Setting Boundaries When Working with Clients
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Psychologistattitudesandethicalconcerns.pdf
Psychologists’ Attitudes and Ethical Concerns Regarding the Use of Social Networking Web Sites
Laura Taylor, Mark R. McMinn, Rodger K. Bufford, and Kelly B. T. Chang George Fox University
Most psychologists seek to control self-disclosures they make to patients, but the Internet’s rapid development and widespread use over the past decade have introduced new problems for psychologists trying to avoid inappropriate disclosures. A total of 695 psychology graduate students and psychologists were surveyed about their current use of social networking Web sites (SNWs), opinions regarding regulation of online activities by the American Psychological Association (APA), and interactions in clinical work as a result of online activities. Established psychologists seldom use SNWs and may lack the experience to provide relevant supervisory guidance. No consensus about the need for APA guidelines emerged. Historically, APA has not issued guidelines in technological areas of rapid change. Thus, graduate training and continuing education should address the ethics of SNWs.
Keywords: social networking, MySpace, Facebook, self-disclosure, Internet
During an intake interview, a male client asks a female psychol- ogist if she is married. Should the psychologist provide a direct answer, or would it be better to focus on the client’s feelings and motives in asking such a question? It would be a much simpler matter if the client were to ask the psychologist for sexual favors— the answer to such a question is no and is clearly mandated by ethics and practice standards. Similarly, it would be relatively simple if the client were to ask for a glass of water. The answer would be yes, supported by human civility, compassion, and common sense. But the question about a psychologist’s marital status is not a simple matter. Is this as innocuous as asking for a
glass of water, or could it be a precursor to sexual innuendo or flirtation?
Whereas some professional practice behaviors are simple mat- ters of adhering to well-defined practice standards, self-disclosure is a more difficult matter because practice standards are not highly prescriptive, and because both advantages and disadvantages abound when it comes to revealing personal information to clients. Not surprisingly, different psychologists come to different conclu- sions, but virtually all psychologists affirm the importance of being thoughtful and intentional about how they handle issues of self- disclosure (Schwartz, 1993).
Professional distance helps maintain safety for clients. Psychol- ogists who fail to maintain personal boundaries can emotionally harm clients. Appropriate boundaries can aid in focusing thera- peutic work on the issues of clients. Self-disclosures of an intimate nature by the psychotherapist can be especially damaging when a strong therapeutic relationship has not been previously established. There are many instances when self-disclosure is contraindicated, such as when clients have poor boundaries and when the psycho- therapist is especially vulnerable to potential boundary violations because of life circumstances (Goldstein, 1994).
Although there are many possible problems with psychother- apist self-disclosure, there are reasons it is used in some clinical situations when the content of and reasons for the disclosures are carefully considered (Bridges, 2001). For example, disclo- sures about how a psychotherapist experiences the therapeutic relationship are sometimes used to help the client see patterns that may occur in other relationships (Maroda, 1999). Appro- priate disclosures may help psychotherapists improve therapeu- tic rapport with clients (Lundeen & Schuldt, 1989 ; Zur, 2009). These findings should not be used to justify indiscriminate self-disclosure in psychotherapy. Disclosures of psychothera- pists’ countertransference feelings have been found to damage therapeutic relationships (Myers & Hayes, 2006). Psychother- apists must be thoughtful and cautious about the information they share with clients, as it seems that subtle differences in
LAURA TAYLOR received a PsyD in clinical psychology from George Fox University. Her primary research interests are graduate education in clin- ical psychology and impacts of technology on clinical practice. MARK R. MCMINN received a PhD in clinical psychology from Vanderbilt University. He is currently a professor of psychology at George Fox University. His primary research interests pertain to spiritual and religious issues in psychotherapy. RODGER K. BUFFORD is professor of psychology and former chair in the Graduate School of Clinical Psychology at George Fox University. He earned his BA in psychology from The King’s College and master’s and doctoral degrees from the University of Illinois at Urbana–Champaign. Research interests include spiritual well-being, spiritual maturity, and spiritual practices; religious/spiritual concerns, interventions, and out- comes in psychotherapy; assessment of mental health treatment outcomes in managed care settings; and clinical supervision ethics, process, and outcomes. A licensed psychologist, he also practices part time at Western Psychological and Counseling Services in Tigard, OR. KELLY B. T. CHANG received a PhD in psychology: teaching, learning, and cognition from the University of Hawai’i at Manoa. She is currently an assistant professor of psychology at George Fox University. Her primary research interests include positive psychology, emotional intelligence, di- versity, and resilience. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Laura Taylor, 3240 SW 180th Pl, Beaverton, OR 97006. E-mail: haydonla@ hotmail.com
Professional Psychology: Research and Practice © 2010 American Psychological Association 2010, Vol. 41, No. 2, 153–159 0735-7028/10/$12.00 DOI: 10.1037/a0017996
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clients and situations may determine whether an action is help- ful versus harmful to the client.
Zur proposed three different types of self-disclosures in a recent article: deliberate, unavoidable, and accidental disclosures. Delib- erate disclosures are made intentionally. Unavoidable disclosures can be intentional or unintentional. They are disclosures made through the course of the psychotherapist participating in his or her normal daily activities. Accidental disclosures often involve un- planned encounters with clients in public places or other uninten- tional revelations of information (Zur, 2009).
Although self-disclosure practices vary among psychothera- pists, all psychologists weigh several factors, or ought to, when making decisions about self-disclosure. These factors include, but are not limited to, theoretical orientation, established research, and ethical guidelines of practice. The implications for the client of any self-disclosure made by the psychotherapist must always be con- sidered to stay within the minimal ethical guidelines of benevo- lence and nonmalfeasance. Because of the potential consequences of these decisions, psychologists avoid self-disclosures of a hap- hazard or unintentional nature. At the same time, psychotherapists frequently disclose information to clients without the conscious intention to do so (Bridges, 2001; Ehrenberg, 1995). Information can be disclosed through the décor in psychologists’ offices, their styles of dress, the holidays they observe, their physical appear- ance, and many other subtle characteristics (Wilkinson & Gabbard, 1993). These are relatively innocuous examples, but unintentional disclosures can cause problems in psychotherapy if the disclosure involves something inappropriate according to professional bound- aries, if it interferes with the treatment process, or if it damages the client’s view of the psychotherapist as a competent and trustwor- thy individual.
The American Psychological Association’s (APA) “Ethical Principles of Psychologists and Code of Conduct” does not speak directly to self-disclosure. It does advise against multiple relation- ships with clients that could result in exploitation or harm to the client (APA, 2002, Section 3.05). Contact with clients via the Internet, whether intentional or not, can change the nature of a client–psychotherapist relationship. It is easy for a client to begin to view the psychotherapist as a friend rather than a hired profes- sional or expert once the client has knowledge of the psychother- apist’s personal life. Koocher and Keith-Spiegel (1998) stated, “Careful consideration should be given prior to softening a strictly professional relationship” (p. 173). It is difficult to establish firm ethical standards around self-disclosure because different types of self-disclosure have different implications for the psychotherapy relationship (Hill & Knox, 2001; Peterson, 2002). Most psychol- ogists agree that disclosures about current stressors, personal fan- tasies or dreams, and sexual or financial circumstances are almost never considered to be ethical or helpful (Gutheil & Gabbard, 1993). Information disclosed about a psychotherapist’s family, hobbies, life struggles, political opinions, and other topics might be perfectly appropriate if shared with friends, but this kind of infor- mation can be a cause of conflict and can blur boundaries within a therapeutic relationship.
Given the rapid technological changes of the past several de- cades, for today’s psychologists, unintentional self-disclosure is not limited to the art on one’s office wall. A curious client may conduct an Internet search to discover any available information about a particular psychologist’s life. Self-disclosures that take
place over the Internet could also be seen as what ethics experts sometimes describe as “small-world hazards” (Campbell & Gor- don, 1993) or “everyday life hazards” (Zur, 2009). These disclo- sures are thought to be largely unavoidable and should be dealt with in a direct manner as soon as they are recognized. But when small-world hazards involve the very large world of the Internet, it is often difficult to know that any disclosure has been made; therefore, it is difficult to deal with the disclosure in a direct manner.
Many psychotherapists maintain Web sites describing their pro- fessional activities and services. Other psychologists are featured on the Web sites of organizations for which they are employed. Some psychotherapists allow clients to contact them via e-mail, and a few are even conducting therapy over the Internet (Rosen & Weil, 1996). One of the primary ethical concerns regarding use of e-mail and other online communications in clinical psychology is privacy and confidentiality for the client (Jerome et al., 2000). Clients may believe that the Internet is secure or that their e-mails are confidential and private when this is not always the case. Because of these risks to confidentiality, informed consent before a client participates in such activities becomes extremely impor- tant.
Numerous different social networking Web sites (SNWs) have become popular for entertainment and communication in recent years. Popular sites include MySpace, Flickr, YouTube, Facebook, Second Life, Classmates.com, Friendster, Twitter, and Yahoo! 360. A personal Web page on one of these sites can contain a wide array of personal information about the subject of the page, in- cluding names of family members, group and club memberships, or substance use behaviors. A subscriber can post almost any information he or she chooses, and anyone listed as a “friend” can also post information to someone’s Web page. This often means that potentially embarrassing stories, photographs, and information are posted to the site by someone other than the subject of the page. Some of the information typically featured on SNWs might be considered taboo for sharing within therapeutic relationships; how- ever, clients can freely access the SNWs of anyone they choose unless the privacy settings prohibit access. Even if privacy settings do not allow visitors to view a psychologist’s SNW, anyone can send a “friend request” to the psychologist, asking to be accepted as a “friend.” If a client were to do this, then the psychologist is left with a difficult choice of ignoring or rejecting the friend request on the one hand or accepting the friend request and allowing the client access to the psychologist’s personal information on the other hand.
It is not clear how psychologists currently use SNWs, and how they handle the issues of self-disclosure that naturally arise for those who subscribe to SNWs. To gain information about psychol- ogists’ and psychology graduate students’ behavior, we conducted a national survey.
Social Networking Survey
Students enrolled in doctoral-level psychology training pro- grams and currently licensed psychologists were contacted through e-mail and asked to complete an online questionnaire. The names and e-mail addresses of potential participants were obtained through two different means. First, psychologists’ names were obtained through the online membership directory of the APA.
154 TAYLOR, MCMINN, BUFFORD, AND CHANG
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Through random selection, 400 APA members’ names and e-mail addresses were obtained. Of these 400 e-mail addresses, 358 were still active or able to receive the message. Second, we contacted 205 training directors and faculty from selected APA-accredited doctoral programs in clinical and counseling psychology and re- quested that a link to the survey and an e-mail explaining the study be forwarded to students. In total, 929 individuals visited the site, and 695 participants completed the survey. Because of the snow- ball sampling method used, it is impossible to know the exact response rate, but the completion rate of 67% was respectable.
Of the 695 participants, 114 (16%) were men and 580 (84%) were women. One participant declined to report a gender. With respect to ethnicity, 562 (81%) identified themselves as European American, 25 (4%) as Latino American, 24 (4%) as African American, 19 (2%) as Asian American, 18 (2%) as multiracial, 4 (1%) as Native American, 35 (5%) as other, and 8 (1%) did not report ethnicity. The mean age of participants was 29 years (SD � 7.6). The ages of participants ranged from 22 to 79 years. The majority of participants (55%) reported their highest degree to be a master’s degree, 31% a bachelor’s degree, 9% a PhD, 3% a PsyD, and 2% had earned another degree. Only 63 (9%) partici- pants were licensed psychologists, indicating that the majority of the sample (632 or 91%) comprised graduate students. An addi- tional 36 respondents (5%) possessed a doctoral-level degree in psychology but were not yet licensed. The limited number of licensed psychologists included in the study means that findings cannot be generalized to the larger populations of psychologists or APA members.
The online questionnaire was developed specifically for the purposes of this descriptive study, although the format is similar to ethics questionnaires used in past research on the beliefs and behaviors of psychologists (e.g., McMinn, Buchanan, Ellens, & Ryan, 1999; Pope, Tabachnick, & Keith-Spiegel, 1987). It featured 14 questions intended to gather information about participants’ current use of SNWs and other online activities, beliefs about possible regulation of online activities by the APA, and interesting or difficult encounters participants have had with clients as a result of online activities. Nine of the 14 questions were rated on two separate 5-point Likert-type rating scales— one scale based on
whether the respondent engages in this practice (1 � never to 5 � very often) and one scale based on whether the respondent believes the behavior to be ethical (from 1 � unquestionably not to 5 � unquestionably yes). An additional item asked respondents whether they maintained a SNW (yes or no) and then asked respondents to rank the ethics of doing so on the same 5-point Likert-type scale used for other ethics ratings. For those respon- dents who did maintain a SNW, they were asked if the page was set to “private.” Respondents were also asked whether they thought APA should create ethical standards around the use of Web resources, rated on a Likert-type scale ranging from 1 (def- initely no) to 5 (definitely yes). They were also asked whether they had thought about possible ethics and safety ramifications of SNWs, rated on a Likert-type scale ranging from 1 (not at all) to 5 (a great deal). The survey also featured a short demographics section and an open-ended question asking respondents to describe a challenging or interesting interaction with a client regarding online activities.
The majority of participants (77%) reported maintaining a page on an SNW. Of those who do have an SNW, most (85%) reported they were using privacy settings to protect their personal informa- tion. As expected, there was a significant negative correlation (r � –.45, p � .01), indicating that younger respondents were more likely to maintain an SNW than older respondents. Although there were only 15 respondents over the age of 54 in the sample, none of them reported that they maintained an SNW. In contrast, 86% of the 528 respondents under the age of 30 did.
Participants ranked nine behaviors (shown in Table 1) according to how often they had engaged in the particular behavior. The behaviors are listed in order from those most frequently engaged in to those least frequently engaged in by survey participants. A repeated measures multivariate analysis of variance (MANOVA) indicated overall differences in the ratings, Wilks’s �(8, 508) � .26, p � .05. Adjacent items were then compared using a profile analyses with paired sample t tests to determine which items on the list were rated significantly differently from the items preceding them. Significant differences were observed for all but one of the adjacent means. In particular, participants stated that they would reject or ignore attempted client contact by SNWs (a rating of 3.4)
Table 1 Behaviors Ordered by Frequency of Reported Occurrence
Item M SD
Comparison with previous item
t(8) d
Rejecting or ignoring a client when they attempt to make contact through a social networking website 3.4 1.8 Posting photos or video of self on a website for private use 2.9 1.3 5.4�� 0.28 Posting photos or video clips of friends or family members online 2.8 1.3 3.3� 0.07 Allowing clients to e-mail you 1.8 1.1 15.8�� 0.88 Using phony names or photos when engaging in online activities in order to disguise identity 1.5 1.1 3.8�� 0.21 Searching for a client on a social networking website 1.3 0.6 6.3�� 0.28 Posting photos or video clips of self on a website for professional use 1.2 0.6 2.6�� 0.18 Working with clients who learned of you through an Internet search 1.2 0.6 1.6 Discussing aspects of online activities with clients 1.1 0.3 2.9� 0.17
Note. Ratings were provided on a Likert-type rating scale based on whether the respondent engaged in this practice, ranging from 1 � never to 5 � very often. The t values are reported for paired samples t tests, and d values are reported for effect size using Cohen’s d. � p � .01. �� p � .001.
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but often posted photos or videos of themselves (a rating of 2.9) and family or friends (a rating of 2.8); all of these behaviors were much more likely than the other behaviors investigated (Cohen’s d � 0.88). These same nine items—plus an item about a psychol- ogist having an SNW—were also rated on the basis of how ethical they were perceived to be and are reported in Table 2. A repeated measures MANOVA demonstrated overall differences among the ethics ratings, Wilks’s �(9, 656) � .18, p � .05. Adjacent ethics ratings were then compared using a profile analyses with paired sample t tests.
When asked to rate the amount of thought they had given to the ramifications of using SNWs, most participants (n � 407) reported that they have thought about this issue either somewhat (a rating of 3) or quite a lot (a rating of 4), with an overall mean rating of 3.6 on the 5-point Likert-type scale. Only 56 people reported that they had not thought about the ramifications of using SNWs at all. A negative correlation was found between age and the degree to which a person reported having thought about the ramifications of using SNWs (r � –.23, p � .01).
Respondents were also asked whether they would like APA to impose specific rules and guidelines regarding the use of Web sites, including SNWs. There was no clear consensus on this matter, with a mean rating near the midpoint of 3 on the 5-point Likert-type scale (M � 3.2, SD � 1.2). A small but significant negative correlation was found with age (r � –.16, p � .01). This correlation indicated that the younger a respondent was, the more likely he or she was to favor APA involvement in these issues.
A total of 100 individuals also provided qualitative information about challenges they have faced regarding use of SNWs or other online activities. Several different themes came up in numerous responses. Many respondents provided personal stories about dis- covering that they shared common friends or acquaintances with their clients through SNWs. Most of these respondents stated that they promptly removed their pages entirely or altered the content of their pages after discovering the connections. Many other re- spondents reported that they maintain SNWs, but that they try to avoid ethical problems by keeping their pages set to the highest
privacy settings available. Some of these people stated that they do not use their real names on pages or that they use only a first name.
Several respondents drew a distinction between issues that arise when they are working as a professor as opposed to working as a psychotherapist. Of these participants, many expressed the opinion that students were more likely to try to contact them through an SNW than clients were. Most stated that they maintain the same personal policy toward students that they use for clients, which is no contact with students via SNWs.
Many respondents made a point of stating that they feel it is very important for the strength of the psychotherapy relationship to discuss attempts by clients to contact their psychotherapist online in the next face-to-face session. Other concerns mentioned in- cluded inadvertently coming into contact with clients or relatives of clients on dating Web sites, clients mentioning suicidal or homicidal ideation on blogs or Web sites, and clients who want to be contacted via e-mail because they do not have a telephone.
Professional Implications
MySpace was launched in August 2003 and Facebook in Feb- ruary 2004. Since the introduction of these sites, millions of people worldwide have joined SNWs by posting their own pages. These sites provide entertainment and communication opportunities, but they also present unique ethical and safety issues for psychologists who must be vigilant about issues of self-disclosure, client confi- dentiality, and safety.
Early Career Psychologists, Graduate Students, and SNWs
Of the mostly early career psychologists and doctoral-level psychology students who participated in this study, 77.3% reported that they communicate with friends and family through SNWs. On the basis of this survey, it seems that respondents with SNWs are aware of the clinical and ethical implications, but it also seems
Table 2 Ethics of Behaviors Ordered by Degree of Endorsement
Item M SD
Comparison with previous item
t(9) d
Posting photos or video of self on a website for private use 4.1 0.8 Posting photos or video clips of friends or family members online 4.0 0.9 6.3�� 0.18 Maintaining a page on a social networking website 3.9 0.8 1.6 Working with clients who learned of you through an Internet search 3.7 1.0 5.6�� 0.28 Rejecting or ignoring a client when they attempt to make contact through a social networking website 3.7 1.2 0.6 Posting photos or video clips of self on a website for professional use 3.6 1.1 1.5 Using phony names or photos when engaging in online activities in order to disguise identity 3.3 1.2 5.5�� 0.27 Allowing clients to e-mail you 3.2 1.1 1.7 Discussing aspects of online activities with clients 2.1 0.9 23.3�� 1.05 Searching for a client on a social networking website 2.0 1.0 3.4� 0.14
Note. Ratings were provided on a Likert-type rating scale based on whether the respondent believes the practice to be ethical, ranging from 1 � unquestionably not to 5 � unquestionably yes. The t values are reported for paired samples t tests, and d values are reported for effect size using Cohen’s d. � p � .01. �� p � .001.
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evident that SNWs amplify the possibilities of unintentional dis- closures to and encounters with clients.
The relationship of age to SNW use is intriguing for at least three reasons. First, psychologists with the least amount of pro- fessional experience will be facing some of the most complex situations regarding the distinction between professional and pri- vate information. Normally, early career psychologists could look to more experienced psychologists in situations such as this, but if the more experienced psychologists do not understand the nuances of SNWs, they are not likely to be able to provide helpful consul- tation on this matter. Students may avoid seeking guidance on these issues because of a perceived lack of knowledge regarding these issues on the part of supervisors. Technology could create a threat to usual patterns of supervision that occur in professional psychology. These early career psychologists were also more likely than their more experienced colleagues to express a desire for APA involvement in these issues. It seems that these early career psychologists want more guidance and supervision on these difficult issues. In addition, there may be ethical issues about the use of SNWs in investigating students for placement decisions because training directors of doctoral programs, practicum sites, and internships can access the information on these sites, just as anyone else can (Lehavot, 2009). In some cases, students or employees may be reluctant to bring up issues related to SNWs or the Internet out of a fear that their supervisors will then decide to search for information about the supervisees online.
Because SNWs are most prevalently used by young early career psychologists and graduate students, it would not be difficult to predict that this social phenomenon could be underestimated or overlooked by APA leaders, who tend to be older, more estab- lished psychologists, and are thus less likely to use these technol- ogies. McMinn, Hathaway, Woods, and Snow (2009) recently surveyed APA council representatives and division presidents and reported an average age of 58.5 years, which is notable because not a single respondent over the age of 54 in the current study main- tained an SNW. It is encouraging that APA Ethics Director Ste- phen Behnke has recently devoted two APA Monitor on Psychol- ogy columns to the complexity of ethics situations that arise because of the Internet (Behnke, 2007, 2008).
Third, it seems likely that technological changes may drastically affect the way clients and psychologists associate in the future. Youthful clients may use SNW and other online resources as a point of connection with their psychotherapists. Schwartz (1993) discussed psychotherapist self-disclosure as a means of achieving a better match between client and psychotherapist. He asserted that closeness, match, and relationship are so important to the success of psychotherapy that some sharing on the part of the psychother- apist may be necessary for the client to be able to make an informed choice when selecting a psychotherapist and to continue to feel bonded to that psychotherapist over the course of their work together. It seems that clients and psychotherapists in their 20s and 30s are using SNWs as one possible way to make these connec- tions. Clients may seek the match Schwartz discussed by learning more about potential psychotherapists online. In the present study, respondents reported very little online communication with clients, and they saw this as ethically problematic. Never was the most common response for participants in this study when asked how often they allow clients to e-mail them, search for a client on an SNW, or work with a client who learned of them through an
Internet search. But as culture changes and computers and wireless technology become increasingly prominent means of communicat- ing, it seems possible that psychologists will become more accept- ing of this as a way to communicate and connect with clients and potential clients. If so, this raises interesting professional and ethical challenges as the distinctions between private and public blur (Behnke, 2008). Online communications can also be more casual and spontaneous than other types of interactions, often leading people to disclose information online that they would have otherwise withheld (Gutheil & Simon, 2005).
The Demise of Intentionality
The greater concern about Internet communications may not be the ubiquity of communication but the diminishing of intentional- ity. All psychologists make disclosures to clients. For example, it would be inconceivable for a psychologist not to disclose his or her office location or fee structure. Some make more personal disclo- sures, such as marital status, the number of children they have, their religious affiliation, and so on. These disclosures may help establish rapport by helping the psychologist be perceived as honest, accessible, and genuine (Maroda, 1999), whereas exces- sive or unintentional disclosures may easily shift the focus of therapy away from the client and damage the psychotherapeutic relationship (Bridges, 2001). Regardless of how much a psychol- ogist discloses, it is important to have personal guidelines around self-disclosure. Myers and Hayes (2006) emphasize the impor- tance that all self-disclosure decisions made by psychotherapists be grounded in an underlying rationale. They stated that making decisions about self-disclosure is unavoidable in therapeutic work, but that psychotherapists must structure personal guidelines around theory and ethics and be able to explain their decisions if called on to do so. Even when a psychologist creates concrete guidelines for himself or herself around the area of self-disclosure, the Internet can potentially counteract even the best of intentions on the part of an ethical psychologist.
This is not to say that some intentionality is no longer possible, but full intentionality is a thing of the past. Psychologists can be cautious in their privacy settings on SNWs, and many in the present study were. Alternatively, psychologists may choose not to have an SNW at all. But even with this choice, the widespread availability of search engines makes virtually any psychologist easy to research. Clients with an Internet connection have free access to some public records, and for a small fee many sites make other records available. Intentionality about self-disclosure is an important issue, but full intentionality may be impossible. How can psychologists manage professional work in a time when in- formation can no longer be kept from inquiring clients? This is a professional issue that needs to be discussed in various venues.
The Dilemma of Regulation and Need for Training
Respondents in the present study expressed uncertainty, or per- haps ambivalence, as to whether the APA should be involved in establishing guidelines or regulations regarding Internet commu- nications with clients. This uncertainty is reasonable considering the situation in which psychologists find themselves. On one hand, psychologists and graduate students in this survey—most of them young and relatively inexperienced in professional psychology—
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could benefit from having clear guidelines for how to manage technology advances. On the other hand, technological change is too rapid and ubiquitous to maintain any expectation that the APA Ethics Committee could possibly keep up and publish relevant standards on each new technology that has implications for pro- fessional psychology. Other than two iterations of a statement on services by telephone, teleconferencing, and the Internet (APA Ethics Committee, 1997), the committee has tended to avoid efforts to offer advisory or regulatory statements pertaining to technological advances. Rather, it has attempted to coordinate the development of the APA “Ethical Principles of Psychologists and Code of Conduct” (e.g., APA, 2002) in a way that provides guidance for psychologists who will inevitably need to respond to changes in the field, including technological changes.
Thus, it seems unlikely that the APA Ethics Committee will set any formal guidelines on the use of SNWs in the near future, and this lack of action is likely the most reasonable response given the accelerating rate of technological change. The APA “Ethical Prin- ciples of Psychologists and Code of Conduct” (APA, 2002) states:
In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organiza- tional clients, and others from harm. (Principle 2.01e)
What are the reasonable steps that psychologists can take in response to the blurring of public and private information resulting from Internet technology? We recommend that graduate programs consider adding some discussion of Internet technologies to their ethics training. Also, continuing education in ethics should address issues created by the growth of Internet communications. Early career psychologists must be asked to consider problems and situations that can arise from their use of the Internet. Many ethics courses and trainings feature the use of vignettes and ask partici- pants to consider what the most ethical course of action would be if they found themselves in a similar situation. These same tactics could be applied to situations involving SNWs and the Internet. The primary guidelines for such training would likely involve maintaining appropriate boundaries with clients, keeping psycho- therapy focused on the needs and issues of the clients, and avoid- ing actions that could cause psychological or emotional harm to clients.
Self-Monitoring
One of the primary implications of this study, for psychologists and graduate students, is that individual practitioners must estab- lish their own self-monitoring strategies regarding online behavior. Peer consultation, documentation, and thoughtfulness may be the best methods psychologists have to protect themselves. The qual- itative data provided by study participants provide some sugges- tions for prevention of online disclosures. Several participants reported that they announce to students that all attempts to contact them via SNWs will be ignored or rejected. Other study partici- pants recommended that psychologists “Google” themselves to see what comes up through the search. This could be helpful not because one can control the information that circulates on the Internet, but rather so the practitioner would be informed if a client ever brought such information up in psychotherapy. Many respon-
dents emphasized the importance of having open discussions in the next session following any online contact with a client. Most stated that they believe being open and honest about such contact can repair any damage to the relationship and can help correct any false interpretations of information obtained online. Also, a num- ber of participants reported that their Web pages are set to the highest allowable levels of security; others stated that they use pseudonyms online for the specific purpose of making it difficult for clients to locate them.
Although these suggestions are probably helpful in most cases, other reports served as reminders of the dire possibilities that emerge because of online networking. Some respondents noted that they occasionally found pictures of clients on the Web sites of their friends or family members, and that they had no prior knowledge of these relationships. A few participants even reported that they had been matched to current or former clients through anonymous dating Web sites.
It seems clear that psychologists must consider the potential risks and consequences associated with maintaining SNWs. For psychologists who choose to maintain a page on one of these sites, a number of important decisions must be made regarding whether or not the site will be set to private, how they will handle attempts by clients to make contact with them, and what specific content they will post on their page. Considering the “small-world haz- ards” that rural psychologists often face, and how they manage these hazards, may serve as a helpful point of comparison for psychologists with SNWs (Campbell & Gordon, 1993). Rural psychologists almost inevitably have unplanned encounters with some of their clients because of the size of the communities in which they live and practice. The Internet harbors similar hazards because psychologists have little control over when, where, and how their clients may encounter information about them online. Psychologists must take reasonable actions to avoid foreseeable problems with online information, and they must be prepared to do damage control after clients seek their information through the Internet.
Conclusion
This article provides an initial look at the professional and ethical implications of SNWs, but much more research and pro- fessional discussion are needed. There are a number of limitations to this study, including the preponderance of graduate student respondents as compared with a small number of psychologist respondents, the relative homogeneity of the sample with regard to age and ethnicity, the exclusive use of electronics to distribute the survey, the limited number of questions posed to respondents, and the possible selection bias among those who chose to respond to the survey.
More research and professional conversation are needed to explore further the topic of SNWs and related topics. We have focused on the beliefs and behaviors of psychologists regarding SNWs, but it would also be interesting to find out more about the online behavior of psychotherapy clients. It would be helpful to know the types of information clients seek when searching for a psychotherapist online, and which information has the greatest impact on the client’s ability to work effectively with the psycho- therapist. It seems reasonable to hypothesize that self-disclosures made through SNWs might affect the therapeutic relationship in
158 TAYLOR, MCMINN, BUFFORD, AND CHANG
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ways similar to other forms of self-disclosure, but further research could test this hypothesis. Currently, the percentage of clients who participate in SNWs and the frequency with which they search or try to interact with psychotherapists through this venue are un- known. Future research could examine these questions.
In the meantime, we hope this article helps promote conversa- tions among psychologists and those who train psychologists. Technological change is nothing new to psychologists, and more change is certain to come in the future. The challenge facing us now is a familiar one as we attend to the professional and ethical implications of contemporary change.
References
American Psychological Association. (2002). Ethical principles of psy- chologists and code of conduct. American Psychologist, 57, 1060 –1073.
American Psychological Association Ethics Committee. (1997, November 5). Services by telephone, teleconferencing, and Internet: A statement by the Ethics Committee of the American Psychological Association. Re- trieved from http://www.apa.org/ethics/stmnt01.html
Behnke, S. (2007, January). Posting on the Internet: An opportunity for self (and other) reflection. APA Monitor on Psychology, 38(1), 60.
Behnke, S. ( 2008, July/August). Ethics in the age of the Internet. APA Monitor on Psychology, 39(7), 74.
Bridges, N. A. (2001). Therapist’s self-disclosure: Expanding the comfort zone. Journal of Psychotherapy: Theory, Research, Practice, Training, 38, 21–30.
Campbell, C. D., & Gordon, M. C. (1993). Acknowledging the inevitable: Understanding multiple relationships in rural practice. Professional Psy- chology: Research and Practice, 34, 430 – 434.
Ehrenberg, D. B. (1995). Self-disclosure: Therapeutic tool or indulgence? Countertransference disclosure. Contemporary Psychoanalysis, 31, 213–228.
Goldstein, E. G. (1994). Self-disclosure in treatment: What therapists do and don’t talk about. Clinical Social Work Journal, 22, 417– 433.
Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: Theoretical and risk-management dimensions. Ameri- can Journal of Psychiatry, 150, 188 –196.
Gutheil, T. G., & Simon, R. I. (2005). E-mails, extra-therapeutic contact, and early boundary problems: The Internet as a “slippery slope.” Psy- chiatric Annals, 35, 952–960.
Hill, C. E., & Knox, S. (2001). Self-disclosure. Journal of Psychotherapy: Theory, Research, Practice, Training, 38, 413– 417.
Jerome, L. W., Deleon, P. H., James, L. C., Folen, R., Earles, J., & Gedney,
J. J. (2000). The coming of age of telecommunications in psychological research and practice. American Psychologist, 55, 407– 421.
Koocher, G. P., & Keith-Spiegel, P. (1998). Ethics in psychology: Profes- sional standards and cases. New York: Oxford University Press.
Lehavot, K. (2009). MySpace or yours? The ethical dilemma of graduate students’ personal lives on the Internet. Ethics & Behavior, 19, 129 –141.
Lundeen, E. J., & Schuldt, W. T. (1989). Effects of therapist’s self- disclosure and a physical barrier on subjects’ perceptions of the thera- pist: An analogue study. Psychological Reports, 64, 715–720.
Maroda, K. J. (1999). Creating an intersubjective context for self- disclosure. Smith College Studies in Social Work, 69, 475– 489.
McMinn, M. R., Buchanan, T., Ellens, B. M., & Ryan, M. K. (1999). Technology, professional practice, and ethics: Survey findings and im- plications. Professional Psychology: Research and Practice, 30, 165– 172.
McMinn, M. R., Hathaway, W. L., Woods, S. W., & Snow, K. N. (2009). What American Psychological Association leaders have to say about Psychology of Religion and Spirituality. Psychology of Religion and Spirituality, 1, 3–13.
Myers, D., & Hayes, J. A. (2006). Effects of therapist general self- disclosure and countertransference disclosure on ratings of the therapist and session. Journal of Psychotherapy: Theory, Research, Practice, Training, 43, 173–185.
Peterson, Z. D. (2002). More than a mirror: The ethics of therapist self- disclosure. Journal of Psychotherapy: Theory, Research, Practice, Training, 39, 21–31.
Pope, K. S., Tabachnick, B. G., & Keith-Spiegel, P. (1987). Ethics of practice: The beliefs and behaviors of psychologists as therapists. Amer- ican Psychologist, 42, 993–1006.
Rosen, L. D., & Weil, M. M. (1996). Psychologists and technology: A look at the future. Professional Psychology: Research and Practice, 27, 635– 638.
Schwartz, R. S. (1993). Managing closeness in psychotherapy. Journal of Psychotherapy: Theory, Research, Practice, Training, 30, 601– 607.
Wilkinson, S. M., & Gabbard, G. O. (1993). Therapeutic self-disclosure with borderline patients. Journal of Psychotherapy Practice and Re- search, 2, 282–295.
Zur, O., Williams, M. H., Lehavot, K., & Knapp, S. (2009). Psychother- apist self-disclosure and transparency in the Internet age. Professional Psychology: Research and Practice, 40, 22–26.
Received June 21, 2009 Revision received September 14, 2009
Accepted September 16, 2009 �
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