographic studies, and professional ethics.