American Psychological Association
Boston, August 14-17 2008
ASYNCHRONOUSLY LIVE FROM APA -
Boston, 15 Aug 2008
Greetings from Boston. Here's a quick report on a symposium which I attended today on a subject near and dear to my heart, a Current Topic in Psychology, and also relevant to "Online Therapy" and "Cyberpsychology". Like Sternberg, I have my triarch!" ;-)
Symposium: My Space, You Tube, Psychotherapy and Professional Relationships -
Crisis or Opportunity?
This was a well-attended continuing education symposium presented by a panel of ethics experts, including Dr. Jeffrey Barnett, who has been editor of a scholarly journal series about ethics in practice today, Stephen Behnke, Ph.D., JD, director of the APA ethics office, David Powers of Loyola, who studies training models in the Internet age, and Keren Lehavot, a graduate student who won an award for her work in ethics, where she explored academic & personal use of social networking sites.
There were several recent studies and statistics shared; here are some of the key findings and the 'main idea', straight from the event today. Dr. Barnett noted that he learns a great deal by observing his teenage daughter and is fortunate to be able to consult with her as an expert.
[As I've described elsewhere recently, I was quite impressed with how a teen responded so poignantly when I asked about comfort with multi-tasking and using multiple devices, etc.: "We don't know anything else. What do you expect? You had television and the telephone. We grew up with cell phones, computers, and Internet." Cameras now, too.]
One thing his daughter underscored for Dr. Barnett was that whatever one wants - or reveals - "it's out there on the Internet. And everybody can see it."
- MySpace is the 6th largest "country" in the world" with more monthly visitors than any other site, and with the most rapid growth of any Internet site in history. (Rosen, 2007)
- 73% of US adults are now online, 55% with broadband connections. [Our saturation and bandwidth/speed lags as a nation behind much of the world still, fwiw!]
- 82% of college students own their own computer.
- 72% "check their email at least once a day". [The speaker quipped: C'mon! Only once a day? We know better! :-) ]
And now: ethics issues. They impact all of us, as individuals as well as organizations, for example APA, and its lists and data, etc. There is attention always to boundaries, confidentiality, etc. On a personal level, Dr. Barnett observed that if he puts up photos of his vacation to Maui, with limbo dancing contests and romps on the beach, etc., he takes a risk. If it's "out there" even on a page you think is private, could a client access it? And then what?
As a training issue, we may need to *anticipate* what would apply in such a situation. Does an ethical code apply? Yes, in terms of beneficence, maleficence, etc. In other words, whatever might come about one needs to be concerned about the client's wellbeing first.
Relevant standards in discussions of online presence and behavior include privacy & confidentiality, boundaries, and informed consent.
Now we have a question (which I and others have also posed) of "is it ethical to be on a client's 'friends' list? Some say, 'But I work with teens. There are benefits there!'" This may be true [and I can attest to the potential first-hand] but "you also need to look at the risks". For example, in an academic context, "am I altering the professional relationship? You don't want to share everything with everyone. There need to be some limits, and we need to anticipate some consequences." Even with email, used routinely to confirm or change appointments appointments, etc. "It's a great tool but clients need to know the limits of confidentiality" too. (I.e., informed consent) He personally avoids "information transferring via the Internet". [Of course HIPAA controls some of this security issue too.]
Of course it's not only Internet technology; phones too raise concerns, and even some toys apparently can intercept phone discussions.
Need we be extreme here? "Are we allowed to have a personal life?"
- "If I'm on an admissions committee, should I google applicants, or take a look at YouTube?" [This evoked quite a bit of discussion and some audience questions/comments.]
- "What about clients searching for us online?" Again, "We need to be careful about what we put out there". [One comment in the audience was about the value of intentionally putting out info, rather then fearing it - my response was/is that calling-card type sites are just that, and if the goal is truly to attract attention, Google can help with that.]
Answer: "Yes, but we need to be mindful". And "you can't take it back" once it's out there.
Some may have been thinking this sounds very rigid, but the point made next was that the APA ethics code is NOT 100% rigid. There are situations where multiple relationships or boundary crossings may be appropriate, acceptable, maybe even valuable.
Some say they will be friends with former clients - but what if they need treatment again and want to resume?
On the other hand, there are ex-students who send him pictures of new babies. Is that wrong?
As for "self disclosure" generally, there are different types, from deliberate sharing of personal information to "automatic" give-aways, like wedding bands, an accent, pregnancy... Certainly all are self-disclosing. Zur (2008) describes 5 types of self-disclosure. Aside from the accidental there are also what may be inappropriate types of disclosures and some online activities may invite a disinhibition or even unintentional sharing of personal information. Is MySpace one such example? Again: "We need to be thoughtful."
"Boundaries are porous"
Some say they only allow "friends" they know, but this can be of limited value, in practice. [On several lists, APA and ISMHO among them, there have been recent discussions about this specific dilemma, and possible solutions, like having private and public pages of Facebook.] Where do we go from here?
And with this broad overview and laying out of some provocative/evocative questions, the floor was handed to Keren Lehavot, who shared some "hot off the press" empirical data from her own work and reviews of the literature.
Ms. Lehavot's presentation was entitled "Graduate students' use, misuse, and nonuse of social websites". To begin with, she reported that 82% of undergrads now use online social networks (Caruso & Salaway, 2007) . There seem to be both pros and cons. An obvious pro: it's effortless. Cons include questions about ethics. She mentioned the issue of it not being unusual for professors to google students. But is it really ethical, or just one of those many "grey areas"? (Lazarus spoke about this in a recent journal article - sometimes it's not ethical to ignore the true needs of a client, or their culture, by being rigid.)
A key concept is privacy. On one hand the Internet is a public domain. On the other hand, we do have expectations. Again the example: "googling students". Is it perhaps unethical? What about the principle of autonomy? Shouldn't we have the right to access the Internet?
In Lehavot's study of 302 graduate students (82% of whom were student therapists), 37% had a MySpace profile, 33% Facebook, 20% "other social websites". (Interesting comments were made about the way Facebook evolved from .edu addresses only to being more open, while the reverse is true for MySpace. MySpace, would you believe, is still only 4 years old!)
67% said they use their real name on MySpace. Sixty percent protect their personal information by limiting access to "friends". The operational question for most people is, or should be, of what goes online -- be it photos or personal information -- what would we want our friends to see? Lehavot asked the question. Basically students were comfortable sharing both photos and info with classmates, but more than 4x as many would be Uncomfortable sharing the photos with faculty, and almost twice as many would be uncomfortable sharing personal information. (Not surprising?) Interestingly, 29% of student therapists said they'd posted photos they'd not want their clients to see, and 36% said they'd posted information they would be uncomfortable about being seen by clients.
Other quick stats:
In sum: Be mindful of what you do!
- 7% of student therapists surveyed said they'd been informed by a client that they (clients) had gotten info about their therapist online.
- 27% of the therapists did some online "fact-checking" of clients' statements, visiting MySpace pages for example - to see, as one example, if clients were being truthful with them.
- 8 of 10 Americans use the net to verify or find health information. (This was one of the first and most robust findings about Internet use.)
Training and modeling professionalism in the Internet Age
David Powers addressed the implications for faculty members, fondly recalling a favorite description of Facebook given to him by a friend who first welcomed him there, something to the effect of "Welcome to Facebook, where narcissism forcefully collides with wisdom". He reiterated what Dr. Barnett said, that ethical codes provide a "general theoretical frame" but not specific details to navigate new types of situations. Dr. Powers tells his students not to put up anything online that they wouldn't want to have up on a big billboard in the Quad. Loyola College has a series of "statements of professional behavior" which begin in one case with the directive to "refrain from posting unprofessional statements or pictures that may be viewed by clients, supervisors, instructors or colleagues". Reasonable, no?
Some key points to be cognizant of included the challenges of accurate communication, for example: "You lose tone in email". [Of course one can work at developing compensatory skills! This area begs study!] ;-)
Dr. Powers then presented some slides of public Facebook pages. At the membership pages for interest groups pertaining to psychology, most groups had small numbers of members. "Psychologists against SPSS" (as of a few days ago) had 265 members. "Psychologists are HOT" has 2, 054. (Who would've known?)
While the group is public, individuals' pages may be designated as friends-only, or private - yet the group's public "splash" page randomly rotates pictures of its members - with names. Using a number of examples, Dr. Powers made the point about the need to understand the nature of online communication with the attendant issues not only of privacy and confidentiality, but also about the need for familiarity with online behavior, and one's own online presence, in order to strive for "e-professionalism". Clearly his own university has shown awareness and commitment to professional practice of the faculty, and the implication is that other institutions need to be cognizant and proactive as well. His conclusions:
The last speaker was Stephen Behnke, APA ethics director.
- Faculty are generally unaware of what's e-happening, especially beyond email.
- So far the focus of discussion and guideline development has been on confidentiality and email.
- Social networking technology makes the public/private distinction less clear.
- Development of faculty guidelines and social networking use may be helpful for faculty and students.
- These guidelines should be mindful of the power differential between students and faculty/supervisors, as well as of professional presentation.
Dr. Behnke began by saying he was impressed by the richness of the *cultures* which are seen among online groups. He also noted that we'd barely mentioned the ethical area of research in this Internet age, and clearly this is an area of importance as well.
Time was drawing to an end, so following Dr. Behnke's recap of key issues, the panel did a brief Q&A. The questions involved dating web sites, the dynamic of anonymity, the diagnostic potential for working therapeutically at the computer with child/teen clients, gambling distorders and narcissism.
In conclusion Dr. Barnett reiterated that "this is really new stuff. It IS the cutting edge. Some of the ideas being discussed today might influence future ethical principles", discussions, etc. I smiled, knowing it's already underway, particulary in education and increasingly reflected in practice and research. I was pleased to see mainstream APA discussions as well as student and faculty research and training getting up to speed in reflecting the 21st Century.