Clinical Implications of Therapist-Client Interactions on the Internet: Boundary Considerations in Cyberspace
May 10, 2010 by Steve Sobelman
Filed under Latest from the Division of Psychotherapy
By Dr Keely Kolmes and Dr. Dan Taube.
Our society and, indeed, the world, is becoming increasingly networked via the Internet, and mental health practitioners are beginning to rely more heavily on the World Wide Web. As this happens, reports of encounters with clients and treatment complexities have begun to emerge (Grohol, 2008; Hsiung, 2009). The increased visibility of and access to friend networks and public Internet postings has created new possibilities for intentional and accidental virtual contacts between therapists and clients. The growth of social networking and web-based information also raises the possibility of clients searching for and finding professional and personal information about psychologists, and for psychologists to search for and find similar information about clients.
The former concern has caused unease among mental health providers. Zur and Donner (2009), for example, explored the availability of large caches of online information about therapists and framed the access to such information as an issue of therapist transparency and disclosure. They outlined the difference between deliberate versus non-deliberate, verbal versus nonverbal, and avoidable versus unavoidable therapist disclosures. Zur and Donner noted that the motivations of clients who seek information on therapists can range from harmless curiosity to criminal stalking. They recommended that therapists using the Internet should remain aware that all of their online postings, blogs, chats, and other interactions may be viewed by clients and will be forever archived online. They further encouraged therapists to search online for information about themselves regularly to be sure what clients are discovering about them, and they made recommendations about how we should attempt to monitor and address concerns about our own privacy.
Increasingly, ethics commentators have turned their focus to the problems and promises of psychologists searching for information about applicants, clients, and others on the Internet. Behnke (2007) noted that some clinical training directors and graduate program faculty have started to use the Internet to search for information about trainees and applicants. He raised the question of how this third party information should be handled and he noted the risks related to psychologists shifting from a clinical to an investigatory role. Barnett (2009) focused on the potential for therapists to secretly access client information online. He defined such behavior as a boundary issue and suggested that these pursuits may violate an implied contract and may affect the public’s trust in psychologists, unless this behavior is clearly addressed in the process of informed consent.
Hughs (2009), on the other hand, asserted that it is not necessarily unethical to search for patient information online. Her argument was that if information was sought to promote patient care, rather than to satisfy a therapist’s curiosity, it could further a legitimate clinical interest. For example, if a client refused or was unable to provide historical information, an online search might be a reasonable way to obtain supplemental data.
Thus, there are ethical and practical issues emerging in regard to extra-therapeutic contacts on the Web. Theoretically, there are ethical hazards related to multiple relationships (APA, 2002), but such contacts may have the potential to benefit clients and treatment. Yet there is little in the way of empirical data about these risks and benefits. One of the only empirical investigations that has been conducted thus far was a study by Lehavot, Barnett and Powers (2010), that surveyed graduate psychology students to assess, among other things, the degree to which they sought online information about clients. The authors reported that some 27% of their participants engaged in this activity. They acknowledged that searching for client information has the potential both to have negative and positive influences on the clinical relationship.
The Current Research
In our current, ongoing survey, we aim to extend Lehavot et al.’s (2010) study to include a wide range of professionals (psychologists, marriage and family therapists, clinical social workers and psychiatrists) at a variety of training levels (e.g., clinicians in training, recent graduates, and experienced clinicians). We also hope to explore ethical issues faced by practicing psychotherapists who have had intentional and accidental extra-therapeutic encounters with their clients on the Internet.
Our study has been approved by the Institutional Review Board of Alliant International University. If you are interested in participating, you may access the survey and begin the Consent Process.
Our findings will be posted at the end of August, 2010 in several places: Dr. Kolmes website, Dr. Taube’s website, and an interim report was presented at the California Psychological Association’s 2010 Convention in a session by Dr. Kolmes called Friending, Fanning, and Following: Findings on Client-Therapist Internet Interactions and their Influence on Treatment.
References
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.
Barnett, J., (2009) Social Networking Sites, Clients, and Ethics: Dilemmas and Recommendations. [Lecture]. From International Conference on Use of the Internet in Mental Health, Montreal 2009. Retrieved from http://bcooltv.mcgill.ca/Viewer2/?RecordingID=27892
Behnke, S. (2007, January). Posting on the Internet: An Opportunity for self (and other) reflection. APA Monitor on Psychology, 60-61.
Behnke, S. (2007, July/August). Ethics in the age of the Internet. APA Monitor on Psychology, July74-75.
Grohol, J. M. (2008, May 14). Social network may blur professional boundaries. Message posted to http://psychcentral.com/blog/archives/2008/05/15
/social-networks-may-blur-professional-boundaries/
Hsiung, R. (2009, May). How to friend: Social networking Web sites for beginners [PowerPoint slides]. Retrieved June 19, 2009, from American Psychiatric Association Annual Meeting, http://mythreeshrinks.com/apa09/slides-hsiung.pdf
Hughs, L. (2009, May). Ethics Corner: Is it ethical to Google patients? Psychiatric News, 44, 9 & 11.
Lehavot, K., Barnett, J., & Powers, D. (in press). Psychotherapy, professional relationships, and ethical considerations in the MySpace generation. Professional Psychology: Research and Practice.
Zur, O., & Donner, M. B. (2009; January/February). The Google Factor: Therapists’ Transparency in the Era of Google and MySpace. The California Psychologist, 23-24.
We want to thank everyone who participated in our study and helped promote it. For those who are interested, we have posted a summary of our results on my website at:
http://drkkolmes.com/research-2/#therapist%20survey
A larger slide show that is easier to read can be found at:
http://bit.ly/ePFes0
We are writing up an article with more detailed information about our findings which we hope to publish.
Thanks again.
[...] To read a brief lit review and description of the research, please see our article Clinical implications of therapist-client interactions on the Internet: Boundary considerations in c…. [...]
Thanks for the comment, and you raise some very interesting points. Most of these questions are not the subject of this particular article, but you might find some resources in the two articles I list below or colleagues may chime in with some others.
Maheu, M. (2001, July/August). Practicing psychotherapy through the
Internet: Risk management. The Los Angeles Psychologist, 9-13.
Maheu, M., & Gordon, B. (2000). Psychotherapy on the Internet: Legal,
ethical and practice issues. Professional Psychology: Research and
Practice, 31(5), 484-489.
When a person contacts a service of online “therapists” I would like to know,
Isn’t there something missing when there are no visual cues to evaluate a patient? Much of
1) How can they be assured of their credentials or licensing to offer couseling?
2) How are HIPPA laws enforced to protect caller’s rights?
3) How is privacy assured? How can one be sure a supervisor isn’t listening in or if calls are
being recorded.
4) How do they get away with charging the same or more for a service that is not covered by
insurance? Give me a break – $5.00/min and it could be a college student reading from a
guided script on the other end of the line.
6) How can one be sure that there is not motive on the part of the “owner” of the site to train
said personel to lure and keep callers on line for higher profits?
7) Are records, including phone charges protected under the same confideniality clauses required
under doctor/patient relations?
evaluation is based on what tyhe patient doesn’t say. This weakens the relationship.
9) How is disclosure of the individual’s identity made and is this on the caller’s dime?
As quoted by Albert Einstein:“It has become appallingly obvious that our technology has exceeded our humanity.”
The dangers of internet therapist/client largely affect those who, rather than seeking easy money, are easy prey due to vulnerability. What they say may come back to haunt them in job serches, college, personal relationships, and Lord forbid, future legal problems.