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Ethics - Online Psychological Services and Assessment

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Emilia Gencic

on 4 April 2011

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Transcript of Ethics - Online Psychological Services and Assessment

Historical Context
74% adults went online

57% households had broadband

61% adults looked online for health information

21% adults searched online for mental health issues

7% adults participated in an online discussion etc. Mobile Phones and Social Networking Online Depression Testing and Assessment

Psychological Services
 Email
 Chat
 Audio/visual (Skype) Person to person Basic aids to therapy Our Practice Person to person sessions
Using (email) and skype Self-help systems 46% adults had access to the internet

5% households had broadband

25% adults looked online for health information

12% adults search online for mental health issues In 2000 Pew Research Center
The Pew Internet & American Life Project In 2009 Being caucasian

Being employed with comfortable income Health related searches

College degree

Being a student
Mental Health Searches Early Phone Counselling 17% cell phone users used their phone to look up health or medical info

9% had "apps" on their phones to help track and manage their health

37% adults use social networking for health information

Age related
18 to 49 ↑
50+ ↓

Consistently ~1/2 of online health inquiries are on behalf of someone else Early Internet Ethics Formed in 1997

2000 - 300 online counselling websites worldwide

2005 - expected growth to over 5,000

1999 - Disinhibiton The International Society for Mental Health Online (ISMHO) Suggested Principles for the Online Mental Health Services Informed Consent

Standard Operating Procedure

Emergencies Complete self-help systems 1879 - Telephone used in diagnosis

1953 - Telephone crisis counselling started

? - Freud practiced and treated patients by letter

1973 - Psychiatrist use two way televisions set

1987 - Social worker - telephone to provide weekly therapy for over 1.5 years Three areas of our practice “The administration, scoring, and perhaps the interpretation of individual test scores by applying a descriptive meaning” (Naglieri et al., 2004, p. 153) Testing Assessment “The emphasis is typically on the person being assessed and the referral question, rather than on specific test results” (Naglieri, et al., 2004, p. 153) Assessment - Online
Client Integrity


Competence of clinician

Unauthorized copying test


Cultural diversity

Client reaction - limitations Benefits: Accurate scoring

Assessing abilities and skills that are difficult to assess
by paper-and-pencil testing (e.g. video clips to assess clients conflict-resolution skills) Ethical Considerations Obtain client details including age

Assess if the client is suited to the internet The clinician (clearly visible on website or program)

Terms and advertising

Competence & scope of practice (referrals)

e-Therapy and e-Psychotherapy Advantages



Costs effective

Privacy Disadvantages Unqualified individuals

Inferior nature of counselling

Serious disorders being sidetracked Chat/email Therapeutic Process
Online Disinhibition

Textual Focus


Opportunities to Reflect

Journaling / transcripts

Challenging Assumptions Advantages Lack of Visual and Verbal Cues

Lack of Physical Presence

Asynchronous Nature of Email


No Regular Appointment Times

Computer Concerns

Internet Service Failures

Confidentiality and Privacy Disadvantages Records


Safeguards and alternatives

Emergency procedures and back-up

Referral (if necessary)

Data encryption for emails

Security passwords
Case Study No opportunity for cultural adaptation- building trust

Familiarity with technology and skill level

Access to technology
Four most common ethical issues for rural practitioners Limits to competence in a broad range of domains, especially when working with indigenous clients

Boundary management


Professional (as well as personal) isolation But Wait! Testing and Assessment Online self-help systems
Reduce the need for a clinician by 80%-95% by Helping the client it detail their problems

Draw up a day to day treatment plan

Rate their progress

Practise coping with setbacks

Relapse prevention

Recruit relatives as co therapists High satisfaction across age ranges

Drop-out rates equivalent

Efficacy and cost

No waiting Studies report Diagnosis of relevant disorders

Informed written consent

Without alcohol/substance misuse

Without psychosis

Ability to read and/or write in English

With/without recent changes in meds

Suitability for client

Safeguards and crisis procedures Ethical Considerations summary Version 3.11, 2000
The potential risks and benefits

Confidentiality/ limits to confidentiality

Give responders the opportunity to decline

Identify possible consequences

The structure of the service – frequency etc. Informed consent about the process

Provide further information with regards to Psychologists must, where possible Building an Ethical Practice BTSTEPS Good Days Ahead Beating the Blues
Good Days Ahead
Beating the Blues Video clips for phobic anxiety Demographic Characteristics Each independently predict internet use People with disabilities Includes added available client information

Valid assessment instruments



Referral source

Information from friends and/or relatives

Skill required to interpret results and deliver information Internet Ethics Lise, Emilia & Andrea Ethics and Professional Issues 38% of adults with disabilities go online, compared to 58% of all adults

Of the disabled online, 1/5 say their disability makes using the Internet difficult

28% of non-users with disabilities say it's difficult or impossible to go online

High cost of Internet-adaptive technologies Can be administered by a computer

Requires little training

Often may not be scientifically based

Lay person can interpret results

Usually designed for the layperson or public consumer

Primarily designed for personal development and growth eg video clips to assess clients conflict-resolution skills APS - the rural setting Complete self-help systems e-psychotherapist in Canada

Client in Iceland - schizophrenic who was suicidal

Hospital do not recognise your license

What would you do?


Good foundations


Refer to GP
Provide information regarding APS Internet Guidelines Apply Principles Practice Your Skill
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